Indigenous Health Curriculum Research Articles

Shaping competencies for culturally safe practice among medical students.

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.

Exploring medical students’ experiences with indigenous patient care: a phenomenological study

ABSTRACT Background Indigenous Peoples in Canada bear a disproportionate burden of disease and experience poorer health outcomes as compared to non-Indigenous populations within Canada; these conditions are said to be mediated and exacerbated by pervasive and uninterrupted anti-Indigenous racism. Third and fourth-year medical students at a Canadian medical school were asked to reflect on their experiences working with Indigenous patients in clinical settings, and how their preclinical Indigenous health curriculum impacted these experiences. Method Phenomenology was used, guided by Goffman’s theory of social stigma. Eleven undergraduate medical students were recruited using purposeful sampling. Semi-structured phone interviews were conducted to gain an in-depth understanding of the participants’ experiences. Interviews were recorded and transcribed verbatim. Data were analyzed using the four main processes for phenomenological analysis. Results Four main themes emerged from students’ descriptions of clinical experiences involving Indigenous patients: 1) students describe how their Indigenous patients encounter the health care system and their own lack of cultural sensitivity in this context; 2) racism was evident in students’ clinical interactions with Indigenous patients, but students do not always perceive these biases nor the impact of this on patient care; 3) identifying the impact of racism on care is complicated by situational clinical encounters; and 4) practicality of preclinical Indigenous health education is desired by students to prepare them for working with Indigenous patients in the clinical setting. Conclusions In their clinical experiences, students witness racism against Indigenous peoples yet are unprepared to stand up against it. Findings highlight the importance of enhancing undergraduate medical training to allow students to better understand the unique experiences and perspectives of Indigenous patients. The results support the need for ongoing Indigenous health education, to foster culturally sensitive experiences while learning about Indigenous patients.

Evaluating the Effectiveness of Indigenous Health Curricula: Validation and Application of the NOSM CAST Instrument.

In recent years, Indigenous health curricula have been integrated into medical education in response to international calls to improve Indigenous health care. Instruments to evaluate Indigenous health education are urgently needed. We set out to validate a tool to measure self-reported medical student preparedness to provide culturally safe care to Indigenous Peoples. We then applied the tool to evaluate the effectiveness of the Northern Ontario School of Medicine University's (NOSM U) Indigenous health curriculum. We conducted psychometric testing of a 46-item draft NOSM Cultural Competency and Safety Tool (CAST). Testing included principal components analysis, subscale and item analysis, and the use of paired sample t-tests to examine pre- and posttest change to measure learner outcomes. The NOSM CAST was transposed to create a retrospective pre-posttest survey with single-point-in-time scoring. Respondents included five cohorts of first-year undergraduate medical students, with 305 of 320 participating (response rate of 95.3%). The validated survey subscales included knowledge, confidence/preparedness, attitudes, intentions for advocacy, antidiscrimination, and self-reflective practice, measured using 36 scale items. Cronbach's alpha showed good to excellent internal consistency for the scales (α range = 0.82-0.91). Composite reliability values were acceptable. The pre-posttest analysis showed statistically significant increases on four scales: knowledge [t(254) = 15.10, P < .001], confidence/preparedness [t(254) = 15.85, P < .001], intentions for advocacy [t(251) = 3.32, P = .001], and self-reflective practice [t(254) = 8.04, P < .001]. The largest mean increases were for knowledge (d = 1.07) and confidence/preparedness (d = 1.15). The NOSM CAST tracks student progress in Indigenous health curricula. NOSM U's classroom and immersion-based Indigenous health curriculum enhanced students' self-reported preparedness for culturally safe care. NOSM CAST implemented together with an assessment of Indigenous patient experiences with the same learners constitutes a rigorous evaluation approach to Indigenous health curricula.

Identifying Relevant Content to Inform a Comprehensive Indigenous Health Curriculum: A Scoping Review.

To identify the entry-level curricular content related to Indigenous health recommended for entry-level physiotherapy (PT) programs in Canada and other similar countries. Design: Scoping review. Procedures: Four electronic databases were searched using the terms physiotherapy, Indigenous health, entry-level curriculum, and their derivatives. Grey literature sources were hand searched and included Canadian PT professional documents, PT Program websites, Truth and Reconciliation Commission (TRC) sources, and a Google search. Data related to curriculum characteristics, methods of delivery, and barriers and facilitators to implementation were extracted from relevant references. Stakeholders reviewed study findings. Forty-five documents were included. Documents focused on Indigenous peoples in Canada, Aboriginal and Torres Strait Islanders in Australia, and Māori in New Zealand. Canadian PT programs appeared to rely on passive teaching methods while programs in Australia and New Zealand emphasized the importance of partnering and engaging with Indigenous people. Barriers to incorporating indigenous health curriculum included an overcrowded curriculum and difficulty establishing relevance of Indigenous content (i.e., meaning). Similarities and differences were found between curricula content and approaches to teaching IH in Canada and the other countries reviewed. Strategies to promote greater engagement of Indigenous people in the development and teaching of IH is recommended.

