"As natural as learning pathology" The design, implementation and impact of indigenous health curriucula within medical schools.

Initially drawing on the field of cultural safety and cultural competency, indigenous health has developed as a subject in its own right, defined from the perspective of indigenous populations. Current Australian and Aotearoa/New Zealand medical school accreditation processes require culturally responsive curricula and initiatives for indigenous peoples. To date, there has been little evidence to demonstrate whether medical schools are implementing and/or evaluating indigenous health curriculum. A Kaupapa Māori research theoretical framework was used to ensure an indigenous agenda was presented within the field of medical education. Two phases were employed: Phase one surveyed multiple medical sites in a case study (multiple sites bound by the concept of indigenous health curriculum), while phase two involved multiple stakeholders within one medical school site (multiple perspectives of indigenous health curriculum bound by one site). Semi-structured interviews were used to explore the same six subject areas of the medical school’s indigenous health curriculum across all stakeholder groups. Inductive analysis was used to encode and order the qualitative data. Data collected from quantitative surveys from each medical school site were collated and a comparative analysis presented. The findings revealed that the design of an indigenous health curriculum is highly influenced by the level of systems support, the recognition of the role of the indigenous community and the role of an indigenous health framework. The implementation of an indigenous health curriculum is characterised by a sequential method of delivery and the role given to stakeholders. The findings suggest that meaningful engagement with an indigenous community promotes transformative education and that such an approach has positive impacts on health care. As a result of the research three specific evaluation frameworks are proposed. Framework one provides the components necessary to map an indigenous health curriculum. Framework two documents a method to determine what constructive alignment looks like in an indigenous health curriculum, and framework three highlights the process by which engagement with indigenous stakeholders promotes a model of social accountability between the medical school and the indigenous community. This research argues for the use of evaluation frameworks that are able to draw on the complex interactions between variables that influence the design, implementation and evaluation of indigenous health curricula. The importance of an indigenous health framework as a core component of an indigenous health curriculum, which promotes transformative practice and community investment within a medical school and broader health environment is noted. This research also offers a counter narrative to those documented within the literature of negative health experiences by indigenous communities. This research found that an indigenous health medical curriculum can be a vehicle to promote positive health experiences as indigenous community members are re-positioned as key health stakeholders and experts in indigenous health, as opposed to solely ‘recipients’ of health care