Being an Indigenous-specific antiracist educator in health professions: a qualitative study of health educators’ learning journeys in Canada

Abstract

Background

Racism experienced by Indigenous Peoples in Canada is rooted in ongoing settler colonialism and represents a structural determinant of health and a significant barrier to their access to healthcare and well-being. Indigenous-specific antiracist education, which centers colonial relations to land and Indigenous sovereignty, is therefore imperative in health professions’ initial and continuing education. Antiracist pedagogy shows promise as it relies on learners’ and educators’ critical reflection and action to transform practices and organizations. This Canadian study aimed to explore educators’ experiences engaging in Indigenous-specific antiracist education, focusing on how they navigate the challenges and complexities of this approach in their practices.

Method

Following a biographical narrative methodology, we conducted 17 in-depth interviews with educators from diverse racial and experiential backgrounds.

Results

We identified three interconnected components of being an Indigenous-specific antiracist educator: situating oneself in relation to the land and Indigenous sovereignty, taking responsibility for unlearning colonial narratives and learning from Indigenous knowledge systems, and showing up to navigate resistance to decolonization. By framing these experiences as part of a never-ending learning spiral grounded in relational accountability, this research offers a framework for understanding the complexities of Indigenous-specific antiracist work in educational and healthcare settings.

Conclusion

The results of this research will help guide and support the practice and training of health professions educators to engage and deepen the dialogue about racism in health care and support action-oriented strategies that address issues of racism and interlocking systems of oppression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-09001-4.

Introduction

Racism experienced by Indigenous Peoples in the Canadian healthcare system is recognized as a significant barrier to access to healthcare and the well-being of these populations [1]. Indeed, systemic racism present in social institutions is inherent in producing and maintaining health inequities [2]. Krieger, for example, demonstrated a direct causal relationship between racial discrimination and hypertension, low birth weight, and preterm labour [2]. Other authors have shown that racism affects access to education, employment, housing, and health care [3, 4]. Indigenous people who seek health services face obstacles that are difficult to overcome, such as prejudices and a lack of understanding of Indigenous realities [1, 5, 6].

In this context and as stated in the calls to action of the Truth and Reconciliation Commission of Canada [7], it becomes imperative to include notions related to Indigenous-specific racism in both the initial training and continuing education of health professionals. Antiracist pedagogy shows promise because it focuses on the critical thinking of learners and educators on discrimination to transform practices at individual and structural levels [8]. In health education, antiracist pedagogy focuses on critically examining and addressing how systemic racism affects health outcomes and opportunities within the healthcare system. It aims to transform healthcare practices by challenging individual biases and institutional structures perpetuating racial inequities, ensuring that future healthcare professionals are equipped to provide culturally safe, equitable care [9].

Yet, historically, in health professions education, issues of racism, discrimination, and equity have been addressed through the lens of multiculturalism, cultural sensitivity, and cultural competence [10]. However, an increasing number of studies show that culture-centred teaching does not allow for a change in practices or a reduction in the impacts of systemic racism [11]. Indeed, multicultural approaches fail to identify the issues associated with race and racism and to allow learners to develop an in-depth understanding of relations of power and oppression at the system level [12–14]. Critical perspectives, such as an antiracist pedagogical approach, enable learners to understand the societal and structural factors underlying health inequities by focusing on the legacy of colonialism and the recognition of power relations prevalent in the culture of health sciences and health care practices and systems [15–19].

Studies that describe the experiences of educators who must address issues related to racism in health care conclude that many of them are reticent and actively avoid doing so [20–22]. This discomfort is often attributed to insufficient knowledge or inadequate training and a lack of credibility or confidence [17, 21, 23]. Becoming an antiracist educator is raised as both an individual and professional process, sometimes uncomfortable and requiring a re-examination of one’s preconceptions and biases. These findings underline the numerous requirements for adopting antiracist pedagogical approaches and emphasize the importance of allocating more time and resources to training educators who need to integrate these approaches [12].

Consequently, and because an antiracist pedagogical approach is rarely used in health professions education [24], supporting educators should be a priority when redefining Indigenous health programs to ensure their mobilization and the success and longevity of the programs [12, 17, 25]. Despite growing recognition of the need for Indigenous-specific antiracist education in health professions, significant gaps remain in our understanding of how to effectively prepare and support educators to do this work. While there is emerging literature on Indigenous health curricula and cultural safety training [26–29], less is known about the educators themselves, how they develop the knowledge, critical consciousness, skills, and dispositions required for Indigenous-specific antiracist pedagogy, and how they navigate the complexities and challenges of implementing this approach in educational and healthcare settings. Understanding educators’ experiences and learning journeys is critical for several reasons. First, educators serve as the bridge between policy commitments to equity and the actual transformation of educational practices. Institutional statements supporting Indigenous health equity are meaningless without educators who can translate these commitments into pedagogical action. Second, Indigenous-specific antiracist education is inherently challenging work that requires ongoing learning, reflexivity, and navigation of resistance from students, colleagues, and institutions [23–25, 28]. Understanding how educators actually engage in this work, including their strategies and the barriers they face, can inform more effective educator development and institutional support.

This study addresses these gaps by exploring the experiences of health professions educators engaged in Indigenous-specific antiracist education across Canada, examining how they navigate the challenges and complexities of this approach in their practices.

Theoretical underpinnings

Indigenous-specific antiracism: conceptual distinctions

To situate this study, we define Indigenous-specific antiracist education in relation to commonly cited approaches in health professions education. Cultural competence and cultural sensitivity focus primarily on developing knowledge, skills, and respectful attitudes toward cultural differences but have been critiqued for treating culture as static and for insufficiently addressing power relations and systemic racism [26, 27, 29]. Cultural safety, originally developed by Māori nurse Irihapeti Ramsden, advances this conversation by centering patients’ experiences and requiring practitioners to examine power dynamics; however, it does not always explicitly foreground colonialism, land, or Indigenous sovereignty as structural determinants of health inequities [26].

Antiracist education moves further by explicitly naming racism as systemic and by promoting critical consciousness and action to transform inequitable structures (23–25). Indigenous-specific antiracist education builds on this foundation but is distinguished by its grounding in settler colonialism and its explicit attention to land, treaties, and Indigenous sovereignty [28, 30, 31]. It recognizes that racism toward Indigenous Peoples is inseparable from the ongoing colonial project and therefore requires educational approaches that confront these structures rather than focusing solely on cultural understanding or interpersonal bias.

Therefore, Indigenous-specific antiracist education requires recognizing ongoing relationships to Indigenous lands and the responsibilities these relationships entail [31, 32], centering Indigenous sovereignty and self-determination [30, 32], and understanding colonialism as an ongoing structure shaping contemporary healthcare, education, and social systems [1, 5, 6]. It also demands accountability to Indigenous knowledge systems, epistemologies, and pedagogies, emphasizing learning from Indigenous Peoples rather than merely learning about them [28, 32]. Finally, this work requires sustained attention to positionality, whether Indigenous, white settler, or racialized settler, and to the distinct relationships each position holds in relation to land, colonialism, and accountability [30, 31].

Experiential learning in the integration of an antiracist pedagogical approach

This study is grounded in Indigenous epistemologies and pedagogies, complemented by experiential and critical learning theories.

