Health Sciences cultural safety education in Australia, Canada, New Zealand, and the United States: a literature review.

Objectives: To review the research literature on cultural safety education within post-secondary health science programs.
Methods: We conducted health and social science database searches from 1996-2016, using combined keywords: cultural competence or safety; teaching or curriculum; universities, polytechnics or professional programs; and Aboriginal or Indigenous. In dyads, authors selected, and reviewed studies independently followed by discussion and consensus to identify thematic linkages of major findings.
Results: A total of 1583 abstracts and 122 full-text articles were reviewed with 40 selected for final inclusion. Publications from Australia, Canada, New Zealand and the United States described curriculum development and delivery. A variety of evaluation approaches were used including anecdotal reports, focus groups, interviews, course evaluations, reflective journals, pre-post surveys, critical reflective papers, and exam questions. Duration and depth of curricular exposure ranged from one day to integration across a six-year program.  Changes in student knowledge, attitude, self-confidence, and behaviour when working with Indigenous populations were reported. Cultural safety education and application to practice were shown to be linked to improved relationships, healthier outcomes, and increased number of Indigenous people entering health education programs and graduates interested in working in diverse communities.
Conclusions: This review provides a summary of multidisciplinary didactic and experiential instructional approaches to cultural safety education and the impact on students, educators and Indigenous people.  Institutional support, strategic planning and cultural safety curriculum policy within post-secondary settings and community engagement are imperative for positive student experiences, advocacy, and actions toward health equity and improved health for Indigenous people and communities.