Objective: To synthesise and appraise the design and impact of peer-reviewed evaluations of Indigenous cultural safety training programmes and workshops for healthcare workers in Australia, Canada, New Zealand and/or the United States., Design: Systematic review., Data Sources: Ovid Medline, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Bibliography of Indigenous Peoples in North America, Applied Social Sciences Index & Abstracts, ERIC (Education Resources Information Center), International Bibliography of the Social Sciences, ProQuest Dissertations & Theses Global, Sociological Abstracts, and Web of Science's Social Sciences Citation Index and Science Citation Index from 1 January 2006 to 12 May 2022., Eligibility Criteria: Studies that evaluated the outcomes of educational interventions for selecting studies: designed to improve cultural safety, cultural competency and/or cultural awareness for non-Indigenous adult healthcare professionals in Canada, Australia, New Zealand or the United States., Data Extraction and Synthesis: Our team of Indigenous and allied scientists tailored existing data extraction and quality appraisal tools with input from Indigenous health service partners. We synthesised the results using an iterative narrative approach., Results: 2442 unique titles and abstracts met screening criteria. 13 full texts met full inclusion and quality appraisal criteria. Study designs, intervention characteristics and outcome measures were heterogeneous. Nine studies used mixed methods, two used qualitative methods and two used quantitative methods. Training participants included nurses, family practice residents, specialised practitioners and providers serving specific subpopulations. Theoretical frameworks and pedagogical approaches varied across programmes, which contained overlapping course content. Study outcomes were primarily learner oriented and focused on self-reported changes in knowledge, awareness, beliefs, attitudes and/or the confidence and skills to provide care for Indigenous peoples. The involvement of local Indigenous communities in the development, implementation and evaluation of the interventions was limited., Conclusion: There is limited evidence regarding the effectiveness of specific content and approaches to cultural safety training on improving non-Indigenous health professionals' knowledge of and skills to deliver quality, non-discriminatory care to Indigenous patients. Future research is needed that advances the methodological rigour of training evaluations, is focused on observed clinical outcomes, and is better aligned to local, regional,and/or national Indigenous priorities and needs., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at qqq.icmje.org/disclosure-of-interest/. B-JH, SF and CZ declare no competing interests. JS has no significant competing interests. JS is a sibling of DS. JS and DS are both members of the Indigenous Cultural Safety Learning Series Advisory Circle in Canada, funded by San’yas and co-hosted by the Ontario Federation of Indigenous Friendship Centres. The Indigenous Cultural Safety Learning Series is a webinar series focused on Indigenous cultural safety. It is guided by an Advisory Circle of Indigenous leaders from across Canada. DS was employed by the Southwest Ontario Aboriginal Health Access Centre (SOAHAC) (one of the funding agencies), in the early stages of this review until March 2020. DS is currently employed by San’yas Indigenous Cultural Safety Learning Programs, Indigenous Health, Provincial Health Services Authority as of September 2020. They offer educational interventions and consultation services designed to uproot anti-Indigenous racism and promote cultural safety for Indigenous peoples. One of the interventions studied included an early version of one of the online training programmes offered by San’yas. It was referred to as Indigenous Cultural Competency (ICC) and was applied as part of a larger intervention in one of the articles included in the systematic review. This version was delivered prior to DS’ employment with San’yas. The program is situated within a Provincial Health Services Authority (PHSA) in British Columbia, Canada and operated on a non-profit, cost recovery model through fees charged for the training and with oversight by PHSA Indigenous Health Leadership. All of DS' compensation is subject to PHSA policies and DS is not permitted to receive any compensation or payments outside of salary and benefits. DS' contributions were limited to the conceptual design of the study as well as high level commentary and feedback on high level thematic analyses and draft manuscripts. DS was blinded to the mention of ICC (now San'yas) training materials in any discussions related to higher level thematic analysis., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)