Indigenous epistemologies and pedagogies

This study is grounded primarily in Indigenous epistemologies, recognizing that Indigenous-specific antiracist education must be rooted in Indigenous ways of knowing, being, and relating. Indigenous knowledge systems are inherently relational, with knowledge emerging through relationships to land, ancestors, communities, and all living beings [33]. This relational ontology calls for relational accountability, an ethical responsibility to act in ways that honor these relationships through ongoing engagement with Indigenous communities, territories, and knowledge systems. Central to this perspective is land-based pedagogy, which positions land as a teacher and foregrounds questions of territory, treaty, sovereignty, and the ongoing realities of settler colonialism [34, 35]. The need for critical reflexivity is also important, urging educators, particularly settlers, to recognize their implication in colonial structures and move beyond innocence toward accountability [30].

Experiential learning and critical pedagogy as complementary frameworks

While Indigenous epistemologies provide the primary grounding for this research, experiential learning [36] and critical pedagogy [37] serve as complementary frameworks for understanding participants’ learning processes. Experiential learning emphasizes the interplay of experience, reflection, and action, a cycle reflected in educators’ evolving practices. Critical pedagogy underscores that education is never neutral and calls for the development of critical consciousness alongside praxis oriented toward social transformation. We remain attentive, however, to the Western origins of these theories and hold them accountable to Indigenous epistemologies, recognizing the longstanding pedagogical traditions developed by Indigenous scholars [38].

A relational, land-based, critical learning framework

Together, these perspectives frame Indigenous-specific antiracist education as requiring relational accountability to land, communities, and knowledge systems; a land-based consciousness attuned to territory and sovereignty; and ongoing reflexivity about one’s positionality within colonial relations. Experiential engagement and critical praxis further support learning that is both reflective and action-oriented. This integrated framework guided our research design, data collection, and analysis, providing a lens for understanding the journeys of educators engaged in Indigenous-specific antiracist education.

The use of racial categories in this research

Antiracism recognizes that our experiences unfold within specific contexts that are not neutral. In Indigenous-specific antiracism, there is an understanding that our experiences and identities are shaped by the ongoing impacts of colonialism, which is embedded in both time and place. This approach acknowledges that antiracist work must consider the historical and contemporary colonial structures that continue to shape Indigenous experiences, particularly within systems like healthcare and education [1, 28]. By anchoring antiracism in the specific time and place of colonial history and its present-day manifestations, Indigenous-specific antiracism aims to disrupt colonial legacies and promote equity in a way that respects and uplifts Indigenous identities, histories, and sovereignties.

We recognize Canada’s unique history and that Indigenous Peoples’ encounters with systemic racism are often overlooked and erased. To highlight the distinctiveness of Indigenous experiences globally, we use the racial categories of Indigenous Peoples (IP), racialized settlers (RS), and white settlers (WS). In the Canadian context, these categories reflect the specific history and ongoing reality of settler colonialism, in which settlers (both white and racialized) occupy Indigenous lands and benefit from colonial structures, while Indigenous Peoples continue to assert sovereignty and resist erasure [30, 36]. The category of racialized settlers acknowledges that some settlers experience racism while being positioned as settlers in relation to Indigenous Peoples, a complexity that shapes their engagement with Indigenous-specific antiracism. We use racialized settlers to describe individuals who share experiences of political struggles for equity in a society favouring whiteness, with the caveat that they are also settlers who share the unearned benefits of living on Indigenous lands. However, unlike white people, we acknowledge that racialized settlers do not benefit equally, or at all, from their settler privilege. We recognize the risk of homogenizing and simplifying experiences but opted for the term to balance clarity and confidentiality.

Our use of “racialized” aligns with the Ontario Human Rights Commission’s definition, which recognizes race as a socially constructed distinction. However, we acknowledge that the term may not fully capture Canada’s unique history or the systemic racism faced by Indigenous communities. The term “Indigenous” encompasses individuals identifying as First Nations, Métis, or Inuit, acknowledging their distinct experiences and the international legal rights outlined in the UN Declaration on the Rights of Indigenous Peoples. Grouping by this distinction is a strategic approach that facilitates discussions of shared experiences. These categories reflect a political and ethical stance rooted in Indigenous-specific antiracism, which foregrounds place-based colonial histories while recognizing the differential and unequal ways settler colonialism confers privilege. Importantly, the analysis remained attentive to how Indigenous participants spoke from a distinct positionality tied to sovereignty, land, and ongoing colonial violence, even when this was not presented in a separate results section. We acknowledge that further disaggregation may be warranted in future studies with larger and more balanced samples, and we remain committed to amplifying Indigenous voices in ways that are both rigorous and relationally accountable.

Methodology

This study was guided by two research questions: (1) How do educators experience engaging in Indigenous-specific antiracist education? (2) How do educators navigate the challenges and complexities of engaging in this work? By experience, we refer to the lived, embodied, and relational dimensions of educators’ engagement with Indigenous-specific antiracist education. This includes their learning processes, professional identity development, emotional responses, relational dynamics, and navigation of institutional contexts.

Our focus on experience aligns with biographical narrative methodology, which understands experience as lived, storied, and shaped by social, historical, and political contexts [39]. This methodology further recognizes that we learn from life experiences, whether inside or outside, and sometimes even despite educational institutions [26, 27].

We report the methodology of this research following the COREQ guidelines [40] to ensure comprehensive and transparent reporting of the study’s design, implementation, and analysis.

Indigenous methodological considerations and research team reflexivity

We recognize that conducting research about Indigenous-specific antiracism requires methodological approaches that align with the values and epistemologies we seek to honor in our findings. While this study employed biographical narrative methodology as its primary methodological framework, our research was guided by Indigenous principles and epistemologies, particularly the concepts of relational accountability, reciprocity, and critical reflexivity as described elsewhere [41].

We believe that who we are, where we write from, and the land we are on now inform the knowledge and understanding we develop and share. Our team comprises members with expertise rooted in Indigenous and settler identities. Indigenous scholars, educators, and health and social services professionals (n = 4) from various Nations (Kwakwaka’wakw, Atikamekw, Metis, Innue) contribute insights shaped by their cultural heritage, community connections, and lived experiences. Their work focuses on decolonizing healthcare education, advocating for health equity, and integrating antiracism into curricula to address Indigenous-specific systemic racism and health inequities. Alongside them, white settlers scholars and educators (n = 4) bring extensive experience in health professionals’ education, antiracism, and social justice. They are committed to challenging colonial narratives, incorporating antiracist approaches into education, and promoting equity within academic settings. Collectively, the team is dedicated to advancing culturally safe, Indigenous-specific antiracist educational practices that honour diverse voices, respect various knowledge systems, and address systemic barriers to Indigenous health equity.

All team members were involved in research design, and Indigenous team members had particular authority in decisions about ethical protocols, interpretation of data, and ensuring the research remained accountable to Indigenous communities. Conscious of the risks of epistemic extraction (i.e. the use of Indigenous knowledge without accountability), Indigenous members of the team were full partners with decision-making authority. Additionally, we centered Indigenous epistemologies in our framework and analysis and maintained relationships with participants and communities throughout the study while acknowledging the limits of our work. We also sustained critical attention to power and positionality through ongoing reflexive dialogue. Reflexivity remained integral across all stages of the research. Regular team discussions helped examine how our social locations shaped the process and supported interpretations grounded in both the data and our guiding theoretical and methodological commitments.

Participant selection

Participants were selected if they met the following criteria:

1. Educators are involved in the initial or continuing education of health professionals.

2. Adoption of an antiracist pedagogical approach as defined by Blakeney [9].

3. Addressing Indigenous health issues in their practice.

Educators using multicultural or culturally based non-critical approaches were excluded.

