Footprints forwards blocked by a failure discourse: issues in providing advice about medicine and other health science careers to indigenous secondary school students.
In order to improve the recruitment of Indigenous Australians into medicine and other health careers we applied for funding to carry out what became the Footprints Forwards: Better strategies for the recruitment, retention and support of Indigenous medical students project. This project was undertaken from 2005 to 2007 by a consortium from Monash University (lead agency), James Cook University (JCU) and The University of New South Wales (UNSW) for the Australian Government Department of Health and Ageing (DOHA) initially under the auspices of the Rural Undergraduate Support Committee (RUSC) Program. The overall aim of the project was to look at opportunities for and barriers to Indigenous student entry to medical education. This paper reports on one part of the wider Footprints project carried out by Monash University, which investigated the advice and support offered by career coordinators in Victorian secondary schools to Indigenous students considering careers in medicine.
Effective Indigenous recruitment and retention in medicine and other health science careers requires career development advice and support of the highest quality. In 2006 the Career Industry Council of Australia (CICA) published a Professional Standards for Australian Career Development Practitioners guidebook. In his introduction to the standards document, Professional Standards for Australian Career Development Practitioners, the then President of the CICA reported that the Department of Education Science and Training (DEST) provided funds for the development of the standards. DEST was acting on the Organisation for Economic Co-operation and Development (OECD)'s (2004) recommendations 'that highlighted inadequacies in the training and qualifications of career practitioners in many countries including Australia' (CICA, 2006, p. iii). The President preceded these remarks with the following important statement:
All citizens of this country deserve access to career services of the highest quality throughout their lives. In a knowledge economy the future of Australia is dependent on the development of its human capital and career development is an essential building block to achieve that goal. (CICA, 2006, p. iii)
While the standards do not mention Indigenous career development specifically, many sections do refer to the importance of ethical and unbiased career development (see 3.3.2a and 6.3.5a and b, for example). As citizens, Indigenous Australians deserve access to the highest quality career services. This is not to say that they need or want exactly the same career services as non-Indigenous citizens, as this would likely perpetuate Indigenous disadvantage. Ideally, health career advice for Indigenous students should be provided by trained career development professionals who are culturally competent. The advice and support should combine information about academic requirements with multiple student-centered support and motivational options such as mentoring, role model assistance and help from families and friends, as well as advice about attending open days and career workshops and gaining work experience (Alloway, Dalley, Patterson, Walker, & Lenoy, 2004; Curriculum Corporation, 2003; Indigenous Higher Education Advisory Council Report, 2006; OECD, 2004).
This research was guided by three hypotheses drawn from the literature and from the team's practical experiences in the health career recruitment and retention field (Alloway et al., 2004; Curriculum Corporation, 2003; Johns, 2006; Schwab, 1999). These were: (1) given the dominant reality and discourse that Indigenous secondary school students will probably leave before completing Year 12 and are unlikely to take up tertiary study, Indigenous students would receive sub-optimal career advice about their potential to take up medicine or another health science career; (2) many career advisors would not be well-informed about how to work with Indigenous students, their families and communities; and (3) given the complexity of medical and health science courses, many career teachers would not be aware of the full variety of pathways into medicine and other health science careers.
To test our hypotheses we designed a survey instrument that asked school career coordinators to respond to questions about what advice and support they would provide to Indigenous students interested in medicine and other health sciences. A survey pack was sent to the principals of 532 Victorian public and private schools and included a sealed envelope containing a survey instrument to be passed on to the school's career coordinator. After an extensive series of reminder notices and an advertisement in the Education Times, 135 responses were received from principals and 144 responses from career coordinators. A total of 186 schools (35%) responded to the survey.
Our analysis of survey responses indicated that our hypothesis were proved in this small and non-generalisable sample, and we therefore recommended that action be taken in two key areas: (1) the improvement of career development practitioners' cultural competence and ability to give advice and support to Indigenous students; (2) clearer and more coordinated information to be provided to career development practitioners as well as directly to Indigenous students, families and communities about pathways into health science careers.
