Decolonizing Canadian healthcare
Making changes in cultural biases more important to equity than new rules (1,400 words, 7 minutes)
Skin Spectrum Weekly is published with unrestricted support from Bausch Health Canada
Improving representation and equity of care in the Canadian healthcare system requires active mentorship of underrepresented people and a deliberate effort to confront biases in underlying culture.
This was the message Canadian Medical Association (CMA) President Dr. Alika Lafontaine delivered during a virtual talk on Sept. 30, 2022, as part of the National Day of Truth and Reconciliation. The event was organized by the Canadian Health Coalition.
Dr. Lafontaine, the first Indigenous president of the CMA, said that he struggled in his early academic career due to a lack of cultural familiarity with many concepts—neither of his parents had a science background and his father had been the first person in the family to obtain a Masters degree, in education. However, Dr. Lafontaine said, a chemistry professor in his first year of university convinced him that he would be able to understand things that seemed foreign.
He said his parents “were watching me go through this [struggle with education] where I was experiencing something new to them, too. It required people who were inside the field to look at me and give me the confidence that I could do it.”
“I always came home and my parents said ‘do your best’ and ‘we will love you no matter what’, but it is a very different thing to have someone in a position that you want to reach say ‘I see your future here.’”
When discussing cultural biases in Canada’s healthcare system, Dr. Lafontaine referenced the case of the late Joyce Echaquan, the Atikamekw woman who in Sept. 2020 live-streamed the inferior care she received from a hospital orderly in Montreal shortly before her death.
“The history of racism in the system is well known to people that experience it,” Dr. Lafontaine said. “But like many things in health, a person does not know what it is like unless they are present.”
Echaquan’s video stream forced the reality of racism into the consciousness of many Canadians who may have never encountered it, he said. “It was in front of them, they could not ignore it anymore.”
“That is one of the reasons why I look at today, National Day for Truth and Reconciliation, as a time for reflection. It is a time for us to move outside of the reality that we live in and into the reality of the people whose lives we may not know.”
Reducing these biases will require more than changing the rules of the healthcare system, Dr. Lafontaine said. If the underlying biases remain, they will simply be applied to the new system. Instead, it is necessary to work toward changing the underlying culture.
Cultures can be changed, Dr. Lafontaine said, and there is always hope that people can change the way that they act and the way they interact with each other.
However, he acknowledged that engaging with the truth can be very painful.
“For a physician to realize that their actions—when it comes to racism—are harming the people they are supposed to be treating, that directly attacks the self-image they have.”
From the literature on bias in dermatology and healthcare
Racial and ethnic disparities in clinical research and the dermatology workforce
The authors of this paper note that changes in U.S. racial and ethnic demographics are not reflected in the diversity of clinical trial research participants, science, technology, engineering, and mathematics (STEM) pipeline programs, or the dermatology workforce.
In the paper, they discuss a lack of knowledge regarding how to increase the number of minority subjects who participate in clinical trials. They also describe methods to engage these communities in trial recruitment.
The article also addresses a lack of racial and ethnic diversity in the dermatology workforce and performance gaps in the recruitment of racial and ethnic minorities into the specialty.
Differences in underrepresented-in-medicine applicant backgrounds and outcomes in the 2020-2021 dermatology residency match
This study was conducted to gather information on how dermatology residency applicants from underrepresented-in-medicine (UIM) populations approach and fare in the dermatology residency match process, compared to non-UIM applicants.
Researchers surveyed 232 dermatology applicants from the 2020-2021 year to evaluate applicant characteristics, approaches, and outcomes in the match process. They separately surveyed dermatology residency program directors regarding their approach to the 2020-2021 application process.
Survey responses were analyzed to determine if the differences between variables were statistically significant. An additional survey was administered to dermatology residency program directors to evaluate their approach to the 2020-2021 application process.
The authors write that their findings are important to identify ways to improve equity in the dermatology application process and to improve diversity in the dermatology workforce.
Diversifying the dermatology workforce: Physician characteristics vary by race/ethnicity
The authors of this paper aimed to describe the experiences of racially and ethnically diverse physicians in the U.S. who were successfully matched to dermatology residency positions.
They recruited 100 dermatologists and dermatology residents to complete an online survey. The survey participants provided demographic, socioeconomic, pre-residency and post-residency career data.
Survey findings showed that 30% of participants were dermatology residents and 25% belonged to a group underrepresented in medicine (UIM). Black physicians were 3.69 times more likely to have chosen dermatology as a career before entering medical school (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.04–13.0) compared to non-Black physicians. UIM dermatologists and trainees were more likely to receive a need-based scholarship in medical school (OR, 4.37; 95% CI, 1.30–14.7), graduate from a private medical institution (OR, 6.49; 95% CI, 1.95–21.6), and have at least one UIM dermatology mentor during medical school (adjusted OR, 13.1; 95% CI, 2.77–61.5) compared to non-UIM physicians.
The study authors conclude that a holistic review of dermatology applicants by residency programs may reduce racial or ethnic disparities in the admission process. They write that their findings support pre-medical outreach programs, mentorship, and institutional funding to promote diversity in dermatology.
The essential role of dermatology publications in enhancing professional diversity, equity, and inclusion
The authors of this editorial argue that dermatology publications have the potential to improve patient care through supporting professional diversity, equity, and inclusion (DEI) and through the democratization of knowledge.
In the editorial, they highlight DEI issues, suggest goals for improvement and specific actions that can be taken to support the necessary changes.
VIDEO: Decolonizing dermatology workshop | Peer Medical Foundation
At the intersection of skin and society
The Canadian federal government says it does not know how many of its employees are expected to speak an Indigenous language as part of their job, reports CTV News.
This announcement comes in the wake of calls for the government to expand eligibility for an $800 bilingualism bonus—currently available to employees who speak both French and English—to public servants who speak an Indigenous language.
The annual bonus is available to government employees who work in a position where they are required to speak both of Canada's official languages.
According to the news outlet, the Treasury Board of Canada Secretariat said “there is no public service-wide data” about how many employees are expected to speak an Indigenous language as part of their daily responsibilities.
“It points to the fact that providing Indigenous Peoples with services in their language is not a priority for the federal government,” said Nunavut New Democrat MP Lori Idlout, who speaks Inuktitut.
Idlout was quoted saying that this seeming lack of priority by the federal government suggests a great deal of work is still needed toward reconciliation.
CTV News reports that the Treasury Board has not yet responded to a request for comment.
Kevin Lewis, a Cree language teacher based in Saskatchewan, is quoted saying he only recently learned the bilingualism bonus existed. Lewis said he believes the federal government would be wise to extend it to Indigenous-language speakers, as it could both promote employment opportunities and incentivize non-Indigenous people to learn one of the Indigenous languages.
This week
Oct. 24 is World Development Information Day
Oct. 24 is United Nations Day
Oct. 29 is World Psoriasis Day
Something to think about in the week ahead…
Marcus Garvey, 1887-1940, Jamaican political activist, publisher, journalist, entrepreneur, and orator
Next Week
Falyn Katz, Executive Director of Melanoma Canada, spoke with Skin Spectrum Weekly about her organization’s efforts to support dermatologist education on cancer presentation in different skin types. Katz talks about funding continuing medical education courses on melanoma in skin of colour.
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