Sampling and recruitment

Purposive sampling methods were used for this study [42]. A list of potential participants meeting the inclusion criteria was first formed from the research team members’ contacts across Canada. An email invitation to participate in the study was sent to each of these contacts by the research team member who knew them directly or by another research team member after they were permitted to share their contact information within the team. Following a snowball sampling, each participant was invited to identify other people with characteristics of interest to enrich the study. This snowball sampling technique created a chain of networks of contacts, identifying these cases of interest to assist the researchers in recruiting participants [43]. Recruitment continued until data saturation was reached, ensuring that no new significant information emerged from the additional participants.

Data collection

Data collection occurred through virtual interviews, ensuring convenience and accessibility for participants across various geographic locations. First, participants were invited to a 90 to 120-minute initial interview via videoconference (Teams). The interviews were conducted by two research team members, who, in most cases, did not know the participants. Both interviewers had extensive training in qualitative research and experience in antiracist pedagogy. An oral socio-demographic questionnaire was completed, followed by in-depth interview questions. The questionnaire and interview guide were developed for this study (supplementary file 1). Interviews in English or French focused on participants’ conceptions of antiracist pedagogy, defining moments in their journey, and conditions affecting their approach.

Second, participants provided feedback on the initial interview profiles during race-based focus group discussions (n = 8; 60 to 90 min), one-on-one virtual interviews (n = 4; 30 to 60 min), or in writing (n = 5). These feedback sessions aimed to validate the research team’s interpretations. All interviews were recorded audio-only and transcribed verbatim. Transcripts were anonymized and uploaded into MAXQDA (version 2022) for analysis.

Data analysis

Data analysis followed a biographical narrative approach inspired by Breton [39] and proceeded through iterative stages. We first organized participants’ experiences chronologically to trace their antiracist pedagogical journeys, then developed detailed narratives attentive to relational and pedagogical dimensions. These accounts were subsequently situated within broader sociohistorical and professional contexts to support interpretive depth. An inductive thematic analysis [44], conducted alongside data collection, identified defining moments and contextual factors shaping educators’ engagement in this work. Although we remained attentive to the specificity of Indigenous participants’ experiences, we did not further disaggregate findings by racial category due to confidentiality concerns associated with the small sample and the presence of shared systemic dynamics across narratives.

Coding and theme development were collaborative and iterative, with Indigenous team members playing a central role throughout the analytic process. After initial familiarization by the full team, the first author conducted open coding to capture key experiences, including learning territorial histories, confronting discomfort, building relationships with Indigenous knowledge keepers, and navigating institutional barriers. Indigenous scholars were instrumental in guiding interpretive decisions, helping distinguish Indigenous-specific dimensions of antiracist education from broader equity work, and ensuring that emerging analyses remained grounded in Indigenous epistemologies. Team discussions were structured to centre these perspectives, particularly when examining how experiences differed across positionalities (Indigenous, racialized settler, white settler).

Themes were refined through ongoing dialogue and member checking, with participant feedback further strengthening the analysis and informing the adoption of the “learning spiral” metaphor to reflect the iterative, non-linear nature of educator learning. Indigenous team members also led the validation of interpretations to ensure they honoured Indigenous knowledge systems and accurately represented participants’ experiences. When differing perspectives emerged, they were addressed through relational dialogue, with interpretive priority given to Indigenous viewpoints. In the final stage, the three themes were synthesized into the learning spiral framework, capturing how educators revisited challenges with increasing depth rather than progressing toward mastery. Throughout the process, analytic memos documented interpretive decisions, reflexive insights, and team deliberations, enhancing transparency and methodological rigor.

Ethical considerations

The study received ethical approval from the Université de Montréal Ethics Committee for Research in Science and Health (2021 − 1266) on November 12th, 2022. Participants provided informed consent, ensuring confidentiality and voluntary participation.

Results: being an antiracist educator, an intentional learning journey

A total of 17 interviews were included in the study. One participant withdrew from the study after the interview for personal reasons. Following ethical guidelines, the participant’s decision to withdraw was respected without any consequences, and all their data was excluded from the analysis. Despite the withdrawal, sufficient data were collected to achieve thematic saturation.

Participants (see Table 1) self-identified mainly as female (n = 15), followed by trans and non-binary (n = 1) and genderqueer (n = 1). Participants identified as white (n = 9), Indigenous (n = 5), Black (n = 1), and Asian (n = 2). Participants ranged in age from 32 to 65, with a median age of 48. Most participants worked in academia (n = 7), with varied expertise in different fields, mainly education, nursing, and social work. Ten participants hold a doctoral degree, four a master’s degree, and three a bachelor’s degree. Participants came from British Columbia (n = 7), Manitoba (n = 1), Quebec (n = 3), Ontario (n = 4), New Brunswick (n = 1), and Nova Scotia (n = 1).

Table 1.

Participant Characteristics (N = 17)

Characteristic	n
Gender
Women	15
Non binary	2
Racial/Positional Identity*
Indigenous	5
Racialized settler	3
White settler	9
Years of Experience in Antiracist Education
1–5 years	6
6–10 years	5
11–20 years	4
> 20 years	2
Educational Setting
University (undergraduate, graduate)	7
Clinical/practice settings	7
Continuing professional development	5
Primary Learner Groups
Nursing students	8
Medical students	4
Other health professions students	5
Practicing healthcare professionals	7
Geographic Region
Western Canada	7
Central Canada	5
Eastern Canada	5

*Categories are not mutually exclusive as some participants work in multiple settings or with multiple learner groups. **Some Indigenous participants requested not to have their specific nations identified to protect confidentiality

Our analysis revealed that being an Indigenous-specific antiracist educator involves three interconnected and iterative components: [1] situating oneself in relation to the land and Indigenous sovereignty [2], taking responsibility for unlearning colonial narratives and learning from Indigenous knowledge systems, and [3] showing up to navigate resistance to decolonization. Rather than occurring in a linear sequence or repeating in identical cycles, participants described these components as forming a learning spiral, an ongoing, non-linear process in which they continuously returned to fundamental questions and challenges but with evolving depth and understanding.

We chose the metaphor of a “spiral” rather than a “cycle” intentionally, as it better captures several key dimensions of this learning process. Indeed, participants did not describe a linear or sequential process but rather a complex and sometimes messy journey marked by movement across multiple dimensions of learning. They often returned to questions that initially seemed resolved, such as their responsibilities as settlers or how to honor Indigenous knowledge systems, yet each return was accompanied by deeper insight and more nuanced understanding, reflecting a process of accumulation rather than repetition. The spiral metaphor captures this dynamic by emphasizing that learning is ongoing and never complete; participants consistently framed this work as requiring lifelong commitment, accountability, and engagement. This continuous movement is grounded in relationality, with each turn of the spiral representing the deepening of relationships with land, Indigenous communities and knowledge keepers, learners, and oneself as an evolving educator.

Situating oneself in relation to the land and Indigenous sovereignty

The first component of the learning spiral involved educators situating themselves in relation to the land, not simply in relation to their racial or cultural identities, but specifically in relation to the Indigenous territories they occupy and the ongoing reality of settler colonialism. This land-based positionality is what distinguishes Indigenous-specific antiracism from general antiracist work and grounds educators’ accountability.

