Year : 2014 | Volume
: 27 | Issue : 2 | Page : 132--137
The beyond borders initiative: Aboriginal, torres strait islander and international public health students: Engaging partners in cross-cultural learning
Michelle Dickson1, Giselle Manalo2,
1 Indigenous Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
2 International Public Health Sydney School of Public Health, University of Sydney, Sydney, Australia
Room 326, Edward Ford Building, A27, University of Sydney, Camperdown, Sydney
Background: The University of Sydney«SQ»s Graduate Diploma in Indigenous Health Promotion (GDIHP) and Masters of International Public Health (MIPH) students have expressed a consistent desire to engage more with each other through student tutorials or any small group activity. MIPH students have expressed an interest in learning about Aboriginal and Torres Strait Islander Aboriginal and Torres Strait Islanderpeople and their health issues recognising contextual similarities in health priorities and social-cultural determinants. A and TSI students enrolled in the GDIHP have traditionally had very little contact with other students and are often unaware of the innovative solutions implemented in developing countries. Methods: Through this inclusive teaching innovation the MIPH and GDIHP programmes utilised diversity in the student population and responded to the University«SQ»s Strategic Plan to promote and enhance pathways for supporting Indigenous students. This innovation provided an opportunity for both groups to learn more about each other as they develop into globally competitive public health practitioners. Results: The «SQ»Beyond Borders«SQ» initiative exposed MIPH and GDIHP students to problem-based learning that incorporated global perspectives as well as focusing on the very specific and unique realities of life in Aboriginal and Torres Strait Islander communities. Both student cohorts reported that the knowledge and skill exchange was highly valuable and contributed to their development as health professionals. Discussion: This simple yet effective initiative created a sustainable cross-cultural, interdisciplinary and community-oriented partnership that benefited all involved and assisted in addressing health inequities in Aboriginal and Torres Strait Islander communities and in developing countries.
|How to cite this article:|
Dickson M, Manalo G. The beyond borders initiative: Aboriginal, torres strait islander and international public health students: Engaging partners in cross-cultural learning.Educ Health 2014;27:132-137
|How to cite this URL:|
Dickson M, Manalo G. The beyond borders initiative: Aboriginal, torres strait islander and international public health students: Engaging partners in cross-cultural learning. Educ Health [serial online] 2014 [cited 2020 Feb 17 ];27:132-137
Available from: http://www.educationforhealth.net/text.asp?2014/27/2/132/143729
The Graduate Diploma in Indigenous Health Promotion (GDIHP) and the Masters of International Public Health (MIPH) are two programmes offered through the Sydney School of Public Health at The University of Sydney, Australia. This teaching innovation, "Beyond Borders" united two university programmes by focusing on the mutually shared focus of community led and engaged health interventions.
The GDIHP aims to empower individuals and communities by educating Aboriginal and Torres Strait Islander Aboriginal and Torres Strait Islanderhealth workers via six block-mode intensive health promotion and prevention lectures and workshops. Aboriginal and Torres Strait Islander Australians are the original inhabitants and custodians of the Australian continent and the Torres Strait Islands. GDIHP students learn to identify community health priorities, needs and strengths; work in partnership with communities to develop programmes that effectively address these priorities and needs; and implement and evaluate the programmes using best practice to ensure accountability and continued improvement. All GDIHP students identify as Aboriginal and Torres Strait Islander, and work in a health-related field. The MIPH is a graduate programme that looks at public health issues in various international settings, with an emphasis on developing and emerging countries. MIPH students learn to plan, manage, review and coordinate public health programmes for international agencies, national governments, private and public healthcare service providers working in the developing world. Both graduate programmes focus on community-based health care and interventions. Despite recent improvements in some areas of health and wellbeing, there remains a clear relationship between the social disadvantages experienced by Aboriginal and Torres Strait Islander people and their current health status. , This teaching innovation included 12 members of the academic staff of the School of Public Health, The University of Sydney, 21 GDIHP students and 60 MIPH students.
This teaching and learning innovation used community-oriented and student-centred collaborations, bringing MIPH and GDIHP students together in small, student-led tutorials. We wanted to increase student knowledge about public health issues in international and local (Australian) communities through collaborative knowledge exchange. The small group tutorials provided space for students of both programmes to explore how particular health issues were addressed in international communities and in Australian Aboriginal and/or Torres Strait communities.
'Yarning', or the act of sharing stories, is often the way we communicate in our own communities. We are from cultures that value oral traditions, so we have placed Yarning at the core of this teaching and learning innovation.
