{"paper_id":"032e7d33-ed5b-45e6-affc-11735f9b4db9","body_text":"The extent of Dentistry and Dental hygiene curriculum Indigenization across Canada | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The extent of Dentistry and Dental hygiene curriculum Indigenization across Canada Parisa Shokouhi, Diego Ardengi, Leeann Donnelly, Linda Slack-Smith, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6370523/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To explore the extent to which Indigenous content is taught in dental and dental hygiene curricula across Canada, and to identify their objectives, delivery methods, and barriers and facilitators. Methods: A descriptive cross-sectional design was utilized via an anonymous survey developed using the Qualtrics® platform. The survey was distributed to faculty members from all accredited dental and dental hygiene programs in Canada. The survey included 29 items focusing on demographic characteristics, Indigenous teaching, methods of delivery, assessment techniques, barriers, and facilitators. Descriptive analysis was conducted using SPSS® software version 29.0. Results: Responses were received from 34 programs; 90% of the undergraduate dental programs and 71% of the dental hygiene programs participated. Of the programs surveyed, 94.1% (n=32) include Indigenous content. On average, 12.94 ± 7.44 hours was dedicated to teaching such content. The most common delivery method was didactic format (88%), and the most frequently covered topics were History and Indigenous People's Health, each covered in 79.4% of programs. Major barriers identified were overcrowded curricula (83.3%) and faculty shortages (58.3%), while key facilitators included supportive institutional policies (71.4%) and engagement with Indigenous experts (61.9%). Conclusion: The study reveals that most Canadian dental and dental hygiene programs included Indigenous content within their training. However, barriers such as overcrowded curricula and faculty shortages persist. Supportive institutional policies and the involvement of Indigenous professionals are vital for effective curriculum indigenization. Dentistry Special Education Education Dental hygiene Dentistry Indigenous Cultural competence Figures Figure 1 Figure 2 1. INTRODUCTION The Indigenous Peoples of Canada are defined as First Nations, Inuit, and Métis, and according to the 2021 Canadian census, they made up 6.1% of the Canadian population ( 1 ). Oral health contributes to the well-being of any individual, and in the case of Indigenous Peoples of Canada, the colonial policies, globalization, and transition to Western diets high in sugar and processed ingredients have resulted in a much higher burden of oral diseases compared to their non-Indigenous counterparts ( 2 – 4 ). Moreover, a significant number of Indigenous Peoples experience constant pain in their mouths and have a higher rate of tooth loss compared to the general Canadian population ( 5 ). Mainstream health services often fail to adequately meet the needs of Indigenous Peoples due to their foundation in colonial and westernized biomedical values, with an absence or limited appreciation for holistic understandings of well-being ( 6 ). The Truth and Reconciliation Commission (TRC) of Canada highlighted these issues in their 2015 final report and called for actions to improve healthcare for Indigenous Peoples. The TRC Calls to Action # 23 urges the government to increase the number of Indigenous healthcare providers, retain them in Indigenous communities, and provide culturally safe training for all healthcare professionals when caring for Indigenous Peoples. The Call to Action # 24 asks for medical and nursing schools in Canada to offer courses on Indigenous health issues, including history, treaties, Indigenous teachings, and cultural competency training ( 7 ). Such call for curricula indigenization has been previously answered by other countries, including Australia ( 8 ) and New Zealand ( 9 ). In Canada, educational institutions have tried to comply with this directive and address Indigenous health content through decolonizing care practices within the health system ( 10 ). Still, most dental and dental hygiene curricula focus on oral and clinical science and practice, with some emphasis on health promotion and prevention, motivational, and communication strategies ( 11 ). While dental and dental hygiene training in Canada follow competency frameworks to guide their curricula ( 12 – 14 ), only the dental hygiene competency document explicitly mentions First Nations ( 14 , 15 ). Perhaps not surprisingly, more than half of the senior dental students from one Canadian dental school were not confident in treating patients from diverse cultural groups including Indigenous Peoples due to insufficient cultural competence training ( 13 ). Similarly, a curriculum review in an Australian university emphasized the importance of increasing transcultural content in the dentistry curriculum ( 16 ), similarly to a study from the University of Alberta ( 17 ). Moreover, a recent scoping review explored the worldwide literature on Indigenous content within the oral health professions’ education curricula and only found 23 studies reporting of the teaching such content ( 18 ). However, barriers still exist to promote such practices, including the limited number of Indigenous faculties ( 19 ), the need to train non-Indigenous faculty members ( 19 , 20 ), the lack of guidance and proper framework regarding the implementation of Indigenous content, the competing priorities within the university and faculty, and the notion that curricula is already crowded ( 21 ). Nonetheless, it remains unknown as to whether or not dental and dental hygiene curricula in Canada have been Indigenized. Therefore, this study aimed to explore the extent to which Indigenous content and its objectives, delivery methods, and assessment are addressed within dental and dental hygiene curricula across Canada, and to identify the barriers and facilitators to address such content. For this study, Indigenization was defined as any approach or philosophy of education characterized by delivering Indigenous content and cultural perspectives to oral health care professionals. 2. METHODS Research Design This study followed a descriptive cross-sectional design via a national survey exploring the current pedagogies employed by all Canadian dental and dental hygiene programs to teach Indigenous content with the ethics approval (H23-01846) obtained. The University of British Columbia Behavioral Research Ethics Board Office was consulted and advised that, given the nature of the study, it did not need to go through the Indigenous Research and Ethics Review Board. A twenty-nine-item survey was developed in English and French, using the Qualtrics® platform, tailored to address the proposed objectives. The survey was pilot tested with one faculty member and four graduate students at the University of British Columbia’s, Faculty of Dentistry who provided insights used to refine the survey before the main data collection. On average, the completion time for the survey was estimated to be approximately ten minutes. The introductory page of the survey served as an invitation and consent form for participation, detailing the study's objectives, methods, and confidentiality assurances before respondents began the survey. The survey consisted of both closed- and open-ended questions tailored to collect data on the following areas: Demographic details: Five questions identified the respondents' programs (undergraduate dental and dental hygiene programs), the name of their institution, and whether participants had received Indigenous competency training themselves; no participants’ names or any other identifier was collected. Indigenous teaching: The rest of the 24 questions focused on teaching objectives, content covered, number of instructional hours, pedagogies utilized, employed assessment techniques, as well as barriers and facilitators in incorporating Indigenous content within the curriculum. Display logic was used so that different sets of questions appeared based on respondents’ answers. Although the name of the participating institution was requested to track responses, this information was not reported in the results, and respondents were informed accordingly. Participants and Data Collection Dentistry and dental hygiene educational institutions were identified through the official list provided by the Commission on Dental Accreditation of Canada (CDAC) website (22) . The total number of educational institutions was?? 45, comprising 10 dentistry and 35 dental hygiene programs, and made up the purposefully targeted sample for the survey. Within each institution, faculty members (program or curriculum coordinator, instructors for Indigenous-related courses if informed) were identified per their academic duties and roles as described in their respective websites. This approach ensured representativeness of faculty members from the target educational institutions who would have expertise to fulfill the study’s objectives. The survey was distributed via email between September and October 2023. The email included an invitation to participate in the study and a link to the electronic survey. Participants were asked to complete the survey themselves or forward the survey link to a more informed colleague involved in teaching Indigenous content. Follow-up emails were sent weekly for four weeks to non-respondents to increase participation. Also, to encourage participation, respondents were offered the option to provide their email or contact information, at the end of the survey, to be entered into a random draw for one of five $50 gift cards. To maintain confidentiality, responses were collected through an anonymous link, and any identifiable data provided for the draw were anonymized prior to data analysis, as outlined in the informed consent. Data Analysis Following de-identification, the survey data were imported from Qualtrics® into SPSS software version 29.0 (SPSS Inc., IL, USA). The data were initially screened for missing values and outliers. Due to the survey design in Qualtrics®, which required respondents to answer each question before proceeding, no missing values were found. Additionally, no outliers were detected. Given that the survey included questions that allowed the respondents to select more than one answer option from a list of choices, each response option was dichotomized using “0 = no” and “1 = yes.” In cases where respondents selected more than one option for a question, each combination of selected options was assigned a unique code to ensure a comprehensive record of responses. Subsequently, descriptive analyses were conducted to determine the frequency and means of responses, as well as calculating general data trends. As nonparametric and parametric statistical tests lack statistical power with small samples and preclude achieving statistical significance, those tests were not conducted. 