Welcoming students to JCU’s Indigenous family
From its home in Far North Queensland, James Cook University is committed to improving the health of rural, remote, Indigenous and Tropical communities. Its focus on Indigenous health has been a drawcard for many of the Aboriginal and Torres Strait Islander students enrolling in its medical program.
At a ceremony held one or two days before formal graduation, each Aboriginal and Torres Strait Islander student graduating from medicine at James Cook University (JCU) presses their painted hand onto a canvas that hangs in the foyer of the College of Medicine and Dentistry in Townsville. The painting is a visual reminder of the growing Indigenous medical workforce they are about to join, and a validation of their hard work to get to this point.
“One of our Aboriginal students told me she’d had some hard times during the course but walking down that College hallway and seeing that painting with the handprints of all the people who had come before helped her to get through those tough times,” says Karen Knight, Senior Lecturer with the College of Medicine and Dentistry.
The Handprint Ceremony is also an opportunity for the families of the new Aboriginal and Torres Strait Islander graduates to meet and connect with one another, with other Indigenous graduates and with the academic staff and deans of JCU’s health disciplines in a more intimate context than the formal graduation ceremony. JCU’s Division of Tropical Health and Medicine fosters this kind of personal engagement with families and communities as a means of supporting Indigenous students as well as a potential pathway to recruitment.
JCU’s Indigenous Family
In 2021, there were 25 Aboriginal and Torres Strait Islander students enrolled in JCU’s six-year undergraduate medical degree. The school attracts Aboriginal and Torres Strait Islander applicants from across Queensland, over the border into NSW, sometimes Victoria and in a couple of instances, South Australia and Western Australia.
In each of the last four years, five to seven Aboriginal and Torres Strait Islander students have commenced medicine at JCU, which is a comparatively strong and sustained result . However, the most critical challenge for the College, as for all medical schools, is to nurture and empower these students to progress through what for many may be a difficult and challenging journey to graduation.
All Indigenous medical students at JCU receive a modest annual scholarship which, while it is a help, is smaller than many other scholarships on offer and not a key recruitment strategy for the College.
JCU’s pastoral care and family-oriented culture is at the heart of the university’s offer to Aboriginal and Torres Strait Islander students.
The central hub of what JCU refers to as its ‘Indigenous family’ is the Indigenous Education Research Centre (IERC), a newly built, well-appointed research centre and meeting place on the Townsville campus, which employs a large team of predominantly Indigenous staff who operate in both Townsville and Cairns, and have strong connections with Indigenous communities and families in the region.
JCU also benefits from running the specialist GP Training Program for a large portion of Queensland, which connects the university to a wide range of Aboriginal-controlled health services across the state, providing a network of pathways channelling positive word of mouth about studying medicine at JCU into Indigenous communities.
Preparing Students for University
At the secondary school level, an important recruitment channel is the innovative program of Summer and Winter schools run by the IERC to encourage Aboriginal and Torres Strait Islander secondary school students to apply for university. Winter School is held in the middle of the year for students in years 10 to 12, while the Summer School at year’s end is for Year 12 students only.
“The students come in for a week; they do an induction on things you need to know about university then more specific programs on the courses they’re interested in,” says Donald Whaleboat, a Senior Academic with the College of Medicine and Dentistry. “For medicine, we give them some insight into anatomy and physiology, working with patients, understanding the health care system and that sort of thing. We also test them throughout the workshop, so that we have information which can strengthen their application if they decide they want to do medicine.”
“The whole experience of coming to uni goes a long way toward getting Indigenous students engaged in the system. We’re talking about people who may not have had a family member come to uni so they don’t understand the way the system works, and coming to Summer or Winter School really gives them that sense of connection at an earlier age and something to work towards. When they arrive at university for the admissions process, they know the people who have delivered the content for the Summer or Winter school. They see a familiar face and it makes them feel a bit more comfortable when they do their interviews,” Donald says.
JCU’s Summer and Winter schools started just two years before COVID-19 brought them to a close but are back again in 2022. The IERC is gathering data to develop an evidence base for how this initiative is laying some of the building blocks for the success of Indigenous students at university.
Pathways to Equity
Indigenous applicants to medicine at JCU are able to choose whether to apply through the Indigenous pathway, the mainstream pathway or both. Many choose to apply through both pathways and are interviewed by both selection panels.
“It’s part of the philosophy of the College on equity and working with disadvantaged groups,” Karen says. “They can choose to participate in both.”
