Morisseau, Hailee2026-05-292026-05-292025-06-202026-05-29http://hdl.handle.net/1993/39807Introduction: Colonial legacies have led to significant health disparities among Indigenous peoples in Canada, highlighting the need for increased Indigenous representation in healthcare. The Truth and Reconciliation Commission of Canada has called for action to address these inequities by increasing Indigenous healthcare professionals, yet Indigenous providers remain underrepresented. Physician assistants (PAs) play a growing role in healthcare delivery, but there is limited research on Indigenous representation within the profession. Structural barriers and systemic disadvantages in admissions processes further hinder Indigenous student recruitment in PA programs. While Indigenous admissions pathways (IAPs) have been implemented in some Canadian PA programs, little is known about their effectiveness or the broader challenges Indigenous applicants face. Objective: This study aims to assess current admissions policies, identify barriers and facilitators to Indigenous recruitment, and provide evidence-based recommendations to strengthen IAPs in Canadian PA programs. Methods: An environmental scan and literature review were conducted to explore Indigenous recruitment in Canadian PA programs, focusing on admission processes and IAPs. The review was expanded to include Canadian medical programs due to their similarities in application processes and shared historical context. The search strategy included peer-reviewed and grey literature from Scopus, PubMed, and Google Scholar. Inclusion criteria were primary research on Indigenous student recruitment or admissions in Canada, published between 2010 and 2025. A PRISMA flow diagram outlined the search process, identifying 204 records, with 8 articles included for analysis. Thematic analysis was conducted to identify barriers, facilitators, and best practices for Indigenous recruitment, informing recommendations for improving Indigenous recruitment in Canadian PA programs. Results: Canada currently has five civilian PA programs, with a sixth launching in fall 2025. Canadian PA programs vary in degree offerings, seat availability, and IAPs. While most programs have IAPs, only Dalhousie explicitly reserves seats for Indigenous students. Admissions requirements differ in residency restrictions, prerequisite coursework, GPA thresholds, healthcare experience, and supplemental applications. IAPs also vary, with some schools requiring formal verification of Indigenous identity and additional application components, such as letters of intent and community endorsements. Holistic file review, Indigenous reviewers, and mentorship programs exist at select institutions, but gaps in transparency remain. A review of the literature identified key barriers and facilitators influencing Indigenous students’ pathways into medical education. Six primary themes emerged: systemic and institutional barriers, supportive pathways and mentorship, personal motivations and lived experiences, holistic and inclusive admissions processes, early outreach and pipeline development, and institutional commitment and policy reform. Structural challenges such as proof of Indigeneity requirements, financial and geographical constraints, and academic cut-offs hinder access, while mentorship, targeted outreach, and holistic admissions strategies support Indigenous student recruitment. Conclusion: Increasing Indigenous recruitment in PA programs requires addressing structural barriers and implementing holistic admissions, mentorship, and outreach efforts. These reforms promote equity and enrich the profession with diverse perspectives, improving culturally responsive care. Transparent policies, community engagement, and institutional commitment are key to supporting Indigenous students. Aligning with the TRC’s Calls to Action, these initiatives will help create a healthcare workforce better equipped to serve Indigenous communities.engmanuscript