Strengths and problems with competency-based anti-Indigenous racism education: A mixed methods study

Racism in healthcare remains persistent and particularly impacts Indigenous Peoples. Antiracism has been conceptualised as a framework to address racism, outlining that all individuals have the responsibility to actively address and prevent racism. Although accreditation standards in health professions programs often emphasise healthcare equity with Indigenous Peoples, health professionals can graduate without antiracism skills. Through a conceptual framework of critical inquiry and Critical Indigenous Theory, this study examined the complexities of implementing competency-based anti-Indigenous racism education in health professions education programs.

A convergent parallel mixed-methods design was used to examine student reaction and learning when participating in an anti-Indigenous racism education program at a large multidisciplinary health faculty in Australia. Data collection included student evaluations, pre- and post-module surveys using an adapted Antiracism Behavioural Inventory Scale, qualitative analysis of final assignments, and co-autoethnographic reflection to examine study findings within the context of competency-based health professions education.

Students responded positively to the antiracism education content, though they desired more feedback. Statistically significant improvements were observed in self-rated antiracism behaviours post-program. However, qualitative analysis revealed varied demonstrations of antiracism by students, with superficial learning relating to taking action on racism. Co-autoethnography highlighted a lack of programmatic assessment, particularly in workplace learning, which was likely limited by course accreditation standards.

The issues raised in this study point to a critical requirement for anti-Indigenous racism competency-based education and programmatic assessment models within course accreditation standards. Without this, students may develop an initial awareness of anti-Indigenous racism, but would unlikely build the skills required to practice antiracism and advance health equity for Indigenous Peoples.