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Abstract
BackgroundHealth outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions.MethodsThe E4E program was delivered to rheumatologists in two phases, each delivered as experiential learning workshops where participants engaged with and applied course content within an interactive format focusing on real-time feedback. The phase 1 workshop focused on skill development of E4E Framework concepts and principles. Phase 2 concentrated on building capacity for teaching of E4E content. Evaluation of the program’s effectiveness was through longitudinal responses to the Social Cultural Confidence in Care Survey (SCCCS), self-reported strategies employed to address social issues and improve therapeutic relationships, engagement with teaching others, and satisfaction with the program.ResultsTwo cohorts of participants have participated in the program (n = 24 Phase 1, n = 10 Phase 2). For participants completing both phases of training, statistically significant improvements were observed in exploring social factors with patients, gaining knowledge and skills related to cultural aspects of care, improved communication and relationship building, and reflections on held stereotypes. Strategies to address social issues and build therapeutic relationships remained consistent throughout participation, while the training enhanced exploration and confidence to ask about cultural and traditional practices, and stronger communication strategies for exploring beliefs, expectations, social barriers, and residential school impacts on health. Participants reported feeling prepared to teach Indigenous health concepts to others and subsequently lead teaching with residents, fellows, and allied health professionals. Satisfaction with the delivery and content of the workshops was high, and participants valued interactions with peers in learning.ConclusionsThis CPD intervention had a beneficial impact on self-reported confidence and enhanced practice strategies to engage with Indigenous patients.
Highlights
Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments
Indigenous health education is mandated in Canadian undergraduate medical education programs [7], and the Royal College of Physicians and Surgeons of Canada recently declared that it occur in specialty training [8]
While maintaining fidelity to the structure of the E4E workshops delivered to primary care physicians for diabetes care, case materials were adapted to the rheumatology specialty care context using qualitative data and patient narratives from prior research [5, 16]
Summary
Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions Arthritis conditions, both inflammatory and noninflammatory, affect Indigenous Peoples in Canada to a greater extent than the general population. Related to historical legacies and the current nature of healthcare interactions with ongoing stereotyping and racism [4], Indigenous persons with arthritis have expressed that they are ‘toughing out’ arthritis rather than seeking longitudinal engagement with a rheumatologist [5] This has broad implications for the provision of rheumatology specialty care, in which nearly three quarters of Canadian rheumatologists report providing some element of care to patients with an Indigenous identity [6]. Providing an effective platform for such learning is critical, for individual practice, and for educators in the competence-by-design [11] era
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