Indigenous Health in Toronto: Facing the Truth and Working Towards Reconciliation
Twenty years ago, there was only one identified First Nations student in the four years of the MD program. The Indigenous health curriculum at the time encompassed a brief public health review of health inequities, but it did not delve into how colonization and its resultant practices are deeply connected to the current health status of Indigenous peoples in Canada. That’s starting to change. We are excited by the commitment our students, leadership team, staff and faculty members have shown over the last five years to learn about Indigenous health, practice culturally safe care and collaborate with communities as we together respond to the Truth and Reconciliation Commission (TRC).
Next week, on June 21, we will recognize National Aboriginal Day. It’s an occasion to celebrate the cultures and contributions of Canada’s First Peoples. But we also think it’s an opportunity to reflect on how U of T Medicine has embraced Indigenous health. In doing so, there are numerous opportunities to consider our Faculty’s progress to meet the TRC’s Calls to Action related to medical education and health care.
Since the establishment of the Office of Indigenous Medical Education in 2012, there have been ongoing efforts to integrate teaching about Indigenous health into the MD program beyond didactic lectures related to inequities. As noted in the TRC Calls to Action, the current curriculum underscores the social determinants of Indigenous health, including racism and assimilatory historical practices and policies such as the Indian Act, Residential Schools and the Sixties Scoop.
Once faced with these truths, the learner must be provided with a way to reconcile this history and move forward to build positive relationships in practice, research, education and policy. Lectures, case-based learning, workshops, standardized patients and clinical electives have been incorporated into the new Foundations Curriculum to teach concepts of equity, bias, power, privilege, conflict resolution and cultural safety. Of note, cultural safety — the use of self-reflection to help mitigate the effect one’s own biases — is an Indigenous contribution to healthcare based on the work of a Maori nurse scientist.
With Indigenous students now in all four years of the medical school, and an average of two students being admitted annually, our Faculty has clearly made some progress in the recruitment and support of Indigenous medical students. But we also have more work to do to enhance our recruitment, retention and resiliency. As we train more Indigenous physicians, it is critical to ensure that we also recruit and mentor more Indigenous faculty into leadership positions across the country. As a world leader in both education and research, U of T Medicine should not only participate in this effort; we can lead by example.
Our Faculty’s efforts must extend beyond the MD program to include the entire continuum of medical training. It is imperative that all trainees and practising physicians — Indigenous and non-Indigenous — have the skills to provide appropriate care for First Nations, Inuit and Métis patients. Furthermore, we must ensure that Indigenous trainees at all levels continue to feel supported as they proceed through their training.
Learners in the Faculty of Medicine are exceptional. With a little bit of guidance and support, they have embraced Indigenous health in ways we did not anticipate, but that are boundless and inspiring. A wonderful example of this is Indigenous Health in Ontario: An introductory guide for medical students. This is a guide for students, developed by students. Its development was led by Sarah Park, a Mi'kmaq member of the MD Class of 2018, who based the guide on a similar version tailored for Atlantic Canada. She was joined by other students who are non-Indigenous, but see the value in better understanding the needs of the Indigenous patients they will encounter in practice.
Our students also remind us that knowledge is a two way street. Gaining a better understanding and respect for traditional medicines and teachings is one step down a healing path. For example, Patricia Hoyeck, a member of the MD Class of 2020, is seeking a grant that can transform Hart House’s Indigenous Garden into a living classroom for MD students who, assisted by Elders, can learn about traditional medicine.
As Canada prepares to celebrate the 150th anniversary of Confederation, let us reflect on how historical events continue to impact the health and wellbeing of the original peoples of this land. Let us acknowledge the progress we have made at U of T Medicine to better understand Indigenous health needs, and re-commit ourselves to current and future work to fulfil the TRC Calls to Action. In the end, although one may come to understand the truth on one’s own, reconciliation can only be achieved together.
Tsiouink and Miigwetch.
Jason Pennington and Lisa Richardson
Co-Leads, Indigenous Health Education
MD Program, University of Toronto
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