The recent death of Joyce Echaquan has renewed calls to tackle systemic racism in health care, including changes to how nurses and doctors are trained. Ms. Echaquan, a member of the Atikamekw Nation, was seeking medical help at a Quebec hospital when she went live on Facebook and recorded racist taunts she endured from hospital staff in the last moments of her life.
Canadian medical and nursing schools have taken multiple steps to address systemic racism, including implementing mandatory courses in Indigenous health. But experts say more needs to be done, both while students are in training and after they enter the work force.
Attention needs to be paid that what is taught in the mandatory courses is followed up on in the workplace, said Dr. Marcia Anderson, vice-dean of Indigenous health with the University of Manitoba’s Rady Faculty of Health Sciences.
“One of the big challenges we notice is our [Indigenous education] hours begin in the pre-clinical years – where there is already some mixed messaging in what students may hear in the hallways or through other interactions across the university,” said Dr. Anderson.
“But then our students get immersed in the clinical learning environment – in hospitals and clinics, where what they are learning is how Indigenous people are treated in the real world and in the health care system. So if we are not reinforcing anti-racist, high-quality, culturally safe care in the clinical environment, then we are undoing everything we try to achieve in the mandatory courses,” she added.
Nursing and medical schools have been working on Indigenous issues for years, based on recommendations in 2015 from the Truth and Reconciliation Commission (TRC), the 2019 report from the National Inquiry into Missing and Murdered Indigenous Women and Girls and previous reviews.
Ms. Echaquan’s death in September put a spotlight on the issue again. At an October emergency meeting convened by the federal government, physicians and experts apologized to Ms. Echaquan’s family and pledged to do more to tackle systemic racism in health care.
Her death added urgency to reforms already underway.
The TRC’s final report included 94 calls to action, with the 24th calling on Canadian medical and nursing schools to require all students to take a course dealing in Aboriginal health issues, including the legacy of residential schools.
All 17 faculties of medicine in Canada have agreed to develop and implement Indigenous health courses, said Dr. Geneviève Moineau, president of the Association of Faculties of Medicine of Canada (AFMC).
In its Joint Commitment to Action on Indigenous Health, issued last year, the AFMC said schools had “a range of mandatory curriculum from minimal hours to four-year longitudinal courses.”
An informal survey turned up multiple programs.
The University of British Columbia, for example, introduced a mandatory course for first-year medical students in 2017 that covers cultural safety and how colonialism has affected Indigenous people’s health, said Dr. Nadine Caron, co-director of UBC’s Centre for Excellence in Indigenous Health.
In addition, UBC offers additional required and elective sessions in Indigenous health and clinical work with Indigenous communities, Dr. Caron said.
The Michael G. DeGroote School of Medicine at Hamilton’s McMaster University has several sessions in its undergraduate program focused on Indigenous health, including the impact of colonization and residential schools.
The school is “intensifying our work on curriculum” as part of an Indigenous health initiative that includes hiring and admissions changes, said Paul O’Byrne, dean and vice-president of Faculty of Health Sciences.
The University of Alberta introduced required Indigenous health courses for undergraduate medical students in 2018.
The Indigenous health course at the University of Manitoba’s Max Rady College of Medicine is a longitudinal course that runs throughout a four-year program.
At University of Toronto’s Temerty Faculty of Medicine, medical students are required to learn about Indigenous health through various classes and discussion groups and the subject is embedded throughout the curriculum, said Dr. Patricia Houston, vice-dean of medical education.
Nursing schools are also updating courses and making other changes in response to the TRC.
The Canadian Association of Schools of Nursing (CASN) has multiple initatives underway in response to the TRC Calls to Action, including adding the response to Call to Action 24 in updated accreditation standards, with a vote scheduled in November.
“Currently we are not tracking initiatives, although we have a proposal underway to do so,” CASN spokeswoman Cynthia Baker said in an e-mail.
Many nursing schools have already taken action.
The University of Saskatchewan’s College of Nursing, for example, will require graduate nursing students to take a mandatory course in Indigenous health starting next fall. (Undergraduate nursing programs at the university have included mandatory Indigenous studies credits since 2011.)
B.C.'s Vancouver Island University’s nursing program has introduced mandatory Indigenous health content in all four years of its nursing program.
For many Indigenous nurses, Ms. Echaquan’s death churned up memories of racist incidents and behaviour they have encountered on the job, said Lisa Bourque Bearskin, an associate professor at B.C.'s Thompson Rivers University.
“I am overwhelmed with calls,” said Dr. Bourque Bearskin, who holds a PhD in nursing and this past April was named one of six Indigenous Research Chairs in Nursing across the country.
“It’s triggered so many of us, to say, ‘Enough is enough.’ We need to do something," Dr. Bourque Bearskin said.
She said she wants to see more Indigenous representation on faculties and regulatory bodies for health professions.
The University of Manitoba’s Dr. Anderson said she hopes the discussions resulting from Ms. Echaquan’s death will lead to more action and accountability from institutions, governments and regulators, including data on Indigenous health outcomes and what progress institutions are making in responding to TRC calls to action.
“We have been working this whole time to make the system better for our people and now what I hope to see is some real critical reflection on why the system hasn’t met us in this work the way we have needed it to and what will be different going forward.”
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