Charcot arthropathy of the spine (CSA), also known as spinal neuroarthropathy, is a progressive disease process in which the biomechanical elements of stability of the spine are compromised because of the loss of neuroprotection leading to joint destruction, deformity, and pain. Initially thought to be associated with infectious causes such as syphilis; however in the latter part of the century, Charcot arthropathy of the spine has become associated with traumatic spinal cord injury. Clinical diagnosis is challenging because of the delayed presentation of symptoms and concurrent differential diagnosis. Although radiological features can assist with diagnosis, the need for recognition and associated treatment is vital to limit the lifelong disability with the disease. The goals of treatment are to limit symptoms and provide spinal stabilization. Surgical treatment of these patients can be demanding, and alternative techniques of instrumentation are often required.

Introduction: Considering the relevant 2015 Truth and Reconciliation Commission recommendations, this paper reviews the current state of Canadian medical schools’ Indigenous admissions processes and explores continued barriers faced by Indigenous applicants. Methods: A summary of literature illustrating disadvantages for Indigenous applicants of current admissions tools is presented. A grey literature search of current admissions requirements, interview processes, and other relevant data from each medical school was performed. Tables comparing differences in their approaches are included. A calculation of Indigenous access to medical school seats compared to the broader Canadian population was conducted. Gaps in execution are explored, culminating in a table of recommendations. Results: Despite formal commitments to reduce barriers, Indigenous applicants to medical school in Canada still face barriers that non-Indigenous applicants do not. Most programs use tools for admission known to disadvantage Indigenous applicants. Indigenous applicants do not have equitable access to medical school seats. Facilitated Indigenous stream processes first ensure Indigenous applicants meet all minimum requirements of Canadian students, and then require further work. Discussion: Seven years after the Truth and Reconciliation Commission called on Canadian universities and governments to train more Indigenous health care providers, there has been limited progress to reduce the structural disadvantages Indigenous students face when applying to medical school. Based on best practices observed in Canada and coupled with relevant Indigenous-focused literature, recommendations are made for multiple stakeholders. Conclusions: The study was limited by the data available on numbers of Indigenous applicants and matriculants. Where available, data are not encouraging as to equitable access to medical school for Indigenous populations in Canada. These findings were presented at the International Congress of Academic Medicine 2023 Conference, April 2023, Quebec City, Canada.

Le recrutement de participants à des études au sein de populations marginalisées présente des défis uniques pour les chercheurs et les institutions associées. Les chercheurs doivent être conscients des adaptations spécifiques requises dans le processus de recherche pour mener des recherches au sein des populations autochtones. La conscience culturelle est essentielle pour toute recherche menée au sein de ces populations, afin de comprendre les problèmes passés qui peuvent influencer la volonté actuelle et future de participer à la recherche. Cet article vise à fournir un contexte et des exemples où une sensibilisation culturelle accrue à des principes éthiques spécifiques pendant la phase de recrutement peut avoir un impact sur le processus d’étude ainsi que sur le chercheur lui-même. L’intégration de concepts culturels indigènes dans le processus de recrutement et de conception de l’étude peut contribuer à jeter les bases d’un processus de recherche positif dans son ensemble et faciliter un environnement d’étude approprié pour toutes les personnes impliquées.