Patricia Farrugia

Historically, healthcare in Canada has functioned as a tool of colonialism negatively impacting Indigenous peoples, producing endured health inequities and continues to shape contemporary health pathways for Indigenous patients, families and communities. Indigenous patients’ healthcare experiences are shaped by encounters with anti-Indigenous racism, which directly affect both the quality of care they receive and their overall well-being. Anti-Indigenous racism in healthcare is sustained by denialism. Denialism is process through which anti-Indigenous racism is minimized, rationalized, or acknowledged without meaningful action, allowing colonial harms and inequities to persist. Using a framework that examines the intersection between denialism and anti-Indigenous racism across systemic, interpersonal, and societal levels, this perspective article analyzes how denialism translates recognition of inequity into inaction, stereotypes, and bias; thereby sustaining anti-Indigenous racism in healthcare settings. Addressing denialism is essential to dismantling structural racism in healthcare and to advancing meaningful, accountable change for Indigenous peoples in Canada.

Background: Many Canadian medical schools have introduced equity-focused admissions pathways for Black and Indigenous applicants, yet little is known about how current medical students perceive these policies. Understanding these perceptions is critical to ensuring equity initiatives are effective and well-supported. Methods: We conducted a cross-sectional survey of 95 undergraduate medical students at McMaster University. The survey included Likert-scale, multiple-choice, and open-ended questions assessing attitudes toward Black and Indigenous facilitated admissions pathways. Educational background was categorized by the number of humanities/social science courses taken prior to medical school. Quantitative data were summarized descriptively; qualitative responses were thematically analyzed. Results: Most students supported diversity in medicine and agreed that equity pathways address barriers faced by Black and Indigenous applicants. However, fewer than half felt informed about the purpose of these pathways. Responses highlighted concerns about transparency, fairness, and the possibility that pathways may disproportionately benefit higher-socioeconomic-status applicants. Subgroup trends did not show consistent support among students with greater exposure to humanities/social sciences; some expressed stronger skepticism regarding fairness. Qualitative themes emphasized the need for clearer communication, recognition of socioeconomic barriers, and expansion of equity initiatives. Interpretation: Students broadly valued equity-focused admissions but questioned their implementation and transparency. Concerns about socioeconomic privilege and unclear standards indicate a need for better institutional communication and more inclusive eligibility criteria. Equity pathways should be paired with structured education and clear messaging to foster trust, improve understanding, and align admissions policies with the social accountability mandate of medical education.

Guided by the 2015 Truth and Reconciliation Commission Report, this paper examines the legacy of colonialism in Canada and its continued detrimental effects on the health of First Nations, Inuit, and Métis children. Supporting Call to Action 24, which emphasizes the importance of Indigenous health and histories within medical training, the "Every Child Matters" social movement can inform the domains of education, patient care, non-Indigenous advocacy, and Indigenous inclusion, drawing attention to the negative impacts of Canadian institutions, including residential schools, on Indigenous peoples. This paper argues that "Every Child Matters" can provide a novel conceptual framework within which non-Indigenous paediatric health practitioners may engage in self-reflection, practise cultural humility, and deliver trauma-informed care with the aim of decolonizing their practices and supporting equitable healthcare for Indigenous children. Additionally, this proposed framework can support efforts toward reconciliation, providing opportunities for meaningful partnerships with Indigenous patients, families, and colleagues.

