Cultural Competency, Cultural Safety, Medical Education
Conditions
Keywords
Two-Spirit, Métis, AI, OSCE, Indigenous Health, Obstetrics and Gynecology
Brief summary
Two-Spirit (2S) Métis individuals often encounter significant barriers and discrimination in healthcare settings. This multisite randomized controlled feasibility trial evaluates a novel artificial intelligence (AI)-assisted Objective Structured Clinical Examination (OSCE) designed to assess and improve Obstetrics and Gynecology (Ob/Gyn) residents' competencies in delivering culturally safe, trauma-informed, and identity-affirming care to 2S Métis patients. Up to 90 Ob/Gyn residents across three Canadian academic sites (University of Alberta, University of Manitoba, and University of Saskatchewan) will be randomized 1:1 to complete either a 2S Métis Academic Half Day paired with AI-assisted OSCE evaluation or standard institutional anti-racism training with AI-assisted OSCE evaluation. The primary focus is to evaluate study feasibility (recruitment, retention, and delivery fidelity) and resident performance on clinical communication, trauma-informed care, and cultural humility evaluated using a 2S Métis co-developed scoring rubric.
Detailed description
Two-Spirit (2S) Métis people experience systemic discrimination, exclusion, and culturally unsafe care, particularly in reproductive, perinatal, and gender-affirming healthcare contexts. In response to the Truth and Reconciliation Commission's Call to Action #24, this study introduces an innovative educational model integrating artificial intelligence, Indigenous governance, and culturally specific evaluation frameworks to strengthen resident physician competency. The AI system serves two primary functions: 1. Co-developing culturally grounded assessment rubrics in collaboration with 2S Métis Elders, Knowledge Keepers, and community members. 2. Standardizing patient portrayal during OSCE clinical encounters to ensure consistency, eliminate human actor variability, and avoid the emotional burden associated with repeated standardized patient portrayals. Study Design & Methods: Ob/Gyn residents (PGY1-PGY5) across three participating universities will undergo 1:1 prospective randomization: * Intervention Arm: 2S Métis Academic Half Day (AHD) + AI-assisted OSCE evaluation. * Control Arm: Standard institutional anti-racism and Indigenous cultural safety training + AI-assisted OSCE evaluation. AI Encounter Flow: Participants undergo a 5-minute pre-encounter briefing, a 15-20 minute real-time interaction with the AI-simulated 2S Métis patient, and a 5-minute post-encounter reflection. Recorded encounters will be independently scored by two blinded raters (including at least one 2S Métis community member) using the co-developed structured rubric. Ethics and Data Sovereignty: All algorithms, datasets, and cultural representations are governed by principles of Indigenous Data Sovereignty (OCAP®) and UNDRIP, ensuring community oversight and authority over cultural content, rubric criteria, and data ownership
Interventions
BEHAVIORAL2S Métis Cultural Safety Academic Half Day &AI-OSCE
Ob/GYN residents participate in a dedicated 2S Métis Academic Half Day covering trauma-informed care and cultural humility, followed by a simulated OSCE encounter using an AI-assisted standardized patient and co-developed scoring rubric.
BEHAVIORALStandard Institutional Cultural Safety Training&AI-OSCE
Ob/Gyn residents undergo standard institutional anti-racism/Indigenous cultural safety training, followed by the same AI-assisted 2S Métis OSCE evaluation.
Sponsors
University of Manitoba
University of Alberta
University of Saskatchewan
University Health Network, Toronto
McMaster University
Canadian Institutes of Health Research (CIHR)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Assessors (including 2S Métis raters) scoring the AI-assisted OSCE encounters are blinded to group allocation. Data analysts are also blinded to participant allocation during statistical analysis. Participants cannot be blinded due to the educational nature of the intervention.
Intervention model description
1:1 prospective randomization to either 2S Metis Academic Half Day + AI assigned OSCE or standard institutional training +AI assigned OSCE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Current enrollment in an accredited Obstetrics and Gynecology residency program at one of the participating institutions (University of Alberta, University of Manitoba, or University of Saskatchewan). \* Postgraduate Year 1 through 5 (PGY1-PGY5). \* Fluency in English to ensure comprehension of AI-based encounters. \* Willingness and ability to participate fully in both the Academic Half Day and AI-assisted OSCE assessments. \* Provision of informed consent.
Exclusion criteria
* Prior participation (within 12 months) in Two-Spirit (2S) Métis-specific or similar cultural safety OSCEs or workshops. \* Residents not enrolled in participating Ob/Gyn residency programs.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Study Feasibility Metrics | Up to 12 months | Feasibility evaluated by participant recruitment rate (target of 90 Ob/Gyn residents across 3 sites), study retention/completion rate, and intervention delivery fidelity across all participating institutions. |
| Resident Clinical Communication and Cultural Safety Performance Score | Immediately post-intervention | Objective Structured Clinical Examination (OSCE) performance score assessing clinical communication, trauma-informed care, and cultural humility evaluated using the co-developed 2S Métis scoring rubric (scored by blinded raters). |
Countries
Canada
Contacts
CONTACTMelanie Morris, MD
CONTACTTibetha Kemble, PhD
Outcome results
None listed