Informing critical indigenous health education through critical reflection: A qualitative consensus study

Objective: To examine experiences of anti-Indigenous racism in a Canadian medical school and inform the development of critical and action-oriented Indigenous health education necessary to pave the way for reconciliation within health systems. Design: A qualitative study conducted within a constructivist paradigm which involved (1) semi-structured interviews with students, faculty and staff at a Canadian medical school and (2) consensus-building/collaborative analytical sessions with an Indigenous advisory group and a non-Indigenous working group. Setting: Twenty-three semi-structured interviews were completed with students, staff and faculty working across a Canadian medical school. Results: Inductive coding generated 211 codes that were grouped into seven overarching thematic domains. By engaging in an iterative dialogue with the advisory and working groups, we deductively aligned the thematic analysis with faculty-level and institution-level Indigenous education strategies to ensure local relevance. Self-reflective statements were developed with the advisory group to guide areas for action and resulted in 18 statements with five-point Likert-type-style response options. Conclusion: The results of this study suggest that promoting self-reflexivity in health professional education can prompts educators to engage with Indigenous health curriculum and pedagogy; mentorship and role modelling; and accountability. Critically evaluating systemic injustices at an individual level enables educators to resist systemic oppression and create change in the spaces where they work.

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

To explore the experiences of Indigenous patient actors who co-created and enacted Indigenous patient scenarios in collaboration with medical school faculty. We critically examine the structures and systems in a medical school that mediate cultural safety for Indigenous patient actors. The Truth and Reconciliation Commission of Canada has called on medical schools and healthcare institutions to help address the intergenerational harms inflicted on Indigenous people by the Indian residential school (IRS) system. Institutions are striving to incorporate cultural competency, conflict resolution, human rights, and anti-racism education into their curricula. However, the structural inequities within undergraduate, postgraduate, and continuing medical education practices must be identified and challenged to ensure that medical education is authentic and culturally safe for those involved in the development and delivery of the Indigenous health curriculum. To explore potential structural inequities in the co-creation process of simulated cultural communication scenarios (SCCS), the Indigenous animators at Debajehmujig Storytellers and collaborating faculty and professional staff at the Northern Ontario School of Medicine University (NOSM U) examined cultural safety in their curriculum design and delivery process. We utilized the qualitative Indigenous research methodology of the Learning Circle to deconstruct the co-creation process and to explore the experience of cultural safety from the Indigenous animators' perspective throughout the curriculum design and delivery process. A framework for culturally safe co-creation practices with Indigenous people, rooted within Indigenous teachings of the Medicine Wheel, emerged from the qualitative data. This framework has the potential to guide the practice of culturally safe co-creation of Indigenous patient simulations in medical education and healthcare workplace learning. While the Medicine Wheel teachings are held by specific Indigenous nations, we anticipate that the results and recommendations of this study will apply to Indigenous co-creators and academic medical educators internationally.

Intersectionality Based Policy Analysis of How Racism is Framed in Medical Education Policies Guiding Aboriginal Health Curriculum

Introduction: Racism has a profound impact on health inequities for Aboriginal and Torres Strait Islander people. Australian medical schools are required to include Aboriginal and Torres Strait Islander health curriculum in their medical courses and policies have been developed to support this work. Methods: The research question was: how is racism framed in medical education policies guiding Aboriginal and Torres Strait Islander health curriculum for entry-level medical courses? Applying an Indigenous Research Paradigm and Intersectionality Based Policy Analysis, three key policies were analysed: Australian Medical Council (AMC) Standards for Assessment and Accreditation of Primary Medical programs; Aboriginal and Torres Strait Islander Health Curriculum Framework (ATSIHCF); Committee of Deans of Australasian Medical Schools Indigenous Health Curriculum Framework (CDAMS). Results: The AMC standards did not refer to racism, while CDAMS and ATSICF supported the notion that teaching students about racism would lead to reduced racism or increased anti-racism in healthcare practice. However, both policies’ learning objectives lacked inclusion of critical reflection required to inform responsive action to racism. As the CDAMS and ATSIHCF were not mandated, there is little accountability for medical schools to implement either of the curriculum policies. Conclusion: Realising the goal of medical practitioners who understand racism and practice anti-racism requires a multi-layered approach. This involves evidence-based teaching about racism and anti-racism, Aboriginal and Torres Strait Islander leadership in curriculum development, inclusion of racism and anti-racism in medical school accreditation standards, and development of student critical reflection skills. Importantly, education and health institutions need to value and model anti-racism.

