THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
Please submit final reports to spf@postgrad.med.ubc.ca by Wednesday, April 30th, 2014.
Project Title: Physicians & Healers: Educating Towards Culturally Safe Health Care for Urban
Indigenous Peoples
Contact Person: Dr. David Tu, Associate Clinical Professor, UBC Department of Family
Practice, Research Coordinator Vancouver Native Health Clinic
E-mail Address: davidtu9@gmail.com
Community Partner: Vancouver Native Health Society & Sheway Medical Clinics
Contact information: Lou Demarais (Executive Director), 449 East Hastings St, Vancouver
BC. Tel 604 255 9766; vnhs@shawbiz.ca
Project Goals:
To reduce the health inequities for inner city Indigenous Peoples through training Family
Practice residents to provide more culturally appropriate health services.
Through this project, FP residents were guided to learn ways of working with “non-Western”
health professionals and confront complex issues of culture in medicine. The intent was to
contribute to their competency as a collaborator and communicator with their Aboriginal
patients, and as an advocate for health system change to promote greater health equity for
Aboriginal Peoples.
The main objective of the Elder mentorship program was to increase the competencies of Family
Physicians in-training to provide culturally safe medical care. Secondary objectives of this
project included creating a space for Elders to educate clinic staff on issues of cultural safety;
and creating opportunities for clinic patients to interact directly with an Elder on matters of
culture and health.
Modifications to Project :
The project evolved to address the following primary and secondary questions:
Primary Research Question:
1. What are the impacts of working with an Aboriginal Elder preceptor on the competencies to
provide culturally safe care for Indigenous patients (as measured from the resident, preceptor,
Elder, and patient perspectives) among the Vancouver-site of the ARTS?
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
Secondary Research Questions:
2. How does the self-rated confidence to provide culturally safe care change in the family
practice residents in the ARTS and the St. Paul’s Residency Stream sites?
3. What are the lessons learned from having an Aboriginal Elder integrated into an academic
family medicine clinic?
4. What are the strengths, weaknesses and lessons learned from having an Elder provide
longitudinal mentorship to Family Practice Residents?
Community Involvement
(Please describe how the community partner was involved with the project)
This project was (and is) conducted at Vancouver Native Health Society’s (VNHS) and Sheway
Medical Clinics. Both clinics are a part of the VNHS, which is a non-profit Aboriginal Health
Services organization, and are located in the heart of Vancouver’s Downtown Eastside. There
are over 5000 active patients at VNHS Medical Clinic. The clinic provides comprehensive
primary healthcare services and a variety of drop in specialty and complementary health services.
At any given time, the Sheway clinic cares for approximately 160 high-risk pregnant women and
their dependent children. The majority of the patients at both clinics self identify as being First
Nations. The clinics are both staffed by an inter-disciplinary team of highly experienced
“Western” medical professionals and both are training sites for the UBC Aboriginal family
practice residency training stream. VNHS took the dominant roll in organizing, implementing,
and evaluating this intervention.
Project Outcomes
(Please describe how the project goals were met)
Ethical approvals for the project was obtained through UBC’s Behavioral Research Ethics Board
as well as the VNHS Research Committee.
To answer the primary research question, resident competencies were measured from four
perspectives: (1) Resident, (2) Medical Preceptor, (3) Elder, and (4) Patient. The method of
assessing each of these perspectives is described below:
(1.1) Resident: A pre and post intervention analysis will be used for the two FP residents in the
Vancouver site of the ARTS once the full two year intervention is completed. Within the first 6
months of their residency program both residents completed an evaluation tool based on the
domains from the First Nations, Inuit and Métis Health Core Competencies for Continuing
Medical Education developed by the Indigenous Physicians Association of Canada and the Royal
College of Physicians and Surgeons (The Indigenous Physicians Association of Canada and the
Royal College of Physicians and Surgeons of Canada, 2009. First Nations, Inuit and Métis
Health Core Competencies for Continuing Medical Education; Winnipeg & Ottawa).
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
The responses were used to generate mean baseline confidence scores for both residents. In the
coming months the residents will have an interim analysis of their confidence score, followed by
an end of program evaluation. Base line confidence levels are presented in Table 1.
