We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.
Indigenous Watchdog Status Update
|Current Status||March 31, 2021||IN PROGRESS|
|Previous Status||Dec. 31, 2020||IN PROGRESS|
Why “In Progress?”
Nov. 2020 – The Canadian Association of Schools of Nursing (CASN) in partnership with the Canadian Indigenous Nurses Association developed a framework of foundational strategies, recruitment and retention strategies, and curricular strategies for nursing education to advance responses to the TRC
Oct. 5, 2020 – The Canadian Indigenous Nurses Association (CINA) and Canadian Nurses Association have emphasized the need for a “mandatory” cultural competency and humility training program for health-care professions after the dearth of Joyce Echaquan, a 37-year-old woman from the Atikamekw community of Manawan, Que.
Association of Faculties of Medicine is committed “to addressing the Truth and Reconciliation Commission’s Calls to Action, and putting the education and training about Indigenous persons’ health needs in Canada front and center. The AFMC Board of Directors has established an ad hoc Committee on Indigenous Health, which will advise the Board on strategic issues and it has also set up a new Network on Indigenous Health. The Canadian Association of Schools of Nursing have made “Reconciliation” commitments and member institutes have initiated programs.
Association of Faculties of Medicine of Canada
Founded in 1943, the Association of Faculties of Medicine of Canada (AFMC) represents Canada’s 17 faculties of medicine and is the voice of academic medicine in this country. Our member faculties graduate over 2,700 MDs per year; teach over 11,500 undergraduate medical students; train over 15,000 postgraduate trainees; employ nearly 48,000 full and part-time faculty members and undertake over 3 billion dollars of biomedical and health care research annually
AMC Joint Commitment on Indigenous Health
May 23, 2019 – First and foremost, we need to stop thinking of Indigenous health as an optional topic, left to the discretion and good will of the leadership of each school. We have an obligation to respond to the Calls to Action of the TRC, to honour and respect Indigenous peoples’ right to the highest attainable standard of health and self-determination. We must be training a medical workforce in Canada that can contribute meaningfully to closing the gaps in Indigenous health, through all of the CanMEDS roles and in each arena of physician work. In order to do this we have to be focused on achieving meaningful outcomes.
- Theme 1: Social Accountability and Community Engagement
- Theme 2: Infrastructure and Organizational Culture (Learning Environment)
- Theme 3: Admissions
- Theme 4: Curriculum Theme 5: Postgraduate Medical Education
Prioritized Statement and Related Theme
- Social Accountability and Community Engagement Medical schools respond to their social accountability with respect to Indigenous communities by jointly developing specific Indigenous health goals and reporting regularly on progress within the medical school and also to the Indigenous communities they serve.
- Infrastructure and Organizational Culture (Learning Environment) # 2 Medical schools dedicate sufficient resources to enable full implementation of Indigenous health goals. This includes, for example, appropriate resourcing of Knowledge Keepers, meaningful community partnerships, library and librarian services, and physical space
- Curriculum Medical schools commit to the development and implementation of a longitudinal Indigenous health course with anti-racism as the core pedagogical approach
- Infrastructure and Organizational Culture (Learning Environment) Medical schools invest in the development of a critical mass of Indigenous Faculty and Staff with the appropriate supportive infrastructure to lead all aspects of Indigenous medical education including admissions, student recruitment and retention, curriculum development and implementation, and with structured presence on key decision-making committees within the medical school
- Infrastructure and Organizational Culture (Learning Environment) Medical schools commit to developing a safe work and learning environment for Indigenous learners, faculty and staff by supporting leadership and faculty change through focused and strategic professional development activities based in anti-racism, cultural safety and decolonization. This will include a specific focus on clinical preceptors across all clinical learning sites.
- Social Accountability and Community Engagement Medical schools focus on the development of meaningful relationships with the Indigenous communities that they serve using rights-based approaches to the co-creation of the terms of the relationship. Indigenous communities are recognized as expert resources for the medical school and are provided with the opportunity and resources needed to participate in all aspects of the admissions process, teaching, hosting learners, research and scholarship, and faculty development.
- Infrastructure and Organizational Culture (Learning Environment) Medical schools have robust policies and processes for identifying and addressing anti-Indigenous racism/ sentiment experienced by Indigenous learners, staff and faculty in classroom and clinical environments. This includes institutional measures of the effectiveness of the policy that are regularly reported on.
- Postgraduate Medical Education Medical schools commit to the development of Postgraduate Medical Education curriculum and associated tools in Indigenous health with a core focus on cultural safety and anti-racism. This builds on the undergraduate curriculum in Indigenous health and prepares physicians for anti-racist, culturally safe independent practice
- Admissions Medical schools will work towards admitting a minimum number of First Nations, Métis and Inuit students each year by employing distinctions-based approaches and practicing holistic file reviews. Robust data collection with appropriate data stewardship agreements will allow for review of progress towards goals at the individual school, provincial and national level.