3. RESULTS Surveys were completed by thirty-four educational institutions: nine undergraduate dental programs and twenty-five dental hygiene programs. Despite some of the institutions having both dental and dental hygiene programs, the primary unit of analysis was the program itself. Therefore, the survey achieved a response rate of 90% (n=9) for undergraduate dental programs and 71% (n=25) for dental hygiene programs. Indigenous teaching programs Out of the 34 surveyed institutions, 32 (94.1%) included Indigenous content in their curricula, encompassing all nine (100%) dental programs and 23 (92%) dental hygiene programs. More than half of the respondents (55.9%, n=19) offered Indigenous content across multiple academic years, while 32.4% (n=11) included it in a single academic year. Incorporating Indigenous content into one or more modules was most common, with 97% (n=32) of the respondents reporting this approach. However, only 11.8% (one dental and three dental hygiene programs) had developed a separate course dedicated to Indigenous content. Indigenous content education was optional in one dental hygiene program, while four dental hygiene and one dentistry programs included both mandatory and optional courses. The other 24 programs offered it as mandatory. On average, programs dedicated 12.94 ± 7.44 hours (2-42 h) to teaching Indigenous content. The two most mentioned objectives of programs to include Indigenous content was to promote cultural awareness (82.4%, n=28) and to improve the overall quality and relevance of the programs (64.7%, n=22). The least cited reason was to comply with regulatory requirements or accreditation standards (26.5%, n=9). According to Figure 3.1, lectures and seminars were the most employed delivery method in both dentistry and dental hygiene programs, either alone or in combination with other approaches, with 88% and 87% usage in each program, respectively. In dental hygiene programs, small group discussions were employed by 83% of the institutions. In dentistry programs, small group discussions and case studies/vignettes were equally common, each used in 55% of programs. Notably, one dental hygiene program reported using all the presented methods in the survey. Additionally, 16 programs (47.1%), including five dentistry and eleven dental hygiene programs, mentioned inviting guest speakers, including Indigenous representatives or Elders (data not shown). Among the programs incorporating Indigenous content, only 11.8% (n=4) addressed all the listed topics in the survey (Figure 3.2/Table 3.1). The most frequently covered topics in both dentistry and dental hygiene programs were “History” and “Indigenous People's Health,” with 27 programs (79.4%) addressing these areas. In dental hygiene programs, “Culture and Identity” was also commonly covered, with 20 respondents (87%) including this topic. In contrast, fewer than half of the dentistry programs (n=4) addressed “Culture and Identity.” Additionally, one program mentioned covering \"Indigenous Worldview in Oral Health Care Research\". The most employed assessment techniques were written exams (59.2%) and reflective journals (51.9%) by all the programs combined. While 76% (n=19) of the dental hygiene programs utilized at least one form of assessment, five dental programs reported not using any form of assessment (Table 3.2). Twelve programs (37.5%) reported experiencing barriers in teaching Indigenous content. Among these, the most prevalent barriers identified included “packed curriculum” (83.3%), “shortage of faculty members” (58.3%), and “lack of knowledge” (50%) (Table 3.3). Additionally, four programs cited other barriers not listed in the survey options, including “lack of Indigenous faculty in the institution”, “challenges in achieving consistent collaboration with Indigenous communities”, “competing priorities with other equity focuses, and staff hesitancy/discomfort with Indigenous-focused content”, and a “lack of support from the institution”. Twenty-one programs (65.6%) reported having factors in their program that seemed to have facilitated the teaching of Indigenous content. Among these, the most mentioned facilitator was a “supportive institutional policy” (71.4%), followed by “engagement with Indigenous faculty or experts” and “access to relevant teaching materials and resources”, each mentioned in 13 programs (61.9%). The least cited factor was “student demand and interest” (19%, n=4). Additionally, two programs cited other facilitators not listed in the survey options. One dental hygiene program mentioned \"accreditation requirements,\" while one dentistry program highlighted \"having one Indigenous faculty member responsible for including Indigenous content; otherwise, administration is not supportive of Indigenous content or policies.\" 4. DISCUSSION This study utilized a survey to explore the extent to which Indigenous content has been part of the dental and dental hygiene curricula across Canada, to identify the objectives, delivery methods, and assessment techniques employed, as well as to understand the barriers and facilitators to incorporating such content. To our knowledge, this is the first comprehensive study to explore the extent of curriculum Indigenization in all Canadian dental and dental hygiene programs. The findings provide valuable insights into the current state of Indigenous education in these programs and highlight key areas for improvement. The survey achieved a response rate of 90% for undergraduate dental programs and 71% for dental hygiene programs, which is notably higher than the average response rate for electronic surveys (23). The findings indicated that 94.1% of the programs surveyed cover Indigenous content, which may reflect a growing recognition of the importance of Indigenous-related teaching in preparing healthcare professionals to provide culturally competent care in Canada (7,24,25). The primary objectives for including Indigenous content in the dental and dental hygiene programs in Canada were to promote cultural awareness and improve the overall quality and relevance of their programs. Similar objectives have been reported in other studies assessing cultural education in health sciences (26–28). These findings also align with broader goals of enhancing cultural competence to ensure that healthcare professionals are equipped to address the unique needs of Indigenous populations, as emphasized by the TRC (7). However, compliance with regulatory requirements or accreditation standards was the least cited objective, probably because only dental hygiene competency document explicitly mentions First Nations (14,15), which may suggest that intrinsic motivations related to improving care quality and cultural understanding are likely more influential for the dental programs. This is also evident in a study by Arcobelli et al.(29), which examined physiotherapy curricula and found that the primary drivers for curricular development related to Indigenous Peoples were internal to the university rather than regulatory requirements. Different Canadian programs covered varying combinations of topics related to Indigenous content. The diversity in curricular content among programs, as well as the wide range in the number of hours dedicated to this content, suggest that interpretations of what constitutes Indigenous-related content, the amount of time needed to cover such content, and what should be included in oral health curricula may differ significantly between programs. These variations may also result from differences in terminology used for the topics covered (29,30). For example, what some programs teach under “Culture and Identity” may be referred to as “Culture, Language, and Self-Determination” in other programs, given that both options were given in the survey. Incorporating diverse content may not only help students develop self-awareness but also prompt them to critically assess their own beliefs, leading to an increase in cultural competence (31). However, determining the adequacy of coverage for certain topics remains a challenge. While some may argue that limited coverage indicates insufficient inclusivity, others may contend that the current content is sufficient. This raises the important question: how much is enough?