Locating ourselves in reflective teaching practice
Often we, the academics teaching in the GDIHP and MIPH programmes, forget to look up from our busy teaching lives; we forget to look over the fence to see what else is happening around us. We are busy and get consumed in what we call our core business. Until recently none of us really knew much at all about each other's students, our pedagogy and our teaching lives. As committed educators we, the course coordinators and lecturers on both the GDIHP and MIPH programmes, maintained high teaching loads, provided pastoral care and academic support to our students and busily grew our teaching programmes. However, both programmes remained in a parallel existence; they did not share resources, did not compare teaching philosophy, and did not Yarn with each other. This situation, perhaps, is familiar to other academics who, like the authors, focus their teaching in their own units of study or in programmes, and rarely (if at all) find time to collaborate in a cross-programme relationship.
Exploring parallel curiosity-uniting two public health postgraduate programmes
Both of our programmes highly valued the socio-cultural dimensions that underpin the work our students do in their communities. Betancourt  describes an understanding of diverse health values, beliefs and behaviours as being critical to successful provision of health services. In contrast to Betancourt, who explores embedding these concepts into undergraduate medical education, our focus is ensuring our curricula prepares our postgraduate public health and health promotion students to work collaboratively, and with cultural awareness, in communities representing social and cultural diversity.
The students of the GDIHP had been inspired by some teaching case studies that had introduced global perspectives on the same health issues they faced in their own Aboriginal and Torres Strait Islander communities. Similarly, the MIPH students had expressed a desire to learn more about the health issues, and health promotion practices, experienced in Aboriginal and Torres Strait Islander communities. While the two programmes consist of very different student cohorts, present university learning through very different teaching methodologies and represent a global and a local perspective on health, there was common ground revolving around issues of health/gender inequities, poverty and resource-poor settings.
The MIPH primarily has a global focus on low and middle income countries and the GDIHP has a local focus, but students of each programme expressed a desire for an engagement between cohorts, and to experience teaching and learning that was unique to each other's programme. So even with curricula already at full capacity, we found a shared teaching and learning space to explore a cross-cultural innovation that could provide the students with what they wanted. As responsible educators, we felt the need to respond to the call to action put before us. A proof of concept initiative was conceived, and named 'Beyond Borders: Aboriginal, Torres Strait Islander and International Public Health: Engaging partners in cross-cultural learning'. This proof of concept comprised a series of collaborative teaching and learning innovations, to explore potential shared learning spaces between the GDIHP and MIPH student cohorts.
Community-oriented, student-centred-walking our talk
Our plan was to implement community-oriented and student-centred curricula innovations through an opportunistic and synergistic collaboration between the MIPH and the GDIHP. We wanted to increase student knowledge about public health issues in international and local (Australian) communities through collaborative knowledge exchange. We aimed to explore current health promotion practices in Aboriginal and Torres Strait Islander communities and in developing countries, through the experiences of our students. Overall, we sought to develop solid cultural and health promotion competencies to enable our students to become future globally competitive public health practitioners.
Strategically, this proof of concept teaching innovation met our School's Teaching and Learning goals. We would enhance the global engagement of Aboriginal and Torres Strait Islander and international students and through our teaching, we would ensure that students encountered intellectually challenging, research-driven and professionally relevant content. However, we also had to face challenging and very real questions. For instance:
"Isn't this going to be too hard, take too much time, when we already have so much to teach?""Nobody has combined two different academic programme and student groups before, why bother to do it now?"
Pedagogy - fusion, cultural awareness, curriculum renewal, collaboration
Our big picture included community-based teaching and learning experiences, both locally and internationally, curriculum renewal of both programmes to include greater cross programme collaboration in teaching and learning experiences, and a range of student-driven, shared learning activities. Some research , into embedding cultural competence into medical education programmes supported our existing commitment to locate cultural awareness and cultural competence as core in the curricula of both programmes. We already saw cultural competence and awareness as central to our teaching and learning, never considering it as an add-on workshop, or a stand-alone unit. However, many programmes consider the implementation and facilitation of curricula enriched by cultural competence, engagement and awareness a difficult task and rightly so. We wanted to design a learning innovation that could easily be replicated in other programmes as we utilised the existing cultural diversity of our student groups as a learning tool in itself.
"Little fish taste sweet"
We realised we needed to take baby steps, and so we did exactly that. One author's grandmother used to remind her that "Little fish taste sweet", encouraging her to appreciate small things. And so we set forth to appreciate a "little fish". Applications for internal funding were not successful but instead of seeing that as a barrier, we embraced it as a challenge. We began phase one of our innovation as a proof of concept. We realised that if we could explore the potential, and experience positive outcomes for our students and ourselves, then we could be in a better place to later apply for other funding to enable us to unroll our innovation to the entirety.
