Teaching Culturally Safe Care in Simulated Cultural Communication Scenarios During the COVID-19 Pandemic: Virtual Visits with Indigenous Animators

Abstract

Clinical learning activities involving Indigenous patient actors that specifically address the development of culturally safe care skills among medical students are important in order to improve health care for Indigenous people. In 2020, the COVID-19 pandemic led to strict physical distancing regulations and regional lockdowns that made the in-person delivery of Simulated Cultural Communication Scenarios (SCCS) with Indigenous patient actors impossible due to the disproportionate risk that public health emergencies pose for Indigenous communities. As the pandemic continued in 2021, we co-created a Virtual Visit approach to SCCS for the education of culturally safe care to pre-clerkship medical students. We report on student and tutor evaluation of these virtual sessions and contextualize our findings with our previous results delivering In-Person SCCSs. We found that Virtual Visit SCCS were highly effective in providing authentic exposure to and feedback from Indigenous patients. However, students rated their learning outcomes with Virtual Visit lower than the In-person approach to SCCS. We recommend formal training on interacting with patients in virtual care scenarios prior to Virtual Visit SCCS. We also found that exposure to SCCS with Indigenous animators has the potential to conjure up a diverse spectrum of sometimes unresolved negative feelings related to colonialism among students and tutors including discomfort, embarrassment, and anxiety. Our findings underscore the importance of resolving these sentiments within the safe environment of a classroom. To prepare Indigenous as well as non-Indigenous students and tutors adequately, it is important to acknowledge and critically deconstruct the embodiment of colonialism and Indigenous-settler relations when teaching physicians, as well as future physicians, preparedness for culturally safe care of Indigenous peoples.

Culturally Safe Practices in the Co-creation of Medical Education Curriculum with Indigenous Animators: Outcomes From an Indigenous Learning Circle

“…15,19 Our goal was to co-create SCCS for 64 first-year medical students before their month-long Indigenous community placement. 9,13 We realized that the development process should respect and bridge Indigenous and Western worldviews, supplanting the Western-centric SP model. In early discussions, it became clear that the co-creation and delivery process would require monitoring of the cultural safety experience by the Indigenous animators, and second, it would require compatibility within the medical school curriculum, including culturally competent faculty and clear learning expectations.…”

“…However, assessments of simulations with Indigenous standardized patient (SP) scenarios at the School revealed that the SP model did not allow the Indigenous actors' to apply their lived experience to portray authentic Indigenous clinical scenarios and created culturally unsafe learning environments for Indigenous SPs. 9,13 A program for simulated cultural communication scenarios (SCCS) was developed to mitigate the concerns created by the standardized cultural simulations. The SCCS also allowed us to introduce Indigenous patient actors who consider themselves animators since they do not only act out a character they co-created, but also impart life, interest, spirit, and vitality into patient cases.…”

“…However, assessments of simulations with Indigenous standardized patient (SP) scenarios at the School revealed that the SP model did not allow the Indigenous actors’ to apply their lived experience to portray authentic Indigenous clinical scenarios and created culturally unsafe learning environments for Indigenous SPs. 9,13…”

Reconsidering laboratory‐based anatomy within the backdrop of digital transformation: Bringing an old practice into a new world

“…Advancements in anatomical sciences education has benefitted in the past from adoption of practice models intrinsic to the business and aviation industries (Pal et al, 2018; Collins & Wisz, 2020). In this light, could it be worth exploring already existing constructs that offer (1) Protocols for face‐to face interaction in digitally connected classrooms; (2) Frameworks for synchronous videoconferencing instruction via digital networks of learning and instructional teams (Schmitt & Eilderts, 2018); (3) Immersive learning experiences within the experiential learning model (Dunne & McDonald, 2010; Hendricks et al, 2018); (4) Simulation systems that offer augmented experiences designed for learner development of cultural competency (Qin & Chaimongkol, 2021; Maar et al, 2022); or (5) Artificial intelligence‐based generated virtual human characters (metahumans) and assets (de Borst & de Gelder, 2015; Stein & Ohler, 2017) to increase anatomical proficiency within the clinic. Perhaps, consider that such archetypes may in fact offer greater propensity for non‐technical skill development in the virtual platform (Kwong et al, 2019; Papalois et al, 2022) and that such a platform may indeed offer opportunity to advance the evolving social agenda, reinforce responsibilities toward diversity equity and inclusion and provide wider outreach in our efforts to improve.…”