Clinical Competency Rubric

11. Aboriginal and Torres Strait Islander Health

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The health of Australia’s first peoples is this country’s most pressing and important health priority. Aboriginal and/or Torres Strait Islander peoples are among the most disadvantaged indigenous peoples in the developed world. The available evidence suggests that Aboriginal and Torres Strait Islander peoples continue to suffer a greater burden of ill health than the rest of the population. Overall, Aboriginal and Torres Strait Islander peoples experience lower levels of access to health services than the general population, are more likely than non-Indigenous Australian people to be hospitalised for most diseases and conditions, and are more likely to experience disability and reduced quality of life due to ill health and to die at younger ages than other Australians. Aboriginal and Torres Strait Islander peoples also suffer a higher burden of emotional distress and possible mental illness than is experienced by the wider community. The Aboriginal and Torres Strait Islander health unit of the RACGP curriculum seeks to identify the unique nature and needs of Aboriginal and Torres Strait Islander peoples and their communities and to define the foundation of essential attitudes, skills and knowledge required by all GPs to meet these needs. Attainment of these specific competency based skills will enable GPs to work respectfully, in collaboration with and provide quality care to Aboriginal and Torres Strait Islander peoples and when required, to advocate for individuals and their communities.

This section contextualises all the core competency skills and how they are applied to culturally appropriate, safe, effective and holistic Aboriginal and Torres Strait Islander health care delivery as defined by Aboriginal and Torres Strait Islander peoples. This includes demonstrating cultural understanding, having a culturally respectful, non-judgmental and safe communication approach, acknowledging the impact of colonisation, historical and contemporary events and policies, awareness of intergenerational trauma, systemic barriers to health equity and optimising health outcomes. It specifically requires self-reflectiveness and self-awareness to avoid harmful biases, assumptions, stereotyping and rote learned responses that do not consider the individual patient context and value diversity within cultures.

AH1.1.1 Communicate effectively, develop social and cultural competency with Aboriginal and Torres Strait Islander peoples
AH1.1.2 Develop effective therapeutic relationships with Aboriginal and Torres Strait Islander peoples
AH2.1.1 Optimise health outcomes by early identification and effective management of all health conditions.

AH2.2.1 Identify and address the social and cultural determinants of health in the local community.

AH3.1.1 Promote the health and wellbeing of Aboriginal and Torres Strait Islander communities
AH4.1.1 Support Aboriginal and Torres Strait Islander health research and education
AH5.1.1 Identify and implement effective models of primary healthcare delivery
AH5.2.1 Implement appropriate policies and initiatives regarding Aboriginal and Torres Strait Islander health to optimise outcomes

Required Knowledge

Comprehensive knowledge of local context, health services and referral pathways and social services available

Required skills

Ability to form partnerships and work effectively with local community services
Develop and maintain a culturally appropriate workplace
Actively support and promote local models of Aboriginal and Torres Strait Islander general practice and primary healthcare that involve self-determination, community involvement and self-governance

Required attitudes

Willingness to engage with and support community initiatives (eg NAIDOC community events)
Value for self-determination, community involvement and self-governance as core concepts in Aboriginal and Torres Strait Islander healthcare
Willingness to advocate for policies and laws that promote health equity

Criteria

Use a range of methods to facilitate culturally safe communication with Aboriginal and Torres Strait Islander peoples
Integrate cultural perspectives and beliefs on health and wellbeing of Aboriginal and Torres Strait Islander peoples into holistic clinical practice
Appraise and address barriers to development of effective therapeutic relationships with Aboriginal and Torres Strait Islander peoples
Identify and address obstacles to optimising management of complex health presentations in Aboriginal and Torres Strait Islander peoples
Demonstrate effective diagnostic and management Strategies that enhance health outcomes for Aboriginal and Torres Strait Islander patients
Collaborate effectively with multidisciplinary teams to develop meaningful and holistic management plans
Identify and use professional resources to assist with delivery of best practice care to Aboriginal and Torres Strait Islander patients
Identify and incorporate social and cultural determinants of health into management plans
Use evidence-based preventive and population health approaches to reduce health inequalities in Aboriginal and Torres Strait Islander communities
Identify health delivery strategies to reduce inequities and enhance self determination
Use specific Medicare and PBS programs to improve health outcomes
Appraise the capacity of the primary health care model to comprehensively meet the needs of the community
Develop strategies to promote a culturally safe practice environment
Appropriately use Medicare programs in the delivery of healthcare for Aboriginal and Torres Strait Islander patients
Integrate knowledge of history of government policies and consequent health impacts into delivery of care
Advocate for and use policies and initiatives that promote equity in healthcare

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