From Treaty obligations to medical curriculum: embedding Indigenous health in physician training

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By Dr. Wayne Inuglak Clark, Director, Wâpanachakos Indigenous Health Program; Assistant Professor, Department of Psychiatry, University of Alberta; and Visiting Assistant Professor, Johns Hopkins School of Public Health

Indigenous health has progressed as a comprehensive domain within medicine, integrating clinical practice, cultural safety, land-based healing, and distinctions-based pathways to medical education. Its roots can be traced to early treaty negotiations, most notably Treaty No. 6, which included the “medicine chest clause” as a foundational commitment to Indigenous health. As the 150^th anniversary of Treaty No. 6 approaches in 2026, it is essential to recognize that this promise was later overshadowed by the creation of a federally administered Indigenous health system, which segregated Indigenous Peoples, contributing to systemic discrimination and marginalization.

In the mid-20^th century, federal hospitals nationwide embodied this system. The Charles Camsell Hospital in Edmonton operated from 1946 to 1996 and became emblematic of a segregated healthcare model. As awareness grew around the shortcomings and inequities of this system, Indigenous health began to shift toward more modern practices. These included the introduction of language interpretation services into the broader health system and were a critical component for ensuring Indigenous patients could receive care in their language, communicate effectively with providers, and give informed consent.

This gradual formation highlighted a broader truth: Indigenous health expertise was needed for patient navigation within First Nations, Métis, and Inuit health systems and to support care planning that accounted for the diversity of available healthcare services across Indigenous communities. To bridge these gaps, Indigenous health programs increasingly support interdisciplinary teams by offering patient navigation, advocacy, and other healthcare strategies. Although there have been several reorganizations of Indigenous health governance at the federal level, the creation of the First Nations and Inuit Health Branch (FNIHB) in 1991 marked a formal attempt to begin integrating and coordinating these parallel systems. Despite this, substantial gaps in service delivery and policy alignment remained.

Against this historic and policy backdrop, it becomes clear that medical education must also evolve to meet the needs of Indigenous communities. Given this complex history and the contemporary realities of healthcare delivery for Indigenous populations, it is essential to train medical students in Indigenous health. Studies have shown that culturally unsafe care contributes to lower health service utilization and poorer health outcomes among Indigenous patients. Future physicians must have the knowledge and skills to provide culturally safe and responsive care. This includes understanding the legacy of colonialism, residential schools, and systemic racism, as well as the current jurisdictional landscape of Indigenous health systems.

Training in Indigenous health also prepares students to work collaboratively with Indigenous communities, to respect traditional healing practices, and to advocate for equitable access to care. As Indigenous communities advance self-determined approaches to healthcare, physicians must ensure their involvement reinforces, rather than inadvertently undermines, these initiatives. Embedding Indigenous health education within medical curricula is a matter of health equity, reconciliation, and a professional obligation to ensure competent, ethical, and inclusive care for all patients. This shift aligns with the Truth and Reconciliation Commission’s Call to Action #24, which urges medical and nursing schools in Canada to require all students to take a course on Indigenous health, including the legacy of residential schools and the United Nations Declaration on the Rights of Indigenous Peoples.

At the University of Alberta, this vision is actively being realized through the work of the Wâpanachakos Indigenous Health Program, which is vital in supporting undergraduate and postgraduate medical students in developing the competencies required. The name Wâpanachakos was gifted by Mosom Rick Lightning of Maskwacis, which translates to “the morning star” in English. The term carries rich cultural and symbolic meaning in Cree. For the program, the term symbolizes a new path forward in medical education, guided by Indigenous knowledge and rising with purpose, much like the morning star itself. This is achieved through a comprehensive approach focusing on three interconnected areas: curriculum, community engagement, and admissions. Wâpanachakos prioritizes Indigenous leadership in decision-making, ensuring that Indigenous perspectives inform programmatic elements.

Within the curriculum, the program weaves Indigenous health content throughout undergraduate and postgraduate medical training. Core topics include the history and ongoing impacts of colonialism, the social determinants of health, intergenerational trauma, Indigenous models of wellness, and the complexities of federal, provincial, and Indigenous healthcare systems. By integrating these elements, the curriculum equips all learners with the critical knowledge and practical tools necessary to provide clinically effective and culturally safe care.

Community engagement is central to the program’s approach.

Wâpanachakos works directly with Indigenous communities, Elders, and leaders to identify what they want medical students to learn and how they wish to be involved in shaping educational programs. A key component of this engagement is the integration of land-based education, developed in partnership with community members, which reinforces Indigenous ways of knowing and healing while deepening students’ understanding of relationality, responsibility, and cultural context. This reciprocal relationship helps ensure that education is grounded in community priorities and upholds the principles of respect, relevance, reciprocity, and responsibility.

In admissions, Wâpanachakos advances a distinctions-based pathway that recognizes the unique histories, rights, and experiences of First Nations, Inuit, and Métis applicants. This approach dismantles structural barriers and promotes equitable representation of Indigenous students within medical education, fostering a more diverse and inclusive physician workforce.

Embedding Indigenous health into medical education is both a response to historical treaty obligations and a forward-looking commitment to reconciliation, equity, and excellence in care. As programs like Wâpanachakos across Canada demonstrate, this work must be intentional, community-led, and sustained across all levels of training. Equipping future physicians with the competencies to serve Indigenous communities is not an optional enrichment. By honouring Indigenous knowledge systems and addressing systemic inequities through education, we can take meaningful steps toward restoring trust, transforming healthcare, and fulfilling our shared responsibilities.

Dr. Wayne Inuglak Clark is an Inuk scholar and Fulbright Arctic Initiative fellow. He is the executive director of the Wâpanachakos Indigenous Health Program and an assistant professor in the Department of Psychiatry at the University of Alberta, as well as a visiting assistant professor at Johns Hopkins University. A national leader in Inuit-led health research, he is a principal investigator on several multimillion-dollar studies focused on culturally safe Indigenous clinical trials, Indigenous health equity, and medical education. Dr. Clark’s list of publications includes peer-reviewed articles and presentations on Inuit health, intergenerational trauma, and research ethics. He serves on national and international bodies, including the National Circle for Indigenous Medical Education, the Association of Faculties of Medicine of Canada, the Canadian Society for Circumpolar Health, and the International Union for Circumpolar Health.