How can we decolonize our medical schools?

Can we decolonize and indigenize our medical school?  I have been thinking about this question over the last few years. It underpins my AMS Phoenix fellowship to teach medical students about cultural safety. It also foregrounds a larger challenge about how to make our health care systems welcoming places for all patients, including those who are marginalized or vulnerable. This brief blog post explores some of my musings as a medical educator about how to incorporate Indigenous knowledges into our system.

Several years ago, we started the Office of Indigenous Medical Education with a goal to recruit and support Aboriginal medical students, and to create and deliver curriculum for students, residents and faculty. With operational funding from the medical school, we secured an office and gathering space, hired a fulltime coordinator who does community outreach and student support, and funded a half-day/week for two physicians-educators. We secured grant funding to support an elder-in-residence to meet with students and to assist us with teaching. We built liaisons with numerous local organizations, and created a formal advisory group to advise us about our activities. We integrated lectures, case studies, community panels and elective experiences in Indigenous health for medical students. We have also recruited and supported more than 15 students of First Nations, Inuit and Metis ancestry to our medical school in the past few years.

These accomplishments seem laudable. But they increasingly feel inadequate and clumsy to me. During the course of my AMS Phoenix fellowship activities, I have come to understand some of the challenges for our Office, and how we might reimagine its possibilities.

• The hiring of Indigenous faculty and the recruitment of Indigenous students are not analogous to indigenizing the academy. While the lived experiences of students and faculty as Indigenous peoples are important, we are unlikely to be traditional teachers or knowledge keepers. Out of respect for local Indigenous pedagogy, epistemology and governance structures, these teachings, stories, ceremonies and wisdom must emerge from local Elders and teachers.
• Indigenous knowledges and ways of knowing cannot be molded into our Faculty’s existing frameworks for pedagogy, research or clinical care. Nor can they be essentialized or reified. Our institutions and leaders must recognize the local, dynamic and complex nature of Indigenous knowledges and ways of knowing.[i]
• In addition to creating space for number (2), we must simultaneously work to decolonize our institutions. We must consider the history and ongoing effects of colonialism in Canada. How do its homogenizing, subjugating and traumatizing practices continue to perpetuate inequities in medical education and clinical care? What continuities exist between colonial structures and our current systems for medical education and health care?

The initiatives of our Office fall into the category of indigenizing the medical school. We are working with community members, traditional teachers and elders to incorporate local Indigenous theories and teachings into the curriculum. But my feelings of incompleteness grow out of the fact that we have worked to indigenize without decolonizing our medical school. In order for Indigenous Elders, traditional teachers and community members to share their knowledge with our students, we must create a safe space for them. We must teach students about power, justice, reflexivity and many other ideas from outside the biosciences. Our medical school curriculum must be influenced as much by Freire as by Flexner.

In this reimagining of our Office, I see its liminality as a major strength. It lies at the interface between the Faculty of Medicine and a diverse and evolving urban Indigenous community. In this hybrid space, we must cultivate respectful dialogues, critical and decolonizing pedagogies, and opportunities for experiential learning about local Indigenous teachings for all of our students.

– Lisa Richardson, September 2015

[i] Cannon, M. Ruminations on Red Revitalization: Exploring Complexities of Identity, Difference and Nationhood in Indigenous Education. In G Dei (Ed.), Indigenous Philosophies and Critical Education: A Reader, (pp. 127-141). New York: Peter Lang Publishing.

Image credit: Ken Syrette, created as logo for Office of Indigenous Medical Education.