Registrars - Journey of Healing

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1 Registrars - Journey of Healing Aboriginal and Torres Strait Islander Health Training Posts

2 Terminology Aboriginal & Torres Strait Islander Health Training Post ACCHS Refers to a training position within a college (RACGP/ACRRM) accredited Aboriginal and Torres Strait Islander health training facility. These facilities are accredited to deliver vocational training within an Aboriginal and Torres Strait Islander health context to registrars enrolled in the Australian General Practice Training (AGPT) program. The National Aboriginal Community Controlled Health Organisation (NACCHO) states: An Aboriginal Community Controlled Health Service (ACCHS) or an Aboriginal Medical Service (AMS) is a primary health care service initiated and operated by the local Aboriginal community to deliver holistic, comprehensive, and culturally appropriate health care to the community which controls it (through a locally elected Board of Management). NACCHO, 2011, About Us, para 2, The term ACCHS is used throughout this brochure in reference to both ACCHSs and AMSs. Please note: Some State and Territory owned primary health care facilities, which provide health care to Aboriginal and Torres Strait Islander people, are also accredited as Aboriginal and Torres Strait Islander health training posts. General practice GPET Where the term general practice is used in this brochure it is, where context permits, deemed to include rural and remote medicine. General Practice Education and Training Limited (GPET) manages and funds the Australian General Practice Training (AGPT) program. GPET is a wholly owned government company, set up by the Australian Government in 2001 to establish and administer a regionalised approach to training, which is now delivered by 17 regional training providers (RTPs) across Australia. Acknowledgements: The Australian General Practice Training (AGPT) program is an Australian Government initiative. The program is managed by GPET on behalf of the Commonwealth. GPET would like to thank General Practice Registrars Australia (GPRA) and the AGPT registrars who contributed to the content of this publication. Published by: General Practice Education and Training Limited ACN Level 3, 10 Rudd St CANBERRA ACT 2600 Telephone: (02) Website: gpet@gpet.com.au GPET Limited 2012 Cover Artwork Journey of Healing by: Melinda Brown Journey of Healing by Mel Brown. This picture depicts the journey that we embark upon when we make the decision to begin a healing process. The journey of healing can be that of a physical, emotional or spiritual nature, and each healing process we begin is equally important as the next. Our journey often begins at a very personal level and as the healing builds momentum, others are included and affected by our changes and this creates a ripple effect that then influences others around us, such as our families and communities. Many people cross our paths during our journey, but do not deter us from the path of wellbeing in which we have chosen to walk. As we travel our journey upwards, we become less dependant on others and learn to look within our strength and courage to support us in our journey of healing and wellbeing. GPET acknowledges the review and endorsement of the National Aboriginal Community Controlled Health Organisation (NACCHO).

3 Aboriginal and Torres Strait Islander Health Training Posts Did you know that as an AGPT program registrar you can undertake an Aboriginal and Torres Strait Islander health training post at any time throughout your training? A post offers you the unique opportunity to develop a range of clinical and professional skills in a challenging environment, including: Treatment of diseases not often seen in mainstream primary health care settings Working as part of a multidisciplinary health care team to manage complicated clinical, social and emotional issues Complex chronic disease management Understanding cultural protocols and communicating complex health issues Focusing on population and public heath Health promotion within a cultural context. 1