(32). But it also reflects the inherent aspects of training a robust oral health care provider within the time constraints of a usually crowded curricula, where more often than not students ponder ‘ what I wished I’d learned at dental school ’(33,34). Either way, there is a need for more thorough curriculum development that ensures that all relevant areas are covered sufficiently. This study revealed a preference for traditional didactic formats, such as lectures and seminars, as the most common methods used to deliver Indigenous content, which is consistent with previous research on cultural competency education (26,30). However, the challenge with traditional educational approaches is that it often hinders critical questioning of content, purpose, and relationships (35). But in addition to these conventional methods, many programs also used interactive approaches including small group discussions, case studies, and vignettes, aiming to engage students through discussion and reflective-based learning. Notably, 47.1% of the programs invited guest speakers, including Indigenous representatives or Elders, along the line of the community as the teacher (36). This practice enriches the educational experience by providing students with direct insights from Indigenous perspectives, fostering a deeper understanding and respect for Indigenous cultures and practices (26). Regarding assessment, a notable disparity was observed between dental and dental hygiene programs. While most dental hygiene programs utilized at least one form of assessment, only two dental programs reported employing assessment methods. Despite the ongoing debate on whether assessment drives learning, it is argued that active and purposeful engagement with students, institutions, curricula, and the thoughtful use of assessments and feedback can indeed enhance learning (37,38). Therefore, the disparity in assessment practices highlights a potential area for institutional support to ensure that all students are evaluated effectively and consistently. In term of barriers in teaching Indigenous content, a packed curriculum, shortage of Indigenous faculty members and lack of knowledge were prevalent. These challenges are consistent with findings from studies on other health programs (20,21,39). Additionally, faculty members' sense of readiness, in terms of knowledge and comfort in teaching Indigenous content, were noted as challenges in many other studies (19,29,40–42). In order to address these barriers, resources are available including the Australian \"Health Curriculum Framework\" (43) and the CIPHER (Competencies for Indigenous Public Health, Evaluation and Research) report (44) which is a collaborative effort by researchers from Canada, Australia, New Zealand, and the United States to provide an overview of Indigenous curricula and initiatives. These resources can offer valuable guidance and strategies for integrating Indigenous content effectively. In fact, availability of resources was identified as one of the factors that facilitate the teaching of Indigenous content, alongside supportive institutional policies and engagement with Indigenous faculty or experts. These facilitators underscore the importance of institutional commitment and collaboration with Indigenous People in enhancing the quality and delivery of Indigenous content that should be informed and directed by their voices and supported by allies 1 with the appropriate expertise (21,45). The importance of ensuring knowledge of Indigenous perspectives are at the heart of educational practices and curriculum development. However, student demand and interest were the least cited facilitators. This may reveal a gap in valuing cultural competence compared to technical – clinical – proficiency by students (18,31,46–48). This indicates a need for greater efforts to raise awareness and appreciation for the importance of Indigenous cultural competence among students. One suggested approach is providing real-world experiences within Indigenous communities, which can increase students' acknowledgment of Indigenous knowledge and culture and expose them to Indigenous health issues (27,49). In turn, it becomes imperative to foster stronger partnerships with Indigenous Peoples, enhance training and resources for educators, and advocate for supportive policies. By doing so, we can work towards creating a more inclusive and culturally respectful educational environment. This will better prepare oral healthcare professionals to meet the unique needs of Indigenous People, ultimately contributing to improved oral health outcomes and overall well-being for Indigenous People in Canada. This endeavor is not only about fulfilling educational mandates but also about fostering a deeper understanding, respect, and collaboration that takes us one step closer to reconciliation. Such educational efforts should be ongoing, and not just a ‘ticked box’ on the schools and programs repertoires. Despite the high response rate and potentially being the first comprehensive study to explore the extent of curriculum Indigenization in all Canadian dental and dental hygiene programs, this study has limitations. One limitation is the reliance on participants' self-assessment of the extent of Indigenization in their curricula. The accuracy and consistency of the responses may have been influenced by participants' perspectives, biases, or limited awareness of the full scope of Indigenization. Additionally, we could not ensure that the respondents of the survey were in fact the instructor delivering the Indigenous content in their program, thus caution should be exercised when generalizing these findings. Another limitation is the potential for socially desirable answers. Although respondents were assured that personal identification and institutional names would not be disclosed, there could be a tendency for participants to overestimate the extent of indigenization in their curricula. Finally, the study's cross-sectional design provided a snapshot of the current state of indigenization in dental and dental hygiene curricula but did not capture the dynamic nature of curriculum development and changes over time. This study also did not assess the long-term impact of Indigenization efforts and did not account for potential future changes in curricula, highlighting the need for future studies to address these areas. 5. CONCLUSION This study has provided a comprehensive overview of the current state of Indigenous content within Canadian dental and dental hygiene programs. However, it also highlighted several persistent challenges, including limited scope of content covered, lack of assessment in many programs, the predominance of traditional didactic teaching methods, and barriers such as overcrowded curricula and faculty shortages. Despite these obstacles, supportive institutional policies and the engagement of Indigenous experts have emerged as vital facilitators for effective curriculum Indigenization. Declarations ACKNOWLEDGMENT The authors wish to extend their gratitude to Miss Ashley Lessard and Dr. Trish Goulet for being the Indigenous voices that contributed to and shaped this work. The authors are also grateful to the UBC Faculty of Dentistry for their financial support, which facilitated participation in our survey. This manuscript forms part of the first author’s MSc thesis and was partially funded by the “ University of British Columbia’s Teaching and Learning Enhancement Fund (2022/24) – Small Innovation Project ”. 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J Calif Dent Assoc. 2014;42(10):711–5. Donate-Bartfield E, Lobb WK, Roucka TM, Donate-Bartfield E;, Lobb WK; Teaching Culturally Sensitive Care to Dental Students: A Teaching Culturally Sensitive Care to Dental Students: A Multidisciplinary Approach Multidisciplinary Approach Recommended Citation Recommended Citation [Internet]. 2014. Available from: https://epublications.marquette.edu/dentistry_fac Mariño R MMHM. Transcultural dental training: addressing the oral health care needs of people from culturally diverse backgrounds. Community dentistry and oral epidemiology. 2012 Oct; 40:134-40. Kurtz DLM TDNJMD. Social justice and health equity: urban Aboriginal women’s actions for health reform. Int J Health Wellness Soc. 2014; 3:13-26. Canada School of Public Service. Being an Ally to Indigenous Peoples [Internet]. Ottawa, ON: Canada School of Public Service; 2024 Feb 15 [cited 2024 Jul 24]. Available from: https://catalogue.csps-efpc.gc.ca/product?catalog=IRA1-E29&cm_locale=en. Footnotes “Being an ally involves actively supporting and advocating for marginalized or underrepresented groups and is an ongoing process which requires commitment, social action, strength, courage, humility, and a support network. Being an ally to Indigenous Peoples means recognizing the privileges that settlers have and helping to eliminate barriers and other challenges facing Indigenous Peoples.”(50) Tables Table 3.1 Description of the designated numbers according to Figure 3.2 Addressed Indigenous topics Number Addressed Indigenous topics Number History 1 Colonial Policies & Aboriginal Right 10 Culture and Identity 2 Colonial Histories 11 Indigenous Diversity 3 Aboriginal Health Governance 12 Indigenous Peoples Health 4 Healthcare system & Indigenous People 13 Racism and Impacts on Indigenous Health 5 Two-Eyed Seeing & Models of Wellness 14 Stewardship, Resistance & Activism 6 Research & Health Outcomes 15 Trauma and Violence Informed Care 7 Community Engagement & Transforming Care 16 Determinants of Indigenous People’s Health 8 Effect of colonialism 17 Culture, Language, and Self-Determination 9 Table 3.2 Employed methods of assessment by the program type Employed assessment techniques Program type Total (n=27) Percentage Undergraduate dental programs (n=7) Dental hygiene programs (n=20) No assessment 5 1 6 22.2% Written exams (multiple choice, pretest-posttest, etc.) 2 14 16 59.2% Community feedback 0 8 8 29.6% Objective structured clinical examination (OSCE) 0 2 2 7.4% Reflection/Reflective journal 0 14 14 51.9% Report/essay 0 7 7 25.9% Oral presentation 1 9 10 37% Discussion 0 3 3 11.1% Table 3.3 Barriers to Indigenous education Barriers Program type Total (n=12) Percentage Dentistry (n=5) Dental hygiene (n=7) Lack of knowledge 3 3 6 50% Lack of interest 3 1 4 33.3% Lack of budget 2 1 3 25% Packed curriculum 4 6 10 83.3% Shortage of faculty members 3 4 7 58.3% Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6370523\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":438038657,\"identity\":\"3ecd2105-3fdc-4519-83ce-3a583ade71d0\",\"order_by\":0,\"name\":\"Parisa Shokouhi\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of British Columbia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Parisa\",\"middleName\":\"\",\"lastName\":\"Shokouhi\",\"suffix\":\"\"},{\"id\":438038658,\"identity\":\"63d8d8d2-eed4-4589-ab16-7becfb2e962a\",\"order_by\":1,\"name\":\"Diego Ardengi\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0001-5368-7975\",\"institution\":\"The University of British Columbia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Diego\",\"middleName\":\"\",\"lastName\":\"Ardengi\",\"suffix\":\"\"},{\"id\":438038659,\"identity\":\"7cde8713-d138-438f-8eab-245485fbcc4c\",\"order_by\":2,\"name\":\"Leeann Donnelly\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of British Columbia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Leeann\",\"middleName\":\"\",\"lastName\":\"Donnelly\",\"suffix\":\"\"},{\"id\":438038660,\"identity\":\"2349cba4-5af8-4618-8974-d28372419e89\",\"order_by\":3,\"name\":\"Linda Slack-Smith\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0001-5859-7055\",\"institution\":\"University of Western 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1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":61598,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eEmployed delivery method by program type\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6370523/v1/60cfe1adf1eba410e9a921d1.png\"},{\"id\":79879998,\"identity\":\"7d6ff308-e83e-49e1-9aeb-1fb283386880\",\"added_by\":\"auto\",\"created_at\":\"2025-04-04 03:50:30\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":30257,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eAddressed Indigenous topics based on the program type\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6370523/v1/744a9d77b57258d462c6f7d3.png\"},{\"id\":79880952,\"identity\":\"186c40a2-7e17-445c-ae90-d33e2b3ab03d\",\"added_by\":\"auto\",\"created_at\":\"2025-04-04 04:06:30\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":716197,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6370523/v1/58c80384-4b0d-411c-be02-5512b6b9fc43.