Indigenous Cultural Competency in Pharmacy Education: A Canadian Perspective

By Jason Min, BSc(Pharm), RPh; Simon Albon, BSc, MSc, PhD; and Larry Leung, BSc(Pharm), RPh

We enjoyed reading Dr. Carla Dillon’s insightful post “Can Indigenous Cultural Competency be Assessed in an OSCE?” from the New Zealand (NZ) perspective. If you were like us, you might have felt a mix of curiosity and optimism followed by the pragmatic question: how does this align with cultural competency assessment in the Canadian pharmacy education context? As experienced pharmacy educators and clinicians committed to improving health care outcomes for Indigenous Canadians, the idea of a cultural competency-based OSCE makes a lot of sense as an evolutionary step in curriculum design and assessment of competence of our pharmacy graduates. But is Canadian pharmacy education ready for this evolution?

Cultural Competence, Indigenous Canadians and Canadian Pharmacy Education

In 2017, the revised AFPC Educational Outcomes for First Professional Degree Programs in Pharmacy in Canada were adopted nationwide. Similar to the New Zealand standards, professional roles replete with key competencies and measurable behaviors signal curricular priorities, a framework for curriculum design and pharmacy graduate expectations. In Canada, the process of Indigenous reconciliation has taken a different process at the National and Institutional levels. The challenge to translate any of this work into meaningful curriculum design, pedagogies, and assessment practices remain works in progress. Our Indigenous Health elective at the University of British Columbia (UBC), for example, is among few formalized opportunities in Canadian pharmacy programs for students to learn about cultural competency in relation to Indigenous peoples.

Cultural Competency versus Cultural Safety and Humility

Clarifying our use of language has been a critical aspect of our elective and other Indigenous content development at UBC. In particular, the definition of cultural competency has received a lot of attention. “Cultural competency” suggests that “competency could be achieved through a single training or course” and that a non-Indigenous health care provider could achieve competence in Indigenous epistemology.1 Instead, an approach of cultural safety combined with humility should be considered as best practices for healthcare providers and our students. The definition of cultural safety and humility from the FNHA Policy Statement is “the process of self-reflection that focuses on understanding personal and systemic biases that may affect the fostering and maintenance of healthy relationships built on mutual trust”. It acknowledges the need for life-long learning to more fully comprehend and respect other cultures that are not our own. Broadly across Canada, while cultural safety and humility replace the use of cultural competency, it can still be found in landmark documents as recent as the 2015 Truth and Reconciliation Commission of Canada Final Report.

Assessment of Cultural Safety and Humility

To better convey the message of cultural safety and humility, our elective has seen multiple iterations.  We have also been challenged to utilize more appropriate and effective assessment practices that better reflect Indigenous ways of learning. As pharmacy educators, we are very familiar with Western approaches to competency-based assessment.  We have experimented with traditional quantitative and qualitative assessment practices (e.g. multiple-choice, short-answer, oral presentations) with limited success and while the idea of an OSCE assessment is intriguing, adapting it for our context presents many significant challenges and will require further thought. We have developed, and begun the evaluation of a modified reflexive photography assessment for cultural safety and humility learning. This assessment requires a pre and post-course visual-art representation (not limited to photographs) of what students think it means to practice cross-culturally.2 A rubric based on visual-arts pedagogy was developed in consultation with a working group, including an Indigenous scholar. While still early to make any conclusions, evidence to-date from student feedback suggests this approach to assessment may be more appropriate than traditional OSCE’s for bridging Western ideology and Indigenous ways of learning. Our work with authentic assessment continues.

Allyship

The notion of allyship is crucial in our role as educators and scholars. As non-Indigenous Canadians, allyship is how we can support Indigenous people, enhance the learning of our non-Indigenous students, and contribute meaningfully to the process of reconciliation and decolonizing curricula. Being an ally means practicing cultural safety and humility, engaging in meaningful self-reflection, and being able to identify and address our own biases. Allyship, coming from a strength-based Indigenous perspective, can take any form including advocate, collaborator, care provider, and scholar.

Final Thoughts

As allies, we should strive to practice and teach the approach of cultural safety and humility while exploring innovative assessment methods consistent with Indigenous ways of learning and aligning with Indigenous-centered measures of success. In this approach, terminology is critical, as are assessment methods that can accurately capture learning within the Western structure of competency-based pharmacy curricula. Reflecting on your own knowledge, skills, and beliefs, related to Indigenous health, what have you rooted in cultural competency that could instead be reframed to align with the approach of cultural safety and humility?

Acknowledgements:

We acknowledge that the UBC Vancouver campus is located on the traditional, ancestral and unceded territory of the Musqueam people.

We use the term “Indigenous” to refer inclusively to members of First Nations (status and non-status), Metis, and Inuit peoples in Canada, understanding that many people prefer terms that are specific to their communities.

With sincere gratitude for the years of support and resources made available to us at UBC by the Centre for Excellence in Indigenous Health, the Indigenous Foundations Project, and the First Nations & Indigenous Studies Program.

The First Nations Health Authority in BC for the years of collaboration, leadership, and support to improve pharmacist services.

References:

  1. FNHA’s Policy Statement on Cultural Safety and Humility. http://www.fnha.ca/documents/fnha-policy-statement-cultural-safety-and-humility.pdf. Accessed December 10, 2018.
  2. Min, J. Leung, L. Reflexive Photography: Assessing Cultural Competency in Aboriginal Health. Presented at: Annual Canadian Pharmacy Education & Research Conference; June 1, 2016; Vancouver, Canada. http://www.afpc.info/system/files/public/AFPC-FullProgram-Final-ReducedSize.pdf. Accessed December 10, 2018.

Jason Min headshot.png

Jason Min is a Lecturer and Clinical Pharmacist with the Faculty of Pharmaceutical Sciences at the University of British Columbia. Educational scholarship interests include Indigenous health and allyship, interprofessional team-based care, and health informatics. In his free time, Jason enjoys playing hockey.

Simon Albon headshot.jpg

Simon Albon is a Professor of Teaching at the Faculty of Pharmaceutical Sciences at the University of British Columbia. Educational scholarship interests include scholarly teaching and the Scholarship of Teaching and Learning. In his free time, Simon is an avid fly fisherman.

larry leung headshot

Larry Leung is a Lecturer and Clinical Pharmacist with the Faculty of Pharmaceutical Sciences at the University of British Columbia.  Educational scholarship interests include Indigenous health, interprofessional education and primary care. In his free time, Larry enjoys playing volleyball.


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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