After seeing a lack of co-design with First Nations people in pharmacy curriculum Alex Burke, Proud Wiradjuri man and PhD candidate at the University of Sydney, commenced his PhD exploring cultural safety in pharmacy education.

This included an interview with each pharmacy program in Australia. Alex's aim is to identify areas of curricula that lack cultural safety elements, explore co-design with First Nations people and ultimately implement co-designed materials throughout pharmacy programs across Australia.

Alex presented his research at the recent LIPPE at Noon webinar. Led by Aleena Williams, this session gave insight into how pharmacy academics feel about the current design of cultural safety curriculum. We were also joined by Dr. Rebekah Moles, Associate Professor, Pharmacy Practice, University of Sydney.

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Consultation and co-design in curriculum

One way to begin addressing inequalities in health and social care is by building curricula in consultation with Aboriginal and Torres Strait Islander peoples. Alex emphasised the importance of teaching with Aboriginal and Torres Strait Islander peoples, not about them.

Aleena Williams said that by engaging and collaborating with Aboriginal people, there will be additional benefits to how pharmacists are trained in all areas of the pharmacy program.

The first of five phases of his PhD involved interviewing academics in all pharmacy programs in Australia, and exploring their views on the cultural safety content currently in pharmacy curricula.

Alex used the 8 principles of the Aboriginal and Torres Strait Islander Health Curriculum Framework to guide his PhD work and analyse his interviews. The framework has been used by some other health disciplines and helps schools improve their curriculum. A participant poll indicated that pharmacy educators have little experience using this framework.

Where pharmacy education is struggling

Results from the 22 participant interviews conducted by Alex demonstrate that pharmacy programs are struggling with the following framework principles:

  • Principle 1: Leadership at all levels is key to supporting effective implementation
  • Principle 2: Respectful partnerships and collaboration with shared responsibility between Aboriginal and Torres Strait Islander and non-Indigenous people
  • Principle 3: The process of learning is equally as important as content
  • Principle 5: Holistic health service delivery is essential

Emerging themes within the findings

Common themes emerged across programs around integration of content, placements, and assessment.

Integration of content

Interviewees were almost unanimous in how content should be taught with 15 programs stating it should be integrated, opposed to stand-alone units of study. Though, 3 interviewees favoured an approach that saw stand-alone units introducing concepts in early years, which are then built upon via an integrated approach.

Aleena reflected on the content that was taught when she was a pharmacy student, emphasising how fundamental it is for content to grow alongside a person's study.

"My memory of education of Aboriginal people was that it was really late. It was at the end of my course and it wasn't assessed. As an Aboriginal person, I did not identify with any of the information that was being provided about Aboriginal people. It was really quite a disconnect.

"Hopefully by supporting pharmacy schools to engage with Aboriginal people and make the content a little more informed by the lives of Aboriginal people, then there'll be more pharmacists coming through feeling more comfortable in this space," she said.

Placements in rural communities

Alex found that pharmacy programs interviewees were split on mandatory rural placements:

  • 8 were in favour of mandatory placements in an Aboriginal community in a remote/rural setting, stating that "rural placements seem to change students".
  • 5 were not in favour of this approach, stating that it could become a form of "Cultural Tourism". Many were concerned about the risk management for the community.

Aleena clarifies that experiences in metropolitan areas are just as important as sending someone to a rural area. People working all over Australia need to be culturally competent – it is not a choice to deal with Aboriginal and Torres Strait Islander people; they exist and they are going to need healthcare from a pharmacist.


All pharmacy programs were in favour of removing short answer and multiple choice questions in assessments, and instead delivering more oral-based assessments and reflection essays.

“If you’re a pharmacist and you’re not up to verse on your therapeutic skills, you cannot progress through your course. I’m of the opinion that if you’re not a culturally safe person, you shouldn’t progress through the course either," Alex said.

Collaboration and consistency across programs

Currently, we have the Aboriginal and Torres Strait Islander Health Curriculum Framework and APC's standards attributing importance to the inclusion of Aboriginal and Torres Strait Islander people in the design curriculum. However, Alex highlighted the lack of standardisation across the pharmacy programs and suggested that there should be consistency.

"Schools are meeting the current frameworks and standards to varying degrees. But I don't think this area should be a competition. I think this is one where we should all be working together, where we are collaborative.

"It is up to the individual pharmacy schools to have a deep dive into their own curriculums to be able to identify gaps," Alex said.

"The thing that we all agree on is that [cultural safety] is a fundamental skill. It's required for people to be safe pharmacists. There needs to be some kind of baseline so that people coming from different universities don’t have vastly different capacities in this space," Aleena said.

Discussion: Addressing the principles we're struggling with

In our break out rooms, we responded to the question of what we can do together in LIPPE to help address the principles that pharmacy programs struggle with.

Principle 2: Respectful partnerships and collaboration with shared responsibility between Aboriginal and Torres Strait Islander and non-Indigenous people are required in curriculum design and implementation:

  • Shared resources
  • Clip out some stories and journeys shared by the Indigenous pharmacists in these webinars
  • Supervision of interns in ACCHO by non-pharmacists would help, particularly when there is a pharmacists in the ACCHO - to ensure opportunities are not lost
  • Bringing in Indigenous people for case studies and OSCES is a good idea - builds authenticity

Principle 3: The process of learning is equally as important as content:

  • Facilitate group conversations with First Nations students
  • Week-long immersion programs with other health disciplines to facilitate conversations
  • Provide resources for people to use

Principle 5: Holistic health service delivery is essential:

  • Two-way listening and learning
  • Patient goals
  • Shared decision making
  • Learning about different health service models for First Nations People
  • LIPPE can help with resources for all programs and ways to teach this

Lessons learned

Associate Professor Rebekah Moles spoke on changes that she has seen in pharmacy practice around this space over the past 25 years. For a very long time, Aboriginal health was not talked about at all, and if it was, it was spoken as a deficit model. For example, “their life expectancy is shorter”, “they have cardiovascular disease”. The true history of what occurred, how resilient Aboriginal and Torres Strait Islander people are, and how strong their culture is was not taught.

We have come a long way but there is still a long way to go. We can all be continuously sharing and learning from each other.

What might the future look like?

Alex hopes to see students working with First Nations people in the classroom for their oral-based assessments to address the cultural safety aspect.

The second part of Alex's PhD focuses on co-designing case studies. He would like to see pharmacy educators talking to Aboriginal people about their experiences in the healthcare setting and what they want pharmacists to be taught.

The LIPPE at Noon webinars aim to bring together like-minded people wanting to see Indigenous voices in the delivery of pharmacy education. It's where we build the LIPPE Network!

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