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003eThe extent of Dentistry and Dental hygiene curriculum Indigenization across Canada\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"1. INTRODUCTION\",\"content\":\"\\u003cp\\u003eThe Indigenous Peoples of Canada are defined as First Nations, Inuit, and M\\u0026eacute;tis, and according to the 2021 Canadian census, they made up 6.1% of the Canadian population (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). Oral health contributes to the well-being of any individual, and in the case of Indigenous Peoples of Canada, the colonial policies, globalization, and transition to Western diets high in sugar and processed ingredients have resulted in a much higher burden of oral diseases compared to their non-Indigenous counterparts (\\u003cspan additionalcitationids=\\\"CR3\\\" citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Moreover, a significant number of Indigenous Peoples experience constant pain in their mouths and have a higher rate of tooth loss compared to the general Canadian population (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eMainstream health services often fail to adequately meet the needs of Indigenous Peoples due to their foundation in colonial and westernized biomedical values, with an absence or limited appreciation for holistic understandings of well-being (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). The Truth and Reconciliation Commission (TRC) of Canada highlighted these issues in their 2015 final report and called for actions to improve healthcare for Indigenous Peoples. The TRC Calls to Action # 23 urges the government to increase the number of Indigenous healthcare providers, retain them in Indigenous communities, and provide culturally safe training for all healthcare professionals when caring for Indigenous Peoples. The Call to Action # 24 asks for medical and nursing schools in Canada to offer courses on Indigenous health issues, including history, treaties, Indigenous teachings, and cultural competency training (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). Such call for curricula indigenization has been previously answered by other countries, including Australia (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e) and New Zealand (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eIn Canada, educational institutions have tried to comply with this directive and address Indigenous health content through decolonizing care practices within the health system (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). Still, most dental and dental hygiene curricula focus on oral and clinical science and practice, with some emphasis on health promotion and prevention, motivational, and communication strategies (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). While dental and dental hygiene training in Canada follow competency frameworks to guide their curricula (\\u003cspan additionalcitationids=\\\"CR13\\\" citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e), only the dental hygiene competency document explicitly mentions First Nations (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). Perhaps not surprisingly, more than half of the senior dental students from one Canadian dental school were not confident in treating patients from diverse cultural groups including Indigenous Peoples due to insufficient cultural competence training (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e). Similarly, a curriculum review in an Australian university emphasized the importance of increasing transcultural content in the dentistry curriculum (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e), similarly to a study from the University of Alberta (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). Moreover, a recent scoping review explored the worldwide literature on Indigenous content within the oral health professions\\u0026rsquo; education curricula and only found 23 studies reporting of the teaching such content (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). However, barriers still exist to promote such practices, including the limited number of Indigenous faculties (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e), the need to train non-Indigenous faculty members (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e), the lack of guidance and proper framework regarding the implementation of Indigenous content, the competing priorities within the university and faculty, and the notion that curricula is already crowded (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). Nonetheless, it remains unknown as to whether or not dental and dental hygiene curricula in Canada have been Indigenized. Therefore, this study aimed to explore the extent to which Indigenous content and its objectives, delivery methods, and assessment are addressed within dental and dental hygiene curricula across Canada, and to identify the barriers and facilitators to address such content. For this study, Indigenization was defined as any approach or philosophy of education characterized by delivering Indigenous content and cultural perspectives to oral health care professionals.\\u003c/p\\u003e\"},{\"header\":\"2. METHODS\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eResearch Design\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study followed a descriptive cross-sectional design via a national survey exploring the current pedagogies employed by all Canadian dental and dental hygiene programs to teach Indigenous content\\u0026nbsp;with the ethics approval (H23-01846) obtained. The University of British Columbia Behavioral Research Ethics Board Office was consulted and advised that, given the nature of the study, it did not need to go through the Indigenous Research and Ethics Review Board.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eA twenty-nine-item survey was developed in English and French, using the Qualtrics\\u0026reg; platform, tailored to address the proposed objectives. The survey was pilot tested with one faculty member and four graduate students at the University of British Columbia\\u0026rsquo;s, Faculty of Dentistry who provided insights used to refine the survey before the main data collection. On average, the completion time for the survey was estimated to be approximately ten minutes. The introductory page of the survey served as an invitation and consent form for participation, detailing the study\\u0026apos;s objectives, methods, and confidentiality assurances before respondents began the survey. The survey consisted of both closed- and open-ended questions tailored to collect data on the following areas:\\u003c/p\\u003e\\n\\u003cp\\u003eDemographic details: Five questions identified the respondents\\u0026apos; programs (undergraduate dental and dental hygiene programs), the name of their institution, and whether participants had received Indigenous competency training themselves; no participants\\u0026rsquo; names or any other identifier was collected.\\u003c/p\\u003e\\n\\u003cp\\u003eIndigenous teaching: The rest of the 24 questions focused on teaching objectives, content covered, number of instructional hours, pedagogies utilized, employed assessment techniques, as well as barriers and facilitators in incorporating Indigenous content within the curriculum.\\u003c/p\\u003e\\n\\u003cp\\u003eDisplay logic was used so that different sets of questions appeared based on respondents\\u0026rsquo; answers. Although the name of the participating institution was requested to track responses, this information was not reported in the results, and respondents were informed accordingly. \\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eParticipants and Data Collection\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDentistry and dental hygiene educational institutions were identified through the official list provided by the Commission on Dental Accreditation of Canada (CDAC) website \\u003cspan lang=\\\"EN-US\\\"\\u003e(22)\\u003c/span\\u003e. The total number of educational institutions was?? 45, comprising 10 dentistry and 35 dental hygiene programs, and made up the purposefully targeted sample for the survey. Within each institution, faculty members (program or curriculum coordinator, instructors for Indigenous-related courses if informed) were identified per their academic duties and roles as described in their respective websites. This approach ensured representativeness of faculty members from the target educational institutions who would have expertise to fulfill the study\\u0026rsquo;s objectives.