THEORISING CAREER DEVELOPMENT AS A KEY ELEMENT FOR INDIGENOUS HEALTH CAREER RECRUITMENT AND RETENTION
The recruitment and retention of Indigenous students into medicine and other health science careers is a complex task that involves simultaneous or sequential tasks by a number of sectors, agencies and individuals. Secondary school career advice and counselling is just one of the elements involved. But it is an important element that is crucial to get right. Indeed if it can be 'got right' for Indigenous students, then all students will benefit from an important improvement in Australian career development standards and quality.
The OECD published a major report, Career Guidance and Public Policy: Bridging the gap (2004) that was critical of career advice provision in Australia. This report argued that there are two key expectations that government policymakers have about career guidance: firstly that career advice and support ought to improve the efficiency of both education systems and the labour market, and secondly that career guidance should contribute to the promotion of social equity. As educators and academics involved in Indigenous health and wellbeing, we were interested in equity and advancement for Indigenous Australians. We wanted to develop a strong Indigenous health and medical workforce and improve career opportunities for Indigenous secondary school students in general. We have theorised that improving equity for Indigenous secondary school students and their families would also help improve the self-confidence and career self management skills of younger Indigenous children and encourage parents and extended family members to pursue some of the newer pathways into health careers. We wanted to encourage a 'you can do it' culture to replace what we saw as a dominant failure discourse. Our practical experience made us acutely aware that career development practitioners were going to be a key stakeholder group in bringing about a 'you can do it' culture.
The OECD report (2004) demonstrated that providing little or no career guidance or ineffective career guidance hinders student progress into lifelong learning, further education and training as well as entry into jobs and careers. Because of the cultural history of Indigenous Australians and the fact that many Indigenous students live in families and communities that have no personal experience of tertiary education or of working in a health profession, we expected that the need for effective career guidance would be even more essential to Indigenous Australians (Access Economics, 2004; Mellor & Corrigan, 2004). The OECD (2004) report supports the development of strong and effective public policy around planning, developing, supporting and delivering effective career guidance.
To further understand the quality of career advice given to Indigenous students in Victorian schools, we briefly reviewed sample position descriptions for the key people likely to be involved in promoting health careers to Indigenous students, including Koorie Educators, Koorie Education Development Officers and secondary school career advisors. The specific Koorie support people's position descriptions did not mention career advice or counselling as an activity associated with their role. The sample career advisor position listed a large number of career advice tasks but made no mention of equity issues or specifically providing any advice or support to Indigenous students. We also reviewed the requirements for membership of the Australian Association of Career Counsellors, especially the expectations of members' core skills and knowledge set out in the Professional Standards document (CICA, 2006, p. 26). Section 6.3.5 calls for members to 'recognise and respect diversity and conduct their work in culturally sensitive ways' (CICA, 2006, p.26). However, there is no mention of working to achieve equity for these diverse individuals and groups. As the only people specifically charged with providing career advice and counselling, it would seem that the responsibility for providing effective Indigenous career guidance would fall to the career development practitioners (coordinators or teachers). Given the lack of a specific mandate to promote equity for Indigenous students we were interested in finding out the attitudes, knowledge, information, experience and confidence Victorian career advisors had about advising Indigenous students about a career in medicine or other health sciences.
The OECD (2004) report authors argue that effective career guidance ensures the provision of good career information, but they add that it is equally important to augment good information with personal support. A Department of Education, Science and Training (DEST) report entitled School Students Making Education and Career Decisions: Aspirations, attitudes and influences contends that information-centered approaches were not rated as highly by students and parents as student-centered approaches where the career development practitioner worked 'proactively' with the student (Alloway et al., 2004, p. vii). Information-centered approaches rely heavily on individual incentive and family support that may not be as available to Indigenous students (Schwab, 1999). Indigenous students and their families are therefore more likely to benefit from student-centred or client-centered advice and support offered by proactive career development practitioners. Career advice must be developed and delivered in culturally sensitive and informed ways. As Grubb contends:
In many respects the choices about schooling, work and careers are not choices in the same sense that we think of the choices among shirts or fruit or financial services; they are much more difficult issues of identity, involving deeper issues of what a person is, what their values are, how they position themselves with respect to others and to social groups, what they think of as a worthy life-the many different elements defining who they are. (Grubb, cited in OECD, 2004, p. 92)
Culturally competent career development practitioners will be able to provide standard advice and information in ways that are appropriate to the student, their family and community. Developing the cultural competence to help Indigenous Australians will help career development practitioners to learn the skills and techniques needed to assist other groups, especially those who are experiencing educational disadvantage.