Indigenous academics teaching Indigenous health: ‘it’s part of who we are, our spirit, our soul, our knowledge… that goes into our teaching’

Aim: Explore the experiences of Indigenous academics teaching Indigenous peoples’ history, health and culture in Australian Bachelor of Nursing programs. Methodology: Theoretical framework comprises of Indigenous methodologies including Indigenous women’s standpoint theory and Indigenist research principles. Methods: One-on-one research yarns that were voice-recorded, transcribed verbatim, and analysed through an assemblage approach. Findings: Participants of this study shared their doubts about the legitimacy afforded to them and Indigenous health curriculum by some of their colleagues and their school and faculty leaders. They highlighted that strategic and careful disruption of the status quo is a quality imperative. Participants identified the paradox of revisiting personal trauma as pedagogy and curriculum, suggesting a lack of preparedness of their schools to adequately support them. Relational engagement with other Indigenous peoples was emphasised, however, the implicit expectation for them to capitalise on personal relationships involved risking their reputation for their schools, who seemingly demand their resourcefulness as substitute for resources. Conclusion: Indigenous academics care for quality learning and teaching of Indigenous peoples’ history, health, and culture. This care extends to nursing students, fellow academics, as well as school and faculty leadership, despite the lack of care afforded to them. Realising relational and reciprocal care, through providing appropriate support and resources, would benefit them and their academic practice.

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

Introduction: In 2015, the Truth and Reconciliation Commission of Canada released 94 calls to action. These calls were intended to redress harms inflicted on Indigenous peoples as a result of the Indian Residential School system and to advance the process of reconciliation of Canada. Several of these calls to action are directed specifically toward educating health-care providers as a means to actively eliminate racism in health-care experiences for Indigenous peoples. Objectives : To identify the learning needs of pre-clerkship medical students with respect to Indigenous health content and curriculum, and to explore the perspectives of pre-clerkship medical students on existing gaps in the medical curriculum regarding Indigenous health. Methods: This study involved semi-structured interviews with 14 first- and second-year (pre-clinical/pre-clerkship) medical students at one medical school. Thematic analysis was performed using NVivo data management software to identify common themes, and then considered within the context of the existing literature. Results: Three main themes were identified: (a) Familiarity with Indigenous culture prior to medical school, (b) constructive criticism about Indigenous education in medical school, and (c) pervasive lack of education about Indigenous health issues in the program. Discussion: Participants felt they needed more time devoted to learning about Indigenous peoples’ health, as there are many topics to explore. Most participants felt that their understanding of health issues impacting Indigenous peoples has not been sufficient in their primary, secondary, and post-secondary education to date and offered suggestions for improving the Indigenous health content in the medical school curriculum. These suggestions included providing the education earlier in the program, having Indigenous peoples involved in content creation and delivery, and ensuring all learners have sufficient opportunity to learn more about Indigenous peoples and their health. Conclusion: Through this research we gain a glimpse of how future medical providers are interpreting Indigenous health curriculum, and whether and how they intend to apply this education to their own future practice. NOTE: While the term Aboriginal has been used in Canada and Australia, the term Indigenous is used in this paper as an all-encompassing term to speak of the diverse cultures and peoples who are the original inhabitants of Canada, as it is used globally (Indigenous Foundations, 2009).

Six ways to get a grip on teaching medical trainees on the convergence of Indigenous knowledges and biomedicine, within a culturally-safe Indigenous health curriculum.

As Indigenous knowledges and biomedicine come together in healthcare today, to improve health outcomes and strengthen cultural identity among Indigenous Peoples, it is vital for physicians to learn about this convergence during their training. This narrative review article aims to provide practical advice for educators when implementing teaching regarding this topic, using examples from the research literature, and pedagogical and practice-based methods used at the University of Toronto (UofT). The methodology on obtaining the research literature included a search of a computer database called Medline. Moreover, the medical school curriculum information specific to UofT, was obtained through the formal curriculum map and UofT’s Office of Indigenous Medical Education. The following six recommendations provide a way to successfully implement the teachings on Indigenous knowledges and biomedicine, within a culturally-safe Indigenous health curriculum.

