Shaping competencies for culturally safe practice among medical students.

Abstract

Limited evidence exists around authentic activities that can positively influence students' knowledge of and appreciation for the First Nations peoples' culture, impacts of colonisation and other determinants of health. A renewed Indigenous Health curriculum provided us with an opportunity to implement a cultural immersion for medical students to enhance their cultural awareness and competency. Our approach towards the design and evaluation of cultural immersion was guided by three key frameworks-a strengths-based approach towards curriculum design, Indigenous ways of knowing and being and immersions as transformative pedagogy. Pre- and post-immersion surveys were sent to 260 first-year medical students in 2020 and 323 students in 2021 who were the participants. Response rates were 37% (2020) and 47% (2021). The data indicated significant improvements in students' knowledge of Indigenous cultural beliefs and history as well as confidence in working with Indigenous populations. Students' comments indicated their experiences varied on a continuum of four ways of 'knowing': reluctant, receiving, relating and reconstructing their beliefs. Their ways of 'being' varied across four levels: privileged, feeling discomforted, being humbled and agentic. The study extends the limited evidence of theoretically informed interventions that have the potential to positively influence medical students' knowledge and appreciation of Indigenous history, culture and its impact of health outcomes. Cultural immersion experiences, when co-designed with the community and in consideration with students' prior beliefs, are powerful tools to promote capabilities for working with Indigenous patients in culturally safe ways.