The first step in this project was to conduct a thorough literature search. Material was identified by the entire Footprints team through a database search of MEDLINE, CINAHL, ERIC, AMI and APAIS. The last mentioned yielded the most articles, given the policy based nature of much of the material in this field. A Google search using multiple search terms was also undertaken. The search terms used were the following: aborigin * or Indigenous; high school or secondary school *; career *; career promotion * or career support *. Key Footprints stakeholders advised about the inclusion of relevant reviews and programs. Government departments, agencies, professional organisations and non-government organisation websites were searched for relevant research and policy documentation.
An 11-question career coordinator/teacher survey instrument was designed. A series of six closed tick-the-box questions sought answers in the following areas:
* numbers of Indigenous students in the last three years at your school
* numbers of Indigenous students interested in medicine at your school
* suggestions for how advice would be given to Indigenous students
* whether literature from Australian medical schools was available
* whether information on pathways into medical schools was available
* how long the informant had been a career coordinator. Five open questions asked for written comments on:
* advice that the respondent would give to an Indigenous student wanting to get into medicine
* specific difficulties that Indigenous students might experience getting into medicine
* other support and encouragement that Indigenous students interested in medicine might need
* advice the respondent would have for an Indigenous student who would need to leave their community or family to undertake medical education
* alternative career pathways that could be suggested to an Indigenous student who did not get into medicine.
Ethical approval for the project was gained from the Victorian Education Department, Victorian Aboriginal Education Association and Monash University. The Prospective Student Office at Monash University provided a list of all Victorian public and private secondary and P-12 schools. A survey pack mail-out to 532 schools occurred in October 2005. The pack contained three questions for principals:
* the number of Indigenous students at their school
* the number of these students interested in a health career
* whether they would be prepared to pass information about a workshop on to interested Indigenous students.
We were aware that it might be difficult to ensure that the survey got to career coordinators/advisors, so the packs contained a sealed envelope to be passed on by the principal to the career coordinator. During October, November and December 2005 and January 2006, Regional Directors of Education were approached for their support. Five reminders were sent to principals, an advertisement urging support was placed in the Education Times and finally Koorie Education Development Officers were asked to contact schools in their region to urge a response. By May 2006 there were 135 responses from principals and 144 from career counsellors. A total of 186 schools (35%) responded to the survey in some way.
The survey offered career coordinators anonymity, however several respondents wrote the name of their school on the questionnaire. Some coordinators also responded on behalf of other career teachers at the school. All respondents did not answer every question in the questionnaire. As is often the case with a survey, we have no way of knowing if our respondents differ from their colleagues who chose not to respond. Arguments could be made that our cohort of respondents could be more or less sympathetic, skilled or committed to Indigenous students than those who did not respond. We simply do not know. Having tried our best to ensure a high response rate we can only base our analysis, conclusions and recommendations on the answers we did receive. Given the low response rate we recognise that our conclusions and recommendations should be treated with appropriate caution. As our study was conducted in Victoria, we do not claim that our results are generalisable to other Australian states.
The returned surveys were entered into a Microsoft Access database for recording and to enable analysis of the quantitative and qualitative data. The quantitative comments were analysed in two ways. Firstly the answers were assigned to categories for frequency counts by Janice Chesters (JC), Heather Kelly (HK), Helen Chambers (HC) and Leanne Turnbull (LT). Then the responses were separately analysed by Marlene Drysdale (MD), HK and JC. Themes were identified using Silverman's (2001) description of the development of themes and a modified version of Colaizzi's (as cited in Valle & King, 1978) seven step analysis was applied. Colaizzi's seventh step calls for the study's findings to be returned to the respondents for verification. Our methodology did not allow us to undertake this final step. However we have tested our findings with groups of career development practitioners at several workshops and conferences. A copy of the survey instrument is available upon application.
