Appendix

Attend a local cultural workshop/seminar or immersion opportunity or do some research into the cultural history of the lands on which you are located. (Record this separately as EA CPD).

• Who are the Traditional Owners of the local area?
• Find out some local history about your area. The local library, land council or traditional owner group websites are good places to start.
• What did you learn about your local community? What did you learn about yourself?
• How can you strengthen your relationships with local Aboriginal and Torres Strait Islander people you met during your immersion?
• What is the next step in your learning journey to build on this experience?

In the popular media, read a book/documentary/movie about the lives of Aboriginal and Torres Strait Islander people. What experiences of racism and discrimination did this discuss?

• Why did you chose the resource that you did?
• What lingered with you? What challenged you? What surprised you?
• How will this inform future conversations you have with Aboriginal and Torres Strait Islander people?

Investigate your local Aboriginal and Torres Strait Islander organisations and determine what service are available at the clinic/organisation.

• How might these be of benefit to your patients?
• How might you incorporate these into your care plans?
• How do you refer patients to them?
• How can you build an ongoing working relationship with the organisation and its staff?
• Are there activities you can get involved in?

Explore the RACGP’s position statement and other organisations for The Voice to Parliament referendum and some of the experiences of racism reported by Aboriginal and Torres Strait Islander people throughout the campaign.

• What information did you use to guide your vote in the referendum?
• How did the referendum campaign affect you and your views on reconciliation?
• Did you see any experiences of racism during the campaign? How did that affect you or your patients?
• What new understanding do you have about the historical and contemporary lived experience of Aboriginal and Torres Strait Islander peoples?
• What type of advocacy skills would be helpful for you to develop?
• Consider these in relation to your work with individual patients, and also how you might get involved at a systemic level.

For one day, practise asking every patient about their identity: ‘Are you of Aboriginal or Torres Strait Islander origin?’. The learning resources section lists supporting documents to help with this learning activity.

• Familiarise yourself with how to record this data in your practice software.
• Reflect on what might prevent a patient from disclosing their Aboriginal or Torres Strait Islander heritage?
• When asking, how can you build trust and rapport, so they feel safe to answer?
• How do you approach consent to record this information and why is this important?
• When someone discloses that they were Aboriginal and/or Torres Strait Islander, what could you do to further that rapport? How do you pace the consult? What do you ask, what do you leave for another visit?
• At the end of the day, how did you find it? How did you manage any unexpected responses from patients?

Invite an Aboriginal or Torres Strait Islander patient to attend for an MBS item 715 health check. See learning resources section for a guide and health check template. 

• Before the health check, reflect on your previous interactions with an Aboriginal or Torres Strait Islander patient. How did you identify them? What assumptions did you make, if any? How might you learn more about what was important to them and their cultural identity?
• Plan your health check. What will be your priorities? How will you build rapport? What sociocultural history will you consider incorporating? What assumptions and biases are you going to leave behind?
• At the end of the consult, as the patient how they felt the health check went. How did they feel during it? Is there anything they felt you could have done differently?
• Return to your preparation and reflect on your own feelings about the feedback you received and what you might do differently.

Identify several patients from a culturally and linguistically diverse community. Check if interpreters were offered and used in recent consultations.

• What are the main culturally and linguistically diverse populations in your community?
• If interpreters were not offered or used, were there any barriers for you and/or the patient?
• To what extent are patients reliant on family members to translate for them? Does this reliance impact the patient’s access to care?
• If interpreters were used, what strategies did you use to communicate effectively? What resources are available to improve your skills in using interpreters in consultations?
• Get feedback from interpreters and patients at the end of consultations about what worked well and what could be improved.

Consider a scenario where your patient is a refugee who presents with chronic pain. What are the potential impacts of trauma on presentation and options for management. Discuss some strategies to sensitively raise the topic of previous torture and trauma with patients. Discuss how experiences of trauma can affect physical and mental health.

• What trauma-informed consultation strategies can you use to explore the effects of trauma on physical and mental health?
• How can the relationship between trauma and physical symptoms be explained to patients?
• What local services and resources are available to provide quality care to patients who have experienced trauma? What if you are based in a rural or remote area – are there any telehealth or online resources available?
• How do you incorporate questions about cultural health beliefs and/or stigma into consultations?

