Success builds success
Success builds success
No single support strategy explains Newcastle University’s strength, over two decades, in attracting Aboriginal and Torres Strait Islander students to its medical program and supporting them through to graduation. It is a combination of strategies and, most importantly, people.
There are currently 76 Aboriginal and Torres Strait Islander students enrolled in Newcastle University’s Joint Medical Program with University of New England [1], which means that almost one in five of Australia’s Indigenous medical students are studying in this program – a leading position amongst Australia’s 22 medical schools.
“The first 100 Aboriginal and Torres Strait Islander medical students graduated from Newcastle over a period of about 20 years [2] but I think we’ll reach the second hundred within the next five years,” says Professor Peter O’Mara, Director of Newcastle University’s Thurru Indigenous Health Unit, School of Medicine and Public Health. “We have a really strong network and all of our current undergraduates have absolutely got what it takes to get through. The things that might stop them are things we can’t predict or prevent; we can only support them through it.”
Medicine is a demanding course for any student but can be especially challenging for Aboriginal and Torres Strait Islander students from communities which still endure the long-term negative impacts of colonisation and dispossession. Newcastle nurtures the strength and resilience developed by its Indigenous students despite these negative impacts.
For Peter O’Mara, the idea to study medicine only came to him when listening to a talk by a young Newcastle medical graduate, Sandra Eades, who later became Australia’s first Aboriginal Dean of Medicine. Becoming a doctor wasn’t something that was ever in Peter’s sights – or a probable outcome for a former Newcastle mines worker – until he heard Sandra speak. Decades later, Peter, like Sandra, has inspired many Aboriginal and Torres Strait Islander people to study medicine.
Building Critical Mass
Sustained recruitment is the first objective for any medical school seeking to graduate more Indigenous doctors. It builds a critical mass [3] of Indigenous students, who form an expanding network of peer support for each other and become role models for new students once they have launched their medical careers. Attracting a sustained critical mass of Indigenous students has been a fundamental part of Newcastle’s success over time.
Newcastle and New England’s Joint Medical Program approaches recruitment with a high Indigenous admissions target that is set well above parity [4] with Australia’s Indigenous population. It reserves up to 10 per cent of domestic medical student places (up to 17 places) each year for Aboriginal and Torres Strait Islander students, which is a strategic response to the very low proportion of Aboriginal and Torres Strait Island doctors in the national medical workforce. [5] Annual commencement numbers do not always reach 10 per cent and conversely, the target can be exceeded in a particular year, depending on the applicants.
Newcastle and New England each run a bridging program for Aboriginal and Torres Strait Islander people wanting to attend their university. This resonates with research showing the importance of culturally appropriate pre-entry programs for both recruitment and retention of Indigenous students. [6]
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Each year the University of Newcastle’s Joint Medical Program reserves up to 10 per cent of domestic medical student places for Aboriginal and Torres Strait Islander students.
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Targeted recruitment to the medical program is managed by the Thurru Indigenous Health Unit, whose staff travel around the state to engage with Aboriginal communities.
“The success of our program has been built on reputation and grown through word-of-mouth,” says Thurru doctor and academic John Towney. “We go out and talk to people face to face, and they see us and find out who we are. We are all from areas within or around the footprint of the medical program, so we’re travelling and meeting people on an equal level, we’re not waiting for people to come to us to look at the university. You can’t really sit on campus and engage with people who live 500 miles away.”
One strand of this decentralised approach is taking a one-week Indigenous admissions program to multiple locations across regional NSW for applicants wanting to ‘test run’ what it would be like to study medicine. Another is relationship-building with a wide range of Aboriginal-run health and community organisations where Thurru places medical students studying the Aboriginal Health curriculum. This builds positive word-of-mouth about the medical program amongst the staff and clients of these Indigenous-run organisations.
Tough Admissions Process
Accompanying the Joint Medical Program’s high 10 per cent Indigenous recruitment target is an intensive, one-week program for admission through the Aboriginal and Torres Strait Islander entry pathway. Peter O’Mara believes this Miroma Bunbilla Program has been a critical success factor for Newcastle.
