We considered sources published in English or French without year restriction. We considered empirical studies, theoretical literature, doctoral dissertation, reports, and reviews published in peer-reviewed journals or revised by a scientific committee.

The target population for this review was educators, including future teachers, university professors, internship supervisors, mentors, preceptors, and tutors. Because some authors point out that the needs of educators from racialized minorities are poorly considered,²³ we ensured inclusion of texts specifically addressing racialized faculty development and issues related to anti-racist teaching for racialized faculty.^24-26

Concepts of interest were related to critical pedagogies, including anti-racist pedagogy, decolonizing pedagogy, anti-oppressive pedagogy, and anti-discriminatory pedagogy because work on decolonization, indigenization, and cultural safety of teaching and teacher education often refers to anti-racist approaches.^4,27-32 For the context, we were interested in health professions education, including initial and continuing education and professional development.

The search strategy combined concepts related to critical, anti-racist, decolonizing, anti-oppressive, and anti-discriminatory pedagogies in the context of health professions education (pre- or post-licensure) by current or future educators. We conducted comprehensive searches in five databases: CINAHL (EBSCOhost), Education Resources Information Center (ERIC, ProQuest Dissertations & Thesis Global), EMBASE (Ovid), MEDLINE (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded) in March 2021. From 1,755 results, 249 manuscripts published in English or French between 2008 and 2021 were first independently selected by two authors (CLS, VS, ABG). The reference lists of identified articles were hand-searched for additional records. Records were exported into Endnote, and duplicates were removed. Two authors independently assessed titles, abstracts, and then the full texts of potentially eligible records. At each stage, disagreements were resolved by discussion or involvement of a third author. We selected a total of 48 references, which were included based on an evaluation of methodological or theoretical rigor and relevance to this review’s purpose.

We extracted data from primary sources regarding knowledge, skills, and attitudes in reference to anti-racist approaches (or surrogate terms). Within each category, we grouped similar data using a conceptual map. The conceptual map helped display all the coded data from each source by category and compare them iteratively. We reviewed primary sources as we conceptualized data at a higher level of abstraction to verify that the renewed conceptualization was congruent with primary sources and ensure accuracy and confirmability. As a result, we developed three core components of an anti-racist approach among health professions educators related to knowledge, attitudes and skills: developing a critical understanding of power relationships, moving towards a critical consciousness, and taking action at individual and organizational levels.

To engage in genuine dialogue about race and racism with students, health professions educators must understand the complexity of racism and its various forms (individual, internalized, institutionalized, systemic) within broader sociopolitical and historical contexts inseparable from colonialism.^{5, 10, 33, 34} This knowledge is required to develop a critical understanding of the power relationships they are part of and participate in. However, many educators still primarily view the concepts of race as a biological category and “racism” in terms of problematic individual attitudes; their understanding of systemic racism remains embryonic.¹⁰ Therefore, they must understand the intersectionality of systems of oppression (race, class, gender, and sexuality) and their effects on the construction of inequities and the objective conditions of people's lives.^{17, 23} This deeper understanding requires mastery of concepts such as social justice, whiteness, white privilege, white supremacy, race, unconscious bias, microaggression, prejudice, and stereotyping.^17,35-37 Authors suggest teaching white educators about the historical, political, and social construction of whiteness to help them understand this aspect of their identity and their emotional engagement with it.^{17, 36}

Anti-racist education is necessarily critical of hegemonic and Eurocentric knowledge (especially so-called "objective and rational" knowledge) and its supposed universality.^{17, 23, 25, 33} It opposes the hierarchization of knowledge and reveals that all knowledge is necessarily situated, constructed, partial, and shot through with power relations.^{23, 25, 26} For this reason, educators must develop a critical knowledge of the historical, political, and economic context in which their discipline has developed.¹⁷ This includes understanding the factors that maintain the underrepresentation of racialized students and educators and the various barriers to their success.¹⁷ In Canada, for example, educators must know the history of colonization, occupation of the territory, laws, treaties, and attempts to acculturate Indigenous Peoples, mainly through the residential school system, and the persisting consequences for Indigenous Peoples today.^31,38,39 In the United States, it is about knowing the history of segregation and the civil rights movement,^10,17 but also the recent backlash against the movement (e.g., anti-immigration policy, social net reforms at the expense of racialized populations.¹⁷

Becoming aware that a set of hegemonic social and historical practices, norms, ideologies, systems of power, and privileges participate in the reproduction of inequities is central to the development of critical consciousness among educators.^{5, 10, 25-27, 38} It means for educators to become conscious of their racial identity, worldview, and social position to understand: 1) how these have been and continue to be a source of privilege or internalized oppression⁴⁰ and 2) how these structure their classroom interactions, pedagogical approaches, content, and assessments^5,27,36,41,The need for white educators to engage in critical self-reflection is the subject of significant literature.^42-44