Identify a patient who has recently migrated to Australia from a culturally and linguistically diverse community. Review steps to do an evidence-based health assessment and approach relevant to their ethnic and sociocultural background and migration experience.

• What resources support evidence-based screening for various culturally and linguistically diverse communities? What factors are important to consider in providing screening?
• Does age-based screening for non-communicable diseases vary for some culturally and linguistically diverse populations?
• Which conditions of public health importance should be incorporated into routine screening of people who migrate to Australia? Do these vary depending on the country of origin?
• How would you undertake catch-up vaccination, if required?
• What resources are available to support decision-making?

Select a patient who is Aboriginal or Torres Strait Islander or is from a linguistically and culturally diverse background that you are treating for a chronic medical condition(s).

• Review the patient’s records and assess any gaps you have in their biopsychosocial history.
• How would you describe the doctor/patient relationship? Do you have effective rapport?
• Review your treatment plan – are you in line with practice guidelines?
• How have you managed their presenting problems and any associated comorbid health conditions?
• How have you been able to incorporate your patient’s goals/priorities into your management approach? Noting that these priorities may not be medically related. What barriers do they experience to improved health outcomes? What can you achieve for the patient in your scope of practice?
• Were others engaged in your treatment planning (such as patient’s family/support network, other health providers or translators?)
• Would you describe the patient’s health condition as being well managed? What could be done differently?

Conduct a mini-audit for five of your practice’s Aboriginal or Torres Strait Islander patients.

• Check if screening activities are up to date for each patient, as per the RACGP National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.
• Review patients care plans or team-care arrangements (if applicable) and quality of notes in the patient’s files.
• Follow-up with recall/reminders.

If you can’t find five patients, investigate why patients might not be identifying at this practice. 

• What did you learn from this mini-audit? What surprised you most? What are three ways you will change your practice from now on?
• Do you feel your communication and consultation skills are effective?
• What can you do to check if your patients feel culturally safe?
• To extend your learning, present your findings at a practice meeting and discuss other’s approaches to preventive health checks and consultations with Aboriginal and Torres Strait Islander patients.

Use the Step 1 of the NACCHO/RACGP Good Practice tables to improve your practice’s cultural safety. This activity ideally suits a whole of practice approach, so include your practice manager, nurses, administration staff and other GPs in your clinic. To prepare, watch the recorded webinars that are designed specifically to help you. 

• Discuss the table’s recommendations at First Steps, Good Practice, and Best Practice.
• Discuss what the clinic is currently doing well and the which recommendations you would advocate the practice prioritise for improvement?
• How can the practice overcome barriers to implementing other recommendations?
• Implement the changes as a practice and evaluate the impact on practice activity (include clinical and non- clinical improvements).

Take a practice-wide approach to implementing Steps 2-5 of the NACCHO/RACGP Good Practice tables. To prepare, watch the recorded webinars that are designed specifically to help you. 

• Discuss the table’s recommendations at First Steps, Good Practice, and Best Practice.
• Discuss what the clinic is currently doing well and the which recommendations you would advocate the practice prioritise for improvement?
• How can the practice overcome barriers to implementing other recommendations?
• Implement the changes as a practice and evaluate the impact on practice activity (include clinical and non- clinical improvements).

Using practice software, do a mini-audit of your patients who have migrated from a refugee source country. Select 5-10 patients and reflect on strategies that you could use to ensure a culturally safe and trauma-informed approach to consultations.

• What questions did you ask to explore whether the person was a refugee or seeking asylum, or whether they had experienced trauma? If they were a refugee, seeking asylum or had experienced trauma, did you use a trauma-informed approach?
• What aspects of culturally safe care did you integrate into the consultations? What could you improve on?
• If the person had spent time in Australian immigration detention or in a refugee camp, how might this impact their health?

Review five of your patients (children and adults) from culturally and linguistically diverse communities. Consider your approach to prevention (through screening and management) of conditions that the patient may have risk or protective factors for that are related to ethnicity, culture, religion and/or migration experience (eg thalassaemia, developmental delay, diabetes, vitamin D, iron or B12 deficiency, hepatitis B or C, latent tuberculosis, female genital cutting or circumcision).

• Are there guidelines to support your approach or to use as a resource?
• What strategies did you use to do cultural assessments to understand how culture may impact health or access to care? How did you explore migration experience and/or whether the patient had experienced trauma? Did you consider whether gender-specific care was relevant?