Table 1
Resident 1 - Baseline Nov 2013
5.00
4.00
3.00
2.00
1.00
0.00
Physician Preceptor 1
Physician Preceptor 2
Physician Preceptor 3
Physician Preceptor 4
Elder 1
Elder 2
self
Resident 2 - Baseline Nov 2013
4.00
3.50
3.00
2.50
2.00
1.50
1.00
0.50
0.00
Physician Preceptor 1
Physician Preceptor 2
Physician Preceptor 3
Physician Preceptor 4
Elder 1
Elder 2
self evaluation
composite
(1.2) Physician Preceptor: During the first 6 months of residency, both residents were
assessed, by their physician preceptors using the evaluation tool described above. This
generated mean baseline score of each resident’s ability in the Core Competencies.
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
Future evaluations will follow a similar pattern to that described in section 1.1. Baseline
results are presented in Table 1.
(1.3) Elder: During the first 6 months of residency the Elders participated in guided
interviews (interview guides available upon request) which focused on the resident’s
ability in the Core Competencies of providing culturally safe care. Transcripts from these
interviews were thematically analyzed to create a subjective baseline evaluation of the
residents. Future evaluations will follow a similar pattern to that described in section 1.1
(4) Patient: Two Patients were invited to participate in a Guided Interview which will
focused on their health care encounter with the Residents. The interview was framed
around their health care encounter and designed to determine if their experience met the
tenets of culturally safe care. A convenience sampling technique was used and
recruitment will continue until a saturation of themes is achieved and will be presented in
the final report in 2015.
The second research question was addressed by using the methods described in section 1.1, but
applied to residents in the St. Paul’s Residency stream. Baseline results are pending.
The third and the fourth research questions were addressed qualitatively via thematic analysis of
guided interviews with the (1) Resident (2) Physician Preceptor (3) Elder, and field notes from
the weekly inter-professional rounds. (Interview guides available upon request.) The
preliminary results of these analysis are presented in Tables 3a and 3b below.
Project Impact
(Please describe the impact of the project on participating communities and students/residents)
Benefit to Communities: This program has allowed our community organizations to begin the
long awaited process of bringing in Indigenous Wellness approaches into our primary care
settings. The community vision is to provide opportunities for inner-city Indigenous peoples to
re-connect to their culture and engage in healthcare that is culturally safe and appropriate.
Through addressing this need we hope improve access to health services and decrease health
disparities for inner city Indigenous people. More specifically, through this research, we have
gained a much clearer understanding of the specific challenges and potential patient benefits of
expanding this program to be more patient centric (see Table 3a). This work has been
foundational and has allowed our organizations to apply for and receive some convening funds
from the BC provincial Community Action Initiative to apply for funding for a more substantial
and sustainable program of integrated Indigenous Wellness in our clinics.
Educational Benefit to Residents:
This mentorship program (still in its first of two years) has already had a significant impact on
the training of the 2013-2015 UBC Aboriginal Family Practice residents. The priority outcome
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
for this project is an increase in competencies among our residents to care for Indigenous
patients in a culturally safe manner. This project has allowed us to create a unique evaluation
tool (based upon the CANMED-FM roles) to measure resident confidence to deliver culturally
safe care. Our baseline evaluations of resident confidence indicates that there is clear room for
improvement in levels of confidence – that medical trainees have not developed all of these
cultural safety and competency skills in medical school. Our qualitative findings suggest that 1:1
mentorship with an Elder is a meaningful way of developing these skills and confidence. The
program can be further strengthened by allotting more time with the Elder, specifically time
participating in cultural activities (not just talking about them) and time seeing patients together.
In the second year of this project we will conduct an interim and final evaluation of resident
confidence to assess the magnitude of potential benefit to the residents. This will be reported in
the 2015 final report.
Lessons learned from this experience of integrated teaching and exposure to Indigenous
worldviews will be shared with other post-graduate and undergraduate teaching programs.
Specifically these results will be presented at the St.Paul’s Residency academic half day on May
8 2014. And presentation of these results will be made at an Indigenous Health Conference in
Manitoba in the fall of 2014.
If success from this project is well documented from an educational, organizational and
community perspective, it could promote a wider paradigm shift towards more collaborative
medical education and be eligible for long term sustainable funding from the newly created First
Nations Health Authority in British Columbia.
(Please state how many residents were involved in the project, how the project contributed to
resident training, and how resident learning was evaluated)
Two FP residents in the Vancouver site of the ARTS were involved in the preceptorship with the
Indigenous Elders & inner city family physicians. Their learning was evaluated as described in
the Project Outcomes (see above). Approximately 20 St. Paul’s family practice residents have
been invited to the academic half-day session on May 8th/2014.
