Integrating indigenous methodologies into medical education in the west: a conceptual framework for the Hybrid Relational Clerkship Model (HRCM)

Despite growing attention to equity and cultural safety in medical education, Indigenous methodologies remain largely absent from the core structure of clinical training in Canada and America. Current clerkship models are short-term and transactional, emphasizing biomedical exposure rather than sustained relational learning. This disconnect perpetuates inequities and mistrust between Indigenous communities and healthcare institutions. To address this gap, this paper proposes a Hybrid Relational Clerkship Model (HRCM) that integrates Indigenous methodologies—particularly relationality, reciprocity, and land-based learning—within longitudinal clerkship structures. Using a qualitative, interpretive, and literature-based approach, this conceptual study resulted from a narrative review of academic and institutional sources from ten Canadian and U.S. medical schools to analyze how Indigenous and community-based learning are currently represented in clerkship design. Indigenous-authored literature, frameworks such as Two-Eyed Seeing (Etuaptmumk), and principles of the Four R’s (Respect, Responsibility, Relevance, Reciprocity)—guided the analysis. Findings from Indigenous and Western medical education scholarship were synthesized to develop the HRCM as a conceptual framework for curriculum redesign. The review identified a persistent reliance on short-term rural placements that meet accreditation standards but do not foster relational continuity or accountability to Indigenous communities. One Canadian Medical institution demonstrated a longitudinal, community-embedded Indigenous clerkship model -. The proposed HRCM reframes clerkship as an 8–12-month placement emphasizing dual mentorship (Indigenous and biomedical), community co-governance, and Two-Eyed Seeing–based assessment. The model aligns with the Truth and Reconciliation Commission’s Calls to Action 22–24 -, the CACMS Standard 9.5 on narrative assessment, and the United Nations Sustainable Development Goal 10 (Reduced Inequalities). The HRCM provides a conceptual framework for integrating Indigenous knowledge systems as core pedagogical foundations in medical education, moving beyond cultural awareness toward structural reconciliation. By embedding relationality, reciprocity, and community-led assessment into clerkship design, this model supports the development of physicians who are both clinically competent and culturally accountable. Implementing this framework may enhance trust, continuity, and health outcomes in Indigenous communities while contributing to a more equitable and inclusive medical education system.