Understanding relationships to the land

Participants expressed that being antiracist educators is part of their identity and ways of being in the world. They stressed the importance of situating themselves in space and time, bringing forward their relationships with the colonial past and present and with the land they live on. Participants described how their learning began with (and continuously returned to) understanding whose lands they occupy, what treaties or agreements govern those territories, and what responsibilities these relationships entail. This was not simply an intellectual exercise but a fundamental reorientation to their presence on Indigenous lands. A white settler educator explained:

I grew up here, but I never thought about whose land this is. I never thought about what it means that I’m here, that my family has been here for generations, benefiting from land that was stolen. Learning about the specific treaty that governs this territory—what was promised, what was broken—that changed everything for me. It made me realize I have obligations, not just good intentions. (WSP6)

For racialized settler educators, understanding their relationship to land was particularly complex, as they navigated their positioning as both racialized people who experience racism and as settlers who occupy Indigenous lands. One racialized settler participant reflected:

As a person of color, I’ve experienced racism, and I understand oppression. But I had to learn that I’m also a settler. I’m here on stolen land. My family came here as immigrants, and we benefit from colonialism even though we didn’t create it. Understanding that complexity—that I can be both oppressed and an oppressor—that was really uncomfortable but necessary. (RSP17)

Indigenous educators described a different relationship to this component; not learning about their relationship to land but deepening their understanding of how to maintain that relationship while working within colonial institutions. One Indigenous participant shared:

For me, it’s not about learning my relationship to the land—I know who I am, where I come from, my responsibilities. But working in these institutions, I sometimes feel disconnected from those teachings. Part of my journey has been about staying grounded in my identity and my nation’s teachings while doing this work in spaces that weren’t designed for us. (IP1)

Across all groups, participants described antiracism as deeply intertwined with their identities and positionality. However, the specific ways in which antiracism was understood and enacted varied according to these different racialized ways of being in the world. Participants noted the significant historical and contextual differences between anti-Indigenous, anti-Black, and anti-Asian racism, which must be acknowledged to avoid flatlining oppression while on stolen Indigenous land.

Experiencing discomfort as a catalyst for learning

Situating oneself in relation to land and colonialism inevitably involved discomfort, particularly for settler educators. Participants described various sources of discomfort that served as catalysts for deeper learning. Settler educators described the discomfort of recognizing their implication in colonialism, that they are not innocent bystanders but active beneficiaries of colonial structures. As one white settler educator stated:

It’s one thing to learn about colonialism as history. It’s another thing to realize you’re part of it, that you benefit from it every day, that your home is on stolen land. That discomfort… it never really goes away, and I don’t think it should. It keeps me accountable. (WSP3)

Moreover, as they became aware of how centralized whiteness was in institutions and systems, white settler participants also mentioned facing a dilemma between remaining silent to avoid taking the space or speaking for Indigenous Peoples and being passive and inactive, hence complicit to racism.

I was being silent in those meetings […] Not doing– that’s not helpful. How do I carve a space here?” (WSP12).

This discomfort related to the uncertainty of how to respond and what to say or not say was raised by racialized settler participants as well. As a result, they faced constant internal battles between what they could and could not say and do to protect themselves and their livelihoods.

Part for me is always undecided, “Okay, what do you address and what do you let go of?” Usually, in the context of a learning environment, the classroom, workshop, webinar, or even in a paper, because some of the education happens in that form. I always make choices about what I include and don’t include, what I say, what I don’t say. (RSP15)

This dynamic is fundamental as many people avoid stepping up in these situations, and there are consequences to this hesitation. For example, the fear of being labelled as “difficult” or “confrontational” (IP13) may lead individuals to remain silent in the face of harmful comments, allowing toxic behaviours to persist unchecked. Sometimes, hesitating to speak out can result in missed opportunities for educating others, perpetuating ignorance, and maintaining systemic inequities. Moreover, this ongoing internal conflict can take a mental and emotional toll, contributing to burnout, frustration, and a sense of isolation. For Indigenous and racialized settler participants, frustration and anger were expressed as a result of the clash between their antiracist values and the values enacted by the institutions that employed them.

In meetings, I experience a lot of frustration, I experience a lot of anger, I experience a lot of discouragement. (IP4)

The cumulative effect of these hesitations may also prevent meaningful progress in addressing racism, as the discomfort around confrontation stalls open dialogue and constructive change.

Importantly, Indigenous and racialized educators also described the discomfort of being tokenized, of having their knowledge extracted without reciprocity, of bearing the burden of educating others, and of navigating hostile institutional environments. One Indigenous educator shared:

The discomfort for me isn’t about learning I’m complicit in colonialism—I’m surviving it. The discomfort is about whether I can trust these institutions, whether my knowledge will be respected or just used, whether I’m safe to speak truth. (IP1)

Ongoing reflexivity about positionality

Participants emphasized that situating oneself in relation to land and colonialism was not a one-time exercise but required ongoing reflexivity. They described continuously examining their assumptions, biases, and complicity, and how their positionality shaped their teaching and relationships.

The personal journey in this work is significant. Commit to it. It’s an ongoing and daily commitment, not “Now I’m done, and I’m all done and good now.” No, it’s an ongoing learning edge. (WSP12)

Racialized settlers participants explained the need to create a safe space where educators can position themselves as learners. One participant also described this space as a space where one could reflect, talk, connect to oneself and one’s values, and find one’s purpose.

We can critically reflect on ourselves. We need to connect to our values, what matters, and then use those values to guide our action, and such a model is not the outcome that I look to. (RSP16)

Taking responsibility for unlearning colonial narratives and learning from Indigenous knowledge systems

Being an antiracist educator meant for participants to take responsibility for their unlearning and learning by uncovering colonialism and Indigenous-specific racism in health care. Participants described how they were continuously engaged in unlearning colonial narratives and assumptions while simultaneously learning from Indigenous knowledge systems and communities. While unlearning is a component of all antiracist education, the specific content of unlearning in Indigenous-specific antiracism is distinctive. Participants described unlearning not only racial prejudices but specifically colonial narratives about Indigenous Peoples and the ongoing nature of colonialism.

Unlearning colonial narratives

Participants described unlearning colonial narratives as a central dimension of their engagement in Indigenous-specific antiracist education, often beginning with the realization that racism had been insufficiently addressed, or actively obscured, within their professional formation. This process involved developing the language to name racism, colonialism, and white supremacy, thereby making these realities visible in educational and clinical spaces. As one participant explained:

I can remember going in and sitting and having this teacher talk about bell hooks. And I was like, it was just mind-blowing because I thought I’d been through some of those webs in my own life. So that I think, perhaps, changed my thinking around what institutions do, society how things are fluid and they move, and they push, and I think it came from that long process of not being able to get in the door directly. (IP1)

Across positionalities, participants identified several dominant colonial narratives they had to critically examine and unlearn. One was the myth of Canada as a benevolent nation:

I grew up learning that Canada was this peaceful, multicultural nation. I had to unlearn that and learn the truth about residential schools, the Sixties Scoop, forced sterilizations, the ongoing child welfare crisis. Canada has been violent toward Indigenous Peoples, and that violence continues. (RSP17)

Participants also challenged the portrayal of Indigenous Peoples as belonging to the past rather than the present:

I thought of Indigenous Peoples as part of history, not present-day reality. I had to unlearn that and recognize Indigenous Peoples as contemporary, thriving nations with ongoing sovereignty and rights. (RSP16)

Another important shift involved questioning deficit-based framings of Indigenous health that many had encountered in their training. As one participant noted,

In my training, Indigenous health was always framed as ‘health disparities’, what’s wrong with Indigenous communities. I had to unlearn that deficit framing and learn about Indigenous health as a matter of colonialism, racism, and ongoing structural violence, not individual or cultural deficiencies. (IP1)