Project Challenges
(Please describe any challenges that arose during the project)
 Data Collection: The baseline measurement of the family practice residents at St. Paul’s
hospital is pending – a small group of residents have completed our evaluation tool and
their results are forthcoming. The delay in this piece of work was due to the growing
complexity of this project and the limited financial & human resources.

Our partnership with the Coast Salish Elders has begun to grow from an educationallybased relationship to a relationship that includes the provision of direct and collaborative
care for our clinic patients in a limited space and on a consultative basis within the
confines of our medical clinic. Although this is not a new idea, bringing together
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
“health care providers” from different traditions and worldviews is a difficult and
complex task, which in part explains why it is so rarely done. It has taken many years of
our clinic having interactions with Traditional Indigenous Elders in a number of different
projects to achieve a level of bilateral trust to even contemplate such an intervention.
We have found (through the analysis of qualitative interviews with patients) that there are
many patient benefits from “visiting” with Elders and connecting on issues of culture and
spirituality. However, we have also discovered many unique challenges. Lack of
clarity with respect to patient, Elder and clinic staff expectations have led to conflict.
Issues of confidentiality and conflicting worldviews with respect to time, methods of
communication and use of cultural protocol have all been barriers to effective patient
care. To move forward with this intervention effectively we need to overcome these
barriers and develop a shared understanding of the goals of collaborative care, the
magnitude of the problems patients face, and expected patient outcomes.
Budget
Funding received
Expenditure
 Personnel – salaries, benefits
o Administrative- Research Assistant
o Student staff
o Consultants – Indigenous Elders
o Physician Honoraria
 Equipment
 Catering (weekly interprofessional rounds)

Supplies (Traditional Medicines, Gifts, Blanketing Ceremony)
 Rent
 Other (Misc. items: parking, fines)
Total Expenditure as of March 31, 2014
Final Balance
38, 950
5, 925
0,00
27, 455
4, 050
0.00
1368.67
1157.97
4510.00 (in-kind donation)
181.36
40, 138
- 1,188
Table 3a: The “Lessons Learned” from having an Aboriginal Elder integrated into an academic
family medicine clinic
Lesson Learned
Supporting Quotes
1) Integrating an “We are doing something that is so un-charted that we are
Elders
going to hit these bumps along the road.” (Elder)
Program into
a
primary “There are so many changes that need to be made in the
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
care clinic is
challenging
and requires
negotiating
and evolving
a new model
of care
2) Offering both
Traditional and
Modern
approaches
benefits patients
health system to make this partnership actually sustainable
and meet its full potential … we know that the status quo is
resulting in major inequities so we know we need to do
something different” (Physician)
“Elders are in their own category and we can’t treat them
like other health professionals and expect it to work. We are
at the point of just trying to understand what we need to do
to make this work.” (Physician)
“I think the most important lessons learned so far is that the
concept is good [for patients].” (Physician)
“Involvement of an Elder’s can have a transformation impact
on patients” (observation from rounds discussion on comanaged patients)
“I think that having a collaboration between traditional and
non-traditional will result in a better uptake of both health
services if they were brought under one roof with practices
working together.” (Physician)
“My experience is that they [traditional and modern] run
together well” (Elder)
3) Success of
this
integration
should be
judged by
patients (and
their
outcomes)
4) Integration
requires an
environment of
respect &
understand
(patients, staff,
elders)
5) Traditional
ceremonies &
gatherings need
to be part of this
“We hope that having elders here … will translate into better
health outcomes.” (Physician)
“Ultimately I think if we can framing it around patient
outcomes [it will] keep us honest.”(Physician)
“Staff members [need to] be aware of the cultural
teachings…of the role and the respect of the Elders” (Elder)
“If they’re [staff] not in the full mode of acceptance than
there is going to be resistance and then there is going to be
disrespect.” (Elder)
I think if we are on the strengths I’d like to go back to
ceremony. (Elder)
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
integration.
6) Traditional
Elders have
distinct physical
space needs
Need something a little bit more permanent.