Western University Schulich School of Medicine & Dentistry.

Western University Schulich School of Medicine & Dentistry.

The Effects of an Indigenous Health Curriculum for Medical Students

PurposeIndigenous patients experience a variety of healthcare challenges including accessing and receiving needed healthcare services, as well as experiencing disproportionate amounts of bias and discrimination within the healthcare system. In an effort to improve patient-provider interactions and reduce bias towards Indigenous patients, a curriculum was developed to improve first-year medical students’ Indigenous health knowledge.MethodTwo cohorts of students were assessed for their Indigenous health knowledge, cultural intelligence, ethnocultural empathy, and social justice beliefs before the lecture series, directly after, and 6 months later.ResultsResults of paired t test analysis revealed that Indigenous health knowledge significantly improved after the training and 6 months later. Some improvements were noted in the areas of cultural intelligence and ethnocultural empathy in the second cohort.ConclusionsIt is feasible to teach and improve Indigenous-specific health knowledge of medical students using a brief intervention of lectures. However, other critical components of culturally appropriate care including social justice beliefs and actions, ethnocultural empathy, and cultural humility may require increased and immersed cultural training.

Action research to implement an Indigenous health curriculum framework

In recent decades Indigenous health curriculum frameworks have been developed, however, few studies about their implementation exist. This study aimed to employ critical theory and action research to understand how an Indigenous health curriculum framework could be applied and associated learning and teaching iteratively improved. Three action research cycles where conducted from 2017 to 2019. Student reaction (satisfaction and engagement) was collected via survey 2017–2019. Student learning was collated 2018–2019 via self-perception survey (knowledge, attitude, confidence, commitment); multi-choice questions (knowledge) and; content analysis of apply and analyse activities (skill). The teaching team met annually to reflect on findings and plan enhancements to learning and teaching. Over 2017–2019 there was a pattern of improved student reaction and learning. Connecting this research to Faculty level committees led to widening success and improved sustainability of the practice. The online unit and workshop delivery were scalable, overcame a barrier of educator skill and confidence to teach this area, allowed for quality content control and provided data for analysis. Interestingly, learning gained from this unit matched that described as occurring from student placements in health settings with high numbers of Indigenous people. Student learning occurred across the Framework three levels (novice, intermediate and entry to practice) suggesting that the taxonomy of the Framework does not necessarily align with the reality of learning and teaching. Vertical implementation of the five learning domains would benefit from alignment with training evaluation models and validated assessment to understand learning that has occurred rather than the teaching that has been taught. In this study health profession accreditation bodies had driven the imperative for an Indigenous health program and curriculum. Research on Indigenous health learning and teaching relating to behaviour and results in workplaces is needed.

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

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.

Indigenous Health Curriculum and Health Professional Learners: A Systematic Review

Background: Globally, an estimated 370 million Indigenous peoples reside in more than 70 countries with these people commonly experiencing health care access inequity.Purpose: This systematic review aimed to examine the impact of Indigenous health care curriculum on entry-level health professional learners in preparation to deliver equitable health care.Methods: Seventeen articles were identified and analyzed for: context; study design; study measures, teaching and learning delivery mode, content and duration; positive and negative learner reactions; learning gained and article quality was assessed using the Medical Education Research Study Quality Instrument.Results: Most included studies described face-to-face delivery along with blended learning combining a placement in an Indigenous setting, stand-alone placements and digital learning. Descriptions of learning gained covered five domains: remembering, understanding, self-knowledge, perspective and application relating mostly to cultural awareness. Factors contributing to positive learner reactions included attitude, environment, educator skill, pedagogy and opportunities. Factors contributing to negative learner reactions included attitude and environment.Conclusions: There is a need to further explore how health professional graduates are prepared to work in Indigenous health and the appropriate measures to do this. There is opportunity to learn more about Indigenous health teaching and learning across learning domains, in mainstream clinical placements and in digital learning.

Educating for Indigenous Health Equity: An International Consensus Statement.

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence—for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role and, in fact, may be complicit in perpetuating inequities.This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity.The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. To contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership.

Approaches to incorporating indigenous health into the Canadian medical school curriculum

In Canada, there are significant health status disparities that exist between Indigenous and non-Indigenous populations. Cultural competency among physicians is a probable way to address this large gap. The purpose of this article is to discuss the current challenges that exist in designing and delivering an Indigenous health curriculum in Canadian undergraduate medical school programs. This article will highlight the importance of cultural competency for improving the health outcomes of Indigenous populations. Additionally, it will explore potential approaches for better integration of Indigenous health into medical curricula.