Participants also described confronting the myth of settler innocence:

I had to unlearn the idea that I’m not responsible for colonialism because I didn’t personally steal land or run residential schools. I had to learn that I benefit from these historical injustices and have responsibility to address them. (WSP12)

For many white settler educators, this awakening was accompanied by frustration upon recognizing how thoroughly these issues had been absent from their education:

What was so significant about that (course) is that at that point, I had already been a nurse for many years, and I was so distraught and mad that I could get through all my nursing, my baccalaureate nursing education, and get through that many years of professional practice without having those concepts challenged in me. (…) Being in a nursing role where you are framed as being the helper, but without having that challenge to know how we’re actually harming simultaneously. (WSP2)

Participants also emphasized the need to deconstruct white exceptionalism and resist framing individuals as “good” or “bad,” noting that antiracist education does not confer moral status nor reach a point of completion. Pathways into this unlearning varied: some educators actively sought training and engaged in difficult self-reflection, while others encountered disorienting perspectives unexpectedly. One participant reflected on the significance of gaining conceptual language:

I had finally learned that I’m white. And I’m like, that seems really basic, but Okay, now I can see that. So I had to learn that. I think I didn’t understand that race wasn’t biological until then. I don’t think that had ever been challenged. So that was getting all that information and having actually to consider the social construction of race. So that was really big, and being able to put those words right is important because you can think about it. […]. It got me more comfortable with using the word racism because we don’t. It was very intentionally excluded from language. I understand that now that it was excluded from language, it was no longer socially appropriate to say racism. (WSP2)

Together, these accounts suggest that language functioned as a critical tool for bringing racism into conversation and challenging normalized assumptions. Finding the words enabled participants to question inherited narratives and engage more directly with the structural realities shaping Indigenous health and education.

Learning from Indigenous knowledge systems

Beyond unlearning colonial narratives, participants described the importance of learning from Indigenous knowledge systems, pedagogies, and ways of being. This learning required humility, reciprocity, and respect for Indigenous knowledge sovereignty.

It’s not enough to unlearn racist ideas. I also have to learn from Indigenous knowledge systems—and that means recognizing that Indigenous Peoples have sophisticated knowledge systems that are different from Western knowledge, not inferior to it. It means being a good guest and learner, not an appropriator. (WSP9)

Participants emphasized that learning from Indigenous knowledge required building relationships with Indigenous knowledge keepers and communities, following cultural protocols, and understanding that some knowledge is not meant to be shared publicly or with outsiders. Some white settler participants emphasized the importance of being invited into the space to support antiracist education while also finding a balance between being invited and “stepping up.” They highlighted the need to seek guidance from Indigenous peoples respectfully, always mindful of not being a burden and ensuring that their learning does not come at the expense of Indigenous colleagues.

You have to find who is doing the good work that you can be in support of instead of ‘cherry-picking’ who is going to help you in your work. (WSP12).

The learning journey has been supported by mentors along the way with whom I have built strong, ongoing relationships, and whose work I admire, respect, support, and amplify. (WSP6)

Indigenous educators described a different dimension of this component—reconnecting with their own knowledge systems after years of colonial education that devalued Indigenous knowledge.

Part of my journey has been reclaiming my own knowledge, my language, my nation’s teachings. Colonial education taught me to doubt Indigenous knowledge. Unlearning that internalized colonialism and reclaiming my identity as an Indigenous educator—that’s been powerful and painful. (IP11)

Indigenous participants mentioned the high significance of mentoring and engaging white people in their learning journeys. However, while it’s essential to understand and navigate the challenges of these journeys, there was also recognition of the harm that can occur when biases go unchecked. As one participant noted, simply “respecting that other people think differently” (IP5) can have real consequences, especially in fields like healthcare, where failing to address discrimination can lead to harm or even death. This underscores the need for more active engagement in confronting biases rather than passively accepting them.

Recognizing, growing, and nourishing a community of mentors and peers was one strategy some participants mentioned for finding support in their unlearning and learning.

I would say don’t do it alone. One way to do this work over time is to surround yourself with people who have already been doing the work. Who can share the experiences with you, who you can learn from, who can also support you as you’re doing your work and coming up against chance, which you will come up against? That’s just normal. (RSP15)

A community of mentors and peers also serves the purpose of holding educators accountable.

So you need that mentorship, like, of course, there’s great learning out there, great resources, but I feel like there needs to be this ability to talk it out, share your resistance points […] And so the supportive structure and the accountability to Indigenous people calling us to do this work was instrumental in integrating and continuing this work. (WSP5)

White settler participants described the process of building relational accountability as essential in their journeys. For them, ongoing learning and relationship-building helped them remain accountable to their ongoing complicity in white power and privilege, which they continued to benefit from regardless of their antiracist commitments. Most white settler participants identified racial caucusing as key to fostering relational accountability among themselves. They described racial caucusing as structured spaces where individuals from the same racial group meet separately to reflect on their social positioning, examine privilege and racism, and strengthen their capacity for accountable action. Through these caucuses, participants developed processes of relational accountability where they discussed issues with each other before seeking mentorship from Indigenous mentors.

Processes of relational accountability where you kind of have to work out […] what do you do with the issues that come up, you know, and it’s not about asking those caucus- those other caucuses for like, oh, tell us what to do. (WSP9)

By creating these collaborative learning spaces, participants could learn from each other, reduce the shame or guilt some felt, and disrupt individualism. Offering mentorship and help to colleagues was mentioned by a participant as being an important strategy to bring others into the antiracism realm.

The other impact is that sometimes I offer to help. Even if I’m not teaching those courses, I’m open to people being sincere, and they want actually to do something and integrate certain things into their courses; I would be happy to review and provide suggestions. (RSP16)

A primary and key difference in the work between the three groups is that Indigenous participants were invested in ways that the other two groups were not. Indigenous participants’ support systems and mentors—mainly Elders and knowledge keepers from their communities—played a crucial role in keeping them motivated and accountable. This was especially important as finding ways to navigate society while maintaining a critical stance could be challenging. Participants highlighted that a tension existed between being “soft” and creating a space where everyone would feel safe, which tends to preserve the status quo, or using more critical language, being less flexible and being consequently more disruptive and transformative. However, having a support system that held them accountable helped them remain disruptive and engage in transformative actions. Their profound responsibility to their communities and lands allowed Indigenous educators to drive institutional change and make the consequences of doing the work more bearable, a level of investment distinct from that of the other groups.

Showing up to navigate resistance to decolonization

For participants, showing up as an Indigenous-specific antiracist educator meant working toward the transformation of education and health care systems, a long-term process that required sustained effort and collective action. Participants were realistic that systemic transformation was not something they could accomplish individually or quickly, but they described their teaching as oriented toward this larger goal. Participants acted into and beyond the classrooms while fully understanding the cost of inaction. They also expressed being challenged with navigating the resistances and performative initiatives at the organizational level. They fiercely advocated for more organizational accountability, leading to structural changes.

Taking transformative actions and seeking accountability in the classroom

A component of the participants’ journey to becoming an antiracist educator was to engage in transformative actions that were context-specific and action-oriented. They emphasized that transformative actions in the classroom must be tailored to both the content and the learners. This meant that educators needed to understand and study the context they were teaching and the people they were educating. This way, their teachings could become more relatable and, as a result, more impactful. To do so, they had to educate themselves, observe others, and find out how people learned to adapt their teaching approaches accordingly.

