title: Measuring organisational-level Aboriginal cultural climate to tailor cultural safety strategies.
abstract: BACKGROUND
  Australian medical schools have taken on a social accountability mandate to provide culturally safe contexts in order to encourage Aboriginal and Torres Strait Islander people to engage in medical education and to ensure that present and future clinicians provide health services that contribute to improving the health outcomes of Aboriginal and Torres Strait Islander peoples. Many programs have sought to improve cultural safety through training at an individual level; however, it is well recognised that learners tend to internalise the patterns of behaviour to which they are commonly exposed. This project aimed to measure and reflect on the cultural climate of an Australian rural clinical school (RCS) as a whole and the collective attitudes of three different professional groups: clinicians, clinical academics and professional staff. The project then drew on Mezirow's Transformative Learning theory to design strategies to build on the cultural safety of the organisation.
  
  
  METHODS
  Clinicians, academic and professional staff at an Australian RCS were invited to participate in an online survey expressing their views on Aboriginal health using part of a previously validated tool.
  
  
  RESULTS
  Survey response rate was 63%. All three groups saw Aboriginal health as a social priority. All groups recognised the fundamental role of community control in Aboriginal health; however, clinical academics were considerably more likely to disagree that the Western medical model suited the health needs of Aboriginal people. Clinicians were more likely to perceive that they treated Aboriginal patients the same as other patients. There was only weak evidence of future commitments to Aboriginal health. Importantly, clinicians, academics and professional staff demonstrated differences in their cultural safety profile which indicated the need for a tailored approach to cultural safety learning in the future.
  
  
  CONCLUSIONS
  Through tailored approaches to cross-cultural training opportunities we are likely to ensure participants are able to engage with the material and reflect upon implications of a challenging cultural climate on the health and wellbeing outcomes of Aboriginal people.
authors.affiliation: Flinders University, School of Medicine, Mount Gambier, South Australia, Australia. glad0016@flinders.edu.au.
authors.forename: Justin
authors.initials: J
authors.lastname: Gladman
authors.affiliation: Flinders University, Adelaide, South Australia, Australia. courtney.ryder@flinders.edu.au.
authors.forename: Courtney
authors.initials: C
authors.lastname: Ryder
authors.affiliation: Flinders University Rural Clinical School, Mount Gambier, South Australia, Australia. lucie.walters@flinders.edu.au.
authors.forename: Lucie K
authors.initials: LK
authors.lastname: Walters
mesh_terms: D000328:Adult; D001315:Australia; D003430:Cross-Sectional Studies; D054521:Cultural Competency; D065246:Culturally Competent Care / Q000458:organization & administration*; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005180:Faculty, Medical / Q000458:organization & administration; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009936:Organizational Innovation; D011634:Public Health; D019035:Rural Health Services / Q000458:organization & administration; D012577:Schools, Medical / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Australia/Pacific; Community-Controlled Health Services; Cross-cultural Safety; Education; Ethics; Health Service reform; Indigenous Health Worker; Medical; Postgraduate; Primary Health Care; Professional conduct; Public Health; Workforce