Inspired by the experience of Inuk patients and delivered to more than 3,000 healthcare practitioners so far, this workshop supports participants in recognizing how documentation practices can perpetuate – or mitigate – oppression against marginalized communities.
While working as an occupational therapist in Nunavut, Janna MacLachlan, PhD, OT Reg. (Ont.) discovered something that troubled her. Her clinical notes that reported missed appointments had been used as part of an apprehension case for an Inuk child without her knowledge.
The incident prompted MacLachlan to reflect on how unintended bias in the writing and reading of healthcare documentation can inform life-changing decisions about patients. She also heard concerns from an Inuk parent, who described how reading her child’s extensive medical records revealed that authorities viewed her as a bad parent.
When these stories reached the ears of Marie-Lyne Grenier, OT, PhD (c), erg., Assistant Professor (Professional) at McGill’s School of Physical and Occupational Therapy (SPOT), she was moved to act.
The pair teamed up to develop a new half-day workshop titled Anti-oppressive Documentation Practices for Healthcare Practitioners. Combining theory, evidence and applied exercises, the workshop supports participants recognize how documentation practices can perpetuate or mitigate oppression, especially against marginalized communities. It also supports them in applying anti-oppressive approaches in their healthcare practice.
Since it was first offered to occupational therapists in 2021, the workshop has been delivered more than 45 times to over 3,000 health practitioners, educators, students, regulators and leaders. It is also integrated into McGill’s occupational therapy curriculum and recently received an Education Impact Award from the Office of the Vice-Dean, Education and Community Engagement.
Prof. Grenier says: “Documentation is often presented as a technical, administrative skill – or, in some programs, not formally taught at all, with students expected to learn ‘on the job.’ Rarely are learners encouraged to critically examine the broader social, ethical, and political consequences of what they write.” She adds that administrative records and forms have “long been used as tools of surveillance, child removal, land dispossession, and forced assimilation of Indigenous peoples.”
During the workshop, participants learn how implicit bias, socially constructed norms and institutional expectations can slip into the everyday practice of healthcare documentation, unfairly characterizing a patient and their needs or influencing the impressions formed by those who read these notes. Participants then consider how such documentation can influence critical decisions, including whether a patient can continue driving, access housing or maintain child custody, etc. The workshop also gives concrete examples of how health documentation practices can be improved. For example, for people choosing not to accept a service, practitioners should explicitly qualify the reasons for their choice and avoid phrases like “patient is non-compliant,” opting instead to reaffirm a patient’s right to decline services.
In addition, professionals can explicitly note when rights violations take place (e.g. documenting when translation services are not provided instead of writing “patient has difficulty expressing their symptoms”).
To date, the workshop has received high praise from educators, clinicians, students and healthcare leaders. Feedback so far also indicates that it addresses a significant gap in professional education and practice. Building on this success, Prof. Grenier and her team are conducting research on how the workshop influences documentation practices, decision-making, as well as patient and client experiences.
Sara Saunders, PhD, Director of SPOT’s Occupational Therapy Program, and Isabelle Gagnon, PhD, Associate Dean and Director of SPOT, say the workshop’s inclusion in the occupational therapy program “represents a significant educational advancement”. They add, “Importantly, this innovation aligns extremely well with institutional commitments to the Truth and Reconciliation Commission of Canada’s Calls to Action, particularly those related to culturally safe care and the preparation of healthcare professionals capable of addressing systemic racism in healthcare systems. By equipping students with practical tools to critically examine documentation practices, this work moves reconciliation from principle to practice within healthcare education.”
Prof. Grenier and MacLachlan regularly optimize the workshop, which is available to educators who wish to bring this teaching into their own programs.
They believe the workshop’s content can bring benefits beyond health education. Moving forward, they plan to collaborate with regulatory bodies and policymakers to examine how documentation standards, guidelines and professional expectations can better reflect principles of equity, accountability and anti-oppressive practice across different sectors.
“Anti-oppressive documentation should not be viewed as an optional enhancement or emerging trend; it should be recognized as a core component of ethical, high-quality care,” says Prof. Grenier. “While cultural change is essential, policy reform can often accelerate the adoption of more equitable practices across professions.”
Congratulations to Marie-Lyne Grenier and Janna MacLachlan!
If you are interested in bringing this training to your healthcare program, contact Prof. Grenier at marie-lyne.grenier@mcgill.ca.
This article is part of a series profiling the five winning projects awarded Education Impact Awards. Please read about the other winners:
- Award-winning ‘PI School’ gives postdocs practical skills needed to lead research teams
- Implementing a Model of Excellence for Interprofessional Primary Care Nurse Practitioner Clinical Education
- McGill Summer Institutes in Global Health celebrate 11 years of equitable and innovative education
For more information about the Education Impact Award, please visit the Office of the Vice-Dean, Education and Community Engagement website.