Students meeting students-recognising resilience and energy
A highlight in our relationship building was a visit from a number of MIPH students to the classroom of the GDIHP programme. The MIPH students volunteered to come to university on a Saturday morning to meet the GDIHP students. Each MIPH student stood before the GDIHP students and told their personal stories. We shared stories of personal and academic struggle, stories of family and cultural pride, stories of meeting resistance and stories of resilience. Our desire was to have our collaboration visible from the start of the teaching year and so we opted to use an extended amount of time to get to know each other. Culturally, there is no other way that this could have been done.
Challenging logistics, shared cultures and professional experiences
While we continued to gain momentum in engaging each other and building solid teaching and learning relationships, we developed a tutorial space that both student groups would share. Gay  argues that culturally responsive teaching involves the development of a solid cultural diversity knowledge base. It was vital that we explored teaching and learning methods that allowed our students to explore their own cultural diversity knowledge base, and that of each other. We needed to find a vehicle that would support this pedagogy. The MIPH had a core unit of study titled Disease Priorities and Social Methods. The MIPH timetable was adapted to meet the dates of a teaching block in the GDIHP. We operated on very different timetables and so finding a common time for learning and teaching was difficult.
As the lecture scheduled for the tutorial day was on Neglected Tropical Diseases, we explored a health issue that was common in developing countries as well as in Aboriginal and Torres Strait Islander communities. We chose trachoma; however, we encouraged students to use this issue as a launching pad into more open discussions about other health issues and health promotion practices that were of interest to the students and their communities.
Both student groups were given readings associated to trachoma, and asked to pay particular attention to an academic paper that focused on the Australian experience of trachoma. The MIPH students were given a lecture on Neglected Tropical Diseases, and the GDIHP students were given information on trachoma through their health promotion workshops. Traditionally, the MIPH lectures series would be followed by a one hour tutorial based on the lecture topic, and these tutorials would be facilitated by students. For this shared learning activity, we extended the tutorial to two h to allow self-introductions and maintained the student-driven approach that already characterised MIPH tutorials. The MIPH facilitators were carefully selected and were mostly from developing countries. Each tutorial involved students from both programmes, was led by two student facilitators and had regular MIPH academic tutors providing their usual support.
A space where no question was "stupid"
Although we wanted the MIPH student facilitators to drive the tutorials, we also wanted to make sure they were equipped with sufficient knowledge about the GDIHP student group, and about Aboriginal and Torres Strait Islander history and to have a snapshot of the current position of health in Aboriginal and Torres Strait Islander Australia. Kagawa-Singer and Kassim-Lakha  explored how an in-depth understanding of cultural diversity contributes to positive clinical encounters between health professionals, their communities and their clients. Similarly, we believed that greater engagement between the cultures and experiences of an international student cohort and a local Australian Aboriginal and Torres Strait Islander cohort would result in more enriched interactions in their professional lives. 
A student facilitator workshop was designed and implemented, creating space for the GDIHP teaching staff to Yarn about our students, our programme, Aboriginal and Torres Strait Islander history and health.  We were willing to answer any questions that were raised by the student facilitators and tutors. McLoughlin and Oliver.  explored the need to design culturally inclusive online learning environments for tertiary level Aboriginal and Torres Strait Islander students in Australia. While their paper focused on online delivery, we shared their insight into recognising the importance of taking into account cultural variables and recognising that "culture pervades learning". As such, we endeavoured to engage in cross-cultural exchange as faculty members, as health practitioners, between our student cohorts and between our programme curricula. Cultural exchange requires a level of frank question making and responding, something often difficult to create in a postgraduate learning space where many students fear the gaze of others as they ask "silly" questions. , We created a safe space where no question would be considered ridiculous, and no comment would be taken as an offense. We role modelled the use of this safe learning and teaching space, providing a model for student leaders to replicate in their own tutorials. Each pair of student facilitators, with their tutor's guidance, started to plan a creative way of conducting a tutorial. They encouraged and mentored each other.
Process evaluation was used to judge the effectiveness of the project activities. Student tutorial leaders, programme tutors and programme academic staff all completed an anonymous survey to explore the effectiveness of the student facilitator workshop. The survey revealed that being adequately prepared for the shared learning experience was vital. All participants expressed that it was "really important" for the student tutorial leaders to have had the opportunity to attend the preparatory workshop and meet the academic staff from both programmes.
One student leader said "We can all get very locked into just knowing our own lecturers. It was important for us to meet the other academics and get to know more about them and their programme" . Interestingly, only 41% of the participants had read the set tutorial readings prior to attending the student facilitator workshop, with one student stating that "...it was more important to me to take time off work to come to the face to face facilitators meeting, and less important for me to get the pre-readings done. People are the most important part of this experienc e".