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe survey was distributed via email between September and October 2023. The email included an invitation to participate in the study and a link to the electronic survey. Participants were asked to complete the survey themselves or forward the survey link to a more informed colleague involved in teaching Indigenous content. Follow-up emails were sent weekly for four weeks to non-respondents to increase participation. Also, to encourage participation, respondents were offered the option to provide their email or contact information, at the end of the survey, to be entered into a random draw for one of five $50 gift cards. To maintain confidentiality, responses were collected through an anonymous link, and any identifiable data provided for the draw were anonymized prior to data analysis, as outlined in the informed consent.\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFollowing de-identification, the survey data were imported from Qualtrics\\u0026reg; into SPSS software version 29.0 (SPSS Inc., IL, USA). The data were initially screened for missing values and outliers. Due to the survey design in Qualtrics\\u0026reg;, which required respondents to answer each question before proceeding, no missing values were found. Additionally, no outliers were detected.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eGiven that the survey included questions that allowed the respondents to select more than one answer option from a list of choices, each response option was dichotomized using \\u0026ldquo;0 = no\\u0026rdquo; and \\u0026ldquo;1 = yes.\\u0026rdquo; In cases where respondents selected more than one option for a question, each combination of selected options was assigned a unique code to ensure a comprehensive record of responses. Subsequently, descriptive analyses were conducted to determine the frequency and means of responses, as well as calculating general data trends. As nonparametric and parametric statistical tests lack statistical power with small samples and preclude achieving statistical significance, those tests were not conducted.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"3. RESULTS\",\"content\":\"\\u003cp\\u003eSurveys were completed by thirty-four educational institutions: nine undergraduate dental programs and twenty-five dental hygiene programs. Despite some of the institutions having both dental and dental hygiene programs, the primary unit of analysis was the program itself. Therefore, the survey achieved a response rate of 90% (n=9) for undergraduate dental programs and 71% (n=25) for dental hygiene programs. \\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eIndigenous teaching programs\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOut of the 34 surveyed institutions, 32 (94.1%) included Indigenous content in their curricula, encompassing all nine (100%) dental programs and 23 (92%) dental hygiene programs. More than half of the respondents (55.9%, n=19) offered Indigenous content across multiple academic years, while 32.4% (n=11) included it in a single academic year. Incorporating Indigenous content into one or more modules was most common, with 97% (n=32) of the respondents reporting this approach. However, only 11.8% (one dental and three dental hygiene programs) had developed a separate course dedicated to Indigenous content. Indigenous content education was optional in one dental hygiene program, while four dental hygiene and one dentistry programs included both mandatory and optional courses. The other 24 programs offered it as mandatory. On average, programs dedicated 12.94 \\u0026plusmn; 7.44 hours (2-42 h) to teaching Indigenous content. The two most mentioned objectives of programs to include Indigenous content was to promote cultural awareness (82.4%, n=28) and to improve the overall quality and relevance of the programs (64.7%, n=22). The least cited reason was to comply with regulatory requirements or accreditation standards (26.5%, n=9). According to Figure 3.1, lectures and seminars were the most employed delivery method in both dentistry and dental hygiene programs, either alone or in combination with other approaches, with 88% and 87% usage in each program, respectively. In dental hygiene programs, small group discussions were employed by 83% of the institutions. In dentistry programs, small group discussions and case studies/vignettes were equally common, each used in 55% of programs. Notably, one dental hygiene program reported using all the presented methods in the survey. Additionally, 16 programs (47.1%), including five dentistry and eleven dental hygiene programs, mentioned inviting guest speakers, including Indigenous representatives or Elders (data not shown).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAmong the programs incorporating Indigenous content, only 11.8% (n=4) addressed all the listed topics in the survey (Figure 3.2/Table 3.1). The most frequently covered topics in both dentistry and dental hygiene programs were \\u0026ldquo;History\\u0026rdquo; and \\u0026ldquo;Indigenous People\\u0026apos;s Health,\\u0026rdquo; with 27 programs (79.4%) addressing these areas. In dental hygiene programs, \\u0026ldquo;Culture and Identity\\u0026rdquo; was also commonly covered, with 20 respondents (87%) including this topic. In contrast, fewer than half of the dentistry programs (n=4) addressed \\u0026ldquo;Culture and Identity.\\u0026rdquo; Additionally, one program mentioned covering \\u0026quot;Indigenous Worldview in Oral Health Care Research\\u0026quot;. The most employed assessment techniques were written exams (59.2%) and reflective journals (51.9%) by all the programs combined. While 76% (n=19) of the dental hygiene programs utilized at least one form of assessment, five dental programs reported not using any form of assessment (Table 3.2).\\u003c/p\\u003e\\n\\u003cp\\u003eTwelve programs (37.5%) reported experiencing barriers in teaching Indigenous content. Among these, the most prevalent barriers identified included \\u0026ldquo;packed curriculum\\u0026rdquo; (83.3%), \\u0026ldquo;shortage of faculty members\\u0026rdquo; (58.3%), and \\u0026ldquo;lack of knowledge\\u0026rdquo; (50%) (Table 3.3). Additionally, four programs cited other barriers not listed in the survey options, including \\u0026ldquo;lack of Indigenous faculty in the institution\\u0026rdquo;, \\u0026ldquo;challenges in achieving consistent collaboration with Indigenous communities\\u0026rdquo;, \\u0026ldquo;competing priorities with other equity focuses, and staff hesitancy/discomfort with Indigenous-focused content\\u0026rdquo;, and a \\u0026ldquo;lack of support from the institution\\u0026rdquo;.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eTwenty-one programs (65.6%) reported having factors in their program that seemed to have facilitated the teaching of Indigenous content. Among these, the most mentioned facilitator was a \\u0026ldquo;supportive institutional policy\\u0026rdquo; (71.4%), followed by \\u0026ldquo;engagement with Indigenous faculty or experts\\u0026rdquo; and \\u0026ldquo;access to relevant teaching materials and resources\\u0026rdquo;, each mentioned in 13 programs (61.9%). The least cited factor was \\u0026ldquo;student demand and interest\\u0026rdquo; (19%, n=4). Additionally, two programs cited other facilitators not listed in the survey options. One dental hygiene program mentioned \\u0026quot;accreditation requirements,\\u0026quot; while one dentistry program highlighted \\u0026quot;having one Indigenous faculty member responsible for including Indigenous content; otherwise, administration is not supportive of Indigenous content or policies.\\u0026quot;\\u003c/p\\u003e\"},{\"header\":\"4. DISCUSSION\",\"content\":\"\\u003cp\\u003eThis study utilized a survey to explore the extent to which Indigenous content has been part of the dental and dental hygiene curricula across Canada, to identify the objectives, delivery methods, and assessment techniques employed, as well as to understand the barriers and facilitators to incorporating such content. To our knowledge, this is the first comprehensive study to explore the extent of curriculum Indigenization in all Canadian dental and dental hygiene programs. The findings provide valuable insights into the current state of Indigenous education in these programs and highlight key areas for improvement.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe survey achieved a response rate of 90% for undergraduate dental programs and 71% for dental hygiene programs, which is notably higher than the average response rate for electronic surveys (23). The findings indicated that 94.1% of the programs surveyed cover Indigenous content, which may reflect a growing recognition of the importance of Indigenous-related teaching in preparing healthcare professionals to provide culturally competent care in Canada (7,24,25).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe primary objectives for including Indigenous content in the dental and dental hygiene programs in Canada were to promote cultural awareness and improve the overall quality and relevance of their programs. Similar objectives have been reported in other studies assessing cultural education in health sciences (26\\u0026ndash;28). These findings also align with broader goals of enhancing cultural competence to ensure that healthcare professionals are equipped to address the unique needs of Indigenous populations, as emphasized by the TRC (7). However, compliance with regulatory requirements or accreditation standards was the least cited objective, probably because only dental hygiene competency document explicitly mentions First Nations (14,15), which may suggest that intrinsic motivations related to improving care quality and cultural understanding are likely more influential for the dental programs. This is also evident in a study by Arcobelli et al.(29), which examined physiotherapy curricula and found that the primary drivers for curricular development related to Indigenous Peoples were internal to the university rather than regulatory requirements.