Decolonizing medical education and practice through leadership, research and teaching
Dr. Lynden Crowshoe wins Dr. Thomas Dignan Indigenous Health Award
For Lynden (Lindsay) Crowshoe, MD, decolonization underscores all aspects of his career. As a clinician, educator, and institutional leader, his calm, reasoned approach to making change happen is making a difference.
A member of the Piikani Nation in Alberta and director of the Indigenous Health Program at the Cumming School of Medicine, University of Calgary, Dr. Crowshoe is the Royal College’s 2020 winner of the Dr. Thomas Dignan Indigenous Health Award.
“I speak up in a way that motivates people to shift by inviting self-reflection and collaboration, rather than perpetuating oppression and conflict. In doing so, my intention is centred within Indigenous approaches to knowledge, process and relationship.” -Dr. Lynden Crowshoe
The award was founded in 2014 in honour of Dr. Thomas Dignan, a Mohawk from Six Nations of the Grand River Territory at Thunder Bay and a tireless advocate for eradicating disparities in health outcomes and inequities in the quality of health care facing Indigenous Peoples. He dedicated his life to improving the health of Indigenous Peoples in Canada, especially in drawing attention to institutional racism – which is also where Dr. Crowshoe focuses his efforts.
Founder of Elbow River Healing Lodge
“Racism creates a bias toward Western-only concepts and is dismissive of other knowledge bases,” says Dr. Crowshoe, founder of the Elbow River Healing Lodge, a Calgary clinic serving Indigenous Peoples. The lodge demonstrates what is possible through a practice of decolonization and inclusivity.
Its mission “is to provide optimal, integrated Indigenous health care and support access to respectful resources for Indigenous Peoples,” says Cumming School and lodge colleague Dr. Cheryl Barnabe. “The guiding principles of the clinic are connectedness, empathy, non-judgmental approaches, inclusiveness, flexibility, autonomy, and equity.”
At Elbow River, Dr. Crowshoe brought together a talented team of physicians, nurses, social workers, dietitians, administrators and researchers to be part of an innovative approach to patient care. He challenged them to help deconstruct institutional racism, focus on upstream social causes of current health outcomes and integrate traditional Indigenous healing practices within a Western system.
“With elders there’s a nice sharing of understanding,” Dr. Crowshoe says. “You hear the drumming, smell the burning sage. It is a daily reminder of how traditional Indigenous world views and practices promote wellness.”
The lodge developed from iterative engagement with community, patients, health care staff, the broader health care system and emerging primary health care systems evidence.
“I felt that our clinic needed to respect community priorities while grounded in best practice models of care,” explains Dr. Crowshoe. “My job was to translate all this knowledge. I did so, mostly while exercising in the gym where I read articles, deeply reflected, connected ideas and wrote. It was a kinetic process.”
He also sees the lodge as a teaching tool for the next generation of physicians and Indigenous community leaders. Dr. Crowshoe provides undergraduate and postgraduate clinical teaching there and organizes visits for Indigenous high school students.
Decolonizing medical education
“I think that some of the challenges in decolonizing medical education include space and curriculum – or lack of space,” Dr. Crowshoe says. “We’re competing with the needs of other emerging areas because we are always expanding our understanding of health and health outcomes. There are many individuals advocating for space in a curriculum.”
Dr. Crowshoe tackles this problem through research and institutional leadership. His long and successful career as a researcher focuses on health systems and medical education research for improved delivery of culturally safe care.
He has been involved with 58 peer-reviewed grants, including recent CIHR grants for the Indigenous Primary Healthcare and Policy Research Network, the Alberta Indigenous Mentorship in Health Innovation Network, Educating for Equity in diabetes care, an Indigenous dementia and cognitive assessment tool, and a project on Indigenous youth suicide prevention through popular theatre.
Dr. Crowshoe has brought his patient-centred approach to other institutional leadership roles, including that of medical director at Siksika Health Services and medical lead for the Aboriginal Health Program in the Calgary Health Region.
Impacting the academy
At the Cumming School, he sees progress.
“The Internal Medicine Department moved forward very quickly on developing an Indigenous chair after hearing about our Truth and Reconciliation engagement process and outcomes,” he says of his work in advancing reconciliation at the university. “And the Faculty Development Department has moved forward on developing resources for faculty leadership with an Indigenous lens.
“Another unit that is focused on community engagement is building an Indigenous hub as a resource to support all the units within the medical school in developing Indigenous health medical education.”
Facilitating resilience through the arts
As a clinician, Dr. Crowshoe draws upon theatre and music in connecting with patients and communities, especially Indigenous youth. In some of the remote fly-in communities he serves, he’s known as ‘the doctor with the guitar.’
“I’ve been engaging using various types of art, mostly theatre, in order to connect these concepts and ideas that the social sciences offer us,” says Dr. Crowshoe, who plays in a band and also sings. “It’s about exploring these things and engaging young people to build an understanding of the capacities and strengths needed to interrupt toxic stress in their lives.”
There are many outcomes of colonization, he explains, and overwhelming stress is one of them. “What are the resiliencies that we have and can build upon? We then have to move that into a policy dialogue with stakeholders.”
Influencing policy development
“Dr. Crowshoe has an exceptional ability to examine complex subject matter from a holistic perspective,” says Dr. Chris Sarin, Deputy Medical Officer of Health with the First Nations and Inuit Branch of Health Canada in Alberta. “This has made him my ‘go-to guy’ when it comes to considering policy changes impacting the clinical care of Indigenous Albertans.”
And when it comes to policy advocacy, Dr. Crowshoe gets results through calm, thoughtful engagement.
“Of course I get annoyed and fired up!” he says about reacting to elements of institutional racism. “I speak up in a way that motivates people to shift by inviting self-reflection and collaboration, rather than perpetuating oppression and conflict. In doing so, my intention is centred within Indigenous approaches to knowledge, process and relationship.
“There is a time and place for ‘yelling-in-your face advocacy,’ he says, “but there is more time and space for thinking through things in a different light and helping people to see who they are and address their biases.”
Dr. Crowshoe completed his medical degree at the University of Alberta in 1995 and is currently an associate professor at the University of Calgary.