Maar Marion, Urajnik Diana, Hudson Geoffrey L, Manitowabi Darrel, McGregor Lorrilee, Senecal Sam, Strasser Roger, Warry Wayne, Jacklin Kristen
Faculty of Medicine, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada.
Centre for Rural and Northern Health Research (CRaNHR), Laurentian University, Sudbury, ON, Canada.
J Med Educ Curric Dev. 2024 Oct 3;11:23821205241286292. doi: 10.1177/23821205241286292. eCollection 2024 Jan-Dec.
In recent years, Indigenous health curricula have been integrated into medical education in response to international calls to improve Indigenous health care. Instruments to evaluate Indigenous health education are urgently needed. We set out to validate a tool to measure self-reported medical student preparedness to provide culturally safe care to Indigenous Peoples. We then applied the tool to evaluate the effectiveness of the Northern Ontario School of Medicine University's (NOSM U) Indigenous health curriculum.
We conducted psychometric testing of a 46-item draft NOSM Cultural Competency and Safety Tool (CAST). Testing included principal components analysis, subscale and item analysis, and the use of paired sample -tests to examine pre- and posttest change to measure learner outcomes. The NOSM CAST was transposed to create a retrospective pre-posttest survey with single-point-in-time scoring.
Respondents included five cohorts of first-year undergraduate medical students, with 305 of 320 participating (response rate of 95.3%). The validated survey subscales included knowledge, confidence/preparedness, attitudes, intentions for advocacy, antidiscrimination, and self-reflective practice, measured using 36 scale items. Cronbach's alpha showed good to excellent internal consistency for the scales ( range = 0.82-0.91). Composite reliability values were acceptable. The pre-posttest analysis showed statistically significant increases on four scales: knowledge [(254) = 15.10, < .001], confidence/preparedness [(254) = 15.85, < .001], intentions for advocacy [(251) = 3.32, = .001], and self-reflective practice [(254) = 8.04, < .001]. The largest mean increases were for knowledge ( = 1.07) and confidence/preparedness ( = 1.15).
The NOSM CAST tracks student progress in Indigenous health curricula. NOSM U's classroom and immersion-based Indigenous health curriculum enhanced students' self-reported preparedness for culturally safe care. NOSM CAST implemented together with an assessment of Indigenous patient experiences with the same learners constitutes a rigorous evaluation approach to Indigenous health curricula.
近年来，为响应国际上改善原住民医疗保健的呼声，原住民健康课程已被纳入医学教育。迫切需要评估原住民健康教育的工具。我们着手验证一种工具，以衡量医学生自我报告的为原住民提供文化安全护理的准备情况。然后，我们应用该工具评估安大略省北部医学院大学（NOSM U）的原住民健康课程的有效性。
我们对一份包含46个条目的NOSM文化能力与安全工具（CAST）草案进行了心理测量测试。测试包括主成分分析、子量表和条目分析，以及使用配对样本检验来检查前后测变化，以衡量学习者的成果。NOSM CAST被转换为创建一个具有单点时间评分的回顾性前后测调查。
受访者包括五组本科一年级医学生，320名中有305名参与（回复率为95.3%）。经过验证的调查子量表包括知识、信心/准备情况、态度、倡导意图、反歧视和自我反思实践，使用36个量表条目进行测量。克朗巴哈系数显示各量表具有良好至优秀的内部一致性（范围 = 0.82 - 0.91）。组合信度值可以接受。前后测分析显示，四个量表在统计学上有显著增加：知识[（254）= 15.10, p <.001]、信心/准备情况[（254）= 15.85, p <.001]、倡导意图[（251）= 3.32, p =.001]和自我反思实践[（254）= 8.04, p <.001]。平均增幅最大的是知识（= 1.07）和信心/准备情况（= 1.15）。
NOSM CAST可追踪学生在原住民健康课程中的进展。NOSM U基于课堂和沉浸式的原住民健康课程提高了学生自我报告的提供文化安全护理的准备情况。将NOSM CAST与对相同学习者的原住民患者体验评估一起实施，构成了一种对原住民健康课程的严格评估方法。