“When I started working here at the university I felt that we were setting people up for failure. There was an academic mark requirement and we had an interview process, and I felt that some people were being brought on board to the medical program when it wasn’t the right time in their lives or they didn’t have enough science behind them, these sorts of things,” he says.
“Whether it’s uncle, aunty, cousin or sister, whoever becomes a medical student, there’s quite an air of excitement in the community that one of our own is going to be a doctor. But if they get broken and go back feeling a failure, that is generalised to the rest of the community – ‘Oh that Western medicine, it’s not for us. We can’t do that university stuff’. What we’ve done to stop that cycle occurring is develop a program where there are a lot more hoops to jump through – it’s really hard to get in but if you do, the chances of getting through are really high.”
The year before Newcastle piloted the Miroma Bunbilla Program, 50 per cent of its Aboriginal and Torres Strait Islander medical student intake failed the first semester. In the year the pilot was introduced, only one student failed one subject at the end of first semester. “Things just changed dramatically,” Peter says.
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The Miroma Bunbilla program is structured to give participants an insight into what studying medicine will be like, with tutorials and problem-based learning, and participants required to hit learning targets and complete all activities to qualify. It also has a cultural component, giving applicants the chance to connect with Indigenous patients.
In some cases a program participant will choose not to continue with their application for medicine. The Thurru team see this as a part of a successful recruitment strategy and support these applicants in developing an alternative study pathway.
Progressing through to Graduation
After recruitment, the next critical objective for medical schools is supporting Indigenous students to progress through to graduation. Commencement of Aboriginal and Torres Strait Islander students in Australian medical programs has grown in recent years to reflect population parity, but graduation levels have yet to catch up. [7] Targeted and strategic support is required to empower Aboriginal and Torres Strait Islander students to negotiate the additional challenges many face in studying medicine.
Within the culturally safe space of the Thurru Indigenous Health Unit is a hardworking Indigenous team of eight full and part-time academic staff and one administrative staff. They spend a week with Aboriginal and Torres Strait Islander applicants for the Miroma Bunbilla program, then continue to provide academic and pastoral support to successful applicants from enrolment through to graduation. A good proportion of these staff are Newcastle medical graduates themselves, from areas across the footprint of the Joint Medical Program. Together they form the crucial ‘people’ component of the Newcastle success formula. The value of having a relatively large number of Indigenous academic staff, and the positive impact of these staff on Indigenous students, cannot be overestimated.
“Our students feel safe, with our support, to be pushed outside their comfort zone,” says Darren Nolan, lecturer and communications lead with Thurru. “I think that’s part of the reason we have higher retention and graduation rates. We will back students and support them when otherwise they might think, ‘this is just too hard for me’ or ‘I can’t do it’. We say, ‘we know you can do it; we’ll support you’.”
The motivation of Thurru staff to work long hours, travel around the state and push hard to get the students through to graduation comes from a determination to achieve better health outcomes for Aboriginal and Torres Strait Islander communities.
“The students are part of our community and we view them as an extension of our community,” says Karen Nicholls, a doctor and academic with Thurru. “Their getting through the course reflects on us and there’s a lot more at stake because if we don’t have the Indigenous doctors out there, we are not going to have the impact on the health system that we need to close the gap. Every single student that gets through has the potential to make such a huge difference.”
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“When you treat an Indigenous patient and they have never come across an Indigenous doctor before, it is the most humbling and inspiring thing to experience – for both the patient and the doctor. There is nothing like it.”
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Like most of the Thurru team, Karen could be making a more money elsewhere but chooses to work on expanding the Aboriginal and Torres Strait Islander health workforce: “When you treat an Indigenous patient and they have never come across an Indigenous doctor before, it is the most humbling and inspiring thing to experience – for both the patient and the doctor. There is nothing like it.”