RESULTS AND DISCUSSION
The principals who responded told us there were a total of 493 Aboriginal students attending their schools, of which 23 were known to be interested in a health career. Seventy-nine principals were willing to pass on workshop information and only two said they would not pass on information.
The career counsellor respondents said that there were 229 Aboriginal students in the last three years at their schools. Of these 229 students, 48 were thought to be interested in a health career of which 21 were interested in nursing, 6 in medicine, 5 in psychology, 4 in physiotherapy, 3 in dietetics, 2 in pharmacology and 7 in a number of other health science fields.
The main type of advice offered to Indigenous students about how to enter medical schools was related to students' subject choice or academic work requirements only (n = 60 or 42 %). This result aligns with US government research reported on in the OECD study that found that most career advice to any student group is about school work and study options (2004, p. 41). Seventy-five (52%) respondents said they only advised on subject choice or academic work requirements or made negative comments about Indigenous students' academic ability; said they would treat Indigenous students 'the same as other students'; or said they were unsure what to do. We concluded that these respondents hadn't demonstrated that they could effectively provide complex student-centered, culturally appropriate career advice to Indigenous students interested in medicine or another health science.
Just 26 respondents (18%)said they would combine information about academic requirements with multiple student-centered support and motivational options such as mentoring, role model assistance and help from families and friends, as well as advice about attending open days and career workshops and gaining work experience. We judged that these respondents demonstrated the knowledge, skills and understanding to effectively advise and support an Indigenous student who expressed an interest in a health career.
We found that 74 respondents (51 %) had been career counsellors for five years or more and 49 respondents (34%) had less than five years experience. When respondents' advice to students was analysed by length of service, we found that there was no significant difference between the less experienced and the more experienced advisors.
Seventy-nine career counsellors (55%) said they had information about Australian medical courses, and a further 38 counsellors (26%) had some material. Many of the written comments made indicated to us that respondents didn't have a good understanding of the complex pathways into Australian medical schools. Sixty-six respondents (46%) said they had information about alternative pathways into medical schools. However, only 13 respondents (9%) went on to accurately describe possible alternative pathways for Indigenous students who didn't have the requisite score for entry to an undergraduate medical course.
The results from this study, our practical experience and literature in the field indicates that if career advisors believe that no students in their school would be successful enough academically to get into medicine then they are likely to give a 'reality check' to any student who asks about medicine (Alloway et al., 2004, pp. 24-27). This 'reality check' will inform students that they have no chance of entering a medical career. This may be especially true for Indigenous students in this study as 'academic difficulties' was the most frequently rated difficulty faced by Indigenous students considering entry to medicine. Our research indicated that this 'you cannot do it' message does not take account of alternative pathways into medicine and other health science careers.
We asked respondents to describe any other support and encouragement that would help an Indigenous student interested in medicine. Career advisors suggested that mentorship (n =22 or 15 %) and role modelling (n =12 or 8%) were the best options, followed by information sessions/open days (n=14 or 10%). We were not sure if the respondents knew who were going to carry out the mentoring and role modelling. Perhaps the Koorie Educators and Koorie Education Development Officers were considered to be the most suitable people to provide the mentoring and role modelling. However, these workers are not trained for the task and are called on to undertake a vast array of other roles. As the OECD report makes clear, the best career advice outcomes come from collaborations between career advisors, students, parents, community and external agencies such as universities and the VET sector (2004).
Some career coordinators were clearly aware of support available for Indigenous students leaving family and community to enter medical courses. The work of university Indigenous support units was known to 28 respondents (19%). Career coordinators who stated that they would recommend the 'same as for non-indigenous students' (n=11 or 8%) and others who indicated that advice 'was not relevant' or 'unsure' demonstrated that they lacked knowledge about cultural differences and alternative pathways such as pre-medicine programs, bridging courses, graduate entry or the need for students to apply for places Australia-wide. It is important to recognise that treating Indigenous students 'the same as other students' means that the serious educational disadvantage experienced by Indigenous Australians will remain unchallenged and that students will miss out on the existing opportunities for support and assistance in entering medicine and other health careers.