The student facilitator workshop was designed to provide an opportunity for information exchange and to reduce potential anxiety of the student tutorial leaders. Almost all participants stated that the student facilitator workshop provided the information they felt they needed to continue on to lead their tutorials. In the words of one MIPH student facilitator "This workshop gave me more knowledge than I expected. I came thinking I knew what I wanted to find out, but I have absorbed that knowledge and whole lot more0". Interestingly, at the start of the student facilitator workshop 100% of participants ranked their anxiety about being student tutorial leaders as "high" or "extremely high". After the workshop, 86% ranked their anxiety at a "normal" level, with 14% stating they still had "above average" levels of anxiety. The workshop adopted a "no question is stupid" philosophy to encourage an open discussion about key issues related to Aboriginal and Torres Strait Islander history, contemporary issues and health. One student facilitator commented that "…I appreciated being able to ask questions openly, and have them answered honestly. In this age of political correctness sometimes we become too scared to ask a question, in case the question itself is offensive, even though it is not intended to be offensive".
Making it happen
After the student facilitators workshop, we maintained a clear open door policy. Student leaders felt comfortable to email, phone or personally visit us to "check in" and test whether their tutorial design plans were on the right track. We introduced the names of both the MIPH academic tutors and the student facilitators, so every member of every tutorial group knew who was going to be in their learning space. Quickly, emails began to be exchanged between students, with the student facilitators asking their group members to introduce themselves by email, in an effort to debunk the stress of not knowing each other.
The collaboration also was supported by other MIPH faculty members, who visited the teaching room of the GDIHP students on the day of the tutorial, introduced themselves and expressed their excitement over the pending shared tutorial. A sense of being pioneers hovered in the air.
Dynamic student learning - real and robust
We provided tools like the background tutorial reading, teaching materials and importantly, maps of Aboriginal and Torres Strait Islander Australia, and of the world. Students used the maps to position themselves, showing their home community and charting how they had journeyed to reach their programme of study at the University of Sydney. This locating oneself in the process provided time for students to yarn and get to know each other, and was a successful example of students embracing cultural diversity and of increasing cultural awareness. Students also provided food and drink to share, with the act of sharing food being appreciated as a welcoming gesture.
While the MIPH student facilitators conducted their tutorials, two of the authors moved around each of the six rooms, taking photographs in an acknowledged but inconspicuous manner. One of the authors was a tutor and experienced the full impact of this unique tutorial, from a teaching perspective.
Students encouraged each other to share their knowledge and skills related to working in the community on various health issues, not limiting themselves to trachoma. Many groups created visual methods to engage a community on health issues. Posters, songs, role plays and Yarns were also creatively proposed as ways of working with a community on health issues.
The energy was real and robust. Students shared stories about what health promotion practices worked in their communities, and critically explored how others might modify some practices to better suit their own communities. The academic debates that were formed by the critiquing of the range of health promotion practices presented by students were rich and inspiring. Noise levels were high, as students encouraged each other to think about health issues and health work practices from differing cultural perspectives. This was cross-cultural collaboration and knowledge exchange in practice.
93% of participating MIPH and GDIHP students stated that they "very much" enjoyed the shared tutorial, with 100% of students stating that they felt the innovation provided a supportive learning environment in which to explore health issues. One student reported that "I can tell that a lot of time was put into getting this right, and I think it paid off. We all felt comfortable and were really happy to jump in and get started". When asked if the length of time spent together in the tutorial was adequate, 94% of students responded that more time would be beneficial. Interestingly, both programme areas have busy timetables, and finding time for this one united tutorial was difficult. Listening to the feedback from students has allowed programme coordinators to plan even more time for future tutorial collaborations.
Many university programmes keep their teaching and learning experiences within their own programme area, and a number of students (64%) had expressed concern, prior to the shared tutorial, about not knowing what to expect from a collaborative learning opportunity. The post-tutorial survey asked students to rank the importance of a number of workshop activities related to reducing the "mystery" of the teaching innovation. 76% of students stated it was "really important" that they knew who was going to be in their tutorial group before it was conducted; 83% stated that it was "very important" that they had email communication between the student tutorial facilitators and other members of their tutorial group before they had the tutorial, and 95% thought it was "very important" for students to have been given time at the start of the tutorial to properly introduce themselves to their other group members.
