What Outcomes Are Associated with Learning About Colonialism and Its Impacts on Indigenous Peoples in Health Professional Programs? A Critical Integrative Review.

Background: The Truth and Reconciliation Commission of Canada called upon health professional programs to teach about historical and on-going colonalism. Since these calls to action, there has been an increase in educational opportunities on the topic. Although it is generally assumed that learning about colonialism will reduce racism and improve allyship towards Indigenous Peoples, an evaluation of this assumption is needed. Purpose: An integrated review of the literature was conducted to assess how participation in educational experiences is associated with learner outcomes and how they may vary according to course design considerations including the guiding framework, content foci, mode of delivery, activities, and duration. Methods: Studies assessing outcomes of educational activities related to the legacy of colonialism identified in a previous scoping review, as well as any such studies published since then were included in the present study. Data synthesis was performed using content analysis of the results and discussions presented in the included papers. Results: A review of 15 papers identified a backfire effect that was only evident among the studies that included a delayed post-evaluation timeframe. In two educational experiences, it was found that learners were more likely to express unfavourable attitudes towards Indigenous Peoples post-training. These educational opportunities were designed using a cultural safety framework and followed a similar course delivery (e.g., viewing of vodcasts, use of case studies) and provided similar content (historical policies, Indigenous cultural beliefs and practices). Conclusions: The findings should be interpreted with caution but point to plausible implications related to the backfire effect of educational opportunities on learners' attitudes towards Indigenous Peoples post-training.