Indigenous Medical Education

As part of U of T Medicine’s response to the Truth and Reconciliation Commission of Canada’s Calls to Action, the Academic Strategic Plan identified expanding support for Indigenous members of our community – coupled with expanded educational opportunities for all learners, faculty and staff – as critical goals. These included:

• Expand the mandate of the Office of Indigenous Medical Education to support learners, faculty and staff across the education continuum while identifying appropriate resources and Indigenous leadership.

• Endeavor to take a holistic and humanistic approach in cultivating and promoting a learning and working environment in which is culturally safe and where Indigenous history, values and knowledge are respected and valued whilst co creating an eco-system of partnership and wellness.

• Endeavor to work collaboratively, in partnership, in an integrative and synergistic way to facilitate and provide guidance for the development of policy and procedures as related to Indigenous Health Education within the Faculty of Medicine grounded in traditional Indigenous values, knowledge and ways of knowing. Key collaborators (staff, faculty and learners) will have access to culturally safe forums for discussion of issues related to policy, education and will reflect Indigenous wisdom and leadership.

2020 Highlights: 

• Established space where Indigenous learners, faculty and staff can come together, socialize and study in partnership with Women’s College Hospital.

• Drafted a plan to expand the mandate of the Office of Indigenous Medical Education across the Faculty, which includes calls to recruit Indigenous faculty and staff to lead all aspects of Indigenous medical education and create a circle of Indigenous faculty and staff to identify support, mentorship, professional development activities.

• Established an Elder-in-Residence role for the Faculty of Medicine to support learners across U of T Medicine.

Lisa Richardson [left], a mixed Anishinaabekwe physician, is Strategic Advisor, Indigenous Health, in the Faculty of Medicine and Vice Chair, Culture & Inclusion, in the Department of Medicine. Victor Vien [right], a Metis physician who recently completed postgraduate training in psychiatry at U of T, is now a staff physician at the Centre for Addiction and Mental Health.

Q: What are some of the impediments that Indigenous students face on the pathway to medical school?

Richardson: We have heard from Indigenous students that even by the time they reach high school, they may have been dissuaded from careers in science and medicine. We need to  look even further back to younger Indigenous students – like aged 9, 10 or 11 – and have them learn about careers and opportunities in healthcare, and then build pathways of support like the Summer Mentorship Program.

Vien: I agree and many Indigenous students likely do not think being a doctor is an option given our lack of representation in medicine. There are many more Indigenous physicians now compared to our recent past, though still far less than expected based simply on the number of Indigenous people in Canada.

Richardson: Having a role model is so important. There is also the issue of streaming in schools, and we know that racism can play a role in how students are directed into different courses. Also, schools on reserves were severely underfunded for many years compared to schools off reserves meaning that the educational barriers have been significant. Streaming and funding differences are examples of how structural racism leads to differential outcomes.

Q: What were your experiences as Indigenous medical students?

Richardson: There is still this common belief that Indigenous student admissions pathways mean the Indigenous students admitted to medical school are less qualified or less prepared or less intelligent. Consequently, many students (including me) were worried about self-identifying as being Indigenous or having Indigenous ancestry. This is why the Elders who were advising us and other medical schools across Canada on the creation of the admission pathways clearly stated: “No, the GPAs and the other requirements have to be the same.” We need everyone to know — patients, leaders, medical teachers — that the requirements are rigorous and that Indigenous learners are not less accomplished. I like to use the phrase “distance travelled.” And when you consider that idea both literally and metaphorically, you realize that the resilience, knowledge beyond the health sciences and community contributions of Indigenous medical students — all in addition to their outstanding academic performance – are remarkable.

Vien: I agree there can be this perception regarding the medical school admissions process at times. What I have found going forward in my medical and psychiatric training is that we have a number of impressive clinical initiatives, research groups and mentors within our Faculty. Overall, I have a sense that we are at a critical time where so much progress has been made, and there is so much potential to positively impact the health of our communities as we continue to go forward.

Q: Is there sufficient training in medical education on Indigenous health topics?

Richardson: We’ve made some great progress, but there is still a lot more to do. For example, one of the things we worked on, and Victor has been involved in this, was for the Royal College to mandate that Indigenous health become part of the requirements for all specialty training programs.  With this change, and a similar one at the College of Family Physicians Canada, we’ve developed core competencies in Indigenous health which will become requirements for accreditation in a few years.  It won’t be enough to just deliver training in the MD Program, but throughout postgraduate training too. 

Q: And what role does advocacy play in improving Indigenous health?

Vien: The role of advocacy is very significant since there is a need for specific training and clinical program development in addition to appropriate focus on Indigenous social determinants of health. I think we should move forward with a culture in medicine where advocating for access to clean water and food security is not only reasonable, but also encouraged in our role as physicians.

– Liam Mitchell