The 16 respondents (11%) who made additional comments at the end of the survey summed up the range of themes that emerged in this study. Some of these responses were complacent, such as, 'in my professional opinion Indigenous students are given excellent support from all schools' and 'I have very little experience with this group and would treat them as any other client'. More encouraging responses included, 'would like more information provided to careers coordinators covering [your] questions 7-10', 'I wasn't aware that we had any Aboriginal students until I sought information to fill in this questionnaire' and 'as I have not worked with these students I cannot comment, my apologies'. The most inspiring comment was 'we are working at the grass roots level; we believe that if we can get Koorie students here, we can retain them. Last year two Year 12s completed'. Several respondents noted that there were few Indigenous students at their school but we were surprised at one comment: 'we are a Catholic school and therefore do not usually have Aboriginal and Torres Strait Islander students'. The final theme that emerged was particularly depressing and included comments such as '[we] rarely have an Australian white student who wants to pursue Medicine' and 'we are a TAFE college offering VCE and VCAL. Very few students aspire to medicine. ATSI students are not identified as such unless they choose'.
This research indicates that Indigenous students in Victoria may not be receiving career development of the highest quality. To rectify this situation we make the following recommendations based on this study, the team's practical experience in the field and the literature we have surveyed. Our recommendations fall into three main areas. Firstly recommendations that affect Indigenous students directly, secondly recommendations that impact on career development practitioners and finally recommendations about national information provision.
1. Indigenous Students
Although we are primarily concerned with ensuring students have effective advice, information and support about preparing for recruitment and retention into medical education and careers, it is obvious to us that we need to make a general recommendation about effective career advice being a right for all Indigenous students. We believe that this advice needs to commence in primary school rather than secondary school.
The provision of career advice to Indigenous students needs to be a responsibility shared between governments, policy makers, educators, career development practitioners, universities, the VET sector and a large number of other agencies. However in the absence of national or state programs, we recommend universities do what they can to work with school career development practitioners to provide a full range of career advice to students interested in medicine and other health careers.
2. Career Development Practitioners
On the basis of our research it is apparent to us that career development practitioners need to have access to professional development in both working with Indigenous students and advising students about medicine and health career choices. However, career development practitioners--especially in schools--have a high work load and we also note that a similar recommendation was made in a report entitled Career Guidance and Advice for Indigenous Students (Curriculum Corporation, 2003). We can therefore assume that this recommendation will not be easy to achieve. We recommend starting the process by working with the Career Development Association of Australia (CDAA) and other similar national and state bodies to develop additional standards in this area, and a series of professional development modules about culturally appropriate career development work with Indigenous people for delivery across Australia.
3. Nationally Available Information
We believe that the majority of current medical and health career advice is provided opportunistically and is not organised, structured nor necessarily based on the latest research evidence. There appears to be no planning or orderly roll-out of the necessary programs. We therefore recommend that a national body or bodies work to create a national, sustainable, funded program to provide career advice to Indigenous students. Other key initiatives could be a state-by-state audit of materials, activities and career development practitioner and general teacher training. An interactive, game orientated, second generation Indigenous health career advice clearing house project should also be established. Due to the lack of broadband Internet access in rural areas and lower socioeconomic households, some face-to-face career information and support components will need to be delivered with the website.
In concluding this paper we want to point out that we fully understand the very difficult work that career coordinators and teachers undertake, and the often demanding environment that they work in. One of our team has been a career teacher and she has constantly reminded us of the realities of trying to work with every student and meet requirements of students with diverse needs. In addition, we note that in many schools classroom teachers undertake numerous roles including the career development role. However only 26 out of 144 respondents could list the basic advice, information and support that would be needed by an Indigenous student interested in a career in medicine or another health science. This is not satisfactory. Action needs to be taken to close the gap between Indigenous and non-Indigenous health by helping career development practitioners get the professional development and support they need to provide excellent, culturally appropriate career advice. In addition, career development practitioners, governments, universities, parents and students need timely access to high quality information regarding health career opportunities and processes.