- Admissions Medical schools will add a prerequisite for consideration of admission for all candidates in Indigenous studies, cultural safety, anti-racism or related discipline.
Royal College of Physicians and Surgeons
June 6, 2018 – The Royal College of Physicians and Surgeons of Canada will soon require all residency programs to provide Indigenous health and cultural safety training. Few programs are prepared or know what that training should include, according to medical educators at the recent Indigenous Health Conference in Toronto.
Indigenous people often face racism and ignorance in health care and medical education. “The health statistics for Indigenous people are horrendous, and it’s the result of discrimination and neglect over hundreds of years of colonization,” said Dr. Anna Banerji, director of global and Indigenous health for continuing professional development at the University of Toronto. “The path to reconciliation will not be an easy one and many non-Indigenous people are afraid of making mistakes. Instead of fearing, let’s embrace it.”
British Columbia has led the way, introducing cultural safety training for health workers to help them better understand Indigenous culture and provide more sensitive care. Other provinces are following suit, but medical education has been slower on the uptake. Most trainees have “zero” awareness of the history and health impacts of colonization, let alone their own harmful biases, said Dr. Jason Pennington, an assistant professor of general surgery at the University of Toronto. As for faculty, “sometimes they’re actually even worse than zero.”
Canadian Association of Schools of Nursing
Canadian Association of Schools of Nursing is the national voice for nursing education, research, and scholarship and represents baccalaureate and graduate nursing programs in Canada.
Strategic Plan 2019 – 2023
One of their 5 core objectives is: Advance leading practices, equity, and the national response to the TRC Calls to Action in nursing education and scholarship.
- Facilitate evidence-based teaching and learning.
- Utilize an equity lens to support culturally safe, responsive and accessible nursing education.
CASN Framework of Strategies for Nursing Education to Respond to the Calls to Action of Canada’s Truth and Reconciliation Commission
Nov., 2020 – Created in partnership with the Canadian Indigenous Nurses Association and with cross-country input. It identifies two calls to action that schools of nursing can make a reality:
- increasing in the number of Indigenous professionals working in health care and
- creating a requirement for nursing and medical students to take a course on Indigenous health issues, including the legacy of residential schools, treaties, rights and Indigenous teachings and practices.
The document states that many universities and colleges in Canada have already begun to respond to the TRC’s calls to action and that nursing schools are “well positioned” to address and accomplish these goals. (University Affairs: – “Canada’s nursing programs address racial prejudice in the profession”: Jan. 15, 2021)
The purpose of this discussion paper is to provide national support for reconciliation by fostering reflection related to decolonization and Indigenization, and by offering direction to schools of nursing in responding to the TRC Calls to Action. The background context of decolonization, Indigenization, and reconciliation is presented first, followed by a review of responses to the TRC among post-secondary institutions in Canada. The paper concludes with a framework of strategies to address the TRC Calls to Action in nursing education.
Initiatives underway to respond to the TRC in nursing education can be grouped into the following:
- Foundational strategies supporting reconciliation
- Strategies focused on the recruitment and retention of Indigenous students
- Strategies targeting the curriculum and pedagogy of the program
Taken together they offer guidelines for schools of nursing to support reconciliation.
Foundational strategies being implemented provide a supportive base for both the recruitment and retention of Indigenous students and program changes that the TRC has called for. They include:
- faculty and staff training
- institutional respect, and
- a welcoming environment.
Recruitment and Retention Strategies
Social, cultural, and economic factors are often barriers to the successful recruitment and retention of Indigenous students. Strategies being implemented to facilitate admission into nursing programs and program completion include:
- designated seats
- pre-admission outreach
- transition support
- cultural support, and
- distributive program delivery.
Call to Action 24 of the TRC specifically highlights a need for curricular strategies in nursing education programs in order to address issues related to health care delivery to Indigenous Peoples. Initiatives to respond to this Call to Action have included:
- having Indigenous teachers in the program
- welcoming Indigenous pedagogy in the classroom;
- incorporating Indigenous community placements
- teaching students about Indigenous history, knowledge, and culture; and
- incorporating anti-racism and cultural safety in the curriculum.
Summary and Conclusion
CASN member schools unanimously supported a motion for nursing education to respond to the TRC’s Report. As a result, a task force was struck, chaired by the CEO of CINA, with the goal of supporting decolonization, Indigenization, and reconciliation in nursing education. To this end, a framework of foundational strategies, recruitment and retention strategies, and curricular strategies for nursing education has been developed to advance responses to the TRC.
Official Federal Government Response: Sept. 5, 2019
The Government of Canada is not the lead on a response for Call to Action 24.