As I said, a lot of reading and then also just the experience as you start to talk to people, pay attention to what’s working, what’s not, pay attention to the kinds of questions people tend to ask, the things that make people uncomfortable, the things that people are swift to want to run away from […] Starting to, again, figure those [how people learn] out and learn about those and apply them (RSP15).

They also stressed the necessity of creating safe spaces for all learners, including white students, to question their discomfort and reflect on their actions. Experiential learning emerged as a powerful tool for fostering personal and professional transformation, as it helps students connect more deeply to real-world struggles and assess their roles within systemic issues.

It’s experience, too, and it’s putting that experience in the classroom. That’s how I would teach it. It’s having students talk about experiences or helping create experiences for them that they can navigate and think about. It’s always, who are you and what’s that? What do I bring with me? That’s always going to change; you’re going to learn, and you’re going to do that. Then it’s also like looking at what’s around me, what I can work with, and what I can change. It’s the struggle between the individual and the system (IP13).

Another key finding is the need for accountability structures in the classroom to ensure that antiracist education is impactful and sustainable. Participants built accountability primarily through feedback from students and colleagues. With students, a participant focused on evaluating whether their knowledge and confidence in addressing racism-related issues increased after attending the participant’s class. In addition to assessing the knowledge students acquired, some participants measured students’ intentions to transform their actions and practice and followed up with them later.

I usually like to ask about people’s intentions to do something differently, like change. Then, where possible, I return to them a little while to say, “Okay, have you done anything? […] I think those follow-up evaluations are so important. We don’t do them as often. When I have usually again, even after a year, I tend to see that people’s knowledge has usually increased.” (RSP15).

This feedback helped them evaluate the effectiveness of their teaching, the growth in student knowledge and confidence, and their intentions to apply antiracist principles in their future actions. The use of an antiracist lens in evaluating feedback underscores the depth of commitment to ensuring that the educational experience actively challenges racism. With their colleagues, it was more about reflecting together on the way the participant taught the class, if they had missed something, and how the class went overall:

Also, I’d go through peers and colleagues. If I were doing something with a colleague, I would always want to have a debrief for that person to say, “Okay, what did we plan on doing? What worked well? What are the things I know I missed out on that I should have addressed or things like that? (RSP15)

Several factors could influence the extent of change within a classroom. These include the amount of knowledge acquired, the type of class or lecture given, and external factors from their environment:

It’s not just the workshop which made the difference. It’s the workshop, the knowledge they got, plus the fact that they were in an environment which actually supported that practice change. (IP1)

These findings underscore that ongoing reflection and adaptation are crucial for educators to remain effective and responsive in their antiracist teaching and ensure that their actions lead to meaningful, long-term change.

Disrupting culturalist approaches and seeking organizational accountability

Participants described the resistance they faced from institutions and systems while doing antiracist work. Most participants explained that although institutions claimed to support antiracist work, they resisted any proposed structural changes in their policies and practices. For them, most institutions did not view racism as a priority, even when it was part of their strategic planning, thus continuing to support colonialist structures and policies. The lack of institutional and financial support to do antiracism work made the work additionally challenging in the long run.

There’s always like a zillion demands, so dealing with racism is just one piece, and people can say that they’re invested in trying to do this work, but when you’ve got a zillion other things to do, it just becomes another piece of paper on your desk at some point. (IP11)

Participants described how racism was not prioritized by their institutions, despite official statements about commitment to equity and reconciliation. Hence, institutions would implement approaches that participants called performative, as they do not instigate structural change or work toward transformation. Participants identified the multiculturalist approach and Equity, Diversity, and Inclusion (EDI) measures in their institutions as reinforcing existing power structures and contributing to maintaining the status quo. Participants clearly expressed that the juxtaposition of cultural responsiveness and antiracism was incongruent.

But the system would way rather just now focus on Indigenous culture and ways of being. And maybe dance around EDI, but EDI is not antiracism. (WSP6).

Participants observed that while EDI initiatives ostensibly aimed to address systemic inequities, they often disproportionately benefited white women, ultimately preserving the current hierarchies of power. This pattern highlights how affirmative action can be co-opted to support individuals who are privileged by race, even when it is designed to benefit marginalized groups. The focus on white women in diversity measures was seen as diverting attention from more pressing racial equity issues, allowing institutions to appear progressive without meaningfully addressing racism.

I think it [EDI] maintains the structures that are inequitable. (WSP9).

Many participants described the culturalist discourse as a form of institutional resistance to avoid the discomfort that the antiracist discourse could cause. Culturalist discourse focuses on cultural differences, often framing issues like inequities due to cultural traits or practices. In contrast, antiracist discourse addresses systemic power structures, emphasizing racism and inequality as products of social, political, and economic systems rather than cultural differences. Participants described how, in an Indigenous-specific racism context, the uptake of cultural safety from a culturalist standpoint could be detrimental to learning.

Even cultural safety, you know why is it called safety and why is culture included in this when it’s antiracism? Do we see the term culture as a barrier to people’s learning because they think they will come in? They’re gonna learn how to smudge or something when they need to hold the mirror up and look at ourselves and our own racial identity is really what—when we can get down to telling the truth of what it is. (WSP6)

Another resistance that participants raised was the lack of accountability structures, which allowed people and institutions to engage in antiracism.

If things are always an add-on, like a course or a module, I think they’re never fully integrated. What happens is that people have a choice. We still give people a choice of whether I can do this, but if I feel uncomfortable or don’t understand it, I don’t have to do it. (IP13)

Only when systems implement accountability structures supported by policies that require people and institutions to face the consequences of their actions will transformation occur within organizations and systems.

If it came from the top, things would happen quickly on the faculty level/ the curricular level. If the accrediting body were more specific and explicit, we would have to be more accountable. So it takes a lot longer to go from the bottom up. So that’s where we need to get jobs. Aiming for the top here. (WSP2)

A participant characterized policy endeavours undertaken without adequate accountability structures as mere “window dressing” initiatives (WSP12). Policy work requires substantial resources but brings minimal organizational changes, as policies may undergo varied interpretations contingent upon the individuals implementing them. Moreover, the effectiveness of these policies often relies heavily on the analysis and expertise of human resources staff, which participants noted was frequently lacking. Without knowledgeable and well-trained human resources professionals, policies are inconsistently applied, undermining their potential to effect real change. Structures and policies are interconnected: aligning mission, vision, and values with Indigenous ways of being and doing is crucial. It involves the active participation of Indigenous peoples in governance and guiding the work. Participants unanimously agreed that they seldom observed a transfer of responsibility from individuals to organizations throughout their careers. Because of their lack of actions and accountability mechanisms, organizations were identified by most participants as being complicit in systemic Indigenous-specific racism.

In addition to these gaps, participants highlighted other critical factors contributing to a harmful culture. These included the lack of quality assurance, quality improvement, a “speak-up” culture, and a failure to hold individuals accountable for discriminatory actions. The lack of adequate training for managers to address racism within their teams and the absence of accountability for poor accreditation standards further perpetuate these issues. Moreover, the inaction of leadership from professional colleges was seen as compounding the problem. As one participant noted, racism would never thrive in an organization that was actively hostile to it (WSP12). Without strong leadership, accountability, and cultural transformation, these organizations remain spaces where racism is tolerated, if not implicitly encouraged.

