Health Sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review

Abstract

Objectives To review the research literature on cultural safety education within post-secondary health science programs. Methods We conducted health and social science database searches from 1996-2016, using combined keywords: cultural competence or safety; teaching or curriculum; universities, polytechnics or professional programs; and Aboriginal or Indigenous. In dyads, authors selected, and reviewed studies independently followed by discussion and consensus to identify thematic linkages of major findings. Results A total of 1583 abstracts and 122 full-text articles were reviewed with 40 selected for final inclusion. Publications from Australia, Canada, New Zealand and the United States described curriculum development and delivery. A variety of evaluation approaches were used including anecdotal reports, focus groups, interviews, course evaluations, reflective journals, pre-post surveys, critical reflective papers, and exam questions. Duration and depth of curricular exposure ranged from one day to integration across a six-year program. Changes in student knowledge, attitude, self-confidence, and behaviour when working with Indigenous populations were reported. Cultural safety education and application to practice were shown to be linked to improved relationships, healthier outcomes, and increased number of Indigenous people entering health education programs and graduates interested in working in diverse communities. Conclusions This review provides a summary of multidisciplinary didactic and experiential instructional approaches to cultural safety education and the impact on students, educators and Indigenous people. Institutional support, strategic planning and cultural safety curriculum policy within post-secondary settings and community engagement are imperative for positive student experiences, advocacy, and actions toward health equity and improved health for Indigenous people and communities.

Cultural Safety Training for Health Professionals Working with Indigenous Populations in Montreal, Québec

“…Not only is it important that training be incorporated into the structural organization of a workplace but must also be integrated into formal professional and medical training. A recent literature review investigated cultural safety education in post-secondary health sciences curricula in Australia, Canada, New Zealand, and the USA (Kurtz et al, 2018). This review found 40 articles published between 1996 and 2016 that investigated cultural safety education in health science education.…”

“…Six studies in this review stemmed from Canada (Kurtz et al, 2018). Arnold, Appleby, and Heaton (2008) assessed a cultural immersion weekend with 4 th year nursing students and community members.…”

Cultural diversity should be taught: a reply to UK medical students’ view on interacting with multicultural patients

“…Culture is defined by each person in relationship to the groups that they identify with [3,6]. It includes differences of age or generation, gender, sexual orientation, occupation and socioeconomic status, ethnic origin, religious or spiritual beliefs, disability [4], and experience [5]. As we mentioned in our paper, our paradigm is based on the premise that each person cannot be stereotyped as any one of their various cultural backgrounds.…”

“…The inherent power imbalance between doctors and patients can hinder respect for diversity and threaten the cultural safety of patients [8]. Cultural safety is care that respects all aspects of a person’s identity, empowers the patient to participate in their own care, and is determined as safe by the recipients of care [4]. Having relationships with culturally diverse people in the community is not the same as having relationships with culturally diverse patients in the clinical environment.…”

A tool to assess alignment between knowledge and action for health equity

“…By extension, it also assumes that advancing health equity requires actions that can redistribute power, resources, and wealth. Informed by Paulo Freire's critical pedagogy [25], principles of cultural safety [26][27][28], and allyship [29][30][31], this tool offers reflective questions that can support users to assess how a given action is oriented toward the evidence about causes of health inequities. It could be used to critically reflect on any kind of health equity work, in any setting, at any level of intervention (micro/local, meso/regional-national, macro/global).…”