Medical education plays a crucial role in shaping future healthcare providers' attitudes, skills, and understanding of underserved populations, including those experiencing homelessness. Summarizing the existing literature on medical students’ perception of People Experiencing Homelessness (PEH) can aid medical educators in developing a curriculum to allow medical students to comprehensively care for this population. The databases Web of Science, ERIC, Psychinfo, Embase and Medline were searched from 1946 to June 2023. Published quantitative and qualitative studies reporting on the perceptions or attitudes of medical students towards PEH were included. The studies were analyzed with descriptive statistics and described narratively. The search identified 1667 studies, with 15 ultimately included. Of the included studies, 66.7% were conducted in the United States of America, 26.7% were conducted in Canada, and 6.7% were completed in the United Kingdom. These studies revealed that medical students' perceptions vary, although most studies found medical students possess positive attitudes towards PEH, albeit feeling uncomfortable in their ability to provide care to this population. Additionally, most studies found when medical students were given educational exposures to PEH, they reported improved attitudes, more positive perceptions, and increased confidence in providing care. These results emphasize the benefits of providing structured educational experiences with PEH to medical students for improving patient care. More regionally diverse research in addition to studies examining the long-term effects of exposure to PEH during medical education on subsequent professional attitudes and behaviours is necessary.

Introduction: Considering the relevant 2015 Truth and Reconciliation Commission recommendations, this paper reviews the current state of Canadian medical schools’ Indigenous admissions processes and explores continued barriers faced by Indigenous applicants. Methods: A summary of literature illustrating disadvantages for Indigenous applicants of current admissions tools is presented. A grey literature search of current admissions requirements, interview processes, and other relevant data from each medical school was performed. Tables comparing differences in their approaches are included. A calculation of Indigenous access to medical school seats compared to the broader Canadian population was conducted. Gaps in execution are explored, culminating in a table of recommendations. Results: Despite formal commitments to reduce barriers, Indigenous applicants to medical school in Canada still face barriers that non-Indigenous applicants do not. Most programs use tools for admission known to disadvantage Indigenous applicants. Indigenous applicants do not have equitable access to medical school seats. Facilitated Indigenous stream processes first ensure Indigenous applicants meet all minimum requirements of Canadian students, and then require further work. Discussion: Seven years after the Truth and Reconciliation Commission called on Canadian universities and governments to train more Indigenous health care providers, there has been limited progress to reduce the structural disadvantages Indigenous students face when applying to medical school. Based on best practices observed in Canada and coupled with relevant Indigenous-focused literature, recommendations are made for multiple stakeholders. Conclusions: The study was limited by the data available on numbers of Indigenous applicants and matriculants. Where available, data are not encouraging as to equitable access to medical school for Indigenous populations in Canada. These findings were presented at the International Congress of Academic Medicine 2023 Conference, April 2023, Quebec City, Canada.

Charcot arthropathy of the spine (CSA), also known as spinal neuroarthropathy, is a progressive disease process in which the biomechanical elements of stability of the spine are compromised because of the loss of neuroprotection leading to joint destruction, deformity, and pain. Initially thought to be associated with infectious causes such as syphilis; however in the latter part of the century, Charcot arthropathy of the spine has become associated with traumatic spinal cord injury. Clinical diagnosis is challenging because of the delayed presentation of symptoms and concurrent differential diagnosis. Although radiological features can assist with diagnosis, the need for recognition and associated treatment is vital to limit the lifelong disability with the disease. The goals of treatment are to limit symptoms and provide spinal stabilization. Surgical treatment of these patients can be demanding, and alternative techniques of instrumentation are often required.

Le recrutement de participants à des études au sein de populations marginalisées présente des défis uniques pour les chercheurs et les institutions associées. Les chercheurs doivent être conscients des adaptations spécifiques requises dans le processus de recherche pour mener des recherches au sein des populations autochtones. La conscience culturelle est essentielle pour toute recherche menée au sein de ces populations, afin de comprendre les problèmes passés qui peuvent influencer la volonté actuelle et future de participer à la recherche. Cet article vise à fournir un contexte et des exemples où une sensibilisation culturelle accrue à des principes éthiques spécifiques pendant la phase de recrutement peut avoir un impact sur le processus d’étude ainsi que sur le chercheur lui-même. L’intégration de concepts culturels indigènes dans le processus de recrutement et de conception de l’étude peut contribuer à jeter les bases d’un processus de recherche positif dans son ensemble et faciliter un environnement d’étude approprié pour toutes les personnes impliquées.