Multiple Support Measures
Putting in place one or two isolated support measures – like a scholarship or Indigenous entry pathway – is not enough to nurture and retain all Indigenous students recruited to a medical program. The medical schools which graduate the highest number of Aboriginal and Torres Strait Islander students, like Newcastle, implement a spectrum of best practice measures [8] including: culturally appropriate recruitment and selection processes, orientation and pre-entry programs, a supportive and enabling school culture, Indigenous academics, mentoring and tutoring programs, flexible delivery of content, accessible Indigenous Student Support Centre; social and financial support, and ‘leaving the university door open’ for students who leave before graduation to return.
Peter O’Mara believes that leadership at university level has been another critical enabler at Newcastle: “I have seen a number of universities around the country that have good people there with lot of knowledge, but the leadership don’t listen to them and don’t act on their advice, and as a result they don’t get the outcomes. Our uni listens to what we have to say – whether it’s the Dean of Medicine or the Health Faculty; right up to Vice Chancellor level.”
Teaching Aboriginal Health
Thurru also runs the Joint Medical Program’s Aboriginal Health component, a six-week pathway open to all medical students in 4th and 5th year who elect to have an extra skillset in Aboriginal Health. Now in its third year, the Aboriginal Health pathway has more medical students wanting to take the course than it has places available, says Kirsty Jennings, the doctor and academic who manages the pathway.
“Rather than looking at a deficit discourse or data-based teaching, we’re trying to engage students with lived experience so that they develop empathy and understanding,” she says. “And it’s not just the medically-based Aboriginal Community Controlled Health Organisations (ACCHOs) that we engage with, we travel to rehab services, out of home care, cultural centres; I’ve had students delivering meals on wheels to COVID-positive patients.”
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“We see the Aboriginal Health training we do in medical school and later on in the medical colleges really as a quality control mechanism. It helps graduate better doctors all round.”
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“The community overall have been really positive in contributing to teaching medical students about how to work with our Aboriginal communities – giving them good feedback and experience. I also make sure the students understand the importance of giving something back,” she says.
Success Builds Success
Peter believes that the training provided through the Aboriginal Health pathway equips all graduates to become better doctors: “When students are trained to practice Aboriginal Health well, they become a better practitioner for everyone because Aboriginal Health is about trauma-informed care, whatever the patient group may be…We see the Aboriginal Health training we do in medical school and later on in the medical colleges really as a quality control mechanism. It helps graduate better doctors all round.”
If Peter’s predictions are correct, Newcastle’s Joint Medical Program will be graduating its 200th Aboriginal and Torres Strait Islander doctor in 2027 – a great result in a country with such low numbers of Indigenous doctors in its national workforce. The simple but extremely powerful message that Peter and the other members of the Thurru team continue to spread as they travel to Aboriginal communities across NSW is, “If we can do it, maybe you can too”.
[1] 2022
[2] 105 Indigenous medical students had graduated from Newcastle Uni by 2022
[3] “A critical mass of eight students has been identified as the minimum number of enrolees at any one time likely to result in successful completion of studies.” Meiklejohn B, Wollin JA, Cadet-James YL. Successful completion of the Bachelor of Nursing by Indigenous people. Australian Indigenous Health Bulletin. 2003;3(2).
[4] About 3.3 percent of Australians are Aboriginal and Torres Strait Islanders [Australian Bureau of Statistics].
[5] In 2020, 0.47 per cent of employed Australian medical practitioners identified as Aboriginal and Torres Strait Islander [Australian Government Department of Health], equivalent to 494 doctors.
[6] Beyond Enrolments, Emma V. Taylor, Alex Lalovic & Sandra C. Thompson. International Journal for Equity in Health, 2019. https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1038-7
[7] In 2021, 3.2% of commencing domestic students, and 2.1% of domestic graduates, were Aboriginal and Torres Strait Islander people (2020_MDANZ-Student-Statistics-Report-1.pdf, medicaldeans.org.au).
[8] Emma V. Taylor, Alex Lalovic, Sandra C. Thompson, Beyond Enrolments, International Journal for Equity in Health, 2019.