Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study

Abstract

BackgroundIncluding content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students’ beliefs and behaviours.MethodsA total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students’ sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students’ perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses.ResultsGenerally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community.ConclusionsStudents’ positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students’ future behaviours and ultimately improve physician relationships with Indigenous patients.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1401-1) contains supplementary material, which is available to authorized users.

Participant-reported effect of an Indigenous health continuing professional development initiative for specialists

“…Indeed, much of the curriculum is now delivered within medical schools, rather than residency programs or continuing professional development venues [ 18 ]. Many opportunities may focus on passive learning, providing content information related to the historical and continued legacy of colonization, or elements of cultural practice [ 19 ], recognized to be insufficient for preparation to work with Indigenous peoples [ 20 ], rather than providing transformative learning opportunities to ensure learners demonstrate core competencies to support Indigenous peoples’ health experiences [ 21 ]. Tenets of effective CPD, including establishing meaningful outcomes, applying effective teaching methods, and developing sessions to be interactive and engaging, enhancing participant self-awareness, promoting reflective practice, supporting interprofessional peer learning and lifelong learning, and requiring commitment to change statements must be upheld to support behavior change [ 22 ].…”

Student Perspectives on Indigenous Health Content in Pre-Clinical Medical Education

“…Canada, Indigenous peoples' experiences with health care are shaped by what is referred to as the double burden of racism and colonialism (Yeung et al, 2018). The 2015 Truth and Reconciliation Commission of Canada (TRC) has provided 94 calls to action to support reconciliation between Indigenous and non-Indigenous peoples in Canada, addressing the intergenerational trauma of the Indian Residential School (IRS) system.…”

“…The TRC determined that removing barriers faced by Indigenous peoples when accessing health care at all levels (provider, institutional, and system) would positively influence the health opportunities available for Indigenous peoples (McNally & Martin, 2017). In response to this, a number of medical schools in Canada have implemented mandatory curriculum or community-based activities that focus on Indigenous peoples' health issues as a way to improve the knowledge, skills, and attitudes necessary to shift away from racist and colonialist assumptions (Yeung et al, 2018;Zhou et al, 2012). However, we know very little about whether this type of curriculum is meeting the needs of medical students, and what their perceptions are regarding the curriculum they are receiving.…”

“…Given these issues, it is crucial that medical students obtain appropriate education and training that is well informed and patient centred so that they can develop the necessary skills to navigate health-care issues confronting Indigenous patients. It is important for future health-care providers to learn about the underlying communication issues that can adversely affect the patient-physician encounter and how best to circumvent these, building confidence in their skill to deliver culturally-sensitive medical care, which is a basic human right (Yeung et al, 2018). Cultural sensitivity in health-care encompasses understanding one's own culture, having open and compassionate communication, and listening to patients and families to better understand and incorporate their beliefs and values into their health-care management (Brooks et al, 2019).…”

“…It has been documented that medical students seem to be aware of "Indigenous health issues" generally, but they often have a more limited understanding of the socio-cultural and economic influences on these issues, as well as the intersectional way in which diverse factors such as poverty and racism may combine to affect the health of patients (Zhou et al, 2012). Without a nuanced understanding of the interrelationships between structural determinants that affect the health of Indigenous peoples, it is unlikely that knowledge, skills, and behaviours will be fundamentally altered (Yeung et al, 2018), which raises questions as to whether simply increasing Indigenous content in medical curriculum is sufficient. To date, there has been limited research to assess whether medical students feel that the education they are receiving is effective in transforming their ability and willingness to work with Indigenous patients in a culturally safe way.…”