Cultural competency—Canada’s history and today’s physician

Cultural competence (CC) means that “as physicians, we must make multiple communication adjustments each day when interacting with our patients to provide care that is responsive to the diverse cultural backgrounds of patients in our highly multicultural nation” (Caron, 2006, p.20). Indigenous cultural competency (ICC) is being able to recognize and respect the unique history of indigenous peoples in order to provide appropriate care in a respectful and safe way. One may say culturally competent care is “targeted” or “personalized” medicine based on the individual’s culture, history, and personal sociocultural background.

The Transformative Change Accord: First Nations Health Plan, 2005 was created to direct the improvement of the health of First Nations peoples and close the gap compared to the general population by 2015. This agreement saw the development of ICC curriculum and the commencement of training for health authorities’ staff in 2008-2009.

The San’yas Indigenous Cultural Safety program¹ is an accredited² online training program designed to “increase knowledge, enhance self-awareness, and strengthen the skills of those who work both directly and indirectly with Aboriginal people” (PHSA, 2015). San’yas is a valuable learning opportunity for any individual interested in closely examining the broader issues affecting indigenous peoples attempting to access health-care services.

Why is it relevant?

Creating a culturally safe space in a practice empowers patients to participate more effectively in the patient-physician relationship where the desired outcome is that patients access care sooner, and adhere to treatment plans that are specifically designed to improve their health (NCCAH, 2013). With a focus on patient-centred care it makes sense to establish a culturally competent manner of communication, and care plans that address individual needs, backgrounds and expectations.

Increasingly, BC physicians and trainees are engaging in this San’yas curriculum. Emergency medicine physicians in Prince George committed to completing this training by 2015/16; perhaps not surprising as the Northern Health Authority has the highest participation rate of the geographic health authorities, according to Leslie Varley (personal communication, March 30, 2015). Fraser Health Authority independently committed to training its workforce in ICC by 2015 (PHSA, 2014). Interest has also been shown by BC’s international medical graduate workforce, and the entire 2014/15 first year UBC medical school class enrolled in the ICC training program in parallel to their general medical school curriculum.³

In 2005, then National Chief Phil Fontaine stated that in order to bridge the gap between First Nations patients and their health-care professionals it was important “‘to know our history—our true history, not what they teach in school.’… [and that an] understanding of this history should not be optional” (Caron, 2006, p.23).

By 2014, thousands of health-care professionals had completed the ICC program, and the PHSA continues to consult with other provinces that aim to develop this training for their health care professionals.⁴

College supports ICC courses

With the new First Nations Health Authority requesting this ICC training and accompanying health care services for its people, the College of Physicians and Surgeons of BC has agreed to add a mandatory question to the 2016 Annual Licence Renewal Form inquiring whether registrants have completed ICC training.⁵ The resulting data will be linked to patient satisfaction and health-care evaluations in follow-up analysis. The College supports the utility of ICC courses, such as those offered through the San’yas program, to maintain standards of excellence in BC.

For many at the hub of this movement, it has been a long road. The assertion that “cultural competency is a necessary currency in managing medical conditions today,” (Caron, 2006, p.23) was not questioned in 2006, yet we continue to accept mere “competence” as a goal. Where else in the medical profession is “adequate” a driving goal and ambition? When do we drop competence for a loftier expectation? When nothing less is accepted, as a profession we should expect more.‪ ‪

More information on the Indigenous Cultural Competency Training Program can be found here.

References

Caron NR. Caring for Aboriginal patients: the culturally competent physician. Royal College Outlook [Internet]. 2006 [cited 2015 Apr 7];3(2):19-23. Available from: http://www.med.uottawa.ca/sim/data/Images/Aboriginal_care_Caron_e.pdf

British Columbia; First Nations Summit; BC Assembly of First Nations; Union of British Columbia Indian Chiefs. Transformative change accord: First Nations health plan - supporting the health and wellness of First Nations in British Columbia [Internet]. [Victoria, BC: Province of British Columbia, 2006] [cited 2015 Apr 7]. 20 p. Available from: http://www.nccah-ccnsa.ca/docs/social%20determinates/FirstNationsHealthImplementationPlan_Combo_LowRes.pdf

National Collaborating Centre for Aboriginal Health [Internet]. Prince George, BC: National Collaborating Centre for Aboriginal Health; 2013. Cultural safety in health care [cited 2015 Apr 7]; [about 2 screens]. Available from: http://www.nccah-ccnsa.ca/368/Cultural_Safety_in_Healthcare.nccah

Jayatilaka D. Dancing in both worlds: a review of the aboriginal patient liaison/navigation program in British Columbia [Internet]. Victoria: Provincial Health Services Authority; 2014 [cited 2015 Apr 7]. 88 p. Available from: http://www.phsa.ca/Documents/DancinginBothWorldsFINALJuly2015.pdf

Indigenous cultural competency training program [Internet]. Victoria: Provincial Health Services Authority; 2015 [cited 2015 Apr 7]. Available from: http://www.culturalcompetency.ca

Footnotes

  1. Leslie Varley, Director, Aboriginal Health Program of the Provincial Health Services Authority (personal communication, March 28, 2015) communicated that the PHSA changed the name of the Indigenous Cultural Competency training program to San’yas Indigenous Cultural Safety program as of March 2015.
  2. The ICC training program/San’yas Indigenous Cultural Safety program has accreditation with the College of Family Physicians of Canada and the Canadian Counseling and Psychotherapy Association. It is currently seeking accreditation with the Royal College of Physicians and Surgeons of Canada.
  3. PHSA offered the ICC training to UBC Faculty of Medicine as a pilot project without additional cost to the students or to UBC. At the time of this article, the project underwent an evaluation process and the results are forthcoming.
  4. BC PHSA website: http://www.culturalcompetency.ca/training/ontario
  5. There are Indigenous cultural competency training programs available in and across Canada.

About the authors

Nadine Caron, MD, MPH, FRCSC is a general and endocrine surgeon in Prince George, British Columbia. She is an advocate for aboriginal health and was the first female aboriginal student to graduate from the University of British Columbia (UBC) medical school. Dr. Caron is co-director of UBC’s Centre for Excellence in Indigenous Health.

Jennifer Mackie, MSc, is the administrative manager for UBC’s Centre for Excellence in Indigenous Health and a researcher in indigenous community health.

Leslie Varley is director of the Aboriginal Health Program at the Provincial Health Services Authority.

Cheryl Ward is the provincial lead for the Indigenous Cultural Competency curriculum in the Aboriginal Health Program at the Provincial Health Services Authority.

Evan Adams, MD, MPH is chief medical officer for the First Nations Health Authority and the former deputy provincial health officer.