Navigating the risks of engaging in transformative actions

Participants described risks associated with being an antiracist educator, which impeded their continuous and long-term involvement in antiracist education. The lack of institutional accountability and the persistence of entrenched power dynamics make it difficult for educators to challenge systemic racism without fear of backlash or professional repercussions. To navigate institutions, some educators resorted to “softer” approaches to appeal more to students, their white peers, and organizations. For example, they adopted incremental learning with students to facilitate their learning. They adjusted how they related and spoke with white people in formal settings, such as attenuating their words and tones to avoid being perceived as offensive. For example, two Indigenous participants described their experiences navigating colonial institutions, stating:

I never held back before, and I probably over time, I do that lesson, I pick and choose my battles. […] if it’s a smaller group, I tend to speak my mind, but in a larger audience, I would be more cautious. (IP8)

That has been very apparent and difficult and has made me a bit of a social outcast within my faculty at times, and so I’ve had to learn to moderate my approach and be palatable. (IP11)

Indigenous participants mentioned that the risks of partaking in antiracist education were very high for them. White settler participants also acknowledged that the harm to Indigenous peoples was disproportionate compared to the harm to white people in antiracist education. Some participants expressed that one of the significant risks of doing this work was getting blacklisted and losing their job.

Their [Indigenous people] work is much more vulnerable than mine […], the only person fired in our team was Indigenous people. Not any of the settlers. (WSP5).

The risks for Indigenous educators are professional but also personal and emotional. Many Indigenous participants spoke of the exhaustion that came with constantly being in a position where they had to educate others about their own oppression while simultaneously navigating daily harmful stereotypes and aggressions. This often led to burnout, a sense of isolation, and the feeling that they were being tokenized for their identity rather than respected for their expertise. Additionally, the trauma of reliving colonial violence in their educational work exacerbated the emotional toll. The fear of retaliation, being labelled “troublemakers,” or losing their jobs made the stakes even higher, disproportionately impacting their livelihoods and mental health.

In contrast, white settler participants acknowledged that their white privilege serves as a protective factor against some of the backlash that Indigenous educators face. This privilege allowed them to navigate antiracist spaces with less fear of professional or personal repercussions. This recognition of white privilege highlights the stark power imbalances that continue to shape the experiences of Indigenous and racialized settler educators, further emphasizing the disproportionate burden carried by Indigenous participants in antiracist education.

Despite these risks, participants remained determined to overcome them and advance in their journeys. The consequences of inaction were considered more significant than the risks of being antiracist educators. All participants acknowledged that failing to act results in missed opportunities and contributes to the harm and death experienced by Indigenous Peoples.

Discussion

This study explored the experiences of health professions educators engaged in Indigenous-specific antiracist education in Canada, revealing three interconnected components of a learning spiral: [1] situating oneself in relation to the land and Indigenous sovereignty [2], taking responsibility for unlearning colonial narratives and learning from Indigenous knowledge systems, and [3] showing up to navigate resistance to decolonization. The learning spiral provides a comprehensive framework for understanding these educators’ lived experiences and challenges.

An Indigenous-specific antiracism learning spiral

The spiral framework resonates with Indigenous concepts of cyclical time and ongoing relationship, distinguishing it from linear Western models of competency development that suggest one can achieve mastery. In Indigenous epistemologies, learning is understood as a lifelong journey of relationship and accountability rather than a destination to be reached [33, 38]. In contrast to cultural competence frameworks, which emphasize the development of individual skills and knowledge, this learning spiral is oriented toward systemic transformation and decolonization [27]. It explicitly centers power and colonial relations and rejects the notion of an attainable “competence.” Instead, it frames Indigenous-specific antiracist education as ongoing, relational, and land-based work that requires sustained commitment, reflexivity, and accountability over time.

Findings also suggest that this learning spiral is distinct from general antiracist or critical pedagogical approaches in several key ways. Indigenous-specific antiracism is grounded in relationships to land, treaties, and Indigenous sovereignty, requiring educators to understand their responsibilities within specific territorial contexts [34, 35]. It centers settler colonialism as an ongoing structure shaping Indigenous health inequities, rather than treating colonialism as a historical backdrop [35]. Accountability to Indigenous sovereignty further differentiates this work, positioning Indigenous Peoples not as another racialized group but as sovereign nations with inherent rights [28, 31]. Findings also emphasize that this learning involves being accountable to Indigenous knowledge systems and pedagogies, moving beyond the inclusion of Indigenous content toward respectful engagement with Indigenous epistemologies and protocols [33]. Finally, the learning spiral is shaped by differentiated positionalities, Indigenous, white settler, and racialized settler, each carrying distinct relationships to colonialism and forms of accountability [45, 46].

Settler–Indigenous relationality and institutional resistance

Our findings resonate with Dion’s [45, 46] analysis of settler–Indigenous relationships in education, particularly her concept of the “Double Bind,” in which Indigenous students seek cultural affirmation within institutions historically structured for assimilation. A parallel tension emerged for educators in our study, who were called to advance Indigenous-specific antiracist work while operating within institutional environments that often remain colonial in structure and culture. Dion’s notion of the “Perfect Stranger” further illuminates participants’ experiences: many settlers, especially white settlers, described moving from a position of perceived innocence toward recognizing their implication in colonial systems and their accompanying responsibilities. This recognition appears foundational to the learning spiral. However, the findings also highlight the limits of individual transformation when institutional conditions remain unchanged.

Participants described navigating resistance across personal, organizational, and systemic levels, revealing a persistent tension between aspirations for structural change and institutional pushback. Resistance frequently appeared through performative commitments to equity and reconciliation that were not matched by resources, accountability, or substantive reform, echoing critiques in the literature [47, 48]. Educators reported experiences of tokenization, disproportionate expectations placed on Indigenous and racialized faculty, insufficient workload recognition, reluctance to modify governance or hiring practices, and professional risks for those challenging institutional norms. Consistent with findings by Dogra and colleagues [49], these accounts suggest that policy declarations alone rarely translate into meaningful change without leadership, resources, and clear accountability mechanisms. Taken together, the results indicate that while educator commitment is vital, it cannot compensate for institutional inertia. Thus, advancing Indigenous-specific antiracism appears to depend on structural transformation alongside individual engagement.

Structural asymmetries across positionalities

Our findings highlight pronounced structural asymmetries across positionalities in Indigenous-specific antiracist education, patterns that are well documented in the broader literature on academic labor. Indigenous educators in our study carried disproportionate emotional and professional responsibilities, frequently positioned as institutional experts expected to educate settler colleagues, represent Indigenous perspectives, and advance equity initiatives—often within environments experienced as tokenizing or, at times, hostile. The emotional toll associated with this work echoes research demonstrating that teaching and leading diversity efforts involves significant, often unrecognized emotional labor [50]. Moreover, these expectations align with what has been described as the “minority tax,” whereby racialized faculty assume additional service, mentoring, and diversity work that is insufficiently valued in academic reward structures (51). Participants also noted heightened professional risks when speaking openly about colonialism, suggesting that this labor carries not only emotional costs but potential career consequences.

Racialized settler educators described occupying complex intermediary positions between Indigenous and white settler colleagues. While they experienced racism within academic spaces, they also recognized their status as settlers on Indigenous lands, creating tensions between solidarity with Indigenous peers and awareness of distinct relationships to colonialism. These dynamics resonate with scholarship showing that faculty workloads and expectations are shaped by intersecting racial and gendered hierarchies, often resulting in uneven distributions of service and equity work [52].