Anti-racist pedagogy is based on values of power-sharing and democratic decision-making, fairness, responsibility to others, openness, and transparency. "It is not about imposing anti-racist values on others but practicing those values [our]selves."¹⁷ Embodying these values involves educators rejecting the elitism of academia, having the humility to recognize what one can learn from others, and engaging in an ongoing learning process.¹⁷ It also involves acknowledging that learners come with their backgrounds and rich experiences.^{18,40, 41} Moreover, this humility translates into recognizing the value of sharing with racialized and non-racialized colleagues to address difficult situations^35,45 and reflect on one’s practices and assumptions.^{27, 46}

For health profession educators, implementing an anti-racist approach implies learning to create a safe learning environment, value non-hegemonic knowledge diversity, deal with uncomfortable and confronting situations, and actively engage in decolonizing their institutional settings and communities. Each educator’s implementation of an anti-racist approach is unique. It must consider the specific sociodemographic, socioeconomic, cultural, and racial makeup of the classrooms, institutions, and communities in which it is deployed.

Anti-racist educators learn to create classroom climates that allow students to feel welcomed and safe to address emotionally charged topics such as racism and colonialism.^{5, 25, 27} Establishing a climate conducive to critical questioning and active listening requires acknowledging the dialectical tension between their desire to learn with students and the authority and power inherent in the educator's role.²³ Educators may engage in anti-authoritarian, student-centred educational practices to foster a sense of community and non-competitiveness in the classroom.^{17, 31}

Anti-racist educators learn to cultivate spaces conducive to the emergence of non-hegemonic knowledge and develop pedagogical content that values Indigenous epistemologies and cultures^{25, 27, 32, 38} as well as the forms of knowledge and experiences of minority and racialized groups.^17,25,42 As Kishimoto¹⁷ points out, this does not mean reifying binary oppositions (white/Black; Indigenous/non-Indigenous) and essentializing the experiences of group members but exposing the diversity of lived experiences. For Boutouchent,³⁸ it is therefore crucial that programs only prescribe learning objectives and allow educators to choose the best ways to achieve them, leaving room for creativity.

Anti-racist educators also learn to deploy a "pedagogy of discomfort"⁵ which is to feel comfortable in situations of conflict and confrontation that necessarily emerge from discussing racism.^5,23,26,47 This includes developing their communication skills to facilitate difficult discussions¹⁰ and navigate through silences and unspoken words.^10,23 Acosta and Ackerman-Barger⁵ suggest strategies such as the "courageous conversation" theorized by Singleton.⁴⁸ It is also essential to develop their ability to be vulnerable in the classroom and share their stories and experiences in ways that demonstrate their own learning pathway.⁴⁷

Beyond the classroom, anti-racist educators commit to equity, inclusion, and decolonization in their institutions and communities. They commit to retaining racialized educators¹⁷ to increase the excellence of the education offered to students. Partnering with racialized colleagues to teach, research, or serve on committees, or simply talking informally are ways to participate in their retention.³⁶ Anti-racism also means nurturing relationships, responsibility, solidarity, and commitment to colleagues and students.⁴⁹ Incorporating power-sharing and democratic decision-making, accountability mechanism, openness, and transparency also means becoming more involved with families, students, and the communities in which educators work,³² gaining their trust, and building relationships and partnerships that benefit them. Working on various projects with community members, elders, and other knowledge keepers, while being aware that these resource persons are over-solicited also goes in this direction.38 These partnerships must be based on reciprocity, accountability, transparency¹⁷ and reconciliation.⁵⁰

In medical education, along with train-the-trainer tools and training opportunities, there is a need to develop tools to implement an anti-racist pedagogical approach in health professions education within classrooms and beyond them. The core components of an anti-racist approach in health professions education shed light on the multiple requirements for adopting an anti-racist approach. Both educators and faculties wishing to move away from culture-based teaching, which is still widely used in the training of health professionals and has little effect on the transformation of discriminatory practices,²⁹ will benefit from it. Such conceptualization can also serve as a basis for developing professional development tools (e.g., portfolio, continuing education plan) and assessing the quality of teaching. The development of this knowledge can therefore guide the practice and professional development of health science educators so that they are better prepared to develop and implement a curriculum that challenges racism and discrimination in health care for future health professionals. Since teaching from an anti-racist perspective involves examining various forms of discrimination and the implications of relative privilege and systemic disadvantage, the results may be extended to other professional training such as social work and education. Along with professional development tools to implement an anti-racist approach in medical education, further research is needed to assess the impacts on the development of educators' knowledge, attitudes and skills, and the transformation of educators’ practices and educational institutions.

The inclusion of diverse data sources is a strength of this review because it enhances a holistic understanding of an anti-racist approach in health profession education. We also employed techniques of qualitative research to this review process, which has the potential to reduce bias and error. In addition, we rigorously followed Whitemore and Knafl’s²¹ and Toronto and Remington’s²² guidelines to strengthen this review's process and outcomes. However, three out of four authors of this integrative review identify as white settlers. Although some are trained anti-racist educators or have participated in cultural safety training grounded in critical perspectives, the influence of the Euro-Canadian dominant perspective has affected the analysis and interpretation of the results of this review.

The authors declare that they have no conflict of interest.