How medical schools can Indigenize their programs

At the University of Toronto, students are immersing themselves in Indigenous culture to better serve their future patients
By Anna Wassermann - Published on Jul 25, 2018
An elective in U of T’s MD program helps students learn about the factors affecting Indigenous health. (University of Toronto/medicine.utoronto.ca)

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Lindsay Herzog remembers how nervous she was the first time she attended a community event at Native Child and Family Services. Then a fourth-year medical school student at the University of Toronto, she was hoping to improve her understanding of Indigenous culture to better serve her future Indigenous patients. But as she prepared to attend the event, she worried that others might not feel comfortable having her there.

“My main fear ... was that I would seem like an intruder — someone who was there to learn from the Indigenous community without having anything to offer in return,” says Herzog. “I wasn't sure how I would introduce myself, still working to understand my purpose for being there.”

But when she arrived at Native Child and Family Services, she received a warm welcome from organizers and fellow participants.

“I joined in on a beading group and, over time, felt less like I was studying the Indigenous community and more like I was trying to become a part of it in some ways,” says Herzog.

Over the next four weeks, she attended drumming circles and blanket exercises, youth groups and panel discussions, absorbing as much information as she could.

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The month, she says, had a profound impact on her — and she has her alma mater to thank for the opportunity.

Lisa Richardson and Jason Pennington, co-leads of Indigenous medical education in the MD program at the University of Toronto, had long championed adding courses about Indigenous health to the medical-school curriculum.

In 2014, their efforts came to fruition when they launched the Urban Indigenous Health elective, a course that immerses students in Indigenous culture to help them better understand and treat Indigenous patients. Through community interactions and events, students learn about Indigenous health and the importance of supporting cultural safety and countering racism and oppression.

The elective — the first of its kind in Canada — was inspired by Anishinaabe pedagogy and emphasizes learning through experience.

“Although we have a number of lectures, online modules, and community panels that speak to our students about Indigenous peoples and their experiences in health care, we thought it would be powerful to have interested students learn the experiences of Indigenous peoples in an urban city like Toronto by actually being in the community,” says Richardson.

Final-year medical students who wish to participate in the elective can enroll in two- or four-week sessions that take place each year between February and April, after students have received their residency assignments.

Students are expected to attend upwards of four community events each week and are required to complete a list of readings and to submit a reflective writing piece at the end of the session.

“Through reading and writing, students start to understand that everyone is a bearer of culture, whether that plays out in positive ways or in negative ways — as is particular with Indigenous peoples because of stereotyping and racism.”

Socio-economic determinants, such as income and food security, have a complex and severe effect on the health of Indigenous people in Canada, who experience higher rates of diseases and conditions such as diabetes, HIV/AIDS, asthma, arthritis, anxiety disorders, and high blood pressure. They also experience higher rates of obesity, smoking and drinking, suicide, and infant mortality.

Research shows that life expectancy for Indigenous people in Canada is 15 years shorter than it is for non-Indigenous people. Across the country, more Indigenous than non-Indigenous people report having at least one chronic condition.

The Truth and Reconciliation Commission of Canada, established in 2008, has made a number of health recommendations and called upon the federal government to establish goals aimed at identifying and closing the gaps in health outcomes; it’s also called upon medical and nursing schools to require that all students take a course dealing with Indigenous health issues.

According to Richardson, the Urban Indigenous Health elective is intended to provide medical students with the knowledge and experience necessary to provide Indigenous patients with the safe and appropriate care they’re entitled to but have traditionally been denied.

“A cornerstone of addressing health inequities is culturally safe and anti-racist care,” says Richardson. “To supply this, we need providers to truly understand historical trauma and ongoing experiences that may be contributing to health inequities due to barriers in accessing the system, such as not feeling welcome.”

While Richardson acknowledges that systematic changes are needed, she says the elective serves as a stepping stone that will help future health-care providers start understanding these histories and experiences.

For Herzog, the elective has served as more than just a stepping stone — she sees it as a transformational experience that creates self-aware, compassionate physicians.

“I went into the course knowing it would be a unique experience that would let me learn about a population I hadn’t felt entirely confident in my ability to communicate with or work with,” says Herzog. “But I came out with a whole new understanding of how to work with Indigenous patients, as well as those from cultures or backgrounds that are different from my own.”

Now a second-year family-medicine resident at Mount Sinai Hospital, Herzog says she often employs strategies or activities she learned in the elective. Most recently, she incorporated an Indigenous blanket exercise into teachings about Indigenous health to help her fellow residents understand the historical context for health issues faced by Indigenous people.

Herzog says her experiences have also changed the way she approaches Indigenous patients. “I’m aware that I still don’t know everything,” she says. “But I’m able to be respectful and more aware of their history and what might be impacting their interactions.”

Herzog wishes everyone could have this experience, and she isn’t the only one who feels this way.

According to Richardson, the feedback has been "amazing" — so much so that she’s working on having the elective coordinated out of Women’s College Hospital, which would extend the opportunity to more people.

“To open the elective to involve residents — who are physicians already, not just students — would be wonderful,” says Richardson. “That’s my hope.

This article is from Emerging Voices, a project by master’s students at the Ryerson School of Journalism, with support from Journalists for Human Rights.

Anna Wassermann is a Toronto-based journalist studying at Ryerson University. She has a particular interest in stories about Canada’s health-care system.

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