\\u003c/p\\u003e\\n\\u003cp\\u003eDifferent Canadian programs covered varying combinations of topics related to Indigenous content. The diversity in curricular content among programs, as well as the wide range in the number of hours dedicated to this content, suggest that interpretations of what constitutes Indigenous-related content, the amount of time needed to cover such content, and what should be included in oral health curricula may differ significantly between programs. These variations may also result from differences in terminology used for the topics covered (29,30). For example, what some programs teach under \\u0026ldquo;Culture and Identity\\u0026rdquo; may be referred to as \\u0026ldquo;Culture, Language, and Self-Determination\\u0026rdquo; in other programs, given that both options were given in the survey. Incorporating diverse content may not only help students develop self-awareness but also prompt them to critically assess their own beliefs, leading to an increase in cultural competence (31). However, determining the adequacy of coverage for certain topics remains a challenge. While some may argue that limited coverage indicates insufficient inclusivity, others may contend that the current content is sufficient. This raises the important question: how much is enough?(32). But it also reflects the inherent aspects of training a robust oral health care provider within the time constraints of a usually crowded curricula, where more often than not students ponder \\u0026lsquo;\\u003cem\\u003ewhat I wished I\\u0026rsquo;d learned at dental school\\u003c/em\\u003e\\u0026rsquo;(33,34). Either way, there is a need for more thorough curriculum development that ensures that all relevant areas are covered sufficiently.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThis study revealed a preference for traditional didactic formats, such as lectures and seminars, as the most common methods used to deliver Indigenous content, which is consistent with previous research on cultural competency education (26,30). However, the challenge with traditional educational approaches is that it often hinders critical questioning of content, purpose, and relationships (35). But in addition to these conventional methods, many programs also used interactive approaches including small group discussions, case studies, and vignettes, aiming to engage students through discussion and reflective-based learning. Notably, 47.1% of the programs invited guest speakers, including Indigenous representatives or Elders, along the line of the community as the teacher (36). This practice enriches the educational experience by providing students with direct insights from Indigenous perspectives, fostering a deeper understanding and respect for Indigenous cultures and practices (26).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eRegarding assessment, a notable disparity was observed between dental and dental hygiene programs. While most dental hygiene programs utilized at least one form of assessment, only two dental programs reported employing assessment methods. Despite the ongoing debate on whether assessment drives learning, it is argued that active and purposeful engagement with students, institutions, curricula, and the thoughtful use of assessments and feedback can indeed enhance learning (37,38). Therefore, the disparity in assessment practices highlights a potential area for institutional support to ensure that all students are evaluated effectively and consistently.\\u003c/p\\u003e\\n\\u003cp\\u003eIn term of barriers in teaching Indigenous content, a packed curriculum, shortage of Indigenous faculty members and lack of knowledge were prevalent. These challenges are consistent with findings from \\u0026nbsp; studies on other health programs (20,21,39). Additionally, faculty members\\u0026apos; sense of readiness, in terms of knowledge and comfort in teaching Indigenous content, were noted as challenges in many other studies (19,29,40\\u0026ndash;42). In order to address these barriers, resources are available including the Australian \\u0026quot;Health Curriculum Framework\\u0026quot; \\u003cspan lang=\\\"EN-US\\\"\\u003e(43)\\u003c/span\\u003e and the CIPHER (Competencies for Indigenous Public Health, Evaluation and Research) report (44) which is a collaborative effort by researchers from Canada, Australia, New Zealand, and the United States to provide an overview of Indigenous curricula and initiatives. These resources can offer valuable guidance and strategies for integrating Indigenous content effectively.\\u003c/p\\u003e\\n\\u003cp\\u003eIn fact, availability of resources was identified as one of the factors that facilitate the teaching of Indigenous content, alongside supportive institutional policies and engagement with Indigenous faculty or experts. These facilitators underscore the importance of institutional commitment and collaboration with Indigenous People in enhancing the quality and delivery of Indigenous content that should be informed and directed by their voices and supported by allies\\u003ca href=\\\"#_ftn1\\\" name=\\\"_ftnref1\\\" title=\\\"\\\"\\u003e\\u003c/a\\u003e\\u003csup\\u003e1\\u003c/sup\\u003e with the appropriate expertise (21,45). The importance of ensuring knowledge of Indigenous perspectives are at the heart of educational practices and curriculum development. However, student demand and interest were the least cited facilitators. This may reveal a gap in valuing cultural competence compared to technical \\u0026ndash; clinical \\u0026ndash; proficiency by students (18,31,46\\u0026ndash;48). This indicates a need for greater efforts to raise awareness and appreciation for the importance of Indigenous cultural competence among students. One suggested approach is providing real-world experiences within Indigenous communities, which can increase students\\u0026apos; acknowledgment of Indigenous knowledge and culture and expose them to Indigenous health issues (27,49).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIn turn, it becomes imperative to foster stronger partnerships with Indigenous Peoples, enhance training and resources for educators, and advocate for supportive policies. By doing so, we can work towards creating a more inclusive and culturally respectful educational environment. This will better prepare oral healthcare professionals to meet the unique needs of Indigenous People, ultimately contributing to improved oral health outcomes and overall well-being for Indigenous People in Canada. This endeavor is not only about fulfilling educational mandates but also about fostering a deeper understanding, respect, and collaboration that takes us one step closer to reconciliation. Such educational efforts should be ongoing, and not just a \\u0026lsquo;ticked box\\u0026rsquo; on the schools and programs repertoires.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDespite the high response rate and potentially being the first comprehensive study to explore the extent of curriculum Indigenization in all Canadian dental and dental hygiene programs, this study has limitations. One limitation is the reliance on participants\\u0026apos; self-assessment of the extent of Indigenization in their curricula. The accuracy and consistency of the responses may have been influenced by participants\\u0026apos; perspectives, biases, or limited awareness of the full scope of Indigenization. Additionally, we could not ensure that the respondents of the survey were in fact the instructor delivering the Indigenous content in their program, thus caution should be exercised when generalizing these findings. Another limitation is the potential for socially desirable answers. Although respondents were assured that personal identification and institutional names would not be disclosed, there could be a tendency for participants to overestimate the extent of indigenization in their curricula. Finally, the study\\u0026apos;s cross-sectional design provided a snapshot of the current state of indigenization in dental and dental hygiene curricula but did not capture the dynamic nature of curriculum development and changes over time. This study also did not assess the long-term impact of Indigenization efforts and did not account for potential future changes in curricula, highlighting the need for future studies to address these areas.\\u003c/p\\u003e\"},{\"header\":\"5. CONCLUSION\",\"content\":\"\\u003cp\\u003eThis study has provided a comprehensive overview of the current state of Indigenous content within Canadian dental and dental hygiene programs. However, it also highlighted several persistent challenges, including limited scope of content covered, lack of assessment in many programs, the predominance of traditional didactic teaching methods, and barriers such as overcrowded curricula and faculty shortages. Despite these obstacles, supportive institutional policies and the engagement of Indigenous experts have emerged as vital facilitators for effective curriculum Indigenization.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eACKNOWLEDGMENT\\u003c/h2\\u003e \\u003cp\\u003eThe authors wish to extend their gratitude to Miss Ashley Lessard and Dr. Trish Goulet for being the Indigenous voices that contributed to and shaped this work. The authors are also grateful to the UBC Faculty of Dentistry for their financial support, which facilitated participation in our survey. This manuscript forms part of the first author\\u0026rsquo;s MSc thesis and was partially funded by the \\u0026ldquo;\\u003cem\\u003eUniversity of British Columbia\\u0026rsquo;s Teaching and Learning Enhancement Fund (2022/24) \\u0026ndash; Small Innovation Project\\u003c/em\\u003e\\u0026rdquo;. Additionally, an abstract of this manuscript was presented at UBC Dentistry Research Day on January 23, 2024.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eGovernment of Canada SC. The Canadian Census: A rich portrait of the country\\u0026rsquo;s religious and ethnocultural diversity [Internet]. The Daily 2022 [cited 2023Apr18]. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/221026/dq221026b-eng.htm. \\u003c/li\\u003e\\n\\u003cli\\u003ePoirier B, Sethi S, Hedges J, Jamieson L. Building an understanding of Indigenous Health Workers\\u0026rsquo; role in oral health: A qualitative systematic review. Community Dent Oral Epidemiol. 