White settler educators, particularly those in tenured or senior roles, reported greater institutional protection when engaging critically with racism and colonialism. At the same time, they described the ongoing challenge of remaining accountable to their privilege and complicity rather than seeking moral absolution. Taken together, these patterns reflect broader evidence that diversity-related labor is not distributed equitably across faculty groups and is frequently undervalued despite its institutional importance [50–52]. These asymmetries underscore the importance of institutional attention to how the burdens and risks of antiracist work are allocated, particularly to avoid the exploitation of Indigenous and racialized educators and to support greater shared responsibility in efforts toward decolonization.

Gendered dimensions of equity work

Our sample was predominantly women, reflecting broader patterns in which equity, diversity, and inclusion work is disproportionately performed by women and racialized individuals. Scholarship has shown that diversity-related teaching and service frequently involve significant emotional labor—work that is often constant, demanding, and insufficiently recognized within academic reward systems [50]. These dynamics intersect with gendered and racialized perceptions of faculty workloads, where women, particularly women of color, are more likely to assume service and equity responsibilities that remain undervalued in promotion and tenure processes [53].

Within this context, Indigenous and racialized women educators may encounter compounded expectations to mentor others, lead institutional equity efforts, and educate colleagues while managing the emotional demands associated with confronting racism and colonialism. Such patterns contribute to uneven distributions of academic labor and may reinforce existing structural inequities. Taken together, these findings underscore the importance of institutional attention to how equity work is allocated and recognized, including efforts to ensure that this labor is more equitably shared and meaningfully valued within academic structures.

Practical implications and relevance beyond the Canadian context

The findings suggest several implications for educators, educational leaders and institutions seeking to advance Indigenous health equity through Indigenous-specific antiracist education. For educators, the results point to the importance of approaching this work as an ongoing learning process grounded in reflexivity about positionality, assumptions, and relationships to colonial structures. Engagement in sustained learning opportunities and participation in communities of practice may help support accountability and reduce professional isolation. Greater familiarity with territorial and treaty relationships also appears to deepen educators’ understanding of their responsibilities, while reciprocal relationships with Indigenous communities and knowledge keepers can strengthen the relevance and integrity of educational efforts. The data further indicate that resistance is a recurring feature of this work; access to support networks, attention to well-being, and collective strategies may help educators navigate these challenges. Participants’ accounts also highlight the potential role of institutional privilege, particularly among white settler educators, in redistributing labor, supporting colleagues, and advocating for structural change.

For educational leaders (program directors, department heads), the findings underscore how institutional conditions shape educators’ capacity to engage in this work. The allocation of protected time, funding, and professional development, alongside recognition in promotion and tenure processes, may signal that Indigenous-specific antiracist education is valued. More equitable distribution of labor, combined with appropriate compensation for Indigenous knowledge keepers and community partners, may help address patterns of over-reliance on Indigenous and racialized faculty. Creating spaces for collaboration, such as communities of practice, and providing visible support when resistance arises also emerged as factors that can influence sustainability.

At the institutional level (universities, health authorities, professional associations), the study highlights a gap that can exist between stated commitments to reconciliation and the structural changes required to support them. Progress may be strengthened through governance structures that include Indigenous leadership in decision-making, clearer mechanisms for addressing systemic racism, and investments in Indigenous faculty, staff, and programs. Comprehensive professional development and mentorship opportunities, as well as formal recognition of this work, may further support long-term change.

Although grounded in the Canadian context, these implications may resonate across other settler-colonial settings, including Australia, Aotearoa New Zealand, and the United States, where relationships to land, Indigenous sovereignty, and colonial histories similarly shape educational responsibilities. Elements of the learning spiral, such as sustained reflexivity, engagement with resistance, and attention to systemic transformation, may also inform broader antiracist efforts. At the same time, Indigenous-specific antiracism remains deeply contextual; meaningful application elsewhere depends on careful engagement with local histories, relationships, and accountabilities to Indigenous Peoples and knowledge systems.

Strengths and limitations

A key strength of this study lies in its focus on educators’ lived experiences of Indigenous-specific antiracist education. By centering voices working within systems shaped by racism and colonialism, the study offers insight into both the challenges and possibilities of this work, including its emotional and professional demands and the importance of supportive institutional conditions. The collaborative composition of the research team, which included Indigenous and settler scholars, further strengthens the credibility and depth of the analysis.

Several limitations warrant consideration. The positionality of the lead researcher as a white settler may have shaped aspects of interpretation despite ongoing reflexive and collaborative processes, underscoring the persistence of power dynamics even when efforts are made to foreground Indigenous perspectives. In addition, our decision not to disaggregate Indigenous participants’ experiences—necessary to protect confidentiality within a small community of practice—restricted our ability to examine differences across positionalities. Future studies with larger samples could explore these distinctions more fully and consider their implications for educator support.

The study prioritized educators’ learning journeys rather than providing a systematic analysis of pedagogical strategies, curriculum design, or student outcomes. Although participants referenced teaching approaches, further research could more directly investigate pedagogical practices and their impacts on learners. Similarly, while Indigenous epistemologies informed our framework, future scholarship could deepen this grounding by drawing more extensively on Indigenous theoretical traditions and Critical Race Theory. Finally, although participants described institutional barriers, institutions themselves were not the primary object of analysis; subsequent research could examine organizational structures, policies, and cultures to better understand both obstacles and conditions that support transformative change.

Conclusion

This study explored the experiences of health professions educators engaged in Indigenous-specific antiracist education in Canada, revealing a learning spiral comprising three interconnected components: situating oneself in relation to the land and Indigenous sovereignty, taking responsibility for unlearning colonial narratives and learning from Indigenous knowledge systems, and showing up to navigate resistance to decolonization. This framework offers a way of understanding the complexities and challenges of Indigenous-specific antiracist work that is grounded in Indigenous epistemologies of relationality, land-based accountability, and lifelong learning. Our findings also reveal that individual educator development is insufficient without institutional transformation. Meaningful change requires institutions to move from performative to substantive commitments, backed by resources, structural changes, and accountability to Indigenous communities. As health professions education grapples with persistent health inequities experienced by Indigenous Peoples, Indigenous-specific antiracist education offers a path toward transformation. This path is challenging and requires sustained commitment, but it is essential for addressing the ongoing impacts of colonialism on Indigenous Peoples’ health and for supporting Indigenous sovereignty and self-determination. The learning spiral framework developed in this study provides guidance for educators beginning or continuing this journey and for institutions seeking to meaningfully support Indigenous-specific antiracist education. While grounded in the Canadian context, the principles of land-based accountability, relational learning, and ongoing commitment to transformation may inform antiracist education in other contexts, always with attention to local histories, relationships, and Indigenous sovereignty.

Authors’ contributions

All authors conceived the study and developed the research design.  ABG was responsible for data collection and analysis, ensuring methodological rigour. All authors interpreted the findings and provided critical insights into the discussion section, linking the results to existing literature. All authors contributed to writing and revising the manuscript, focusing on clarity and coherence. ARDC, the research manager, oversaw project management, coordinated communication among authors, and ensured compliance with ethical guidelines throughout the research process. They supported data collection and analysis, assisted with participant recruitment, and helped organize and maintain research documentation. All authors reviewed and approved the final manuscript.

Funding

This study was funded by the Social Sciences and Humanities Research Council of Canada Grant # 430-2020-00151.

Data availability

The datasets used during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The study adhered to the Declaration of Helsinki and received ethical approval from the Université de Montréal Ethics Committee for Research in Science and Health, project number 2021 − 1266, on November 12th, 2022. Participants provided informed consent, ensuring confidentiality and voluntary participation.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.