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Family Medicine Examination Update: 2021 SAMP exam (September 29, 2021)

October 2020

The College of Family Physicians of Canada (CFPC) acknowledges the tragic death of Joyce Echaquan, an Atikamekw woman, and the racism she experienced in her final hours as deplorable and unacceptable. We send our sincerest condolences to her family, community, and nation. We also recognize the immense bravery of both Joyce Echaquan and her family for coming forward to share this painful story.

The CFPC recognizes the pervasive nature of systemic racism within Canada’s institutions and is deeply concerned about its effects on delivery of services to underserved populations.

Systemic racism has no place in Canada’s health care nor in our diverse societal contexts. Unfortunately, many members of racialized communities have been victims of assumptions, prejudices, and racism and have been racialized in clinics, hospitals, and even health professionals’ education and training programs.

Recognizing this, the CFPC is actively working with physician leaders who identify themselves as members of racialized communities to address the adverse effects of systemic racism in the training and practice of family physicians. We recognize that such introspection involves discomfort and critical reflection, but it is a necessity to achieve authentic and meaningful change.

Since 2012 the CFPC Indigenous Health Committee (IHC) has been actively exploring ways to address inequities in Indigenous health and social issues, including racism, to educate family physicians and trainees across Canada through a lens of cultural humility and cultural safety. In support of anti-racism and culturally-safe care of Indigenous peoples, the IHC authored a report in 2016 titled Health and Health Care Implications of Systemic Racism on Indigenous Peoples in Canada*. This document offered clear support for the Truth and Reconciliation Commission Calls to Action and intended to familiarize CFPC members, educators, and trainees with ways to recognize, challenge, and dismantle systemic racism.

Multiple, complementary strategies are needed to address a problem as complex and entrenched as systemic racism:
  • Acknowledging that systemic racism exists and has tangible adverse effects on health of populations subjected to discrimination
  • Guiding practicing physicians, medical learners and the institutions that support their learning across the continuum of medical education
  • Adjusting program accreditation standards, including curriculum and evaluation
  • Supporting Indigenous medical learners, educators, and physicians
  • Advocating for health policy changes to deter systemic racism and encourage inclusivity and representation
Seeing the need for specific Indigenous considerations inherent in all competencies of CanMEDS–Family Medicine (CanMEDS-FM) 2017, the IHC developed a companion document for the framework that highlights unique requirements and opportunities for Indigenous patients’ health care. This educational tool can serve as the foundation to increase knowledge of Indigenous peoples, their lived experiences, communities, and cultures, to learn and achieve culturally safe care. It will be available in November 2020 on the CanMEDS-FM section of the CFPC website.

The Indigenous CanMEDS-FM document will contribute to positive changes in health care by guiding medical trainees and practising physicians to avoid harmful assumptions, stereotypes, and systemic racism often felt by Indigenous peoples. This document will be used to assist family medicine residency programs across Canada to better prepare their trainees to meet the needs of Indigenous patients.

While the Indigenous CanMEDS-FM document and the Systemic Racism fact sheet were created chiefly for family physicians, these can also be used by other health professionals as a learning resource.

Family physicians are often the patients’ first contact with the health care system. They coordinate the care of Indigenous patients in and beyond their local context. It is particularly important for the physicians to practise with a cultural safety and an anti-racism approach. Family physicians can advocate for Indigenous patients and families, but also familiarize themselves with resources that support patients (e.g., actions to address concerns about care or discrimination). By listening and being open-minded, we can foster safe, trusting, and respectful therapeutic interactions in community clinics or emergency departments.

The CFPC encourages practising family physicians, medical students, and residents to not only learn more about Indigenous health and anti-racism, but also discuss the importance of cultural safety with colleagues. Leveraging knowledge of experts with experience in working with Indigenous populations will be helpful in improving family practice teams’ abilities to provide culturally safe and effective care to Indigenous patients.

It is crucial that the actions to address systemic racism are led and informed by authentic Indigenous voices. Many passionate Indigenous advocates dedicate their energy to this work in addition to their roles as clinicians, educators, and researchers. To allow these efforts to effectively thrive, the CFPC maintains strong support of the proposed National Consortium for Indigenous Medical Education. Having a centralized structure that is resourced and equipped to provide the necessary expertise for this important work will greatly expedite progress in improving Indigenous health across Canada.

The CFPC remains committed to doing its part in addressing the inequities and systemic racism experienced by Indigenous people in Canada. We intend to continue our own work and collaborate with others to jointly resolve this urgent social and cultural crisis, and ensure that racist incidents like that which Joyce Echaquan and others have faced will not be repeated.

For any inquiries regarding the CFPC work in this regard please contact Artem Safarov, Director of Health Policy and Government Relations, via [email protected].

Sarah Funnell, MD, CCFP
Co-Chair, Indigenous Health Committee
Darlene Kitty, MD, CCFP
Co-Chair, Indigenous Health Committee
Francine Lemire, MD CM, CCFP, FCFP, CAE, ICD.D
Executive Director and CEO, CFPC
Shirley Schipper, MD, CCFP, FCFP
President, CFPC
  PDF
* College of Family Physicians of Canada. Health and Health Care Implications of Systemic Racism on Indigenous Peoples in Canada. Mississauga, ON: College of Family Physicians of Canada; 2016. Available from: https://www.cfpc.ca/CFPC/media/Resources/Rural-Practice/SystemicRacism_ENG.pdf
Shaw E, Oandasan I, Fowler N, eds. CanMEDS-FM 2017: A competency framework for family physicians across the continuum. Mississauga, ON: The College of Family Physicians of Canada; 2017. https://www.cfpc.ca/CFPC/media/Resources/Medical-Education/CanMEDS-Family-Medicine-2017-ENG.pdf
College of Family Physicians of Canada. CanMEDS–Family Medicine website. 2020. https://www.cfpc.ca/en/education-professional-development/educational-frameworks-and-reference-guides/canmeds-family-medicine

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