Academic journal article Michigan Journal of Community Service Learning

Community as Teacher Model: Health Profession Students Learn Cultural Safety from an Aboriginal Community

Academic journal article Michigan Journal of Community Service Learning

Community as Teacher Model: Health Profession Students Learn Cultural Safety from an Aboriginal Community

Article excerpt

Communication between health care professionals and Aboriginal patients is complicated by cultural differences and the enduring effects of colonization. Health care providers need better training to meet the needs of Aboriginal patients and communities. We describe the development and outcomes of a community-driven service-learning program in which health professional students learn with, from, and about the community through brief immersion in summer camps put on by an Aboriginal agency to teach their own youth about their culture. Outcomes were assessed by semi-structured interviews with students and community members. Health profession students learn about important cultural differences, become more aware of their own values, beliefs and stereotypes, and consider ways to overcome communication barriers that interfere with developing trust with Aboriginal patients. These outcomes are retained long-term and influence relationships with patients in practice as well as career paths. Students are seen by the community as good role models. The opportunity to educate university students enhances the community's sense of pride in their culture.

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Introductory lessons for health professional students about Aboriginal peoples emphasize their poor health status and persistent health disparities, a picture of ill health reinforced during clinical training. Although we need to attend to the disproportionate burden of ill health experienced by Aboriginal peoples, we must also help health profession students understand the contexts in which these disparities exist and better prepare them to work with Aboriginal patients and communities. Lack of understanding of how historical and socio-cultural contexts of Aboriginal people influence health care encounters can lead to poor communication and misunderstandings that jeopardize patient safety (Elliott & de Leeuw, 2009). A study of family medicine residents identified inadequate knowledge of Aboriginal culture, lack of understanding of traditional medicine, feeling like an outsider, and difficulties they experience with medical management of their patients' problems as barriers, whereas having community-based experience was associated with a likeliness to work with Aboriginal people (Larson, Herx, Williamson, & Crowshoe, 2011). Most health profession programs have few opportunities for interactions with the Aboriginal community outside clinical or academic settings.

Cultural safety is an approach to cross-cultural education that has gained attention from health profession educators. It originated as an educational model and pedagogy in New Zealand nursing education designed to redress health disparities as a response to the distrust experienced by Maori people in health care settings (Ramsden, 2002). The Indigenous Physicians Association of Canada-Association of Faculties of Medicine of Canada [IPAC-AFMC] Aboriginal Health Task Group subsequently endorsed cultural safety as a means to implement Aboriginal (First Nations, Inuit, Metis) core competencies for undergraduate medical education (IPAC-AFMC, 2009). A central tenet of cultural safety is that health professionals need to be mindful of cultural differences that make each patient unique (Wepa, 2005). Each encounter with a patient is a unique bicultural (one person to one person) relationship that requires professionals to understand how their own social conditioning (both personal and professional) affects them and their practice (Papps, 2005). Cultural safety's focus on professionals acquiring awareness of their own culture (values, beliefs, biases, and prejudices) makes it distinct from widely held ideas about cultural competence training in which the primary objective is to obtain knowledge about cultural practices of various ethnic groups. Cultural safety asserts that health professionals need to examine their cultural selves through self-reflection that includes analysis of power inequalities between professional and patient (Papps & Ramsden, 1996). …

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