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15environment for trainees to learn and practice their skills with suitable support andguidance, provided there are the mechanisms in place to make this sustainable.I think there needs to be a coordinated approach to this. I think the last thing youwant is the colleges knocking individually on doors of services. So some sort ofbrokerage process that operates at a regional level that works across the collegesystem and …works out the Indigenous Health program and sets up someagreements, some agreed principles, and processes. A kind of an integrated,coordinated approach and that requires some resource. Probably the collegesshould all put in for it to support it, you need a coordinated approach to it forimplementation. Professor Ian AndersonACCHOs will not be the ideal training environment for all specialist trainees at allstages of their training. Integrated curricula in Indigenous health should support thedevelopment of knowledge for trainees working in other health contexts where theywill be working with Aboriginal people, covering the spectrum of the suburbancommunity health centres, to the high tech tertiary hospitals, from inner cities, torural and suburban communities across the country.Quality ReviewIn basic medical education, the implementation of the CDAMS curriculum frameworkin medical schools was supported by the development of a quality review process,called a Critical Reflection Tool.The CRT provides an opportunity for medical schools to critically analyse factorssuch as their structural relationship with existing Indigenous health units, andthe aspirations of the medical school as articulated through mission statements,through to the detail of the curriculum itself (including teaching and learning,assessment, implementation and review and evaluation) and Indigenous studentrecruitment and retention initiatives and strategies (Anderson et al. 2009:580).A similar approach could be developed at College level, supported by CPMC, so thatprogress can be measured, successes celebrated, and strategies for achievementshared across Colleges.Ultimately, the role of accreditation is central in terms of implementing new initiativesin medical training and ensuring that graduate attributes, at all levels, are what isrequired to meet Australian health workforce requirements.The AMC has an expectation that medical specialists will demonstrate culturalcompetence in their practice of medicine (AMC Standards for SpecialistTraining).The AMC is not as specific in its accreditation requirements for specialist education asit is for basic medical education in regards to Indigenous health. As the accreditingbody for college trainees and curricula, the CPMC may wish to work with the AMC tostrengthen these accreditation requirements. Progress in implementation ofIndigenous health curricula in undergraduate course may provide an existingframework, including accreditation criteria, which could be reasonably applied tospecialist training.