Safe, comfortable, need to be in the clinic area,
independent, private (multiple sources)
7) Lots of
problems arise
around issues of
“Time”
“Hard to get patients to understand that they are on a 1-hour
timeline… when they get started and they are heartbroken
and they are crying – and in our culture we don’t shut them
down and say ok an hour is up, I have to let them go until
they cry where they can’t cry no more.” (Elder)
“For the Elder and that they be given the grace of time to
come and get settled in before the day starts” (Elder)
“So much of what we do here is opportunistic … a lot of it is
just, “this is what I need today” and if that need might best
be filled by an Elder working in collaboration with one of the
clinicians then we need to have the elder available when the
clinicians are here and vice versa.” (Physician)
8) For Elders &
physicians to
work together
requires good
communication &
willingness to find
common ground
“It should not be one-sided either way. That we should
honor both sides.” (Elder)
9) There are
many types of
Elders and they
have multiple
roles they can
take for patients
“So I believe I have helped the patient by speaking for them
with the physician.” Elder
“Elders and physicians must both work to find common
ground on some issues (i.e. medical marijuana, child
protection, addictions, sobriety)” (observation from rounds
discussion on co-managed patients)
“I can help [patients] understand why they [doctors] are
doing an assessment [or] that it is about the type of
medicine or treatment they will give you … then they can
relax. “ (Elder)
“We have had several occasions that having an elder on
site when somebody has been in some form of crisis has
been incredibly powerful. I’ve witnessed this a couple of
times and it’s been humbling for me to see this happen in
the context of a medical clinic” (Physician)
“There is a huge gap in in bringing some very ill people into
care and making them feel safe here. If the elders can help
to close that gap in terms of relationship building, that is a
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
valuable piece of the picture.” (Physician)
Table 3b: The strengths, weaknesses and lessons learned from having an Elder provide
longitudinal mentorship to Family Practice Residents:
S1) The
“Discussing cases with Elders can add context to patient’s story”
mentorship
(observation from rounds discussion on co-managed patients)
program offers a
Safe & Reflective
space to ask
“The ability to present complicated or difficult situations to Doris
culturally charged and Roberta has been helpful in that it’s a safe way that I can ask a
questions
question. And get some guidance with people that I have become
comfortable asking questions with.” (Resident)
“And I think importantly it has helped me to develop my own skills
and self-reflection To sort of critically analyze my own words and
actions and to become more aware about how I can provide a
culturally safe environment or prevent a culturally safe environment
in the same way. I’m aware of my own impact in patient
encounters and so that self-awareness and self-reflection piece has
been really important.” (Resident)
“After each of the meetings that we have – there is a huge amount
of reflection that goes on for me and really drives me to reflect upon
what can I do better to be providing culturally safe care, to be better
for my patients. That’s been really important in my learning
process.” (Resident)
S2) Mentorship
provides exposure
to issues of
spirituality and
health.
“Residents gain exposure to the “medicine wheel framework” and
categorize issues as physical / emotional / cognitive / spiritual –
and manage accordingly” (observation from rounds discussion on
co-managed patients)
“Once the patient has gotten off their chest – the spiritual part then
that makes it easier to take care of the medical part.” (Elder)
“On the topic of dealing with patients who are angry: I tell the
doctors to ask the patient about their family members or comment
on their scarf/clothing (make a personal connection with the
patient) – manage a patient’s anger before continuing on with the
assessment again.” (Elder)
“I’ve become a bit more knowledgeable about what is involved in
smudging and ceremony so that when people mention it I have a
little bit more to connect with them on that … Whereas previously
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
there was a reluctance to discuss these things, partly because I my
own ignorance, I didn’t want to ask too many questions because I
wouldn’t know what to do with the answers. Now I have a bit better
framework for how this works so this just sort of opens up the
discussion a bit. So with my new patient intake protocol I am
asking a bit more about spirituality and religion … Its part of what
we are trained to do but we don’t often do it.” (Physician)
“A huge part of FN spirituality is prayer. That is a good role model
for the patients.” (Elder)
“Residents can gain an appreciation into the workings of a spiritual
practice of healing (gratitude, forgiveness, trust, faith, prayer, love)”
(observation from rounds discussion on co-managed patients)
S3) The very
presence of the
program
demonstrates
respect for
Indigenous culture
“The strengths are … they are amazing to see … - the respect of
the culture.” (Elder)
“The respect of even wanting to have us be there (us Elders) and
bringing back the culture to the people” (Elder)
“What I really love about this model is that the physicians … even
offering to pray and bless the food. It is spreading. They’re willing to
participate in the blessing of the food or the table or opening with a
prayer. Those are strengths.” (Elder)
S4) Longitudinal
mentorship builds
supportive
relationships
between
residents, Elders,
and Physician
preceptors
“It builds relationships between the doctors that are there and the
Elders and the trainees.” (Elder)
“I think the biggest thing is just having the ability to develop a
relationship with the Elders so that I feel comfortable asking
questions and seeking their guidance.” (Resident)
“I think if we were doing this with a larger number of Elders who
were kind of rotating through I think it would be a lot more difficult.”
