Indigenous support based on Indigenous values
Indigenous support based on Indigenous values
The University of Otago is home to one of the most successful programs supporting Indigenous health workforce development in Australia and New Zealand. Over the past decade it has made a significant contribution to New Zealand reaching population parity [1] in the percentage of Māori doctors graduating from medical school.
Each year of the medical program at the University of Otago has its challenges but the first year of Health Sciences – a mandatory year for all aspiring medical students – has typically been the point of highest attrition for Māori students. So there was great interest in 2012 when the number of Māori students completing Health Sciences First Year and transitioning into medicine jumped dramatically – from an average of 18 students in previous years to 45 students.
There had been no change in the selection criteria for Māori entry to medicine that year. The catalyst for change was a support program developed by a small and passionate team at Otago’s newly created Māori Health Workforce Development Unit (MHWDU), with funding from the New Zealand Ministry of Health.
Since that time the Ministry has continued to fund MHWDU based on the continued success of its Indigenous support programs. The number of Māori medical graduates at Otago has risen steadily, reaching a high of 21.6 per cent Māori medical graduates in 2021 [2] (61 of the total cohort of 287).
Targeted Support for Māori Students
Professor Joanne Baxter (Ngāi Tahu, Ngāti Mamoe, Waitaha, Ngāti Apa ki te Rā Tō), now Dean of the Dunedin School of Medicine, was one of only two people in the MHWDU team in its first couple of years. Zoe Bristowe (Ngapuhi, Ngāti Porou), Programme Manager with MHWDU, was the other.
“Before we had any targeted support for Health Sciences, Māori students were not doing well,” says Zoe. “We had the Māori Centre providing some academic support and offering a counselling service, but there was nothing targeted specifically to Health Sciences First Year, which had one of the highest attrition rates for Māori students at the university. The issue, of course, was what was happening in secondary school and not all students having the requisite sciences when they got here.”
The MHWDU team identified and recruited 14 Māori students for Tū Kahika, a new scholarship program to support students through a Foundation Year in 2010 – effectively a bridging program between secondary school and the highly competitive Health Sciences First Year common to all health professional programs at Otago. Rather than recruiting the ‘best’ Māori students from the ‘best’ schools – which would have done little to lift overall Indigenous numbers – the strategy was to identify potentially promising students from diverse backgrounds, including some who would not otherwise have been likely to go to university, and provide them with a scholarship, accommodation at an Otago residential college and wrap-around pastoral support during the Foundation Year.
Most of the 2010 Foundation Year scholarship students [3] were admitted to Health Sciences in 2011, where they met with other Māori students. MHWDU stretched its resources to embrace all Māori students in Health Sciences First Year – providing information, food, events and a lot of the team’s time. When the two Māori student groups coalesced, they lifted the collective performance of the Māori cohort in Health Sciences First Year to an unprecedented level, achieving a record 45 places in Otago’s 2012 medical program.
“In an environment that had some quite hostile cultural norms for Māori students we wereable to create a sheltered space around the students,” Zoe says. “We developed really good partnerships with the residential colleges and we would be invited up there for dinner, so we became just like an extended family, all with a similar goal. It was quite motivating for the Foundation students; for some of them it was the first time they had met another young Māori person who wanted to become a health professional. When they went into Health Sciences First Year, they pulled others into the fold.”
An Indigenous Led Model
The Foundation Year scholarship program continues to take an average of 13 to 16 students per year but is relatively costly and time-intensive given its small numbers. The greatest success has been in Health Sciences First Year, where admission rates for Māori students have consistently increased across medicine and nearly all other Otago health professional programs.
“We’ve done well because we’ve been able to implement an Indigenous-led model underpinned by Indigenous values. It’s about that sense of family and connection, and also collective success, which in a year that has always been really competitive can seem foreign. We all support each other so we can all progress together, and that’s been powerful.”
MHDWU currently has eight staff and is applying its proven Indigenous support model to the more recently introduced equity pathway into health professional programs for students from schools in low socio-economic communities (the EQ Project).
The Clinical Years
Otago students complete the first three years of the medicine program together at the Dunedin campus, then separate for three years of clinical training at one of three Otago medical schools, based at Dunedin, Christchurch and Wellington.
About 20 Māori students start clinical training at Christchurch each year and about 50 Māori students are at the Christchurch medical school at any one time. These students come under the orbit of Dr Tania Huria (Ngai Tahu / Ngati Mutunga Wharekauri), Associate Dean Māori and more recently also Associate Dean Student Affairs, Christchurch, a role encompassing all undergraduate medical students across the three clinical years.
Tania’s team first meet the new Māori students coming to Christchurch when they take all new medical students away to a Marae [4] at the start of their first clinical year. The team then has ongoing contact with the Māori students moving forward, providing clear touchpoints within the faculty so that students know who to approach for information or to discuss an issue.
Tania also links the Indigenous students into the Māori Health Innovation Health Institute (MIHI), which runs OSCE practice at crunch times during the year and provides opportunities for students to meet Indigenous doctors working in the community. A Tuakana-Teina (senior-junior) Māori student support network, devised by students, runs a buddy system and schedules dinners and anti-racism/resiliency workshops.
“We don’t get everybody. It’s not a perfect program by any means. But we get most of our students on board at the beginning of the year,” Tania says.
More than 140 hours of the three-year curriculum are devoted to Māori Health, with an emphasis on simulations featuring community members acting out real cases and Māori doctors and other health professionals helping to facilitate the sessions. This practical component is expensive but extremely effective.
Cultural loading [5] on Indigenous students has been a pervasive problem but is beginning to diminish at Christchuch, Tania says. “We’re very clear that we want our Māori students to be students, so if we hear of any incident where they have been asked to be Māori experts – in a tutorial for example – we tell them to ask whoever it is to come and talk to us. This can be really insidious for both staff and the students, although it’s not happening as much now because we’re developing a bit of a critical mass. We do a lot of post graduate training in Māori Health so a lot of clinicians at the hospital have been through our training, which is quite helpful, and a lot of the junior RMOs are our graduates.”
Taking a Stance against Racism
While cultural safety for Māori health students at Otago has improved over time, racism and discrimination remain problems just as they do in the health workforce and society, Tania says. She references a legal case challenging Otago’s Mirror on Society medical admissions policy, which was settled out of court in 2020, and a recent review of the university’s Physical Education Department following complaints of racism toward the Māori unit within that department. In the wake of these events, Otago’s Vice Chancellor has taken a very vocal stance against racism and strongly endorsed the Mirror on Society policy.
“It all comes down to leadership. If a university or a medical school has leadership that supports and invests in equity then it’s great, but if the leadership isn’t prepared to acknowledge racism or inequity, that is an issue. It has to be a priority. It’s not acceptable that Australian and New Zealand Indigenous people continue to have the worst health and wellbeing outcomes.”
Two of the three Deans leading Otago’s medical schools are Māori – Professor Suzanne Pitama, Dean and Head of Campus, Christchurch, and Professor Baxter at Dunedin. This is a proud achievement for these medical education experts but also an inspiring milestone along the path to achieving more equitable health outcomes for Indigenous New Zealanders.
[1] Māori people comprised an estimated 17.1 per cent of the national population in 2021 https://www.stats.govt.nz/
[2] Medical Council of New Zealand, Workforce Survey, 2021 https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/d9d2757aad/Workforce-Survey-Report-2021.pdf
[3] All 14 students became eligible for admission to university, whereas half had not been eligible prior to the Foundation year.
[4] Māori meeting ground.
[5] Requests for Indigenous students to provide information about Indigenous cultures and related aspects of Indigenous health and wellbeing.