2022 Mar 24; \\u003c/li\\u003e\\n\\u003cli\\u003eCanada. Health Canada., Inuit Tapiriit Kanatami., Inuvialuit Regional Corporation., Nunatsiavut., Nunavut Tunngavik Incorporated., Canadian Electronic Library. Inuit Oral Health Survey report 2008-2009. Health Canada; 2011. 72 p. \\u003c/li\\u003e\\n\\u003cli\\u003eReport on the Findings of the First Nations Oral Health Survey (Fnohs) 2009-2010. 137 p. \\u003c/li\\u003e\\n\\u003cli\\u003eCarstairs C, Mosby I. Colonial extractions: Oral health care and indigenous peoples in Canada, 1945\\u0026ndash;79. The Canadian Historical Review. 2020 May;101(2):192-216. \\u003c/li\\u003e\\n\\u003cli\\u003eButler TL, Anderson K, Garvey G, Cunningham J, Ratcliffe J, Tong A, et al. Aboriginal and Torres Strait Islander people\\u0026rsquo;s domains of wellbeing: A comprehensive literature review. Vol. 233, Social Science and Medicine. Elsevier Ltd; 2019. p. 138\\u0026ndash;57. \\u003c/li\\u003e\\n\\u003cli\\u003eTruth, Reconciliation Commission of Canada. Canada\\u0026rsquo;s Residential Schools: The Final Report of the Truth and Reconciliation Commission of Canada. McGill-Queen\\u0026rsquo;s Press-MQUP; 2015. \\u003c/li\\u003e\\n\\u003cli\\u003eForsyth C, Short SD, Irving M, Tennant M, Gilroy J. Navigating the Cultural Interface to Develop a Model for Dentistry Education: Cultural Competence Curricula in Dentistry Education. Transforming Lives and Systems: Cultural Competence and the Higher Education Interface. 2020:51-62. \\u003c/li\\u003e\\n\\u003cli\\u003eNicholson SL, Hayes MJ, Taylor JA. Cultural Competency Education in Academic Dental Institutions in Australia and New Zealand: A Survey Study. J Dent Educ. 2016 Aug;80(8):966\\u0026ndash;74. \\u003c/li\\u003e\\n\\u003cli\\u003eBlanchet Garneau A, B\\u0026eacute;lisle M, Lavoie P, Laurent S\\u0026eacute;dillot C. Integrating equity and social justice for indigenous peoples in undergraduate health professions education in Canada: a framework from a critical review of literature. Vol. 20, International Journal for Equity in Health. BioMed Central Ltd; 2021. \\u003c/li\\u003e\\n\\u003cli\\u003eAssociation CDH. Dental Hygiene Programs [Internet]. Dental Hygiene Schools \\u0026amp; Programs. [cited2022Nov8].Availablefrom:https://www.cdha.ca/cdha/Education/Students/Dental_Hygiene_Schools___Programs/CDHA/Education/Students Dental_Hygiene_Schools___Programs.aspx . \\u003c/li\\u003e\\n\\u003cli\\u003eBrondani MA, Pattanaporn K, Aleksejuniene J. How can dental public health competencies be addressed at the undergraduate level? J Public Health Dent. 2015 Dec 1;75(1):49\\u0026ndash;57. \\u003c/li\\u003e\\n\\u003cli\\u003eAleksejuniene J, Zed C, Marino R. Self-Perceptions of Cultural Competence Among Dental Students and Recent Graduates. J Dent Educ. 2014 Mar;78(3):389\\u0026ndash;400. \\u003c/li\\u003e\\n\\u003cli\\u003eACFD educational framework for the development of competency in dental programs. Association of Canadian Faculties of Dentistry; 2016. \\u003c/li\\u003e\\n\\u003cli\\u003eCanadian Competencies for Baccalaureate Dental Hygiene Programs 2015 2. \\u003c/li\\u003e\\n\\u003cli\\u003eMari\\u0026ntilde;o RJ, Ghanim A, Barrow SL, Morgan M V. Cultural competence skills in a dental curriculum: A review. European Journal of Dental Education. 2018 Feb 1;22(1):e94\\u0026ndash;100. \\u003c/li\\u003e\\n\\u003cli\\u003eHou TY, Bohlouli B, Amin M. Retracted: Differences in Dental Students\\u0026rsquo; Intercultural Competence Across a Four‐Year Program. J Dent Educ. 2019 Nov;83(11):1272\\u0026ndash;9. \\u003c/li\\u003e\\n\\u003cli\\u003eShokouhi P, Bakhshaei A, Brondani M. Curriculum Indigenization in oral health professions\\u0026rsquo; education worldwide: A scoping review. Journal of Dental Education. John Wiley and Sons Inc; 2024. \\u003c/li\\u003e\\n\\u003cli\\u003eVass A, Adams K. Educator perceptions on teaching Indigenous health: Racism, privilege and self-reflexivity. Med Educ. 2021 Feb 1;55(2):213\\u0026ndash;21. \\u003c/li\\u003e\\n\\u003cli\\u003ePitama SG, Palmer SC, Huria T, Lacey C, Wilkinson T. Implementation and impact of indigenous health curricula: a systematic review. Vol. 52, Medical Education. Blackwell Publishing Ltd; 2018. p. 898\\u0026ndash;909. \\u003c/li\\u003e\\n\\u003cli\\u003eDoria N, Biderman M, Sinno J, Boudreau J, Mackley MP, Bombay A. Barriers to Including Indigenous Content in Canadian Health Professions Curricula. Canadian Journal of Education. 2021 Sep 1;44(3):648\\u0026ndash;75. \\u003c/li\\u003e\\n\\u003cli\\u003eCDAC Commission on dental accreditation of Canada [Internet]. CDAC. [cited 2022Nov8]. Available from: https://www.cda-adc.ca/cdacweb/en/search_for_accredited_programs/. \\u003c/li\\u003e\\n\\u003cli\\u003eHoltom B, Baruch Y, Aguinis H, A Ballinger G. Survey response rates: Trends and a validity assessment framework. Human Relations. 2022 Aug 1;75(8):1560\\u0026ndash;84. \\u003c/li\\u003e\\n\\u003cli\\u003eWilson D de la RSBSKZAABL et al. Health professionals working with First Nations, Inuit, and M\\u0026eacute;tis consensus guideline. J Obstet Gynaecol Can. 2013;35: S1-4. \\u003c/li\\u003e\\n\\u003cli\\u003eTurpel-Lafond ME, Johnson H. In plain sight: Addressing Indigenous-specific racism and discrimination in BC health care. BC Studies: The British Columbian Quarterly. 2021 May 5(209):7-17. \\u003c/li\\u003e\\n\\u003cli\\u003eForsyth C, Irving M, Short S, Tennant M, Gilroy J. Strengthening Indigenous cultural competence in dentistry and oral health education: Academic perspectives. European Journal of Dental Education. 2019 Feb 1;23(1):e37\\u0026ndash;44. \\u003c/li\\u003e\\n\\u003cli\\u003eKurtz DLM, Janke R, Vinek J, Wells T, Hutchinson P, Froste A. Health Sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review. Int J Med Educ. 2018 Oct 25; 9:271\\u0026ndash;85. \\u003c/li\\u003e\\n\\u003cli\\u003eSaleh L, Kuthy RA, Chalkley Y, Mescher KM. An Assessment of Cross-Cultural Education in U.S. Dental Schools. Vol. 70, Journal of Dental Education. \\u003c/li\\u003e\\n\\u003cli\\u003eArcobelli LM. Physiotherapy curricula and Indigenous peoples: A snapshot of Canadian physiotherapy programs. McGill University (Canada); 2021. \\u003c/li\\u003e\\n\\u003cli\\u003eRowland ML BCCPS. A snapshot of cultural competency education in U.S. dental schools. J Dent Educ 2006;70(9):982-90. \\u003c/li\\u003e\\n\\u003cli\\u003eForsyth CJ, Irving MJ, Tennant M, Short SD, Gilroy JA. Teaching Cultural Competence in Dental Education: A Systematic Review and Exploration of Implications for Indigenous Populations in Australia. J Dent Educ. 2017 Aug;81(8):956\\u0026ndash;68. \\u003c/li\\u003e\\n\\u003cli\\u003eHarvey A, Paget M, McLaughlin K, Busche K, Touchie C, Naugler C, et al. How much is enough? Proposing achievement thresholds for core EPAs of graduating medical students in Canada. Med Teach. 2023;45(9):1054\\u0026ndash;60. \\u003c/li\\u003e\\n\\u003cli\\u003eOliver GR, Lynch CD, Chadwick BL, Santini A, Wilson NHF. What i wish I\\u0026rsquo;d learned at dental school. Br Dent J. 2016 Aug 26;221(4):187\\u0026ndash;94. \\u003c/li\\u003e\\n\\u003cli\\u003eElmanaseer WR, Al-Omoush SA, Alamoush RA, Abu Zaghlan R, Alsoleihat F. Dental Students\\u0026rsquo; Perception and Self-Perceived Confidence Level in Key Dental Procedures for General Practice and the Impact of Competency Implementation on Their Confidence Level, Part i (Prosthodontics and Conservative Dentistry). Int J Dent. 2023;2023. \\u003c/li\\u003e\\n\\u003cli\\u003eBiesta G. What is education for? On Good education, teacher judgement, and educational professionalism. Eur J Educ. 2015 Mar 1;50(1):75\\u0026ndash;87. \\u003c/li\\u003e\\n\\u003cli\\u003eBrondani M, Harjani M, Siarkowski M, Adeniyi A, Butler K, Dakelth S, et al. Community as the teacher on issues of social responsibility, substance use, and queer health in dental education. PLoS One. 2020 Aug 1;15(8 August). \\u003c/li\\u003e\\n\\u003cli\\u003eWormald BW, Schoeman S, Somasunderam A, Penn M. Assessment drives learning: An unavoidable truth? Anat Sci Educ. 2009;2(5):199\\u0026ndash;204. \\u003c/li\\u003e\\n\\u003cli\\u003eScott IM. Beyond \\u0026lsquo;driving\\u0026rsquo;: The relationship between assessment, performance and learning. Med Educ. 2020 Jan 1;54(1):54\\u0026ndash;9. \\u003c/li\\u003e\\n\\u003cli\\u003eShah CP, Reeves A. Increasing Aboriginal cultural safety among health care practitioners. Canadian Journal of Public Health= Revue Canadienne de Sante Publique. 2012 Sep;103(5): e397. \\u003c/li\\u003e\\n\\u003cli\\u003eBell B. White dominance in nursing education: A target for anti-racist efforts. Vol. 28, Nursing Inquiry. Blackwell Publishing Ltd; 2021. \\u003c/li\\u003e\\n\\u003cli\\u003eRoger Strasser MBBS M PI. From the community to the classroom: The Aboriginal health curriculum at the Northern Ontario School of Medicine. Canadian Journal of Rural Medicine. 2014 Oct 1;19(4):143. \\u003c/li\\u003e\\n\\u003cli\\u003eSchmidt H. Indigenizing and Decolonizing the Teaching of Psychology: Reflections on the Role of the Non-Indigenous Ally. Am J Community Psychol. 2019 Sep 1;64(1\\u0026ndash;2):59\\u0026ndash;71. \\u003c/li\\u003e\\n\\u003cli\\u003eAboriginal \\u0026amp; Torres Strait Islander curriculum framework 2016. https://www.health.gov.au/internet/main/publishing.nsf/Content/aboriginal-torres-strait-islander-health-curriculum-framework. Accessed July 25, 2024. \\u003c/li\\u003e\\n\\u003cli\\u003eBaba L. Cultural safety in First Nations, Inuit and M\\u0026eacute;tis public health: Environmental scan of cultural competency and safety in education, training and health services. Prince George, Canada: National Collaborating Centre for Aboriginal Health; 2013. \\u003c/li\\u003e\\n\\u003cli\\u003eMacLean TL, Qiang JR, Henderson L, Bowra A, Howard L, Pringle V, et al. Indigenous Cultural Safety Training for Applied Health, Social Work, and Education Professionals: A PRISMA Scoping Review. Vol. 20, International Journal of Environmental Research and Public Health. MDPI; 2023. \\u003c/li\\u003e\\n\\u003cli\\u003eRamos-Gomez FJ. Changing the education paradigm in pediatric dentistry. J Calif Dent Assoc. 