(Resident)
“Mentorship provides emotional support to residents.”
(Observations from rounds discussion on co-managed patients)
“I think it [has been] a positive experience and allowed me to
establish a relationship with the Elders so that we could be
comfortable with each other and now when we talk about patients
we can talk about anything. [Elder] Doris will come to me if she's
had issues with a patient or questions about her protocol or issues
about interacting with staff members. She has expressed that she
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
comfortable coming to me and discussing them with me.”
(Physician)
S5) Combined
Elder/Preceptor
combined rounds
create an
interdisciplinary
learning
environment
“I think that is a definite strength because everyone brings in
something a little bit different and particularly around problem
solving around specific patients because we don’t often have the
time to sit down and talk about one person all together. And
everybody has different experiences with them and perspectives
and they are all super valuable.” (Resident)
“I think having the interdisciplinary component of these meetings
has helped to provide many different perspectives of health and
wellness and many different knowledge bases to draw upon so
that’s been really positive.” (Resident)
S6) Mentorship
with Elders can
assist residents’
goal of forming
more authentic
relationships with
Indigenous
Patients
(awareness of
cultural issues,
history, forming
relationships,
listening)
“There’s been a couple of tips that I’ve adapted from our
conversations with Doris & Roberta. One being– not jumping to my
agenda with patients … so starting with asking them how they are
as opposed to what can I do for you today? To better facilitate the
relationship I guess and it certainly seems to have worked in terms
of establishing rapport so I think that is one of the bigger things that
I’ve noticed.” (Resident)
“And just becoming more comfortable and confident about asking
patients both where they are from and if they identify with any
traditional beliefs or if they participate in ceremony or anything like
that. I definitely do that more often than I did previously.”
(Resident)
“I am spending more time getting more detailed family histories and
family relationships than I was previous.” (Physician)
“The knowledge and the wisdom of the Elders that they have
generously shared at the meetings have been invaluable. Working
with the Elders has certainly helped me to understand an
Indigenous perspective of wellness, which can be very different
than my own presumptions about what wellness is, prior to working
with the Elders
I think that’s important to understand the patients’ perception of
wellness in order to support them on their journey to health and
wellness – that’s the pre-requisite.” (Resident)
“I think in many Indigenous communities knowledge is spread by
spoken words, so many of these lessons that you learn along the
way, its information that you couldn’t just read in a book, it needs to
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
be taught, you need to understand the context while you are
leaning it. That makes this invaluable.” (Resident)
“I think that I have a deeper understanding of a more balanced and
holistic view of health and that helps me to understand my role in
the healing journey of patients.” (Resident)
“I think I’ve really learned the value of patient priorities and how to
put these at the forefront of my medical planning and how important
it is to for patients to feel heard in these encounters and a part of
that is prioritizing patient values and perceptions of health”
(Resident)
“Early on I could see that the Elders were giving the residents
feedback on how to greet a patient, how to make them feel
comfortable, how to adapt some of their communication style and I
could see the residents actively trying to employ those and then
asking me questions along those lines and we would have
discussions along those points.” (Physician)
S8) Mentorship
has helped
develop a better
sense of what
cultural
competency &
safety means
“We as clinicians have felt that that we provide culturally safe and
competent care but it's not until we've actually had Elders here and
witnessed how they work, how they expect to work, and how they
expect to be treated that we’re getting a better sense of what that
really means.” (Physician)
“As a resident trying to develop competencies, very rarely do you
actually get someone who has the real ability to say, ‘yes, you're
heading in the right direction’ … and, ‘these are some of the things
that you can work on”. I can see how the Elders really help to
frame the problem for the residents in terms of communication with
the patients. I can see the messages around how long it takes to
build trust, why there is mistrust, and the ways you're likely to be
judged. “ (Physician)
“I think I understand to a deeper extent the hierarchical relationship
that can exist in medicine, where I was a bit more naïve to that prior
to this. And I think I’ve been able to identify barriers to health with
a deeper understanding, since this intervention, and in that regard
been able to reduce the barriers to health and the power differential
that exists within patient encounters with Indigenous patients. “
(Resident)
“I think I am beginning to understand the complexity of cultural
identity – and this has helped me to develop an appreciation for the
diversity among Aboriginal people, which is a very important
component in providing culturally safe care.” (Resident)
