Educator perceptions on teaching Indigenous health: Racism, privilege and self‐reflexivity

Abstract

Introduction: General practitioners (GPs) and family medicine clinicians should respond to Indigenous peoples' health needs. However, medical graduates feel underprepared for this work. The foundational elements of racism, white privilege and cultural self-reflexivity remain conspicuously absent from medical education in general practice programmes, despite inclusion in curriculum frameworks. This study explored the perception and experiences of Australian GP educators in teaching this content. Methods: We undertook a qualitative study that gathered data through semi-structured interviews with GP educators (n = 12) at a medical school in Victoria, Australia. We utilised the Reflection learning domain of the Aboriginal and Torres Strait Islander Health Curriculum Framework to shape interview questions on racism, white privilege and cultural self-reflexivity. Data were analysed from constructivist and Critical Indigenous Theory paradigms to formulate key themes. Results: General practitioner educators were challenged by Reflection content, struggled to articulate a refined pedagogy for provision of anti-racist, self-reflexive learning and felt poorly qualified to teach Indigenous health, articulating preference for delegation of teaching to Indigenous peoples. They simultaneously stated the importance of inclusion of Reflection teaching in general practice, alongside expressing beliefs that appeared to devalue its perceived relevance. Students were perceived as being either disinterested or incapable of Reflection learning, or conversely, more engaged than previous generations with these topics. Discussion: The results call into question how skilled are GP educators to teach elements of Indigenous health education such as racism, white privilege and cultural self-reflexivity. Unskilled educators can reinforce colonialism in curricula, including through minimisation of content. Stronger anti-racist pedagogy is urgently required in medical education. Vital to this is active research on educator preparedness, evidence-based teaching models and accountable curriculum accreditation.

Five ways to get a grip on the need to include clinical placements in Indigenous settings

“…32 Studies have demonstrated that students graduating from medical school feel they lack the sufficient training and experience it takes to provide individualized, culturally safe care to Indigenous peoples. 2 The education of health professionals can become a vector for imperialism, and continued oppression, when it fails to integrate the cultural beliefs and practices of the populations it is designed to serve. 17 Clinical placements in Indigenous settings allow students to uncover and acknowledge cultural differences and employ cultural humility.…”

“…6 Placements in Indigenous settings could allow students to be evaluated by Indigenous peoples and work to establish a true absence of racism in their clinical practice. 2 Studies have found a strong link between rural exposure in clinical placements and rural medical practice. 7 This could promote retention of healthcare providers in Indigenous communities and provide opportunities for growth in cultural awareness and safety.…”

“…1 Students graduating from medical school feel they lack the sufficient training and experience it takes to provide individualized, culturally safe care to Indigenous peoples. 2 Current literature supports an array of benefits from educational institutions implementing clinical placements in Indigenous settings. However, limited capacity for students, among other obstacles…”

Colonization, cadavers, and color: Considering decolonization of anatomy curricula

“…Despite these positive steps, caution must be exercised to ensure that imagery and associated content are as diverse and inclusive as possible and avoid perpetuating associated implicit biases . It is crucial to take a critical lens to antiracism initiatives within anatomy education (Kendi, 2019;Vass & Adams, 2021).…”

Barriers to Including Indigenous Content in Canadian Health Professions Curricula

“…Similarly, the majority of clinical teachers in a New Zealand study reported feeling unprepared to deliver content related to Maori health (Jones et al, 2013), and an Australian study revealed that most health sciences faculty felt unsure or awkward when teaching Indigenous content (Wolfe et al, 2018). Likewise, general practitioner educators at a medical school in Australia reported feeling poorly qualified to teach Indigenous health and preferred that Indigenous educators deliver this content (Vass & Adams, 2021).…”