2014;42(10):711\\u0026ndash;5. \\u003c/li\\u003e\\n\\u003cli\\u003eDonate-Bartfield E, Lobb WK, Roucka TM, Donate-Bartfield E;, Lobb WK; Teaching Culturally Sensitive Care to Dental Students: A Teaching Culturally Sensitive Care to Dental Students: A Multidisciplinary Approach Multidisciplinary Approach Recommended Citation Recommended Citation [Internet]. 2014. Available from: https://epublications.marquette.edu/dentistry_fac\\u003c/li\\u003e\\n\\u003cli\\u003eMari\\u0026ntilde;o R MMHM. Transcultural dental training: addressing the oral health care needs of people from culturally diverse backgrounds. Community dentistry and oral epidemiology. 2012 Oct; 40:134-40. \\u003c/li\\u003e\\n\\u003cli\\u003eKurtz DLM TDNJMD. Social justice and health equity: urban Aboriginal women\\u0026rsquo;s actions for health reform. Int J Health Wellness Soc. 2014; 3:13-26. \\u003c/li\\u003e\\n\\u003cli\\u003eCanada School of Public Service. Being an Ally to Indigenous Peoples [Internet]. Ottawa, ON: Canada School of Public Service; 2024 Feb 15 [cited 2024 Jul 24]. Available from: https://catalogue.csps-efpc.gc.ca/product?catalog=IRA1-E29\\u0026amp;cm_locale=en. \\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Footnotes\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003e \\u0026ldquo;Being an ally involves actively supporting and advocating for marginalized or underrepresented groups and is an ongoing process which requires commitment, social action, strength, courage, humility, and a support network. Being an ally to Indigenous Peoples means recognizing the privileges that settlers have and helping to eliminate barriers and other challenges facing Indigenous Peoples.\\u0026rdquo;(50)\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 3.1 Description of the designated numbers according to Figure 3.2\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"744\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAddressed Indigenous topics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAddressed Indigenous topics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eHistory\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003eColonial Policies \\u0026amp; Aboriginal Right\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eCulture and Identity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003eColonial Histories\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eIndigenous Diversity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003eAboriginal Health Governance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eIndigenous Peoples Health\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003eHealthcare system \\u0026amp; Indigenous People\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eRacism and Impacts on Indigenous Health\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003eTwo-Eyed Seeing \\u0026amp; Models of Wellness\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eStewardship, Resistance \\u0026amp; Activism\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003eResearch \\u0026amp; Health Outcomes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eTrauma and Violence Informed Care\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003eCommunity Engagement \\u0026amp; Transforming Care\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eDeterminants of Indigenous People\\u0026rsquo;s Health\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 40.6711%;\\\"\\u003e\\n \\u003cp\\u003eEffect of colonialism\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.05369%;\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 42.2819%;\\\"\\u003e\\n \\u003cp\\u003eCulture, Language, and Self-Determination\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 8.99329%;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 48.7248%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3.2 Employed methods of assessment by the program type\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"686\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEmployed assessment techniques\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 283px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eProgram type\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal (n=27)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePercentage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003eUndergraduate dental programs (n=7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003eDental hygiene programs (n=20)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eNo assessment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e22.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eWritten exams (multiple choice, pretest-posttest, etc.)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e59.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eCommunity feedback\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e29.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eObjective structured clinical examination (OSCE)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e7.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eReflection/Reflective journal\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e51.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eReport/essay\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e25.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eOral presentation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e37%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 216px;\\\"\\u003e\\n \\u003cp\\u003eDiscussion\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 150px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 89px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e11.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3.3 Barriers to Indigenous education\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"630\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBarriers\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 234px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eProgram type\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal (n=12)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePercentage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003eDentistry\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(n=5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003eDental hygiene\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(n=7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003eLack of knowledge\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e50%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003eLack of interest\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e33.3%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003eLack of budget\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e25%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003ePacked curriculum\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e83.3%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003eShortage of faculty members\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 120px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 90px;\\\"\\u003e\\n \\u003cp\\u003e58.3%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Education, Dental hygiene, Dentistry, Indigenous, Cultural competence\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6370523/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6370523/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eObjective:\\u003c/strong\\u003eTo explore the extent to which Indigenous content is taught in dental and dental hygiene curricula across Canada, and to identify their objectives, delivery methods, and barriers and facilitators.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e A descriptive cross-sectional design was utilized via an anonymous survey developed using the Qualtrics® platform. The survey was distributed to faculty members from all accredited dental and dental hygiene programs in Canada. The survey included 29 items focusing on demographic characteristics, Indigenous teaching, methods of delivery, assessment techniques, barriers, and facilitators. Descriptive analysis was conducted using SPSS® software version 29.0.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003eResponses were received from 34 programs; 90% of the undergraduate dental programs and 71% of the dental hygiene programs participated. Of the programs surveyed, 94.1% (n=32) include Indigenous content. On average, 12.94 ± 7.44 hours was dedicated to teaching such content. The most common delivery method was didactic format (88%), and the most frequently covered topics were History and Indigenous People's Health, each covered in 79.4% of programs. Major barriers identified were overcrowded curricula (83.3%) and faculty shortages (58.3%), while key facilitators included supportive institutional policies (71.4%) and engagement with Indigenous experts (61.9%).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion:\\u003c/strong\\u003eThe study reveals that most Canadian dental and dental hygiene programs included Indigenous content within their training. However, barriers such as overcrowded curricula and faculty shortages persist. Supportive institutional policies and the involvement of Indigenous professionals are vital for effective curriculum indigenization.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The extent of Dentistry and Dental hygiene curriculum Indigenization across Canada\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-04-04 03:50:25\",\"doi\":\"10.21203/rs.3.rs-6370523/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"9eceb102-4ab3-44e1-a816-f39523e3cb04\",\"owner\":[],\"postedDate\":\"April 4th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":46645535,\"name\":\"Dentistry\"},{\"id\":46645536,\"name\":\"Special Education\"}],\"tags\":[],\"updatedAt\":\"2025-04-04T03:50:25+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-04-04 03:50:25\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6370523\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6370523\",\"identity\":\"rs-6370523\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}