A qualitative study of challenges and facilitators to implementing an Indigenous-led cultural safety education program within a large urban emergency department in Vancouver, Canada
Bibliographic record
Abstract
Abstract Background There is growing recognition of the extent and harm of anti-Indigenous racism within public institutions, including healthcare settings. Despite efforts to expand access to Indigenous Cultural Safety (ICS) education programs for healthcare providers, there is limited research examining challenges and facilitators to the implementation of Indigenous-led and -delivered ICS education programs. This study sought to explore the barriers and facilitators to implementing an ICS education program within Western Canada’s largest Emergency Departments. Methods This qualitative process evaluation was guided by a Two-Eyed Seeing approach, and the research team included both Indigenous and non-Indigenous researchers committed to conducting culturally safe research. An implementation team consisting of Indigenous and non-Indigenous administrators participated in an Elder-led sharing circle at the mid-point of the targeted delivery of an ICS education pilot program for nurses and allied health professionals in an urban Emergency Department in Vancouver, Canada. The sharing circle was audio recorded and transcribed, and general interpretivist study design and inductive thematic analysis approach were used. Results A total of 10 implementation team members, two from the Emergency Department and eight from Indigenous Health Department, participated in a 2-hour sharing circle hosted in May 2022. Several common challenges were identified, including external events and time constraints; program readiness and staff recruitment; and difficulty securing facilitators. Several facilitators to program implementation were also identified, including leader buy-in and cross-departmental communication; on-the-ground project management and coordination; flexible scheduling and accommodations; and facilitator and implementation team support. Conclusions These results reinforce the importance of centering Indigenous leadership in the design, implementation, and the evaluation of ICS education programs, while also highlighting the importance of allies in delivering curricula and that facilitators are supported. Efforts are also needed to ensure that programs are flexible and accommodating to address potential recruitment and attendance challenges, including through alternative educational modalities. Lastly, mandating attendance is one approach to addressing recruitment challenges, though compulsory approaches may discourage meaningful engagement. Clinical trial registration Not applicable.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.026 | 0.011 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".