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
“I have a better understanding of the legacy of residential school
and the ensuing complex intergenerational trauma that has created
so many barriers to health within the Indigenous community. And I
think in understanding that that has been important for me to
understand what is providing culturally safe care and how can I go
forward with that. “ (Resident)
“I think one of the strengths is that it's clearly better for the
residents to learn about cultural practices from the elders than it is
from us” (Physician)
“I think certainly that the residents are culturally safe, it’s the
competency aspect which is the harder part to learn. I think that
the safety part is more just an awareness of culture and how it
influences practice but now actually going from being very aware of
culture and how it has affected somebody's life and how that might
affect there their healthcare needs to becoming actually competent
in another culture involves a lot of learning about the specifics of
practices. That is the process that they're going through. The
elders are certainly helping to a great extent for all of us to become
more competent.” (Physician)
W1) The program
lacks opportunities
for residents to
actually participate
in culture
“The residents are participating in the dialogue around culture. It
would be great for them to have a chance to actually participate in
the culture itself – via ceremony, a nature walk in the Squamish
Valley. Etc.” (Elder)
“It would be more beneficial for the trainees to have some time to
work 1:1 with all of the Elders or with one of the Elders and receive
those cultural teachings. Before we even start working in
relationship and in partnership with patients. “ (Elder)
“I would really like to be able to shadow the Elders in their
interactions. Because we’ve done it where they’ve joined us but I
would like to have at least an afternoon or two that we could join
them where they’re leading the interactions – where the patient has
come in to see the Elder.” (Resident)
I’d like to see the residents spend a bit more time with the elders
when the elders are actually leading the consult. This would be
helpful because they are taking ownership of patients from their
perspective so to see that work unfold would be very helpful for the
residents to gain that bilateral understanding.” (Physician)
W2: The program
“I wish the timing (of a meeting) be addressed – that we come
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
is too time
restricted and
never on “Elder’s
Time”
together and to meld both of our ways would be to have 1
time/month for the Elders just to be on Elders time.” (Elder)
“To have those discussions that we end up starting and end up
stopping mid-way. Where we feel cut off, we feel disrespected; we
feel our voice is not being listened to – by that time frame. 1 hour.”
(Elder)
“You feel like you are missing out when you are not there at the
meetings. There is always going to be a challenge in getting
everyone together at a consistent time with such conflicting
schedules. “ (Resident)
“I really felt like they were open and listening and ready to learn
whatever anyone had to share with them. But I really feel that it
would have been more beneficial to both sides, us Elders and to
Bria and Erin if we could have spent more time together than we
did. “ (Elder)
W3: Case based
discussions tend
to over
pathologize
Indigenous health
“I think the case-based format can tend to pathologize our
encounters with Indigenous health rather than celebrating
Indigenous health. So while I think the case-based format is really
important I think including into these sessions other alternative
forms of teaching can really broaden the scope of what we are
leaning and the type of knowledge that we are learning.”
(Resident)
L1) Success of this
program requires
openness and
respect on part of
learner:
“Part of what makes it [developing culturally safe care] happen is
their willingness to learn, their openness and their respect.” (Elder)
“It was just how she approached patients. Both Aboriginal and
non-Aboriginal – she was very respectful in her presence. Being at
their level, speaking to them, not standing up, they were both
sitting down and looking in their eyes and face and speaking to
them in a gentle and respectful voice. And to have the ability to be
with in them in the moment.” (Elder)
“They are very open and willing to learn. They didn’t have that
racism that I had expected.” (Elder)
“So my experience with the training has been a good one. It has
made me want to share my culture and my teachings with them as
a First Nations in a good way. It has been a good experience.”
(Elder)
THE UNIVERSITY OF BRITISH COLUMBIA
Faculty of Medicine
Special Populations Fund
Final Report, 2013 – 2014
L2) To be
successful this
program needs
careful planning
and adequate
resources
L4) Learners need
to adapt to the way
Elders share
knowledge
“I think the challenges of this type of model is that the planning part
of it … to go into something so brand new – and that’s to bring a
partnership between Elders and other professionals together, when
although the thoughts and the deeds are pushing for this to go
forward, it can be planned in a longer time frame and be inclusive
of many things that would make both sides more comfortable.”
(Elder)
“I think too that the understanding and the teachings of the Elders
will be that we don’t say things directly, we don’t say things in bullet
point form. We say things as we’ve been taught from our Elders
through stories” (Elder)