Medical Education - Theses
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ItemThe indigenous health agenda in medical education( 2017)This thesis describes the indigenous health agenda as a unique landscape located within the wider field of medical education. The indigenous health agenda offers medical educators the opportunity to contribute to indigenous health and wellbeing. The thesis reviews the commitments of medical schools in Aotearoa New Zealand and Australia to the indigenous health agenda and asks how these commitments are currently being enacted and can best be realised in future. The research identifies an indigenous rights to health approach as under-utilised and potentially beneficial. Using Kaupapa Māori methodology a research study consisting of thirty-two semi-structured interviews (28 individual, two joint, and two focus group interviews) was undertaken across two research phases. In Phase One, key informant interviews were conducted to gain insight into stakeholder perceptions of medical school commitments to the indigenous health agenda. In Phase Two, a case study was carried out at The University of Auckland Faculty of Medical and Health Sciences, in which key informants discussed the relevance and potential applications of Phase One findings. Thematic analysis was used to encode and order data. Study findings establish the viability of a rights approach, and bring into focus drivers of the indigenous health agenda, obstacles to the indigenous health agenda, and strategic pathways for the indigenous health agenda. The indigenous health agenda is redefined as building a strong indigenous presence in medical schools via four strategic pathways - indigenous knowledge and information, indigenous process and practice, indigenous personnel, and indigenous resource base - and transforming institutions to enable that presence to have impact. When the four strategic pathways are applied across the domains of clinical teaching and learning, cultural understanding and critical awareness, community relations, and indigenous leadership and organisational autonomy, a 4 X 4 table of the indigenous health agenda is developed. The indigenous health agenda is then understood to consist of ends, means, and motives. The ends are to reduce indigenous health inequities and contribute to indigenous health and wellbeing. The practical means are to develop indigenous presence within and across pathways and domains in medical education. The motives are human rights to health and more specifically and powerfully, indigenous rights to health. Developing each facet of the indigenous health agenda is a task still to be achieved, as is mastering the complex dynamics of equitable partnerships between medical schools and indigenous communities, and between indigenous leaders and their non-indigenous allies. Even so, the thesis predicts a bright future for better understanding and further practical developments of the indigenous health agenda in Aotearoa New Zealand and Australian medical schools.
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ItemCommunication performance in the career medical interview: a new model for preparation( 2016)The career medical interview is rare in that it is a central discriminator for aspirant doctors and trainees. Not only does the outcome determine the future job prospects for the candidate, but it also decides access to continued education and training. Despite the importance of the interview and these tensions, little training is provided to aspirants and there are often conflicting messages. Furthermore, the interview is not a reliable test measure; it is susceptible to a range of bias and rating difficulties. Additionally, the number of places is outweighed by the number of potential applicants, hence adding further tension to the process. One possible outcome of the lack of training programs specific to the career medical interview is the susceptibility to impression management. Impression management is where a candidate intentionally influences the outcome of an interview by engaging in the active manipulation of their image portrayal. At worst, candidates might engage in faking (where facts are made up or deceitful responses are given). Presently, little is known about the impact or strategies of medical candidates and impression management in the career medical interview. It is known that a key factor in successful career interview performance is the management of anxiety. Too often, anxiety in regards to the interview or communication apprehension can cause distorted behaviour. This may result in excellent candidates being unsuccessful not because they may not be the best candidates, but because they were unable to manage their anxiety sufficiently well. This can result in clinical and training impacts if the wrong candidates are selected. This thesis successfully proposes a new model for communication training for the career medical interview to address these tensions. Drawing on the body of research known as applied theatre, a new training model is developed and tested using psychometric scales designed to measure anxiety. Kirkpatrick’s model of measuring training effect is utilised. This thesis also draws new insight into existing training strategies used by candidates undertaking interviews in Australian medical contexts as well as capturing data in regards to impression management being utilised by currently successful surgical trainees.