Indigenous cultural competence: A dental faculty curriculum review

Indigenous Cultural Safety Training for Applied Health, Social Work, and Education Professionals: A PRISMA Scoping Review

Anti-Indigenous racism is a widespread social problem in health and education systems in English-speaking colonized countries. Cultural safety training (CST) is often promoted as a key strategy to address this problem, yet little evidence exists on how CST is operationalized and evaluated in health and education systems. This scoping review sought to broadly synthesize the academic literature on how CST programs are developed, implemented, and evaluated in the applied health, social work and education fields in Canada, United States, Australia, and New Zealand. MEDLINE, EMBASE, CINAHL, ERIC, and ASSIA were searched for articles published between 1996 and 2020. The Joanna Briggs Institute's three-step search strategy and PRISMA extension for scoping reviews were adopted, with 134 articles included. CST programs have grown significantly in the health, social work, and education fields in the last three decades, and they vary significantly in their objectives, modalities, timelines, and how they are evaluated. The involvement of Indigenous peoples in CST programs is common, but their roles are rarely specified. Indigenous groups must be intentionally and meaningfully engaged throughout the entire duration of research and practice. Cultural safety and various related concepts should be careful considered and applied for the relevant context.

An Indigenous cultural competence model for dentistry education

Reorientation of education for health professionals is necessary to support future health workforce in meeting population needs. Dental graduates must be competent to effectively communicate with patients, their families and other health professionals involved in their care, regardless of social or cultural background. Indigenous people in Australia experience significant oral health disparities compared to non-Indigenous Australians. Cultural competence has evolved as the leading model to equip future clinicians to deliver culturally safe care. A case study conducted at the University of Sydney School of Dentistry examined the integration of Indigenous cultural competence into dental curricula using four data sources: a systematic review identifying intervention strategies to improve cultural competence; an online survey to provide a baseline analysis of Indigenous curricula practices; and two in-depth interview studies with academics and students to determine barriers and enablers to increasing Indigenous cultural competence among dental students. As a result, an Indigenous cultural model was developed for dentistry education, recognising three major constituents being critical to achieving cultural competence among dental students. Indigenous cultural competence in dentistry education requires stringent governance, adequate faculty resources and effective educational strategies, in order to increase students' knowledge, understanding and skills to achieve a minimum cultural competence standard upon graduation.

A scoping review on social justice education in current undergraduate dental curricula

BACKGROUND

A recent shift in educational components within healthcare has pushed dentistry toward a greater understanding of the role of social components on oral health. There has also been an increased awareness of inappropriate conduct among dental students.

STUDY DESIGN AND METHODS

A scoping review was conducted to determine if, how, and when social-justice-oriented education has been incorporated into dental curricula worldwide. A systematic and reiterative search of articles was performed on February 22, 2018, and combined quantitative and qualitative synthesis of data. An updated search was done on September 26, 2019.

PRIMARY RESULTS

Seventy-three studies were evaluated: 46 quantitative (63%), 24 qualitative (33%), 3 multimethods (4%). The majority used self-reported surveys and questionnaires (66%), while the remaining used interviews (9.5%), student reflections (16%) and focus groups (5.5%). Studies included dental students only (78%); dental students with dental hygiene students (5.5%) or faculty/staff (4.1%); dental students in year 1 (17%), year 2 (1.6%), year 3 (1.6%), year 4 (14.2%); first- and second-year students (3%); third- and fourth-year students (1.6%); all years of study (20%); and academic year not specified (41%). The study areas included "learning in dental school," "experiencing dental school," "focusing on cultural competency," and "addressing dental ethics and social responsibility."

PRINCIPAL CONCLUSIONS

Three major research gaps were identified: no discussion of a social contract between dentists and society, no explicit social justice-oriented topics within undergraduate dental curricula, and no standardized tool to measure these topics. Further research is necessary to understand how such topics can be included in dental curricula to form socially competent dentists.

Strengthening Indigenous cultural competence in dentistry and oral health education: Academic perspectives

INTRODUCTION

Indigenous Australians continue to experience significant oral health disparities, despite numerous closing-the-gap initiatives. Higher education institutions and accrediting bodies recognise the need to incorporate Indigenous culture more widely into dentistry curricula to address these inequalities. This study aimed to define and explore current Indigenous cultural competence curricula, identify enablers and barriers for integration of Indigenous cultural competence curricula and ascertain innovative strategies to aid students in becoming culturally competent upon graduation, from academics' perspectives.

METHODS

Academics from the Doctor of Dental Medicine (DMD) and Bachelor of Oral Health (BOH) programmes at the University of Sydney, School of Dentistry participated in semi-structured interviews to define and explore current and future curricula practices to enable students to become competent in Indigenous culture. Thematic analysis was conducted to synthesise academics' responses.

RESULTS

Thirteen School of Dentistry academics participated in interviews. Following analysis of the data, six key themes emerged: Theme One: Transfer of Indigenous cultural knowledge, Theme Two: Barriers to developing Indigenous cultural curriculum. Theme Three: Importance of cultural immersion, Theme Four: Resources required for Indigenous cultural education, Theme Five: Proposed Indigenous cultural content, Theme Six: Strategies to incorporate Indigenous culture into curricula.

CONCLUSION

Improving Indigenous cultural competence amongst dentistry academics and students requires an educational and philosophical shift, incorporating the social determinants of health whilst maintaining the strengths of the biomedical foundations of dental care. It requires the inclusion of an informed history of Indigenous Australians, immersion within Indigenous communities and reflection upon these experiences, to facilitate culturally appropriate ways to improve the provision of dentistry and oral health for Indigenous peoples.