Evaluating an Indigenous health curriculum for diabetes prevention: engaging the community through talking circles and knowledge translation of results.

Kahnawà:ke is a Kanien'kehá:ka (Mohawk) community in Quebec, Canada. In 1997, the community-controlled Kateri Memorial Hospital Centre in partnership with the Kahnawake Education Center, and the Kahnawake Schools Diabetes Prevention Project (KSDPP) developed an elementary school diabetes prevention health education program, aimed to increase knowledge of Type 2 diabetes, healthy eating and active lifestyles. Long-term goals for KSDPP community and school interventions are to decrease obesity and diabetes. To evaluate the Kateri Memorial Hospital Centre Health Education Program for Diabetes Prevention (HEP) and use key principles of knowledge translation to promote understanding of results to upgrade HEP content and improve delivery. A KSDPP community-based participatory research team used mixed methods for evaluation, combining a cross-sectional survey for 23 teachers with interviews of two elementary school principals and three culturally appropriate Indigenous talking circles with HEP authors, teachers and parents. Questionnaire results were presented as descriptive statistics. The thematic textual analysis identified emerging themes from talking circles and interviews. Facilitators of HEP delivery were an acknowledgement of its importance; appreciation of prepared lesson plans for teachers; and KSDPP's strong community presence. Barriers included reduced administrative support and instructional time due to competing academic demands; the need for increased Kanien'kehá:ka cultural content; and outdated resource materials. Recommendations included increasing teacher training, Kanien'kehá:ka cultural content and administrative support. Community researchers undertook detailed knowledge translation activities of facilitators, barriers and recommendations with hospital and education centre administrators and Kahnawà:ke community to maximize uptake of findings before external dissemination of results.

The Development of an Indigenous Health Curriculum for Medical Students.

Indigenous populations experience dramatic health disparities; yet, few medical schools equip students with the skills to address these inequities. At the University of Minnesota Medical School, Duluth campus, a project to develop an Indigenous health curriculum began in September 2013. This project used collaborative and decolonizing methods to gather ideas and opinions from multiple stakeholders, including students, community members, faculty, and administration, to guide the process of adding Indigenous health content to the curriculum to prepare students to work effectively with Indigenous populations. A mixed-methods needs assessment was implemented to inform the instructional design of the curriculum. In June 2014, stakeholders were invited to attend a retreat and complete a survey to understand their opinions of what should be included in the curriculum and in what way. Retreat feedback and survey responses indicated that the most important topics to include were cultural humility, Indigenous culture, social/political/economic determinants of health, and successful tribal health interventions. Stakeholders also emphasized that this content should be taught by tribal members, medical school faculty, and faculty in complementary departments (e.g., American Indian Studies, Education, Social Work) in a way that incorporates experiential learning.Preliminary outcomes include the addition of a seven-hour block of Indigenous content for first-year students taught primarily by Indigenous faculty from several departments. To address the systemic barriers to health and well-being and provider bias that Indigenous patients experience, this project sought to gather data and opinions regarding the training of medical students through a process of Indigenizing research and education.

Review of Indigenous Health Curriculum in Nutrition and Dietetics at One Australian University: An Action Research Study

This article describes a review undertaken in 2012–2013 by Nutrition and Dietetics, Flinders University, to assess the Indigenous health curriculum of the Bachelor of Nutrition and Dietetics (BND) and Masters of Nutrition and Dietetics (MND). An action research framework was used to guide and inform inquiry. This involved four stages, each of which provided information to reach a final decision about how to progress forward. First, relevant information was collected to present to stakeholders. This included identification of acknowledged curriculum frameworks, a review of other accredited nutrition and dietetics courses in Australia, a review of Indigenous health topics at Flinders University, including liaison with the Poche Centre for Indigenous Health and Well-Being (Indigenous health teaching and research unit), and a review of BND and MND current curriculum related to Indigenous health. Second, input was sought from stakeholders. This involved a workshop with practising dietitians and nutritionists from South Australia and the Northern Territory and discussions with Flinders University Nutrition and Dietetics academic staff. Third, a new curriculum was developed. Nine areas were identified for this curriculum, including reflexivity, approach and role, history and health status, worldview, beliefs and values, systems and structures, relationship building and communication, food and food choice, appreciating and understanding diversity, and nutrition issues and health status. Fourth, a final outcome was achieved, which was the decision to introduce a core, semester-long Indigenous health topic for BND students. A secondary outcome was strengthening of Indigenous health teaching across the BND and MND. The process and findings will be useful to other university courses looking to assess and expand their Indigenous health curriculum.