Interestingly, only 44% of students considered it "important" or "very important" to have been given tutorial readings to do before the group tutorial and only 52% of students stated they had engaged, in some way, in the set tutorial readings. One student reported "…I usually do most of the set readings, but for this one I felt it was more important to get to know the people who I would be sharing the tutorial with, so I spent quite a lot of time sending emails and answering emails around my small tutorial group. It was fun, and I really felt I already knew many people in my group before I met them face to face".
Lessons we learned
Like all good Yarns, there is a time for reflection. So, what might we do next time? Time did not permit the GDIHP students to attend the MIPH lecture on Neglected Tropical Diseases, and some GDIHP students felt that they approached the shared tutorial with less disease-based knowledge than some of the MIPH students. Next time, both student groups will have the same exposure to all readings and lectures. We would also have representatives from the GDIHP group introduce themselves to the MIPH student cohort, in a similar fashion to the introduction offered to GDIHP by the MIPH students last year. Such reciprocal introductions will further engage students and set foundations for firm student collaboration. Next time, the GDIHP student cohort will host a workshop or tutorial, and the preparatory learning around that workshop will also be planned by the GDIHP student cohort. The student facilitator's workshop was an important step in the engagement process, and it would be run again. It is vital that both student groups have adequate background information about each other's cultural, professional and educational lives.
United we stand
We believe that this teaching and learning innovation is transportable to most other disciplines or teaching programmes. A focus on community health education, and a common interest in a nominated health issue brought our two programmes together. Once this common ground was established the teaching and learning could easily be planned and initiated. This model could bring together quite diverse teaching programmes, given there is an established "common ground" starting point. For example, one GDIHP student identified a possible learning partnership between the GDIHP and veterinary science, based on the health promotion student working on environmental health issues concerning dog controls. Another GDIHP student identified potential for collaboration between health promotion (the GDIHP programme) and pharmacy students, based on the common need for both student groups to develop better, client-centred approaches to health literacy.
Sharing our experience
The issue of cultural competence is high on the agenda of our university, and on the agenda of the broader medical and public health educational community. Our teaching and learning collaboration provided an example of cross-cultural learning that ultimately led to increased engagement and awareness of our own cultures and in the culture of others. We aim to present our experiences as a teaching and learning model for other educational programmes to follow. An extension of this teaching innovation is the development of a "Beyond Borders Teaching Collaboration Guide" for tutors, lecturers and students. This tool will provide a realistic, step-by-step guide to setting up, facilitating and evaluating a multi-programme, shared teaching and learning experience. The guide will encourage cross-cultural learning exchanges between disciplines, programme areas and between diverse student cohorts. It will encourage local and international students and programmes to work together, crossing traditional teaching and learning boundaries. We will continue to listen and learn from our students. Our Yarn has only just begun.
|1||Carson B, Dunbar T, Chenhall RD, Bailie R. Social determinants of Indigenous health. Crows Nest, New South Wales: Allen and Unwin; 2007.|
|2||MacRae A, Thomson N, Anomie, Burns J, Catto M, Gray C, et al. Overview of Australian Indigenous health status, 2012. Available from: http://www.healthinfonet.ecu.edu.au/health-facts/overviews. [Last accessed on 2013 Dec 12].|
|3||Betancourt JR. Cross-cultural medical education: Conceptual approaches and frameworks for evaluation. Acad Med 2003;78:560-9.|
|4||Seeleman C, Suurmond J, Stronks K. Cultural competence: A conceptual framework for teaching and learning. Med Educ 2009;43:229-37.|
|5||Kumagai AK, Lypson ML. Beyond cultural competence: Critical consciousness, social justice, and multicultural education. Acad Med 2009;84:782-7.|
|6||Gay G. Preparing for culturally responsive teaching. J Teach Educ 2002;53:106-16.|
|7||Kagawa-Singer M, Kassim-Lakha S. A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Acad Med 2003;78:577-87.|
|8||Khubchandani J, Simmons R. Going global: Building a foundation for global health promotion research to practice. Health Promot Pract 2012;13:293-7.|
|9||Star Mahara M, Whyte N, Duncan SM, Brown J. It takes a community to raise a nurse: Educating for culturally safe practice with aboriginal peoples. Int J Nurs Educ Schol 2011;8:1-13.|
|10||McLoughlin C, Oliver R. Designing learning environments for cultural inclusivity: A case study of indigenous online learning at tertiary level. Aust J Educ Tech 2000;16:58-72.|
|11||Gair S. Creating spaces for critical reflection in social work education: Learning from a classroom-based empathy project. Reflect Pract 2011;12:791-802.|
|12||Starr S, Shattell MM, Gonzales C. Do nurse educators feel competent to teach cultural competency concepts? Teach Learn Nurs 2011;6:84-8.|