An introduction to indigenous health and culture: the first tier of the Three Tiered Plan.

The objective of the present study was to prepare new doctors with an awareness of cultural and health issues to facilitate positive experiences with indigenous patients. The study incorporated the 1998 intern orientation programs in Queensland public hospitals. The study method included tier one of the Three Tiered Plan, which was implemented and audited. Indigenous liaison officers, directors of clinical training and medical education officers were surveyed prior to this implementation to determine whether any or similar initiatives had been carried out in previous years and/or were planned. Post-implementation feedback from interns was obtained by using questionnaires. Follow-up telephone interviews with the directors of clinical training, medical education officers and indigenous hospital liaison officers detailed the format and content of tier one at each hospital. The results indicate that this active intervention improved the implementation rate of tier one from nine of 19 (47%) Queensland public hospitals in 1997 to 17 (90%) in 1998. The 14 indigenous hospital liaison officers (100%) involved in the intervention perceived it as beneficial. Forty-three (67%) of interns who responded to the survey indicated they had encountered an indigenous patient within the last 2-4 months. The level of knowledge of indigenous health and culture self-reported by interns was between the categories 'enough to get by' and 'inadequate'. In conclusion, it appears that tier one has been successful and is to be a formal component of intern orientations in Queensland public hospitals. Further initiatives in indigenous health and culture targeting medical staff (i.e. tier two and tier three), are needed.