4 Why Aboriginal and Torres Strait Islander health? Aboriginal and Torres Strait Islander health is an important aspect of general practice training and experience in this area is key to becoming a clinically and culturally competent GP. This training contributes to the Council of Australian Government s (COAG s) strategy towards closing the gap in health inequalities between Aboriginal and Torres Strait Islander peoples and other Australians. This contribution is made by increasing access to quality primary health care by Aboriginal and Torres Strait Islander peoples. What are the benefits of undertaking a post? Undertaking a post in an ACCHS provides the opportunity to experience cultural immersion. During your post you will be practising in a community setting, which will enable you to participate in a multidisciplinary team, to clinically manage a range of complex chronic diseases and in turn learn to provide culturally appropriate, holistic primary health care. General practice training in Aboriginal and Torres Strait Islander health can provide a model for general practice, which is appropriate in a wide range of situations. 2 You will learn to better understand the social and emotional needs of your Aboriginal and Torres Strait patients through consideration and evaluation of the role of local community relationships and their cultural connections. The skills you develop while undertaking a post will benefit you wherever you choose to work in the future. Making a difference I enjoyed making a difference, and being known by the community (a rare feeling in an urban setting). I really enjoyed the work. You have the best of many worlds. You manage serious, interesting and overlapping conditions like a general physician, but still deal with vital young patients with families and children. - Dr Warren Jennings, Registrar Urban Post, Inala and Logan, Brisbane, QLD. Warren undertook his post part-time over 12 months in conjunction with an academic post during his extended skills training.

5 Aboriginal and Torres Strait Islander Health Training Posts Where do you undertake a post? Posts can be undertaken in metropolitan, regional, rural and remote areas all over Australia. However, the posts within your regional training provider s (RTP s) footprint will take precedence with regard to your placement. If there is no post in your RTP s footprint transfers can be negotiated for you to undertake a post within another RTP s region. Posts are located primarily in Aboriginal Community Controlled Health Services (ACCHSs) and some state and territory owned facilities, which provide comprehensive primary health care to Aboriginal and Torres Strait Islander peoples. Like all accredited training facilities, ACCHSs are accredited according to RACGP and ACRRM standards. How long is the post and how does it fit into your training? A post is usually one term (or six months) or longer as negotiated Part-time or shared post arrangements may be available upon negotiation with the ACCHS and your RTP As an AGPT registrar you can undertake a post at any time during your core training or as part of extended skills or advanced specialised training or as part of an academic post. What services does an ACCHS offer? In addition to general services, ACCHSs may provide a range of services, including: Emergency care Outreach/retrieval services Podiatry Otolaryngology (ear, nose and throat) Optometry Midwifery Child health Dental services Counselling Mental health Drug and alcohol Social and emotional well being Women s and men s health programs Quit smoking programs Health promotion and immunisation programs Chronic disease programs. 3 In addition to these services, other social health programs such as housing and financial counselling are offered by many ACCHSs. Aboriginal Australia The Aboriginal Australia map (overleaf) represents the traditional tribal/nation boundaries of the many Aboriginal and Torres Strait Islander peoples and their locations. It highlights the complex diversity that exists within Australia through language, culture and place. The map provides a great starting point for you to find out the language, tribe/nation of the location where you are training.

6 What is the language, tribe/nation in the area you train? 4 This map is just one representation of many other map sources that are available for Aboriginal Australia. Using published resources available between , this map attempts to represent all the language or tribal or nation groups of the Indigenous people of Australia. It indicates only the general location of larger groupings of people which may include smaller groups such as clans, dialects or individual languages in a group. Boundaries are not intended to be exact. This map is NOT SUITABLE FOR USE IN NATIVE TITLE AND OTHER LAND CLAIMS. David R Horton, creator, Aboriginal Studies Press, AIATSIS and Auslig/Sinclair, Knight, Merz, No reproduction allowed without permission.