Given the low retention of Australian Indigenous students at the senior secondary school level, educationalists may be surprised that we have focused on recruitment into 'high end' health careers such as medicine. Our view is that action on health career recruitment and retention is important and should not wait until other more general improvements in the education of Indigenous Australians have occurred. Indeed our experience in promoting medical and other health science careers has made us aware that students from a wide range of ethnic and diverse cultural backgrounds reported receiving an unhelpful and unwarranted 'you cannot do medicine' message from their career advisors. We found that many career advisors lacked detailed knowledge about the wide variety of pathways into medicine and other health science careers.
THEORY AND PRACTICE
This section is designed as a brief professional review of the article. It provides relevant study questions and answers for readers to test their knowledge of the article.
What career development activities or elements should be combined to provide effective career development advice to Indigenous students?
Answer: Information about academic requirements should be combined with multiple student-centred support and motivational options such as mentoring, role model assistance, help from families and friends and advice about open days, career workshops and gaining work experience. The advice and support should be provided by trained career development professionals who are culturally competent.
Why are Indigenous support or liaison staff not the best people to provide effective career advice to Indigenous students?
Answer: The staff is not usually trained as career development professionals and are usually called on to perform a vast number of other duties. In addition, they may have no personal or family experience of higher education. However they will be able to provide valuable support to trained career development staff.
Who has the responsibility to ensure that Indigenous Australians receive high quality career development advice and support?
Answer: The provision of high quality career development advice and support needs to be a responsibility shared between governments, policy makers, educators, career development practitioners, universities, the VET sector and a large number of other agencies.
What key professional development program needs to be provided to career development professionals to help them provide better career services to Indigenous Australians?
Answer: Career development practitioners need access to learning modules and support to assist them to work in a culturally appropriate way with Indigenous students, their families and communities.
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Janice Chesters, Marlene Drysdale, Isabel Ellender, Susan Faulkner, Leanne Turnbull, Heather Kelly, Anske Robinson And Helen Chambers
Associate Professor JANICE CHESTERS is Acting Director of the Monash University Department of Rural and Indigenous Health. Her research focuses on inter professional learning, mental health and mental illness services and Indigenous workforce issues. Email: Janice.firstname.lastname@example.org
Associate Professor MARLENE DRYSDALE is Head of the Indigenous Health Unit at Monash University Department of Rural and Indigenous Health. Marlene's family ties are in Wiradjeri country in NSW. She has worked in Indigenous education for many years and is an active member of many state and national education and health committees. She is working on her PhD, titled Reconciliation in Australia: A study of communication strategies and symbolism. Email: Marlene.email@example.com
ISABEL ELLENDER is a Senior Lecturer at Monash University Department of Rural and Indigenous Health. Her teaching and research focuses on ethical research, the historical and social determinants of contemporary Indigenous health, and how-as professionals-medical, nursing and health science students can bring about tangible improvements in health outcomes for Indigenous individuals and communities. She teaches across a wide range of health courses at undergraduate and postgraduate levels.
SUSAN FAULKNER is a communication specialist with extensive experience in health. She has worked as a Monash team member on consulting projects over the past six years. Her expertise covers strategy, event management, writing and editing.
LEANNE TURNBULL is the Personal Assistant to Associate Professor Marlene Drysdale. She acted as research administrator to the Footprints Forwards project, contributed to the data collection and helped compile the Methods and Results and Discussion sections of the paper.
HEATHER KELLY is part of the Indigenous Health Unit team at Monash University Department of Rural and Indigenous Health and is involved in teaching and research. Her research focus is workforce issues. She has worked as a careers teacher in Victorian rural secondary schools and is interested in rural and Indigenous health professional recruitment.
DR ANSKE ROBINSON is a Research Fellow at Monash University Department of Rural and Indigenous Health. She teaches in Indigenous health and well being, rural health care issues, and research methods. Her research focus includes the health care needs of rural people, rural health care issues, and the need for the integration of Complementary and Alternative Medicines into conventional medicine.
HELEN CHAMBERS is the data manager/research assistant for Monash University Department of Rural and Indigenous Health. She developed the database and analysed data for the Footprints Forwards project. (1) Refereed paper accepted under previous editor
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|Author:||Chesters, Janice; Drysdale, Marlene; Ellender, Isabel; Faulkner, Susan; Turnbull, Leanne; Kelly, Hea|
|Publication:||Australian Journal of Career Development|
|Date:||Sep 22, 2009|
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