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8 Supervision and support Registrars working in an Aboriginal and Torres Strait Islander health training post are supervised by experienced and accredited GP supervisors and supported by a multidisciplinary team, including Aboriginal health workers (AHWs). Each ACCHS, together with the RTP, ensures that registrars undertaking a post are provided with orientation and support including cultural mentorship throughout the duration of their training. Cultural mentoring is a support provided to registrars working in a post. A cultural mentor is defined as an Aboriginal or Torres Strait Islander person who has knowledge of the region s traditional lands and culture, and is accepted by the local Aboriginal and Torres Strait Islander community. In well-supported posts, cultural mentors provide one-on-one support to registrars through on-thejob cultural mentoring within a local community context. They can provide clarity around cultural misunderstandings, help registrars to bridge the cultural divide, and support registrars to develop culturally safe clinical practices. 6 Employment and remuneration You will be employed by the ACCHS and paid as a salaried doctor while undertaking your post a different arrangement to that of mainstream general practice Salary, conditions and patient load vary from ACCHS to ACCHS You will receive all standard benefits and entitlements of the AGPT program in line with the AGPT policies Your RTP will contribute towards funding the ACCHS to support your salary and on-costs. More information on posts and training terms can be found in the AGPT Guide for GP Registrars available at under Publications. Advice and support regarding negotiating contracts is available to all registrars through their RTPs and General Practice Registrars Australia (GPRA), to find out more speak to your RTP or visit CHALLENGING I found my days at the AHS [Aboriginal Health Service] my most enjoyable working days. This was due to the great team atmosphere, being well supported personally and professionally by the other GPs as well as a diverse range of allied health professionals, and the diversity of patients. The trust that I gained from my patients at the Aboriginal Health Service felt different to that in mainstream general practice. It is challenging dealing with the drug, alcohol, mental health and related issues in Aboriginal and Torres Strait Islander Health, but this is where I found the greatest rewards. - Dr Melanie Dorrington, Registrar Urban Post, Winnunga Nimmityjah Aboriginal Health Service, ACT Melanie undertook her post part-time over 12 months during her GP term 1 and 2 training.

9 Aboriginal and Torres Strait Islander Health Training Posts What are the benefits with regard to obtaining the FRACGP or FACRRM? Experience working at an Aboriginal and Torres Strait Islander training facility will allow you to confidently cover the requirements of the RACGP s Aboriginal and Torres Strait Islander Curriculum Statement Up to 15% of the content of the ACRRM Multiple Choice Question (MCQ) and StAMPS assessments may be directly related to the health needs of Aboriginal and Torres Strait Islander peoples. Undertaking work in a post will assist you in gaining the required knowledge to be successful in these assessments. 7 ADVOCACY AND CLINICAL SKILLS The thing I enjoyed most during both my training posts was providing antenatal and postnatal care to the Aboriginal women. I saw the benefits of providing regular antenatal care to these women, but also learnt a lot about how Aboriginal women view pregnancy, child birth and nurturing their babies I learnt that your priority as a doctor and the woman s priorities were often different and this could not always be rectified. To me, the most important thing was building rapport and doing my best to understand their priorities so I could provide support that would allow them to address both their priorities and mine. My clinical skills in women s health and complicated antenatal care have certainly improved during my terms. I have experienced the difficulties of liaising with a tertiary women s hospital over 2000km from the town where I worked, and gained skills in patient advocacy. - Dr Sarah Moore, Registrar Rural Posts, Kununurra and Broome, WA Sarah undertook two posts the first over a six-month period during her advanced training and the second over 12 months during her advanced rural skills training.

10 What are the benefits to the community? The ACCHS and the community get a registrar well prepared to provide culturally appropriate primary health cares services The ACCHS receives financial assistance for your salary By undertaking a post you are contributing to closing the gap which enriches the community you are working in A clinically and culturally competent GP workforce in the long term. Interested in undertaking a post? What to do next If you know where you would like to undertake a post, do some personal research Talk to your RTP about the local ACCHS and see if it is accredited for training Talk to other registrars who have undertaken training in an ACCHS Talk to your medical educator at your RTP and discuss your options Even if you are not quite ready to undertake a post, it s important to plan early and have a conversation with your RTP to flag your interest in a future post. Your RTP will work with you to incorporate this training into your learning plan Once you have made the decision to undertake a post your RTP will assist in placing you and negotiating your employment with the ACCHS. 8 Further information For more information, testimonials and contacts regarding Aboriginal and Torres Strait Islander health training posts speak to your RTP or refer to the Aboriginal and Torres Strait Islander Health pages of the AGPT website For advice regarding negotiating employment contracts visit the GPRA website For more information on the Aboriginal Community Controlled Health Sector, visit the NACCHO website at

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