Breaking down the inaccurate perception that Indigenous students take the place of other, more suitable candidates is vitally important for medical schools in Australia and New Zealand. This perception is an obstacle for all those working to close the gap in health outcomes for Indigenous peoples by growing the very small number of Indigenous medical practitioners in the national health workforces of both countries . It is also one of the examples of racism most frequently cited by Indigenous medical students in Australia and New Zealand.
“If other students don’t get it at the start, they get it as they go through the program; they understand why there is a targeted [Indigenous] pathway.”
“Indigenous students go through the same exams and assessment process as all the other students, and a lot of Indigenous students are coming through with extra challenges. We have a lot of mature age students in the course who have done other studies and who have to work and support families. They have to do all that on top of studying medicine.”
Linking Pastoral and Academic Support
The IERC is a welcoming space for Indigenous students to visit, during the day and in the evenings, to talk with Indigenous staff and meet other Indigenous students from disciplines across the university. The location of a centralised Indigenous support unit within a university – its proximity to the medical school – can have a big impact on how much busy medical students will visit and benefit from the services it provides. In earlier years there was a dedicated Indigenous support unit for the health programs at JCU but the trade-off for moving to the centralised IERC, located farther away from the College, was the volume of Indigenous staff and students working at and visiting the IERC, as well as the first-class study and recreation facilities located there.
Great care is taken to ensure that the Aboriginal Elders and other Indigenous staff at the IERC who provide pastoral care for Indigenous medical students work closely with the medical school staff who provide academic support at the College.
“Let’s say we have an Indigenous student who has some challenges, we’ll refer them to our medical academic support centre and they will make contact with the IERC to see if there is anything else we need to do, any gaps, in order to support a student,” Donald says. “The same happens if we don’t hear from a student. That student may be disengaged or remove themselves because they’re struggling a bit and they may not be as forward as others in asking for help – or know exactly what they need help with. We need to have our eye on the ball in regard to how they are travelling, so we look for the early warning signs and try to follow them up very quickly.”
Racism, Discrimination and Cultural Safety
An Indigenous student mentoring program linking senior students with those in the early years of medicine was recently introduced at the College. The senior students provide advice on how to navigate the later years of the medical degree to their younger peers and discuss career aspirations and potential career pathways, encouraging the juniors to think long-term about their medical career. This kind of peer support and mentoring can have a powerful positive impact on the confidence and resilience of Indigenous students if the school has a critical mass of Indigenous students to enable it.
The College supports and resources the mentoring program and encourages students to drive much of the discussion content for its events.
Dealing with racism and discrimination is a recurring discussion topic – like discussing whether something said in class can be considered racist or hearing from an Indigenous junior doctor who has come back to the school to talk about their experience of racism and discrimination in the workplace and how Indigenous students might prepare for that. This can be critical for students given the level of bullying, harassment and discrimination reportedly experienced by Indigenous junior doctors in the health workforce .
A commitment to diversity and zero tolerance for racism is woven through the culture and curriculum of the medical program and the College – in the professionalism stream within the medical curriculum, through the STAR Program (Stand Together Against Racism) and in first year orientation for all College students.
“We introduce all our students to this thinking from first year and we have a couple of sessions on what to do if you are faced with racist behaviour or comments, so that if students see it, it’s not the first time they’ve thought about it and they have some skills in their toolbox,” Karen says. “We want all our students to back up our Indigenous students if ever they see racism occurring.”
Another aspect of cultural safety is ‘cultural loading’ – requests for Indigenous students to provide information about Indigenous cultures and related aspects of Indigenous health and wellbeing. Unless medical schools have sufficient expertise on staff to teach Indigenous Health, it is very likely that Indigenous students will experience various forms of cultural loading while studying medicine, adding an unwanted burden to their already busy lives.
Karen is very careful not to pressure any of her students to represent their culture as a whole in a class context: “If they want to share, that’s great, but we are careful not to put anyone on the spot.”
Both Karen and Donald acknowledge the difficulty of ensuring cultural safety for Indigenous students when racism is a society-wide problem: “We’re always thinking ‘Are we doing enough? How well are we integrating diversity? What more do we need to do to support our Indigenous students?’”
Medical schools need to be constantly asking themselves these questions – as JCU are – to welcome Aboriginal and Torres Strait Islander students to their program and support them through to graduation. Building a culturally safe environment remains a substantial challenge for medical schools in Australia and New Zealand, but is a core aspect to contributing to equitable health outcomes by graduating more Indigenous doctors.
 A total of 207 students commenced the JCU medical program in 2021.
 0.47 per cent of employed medical practitioners identified as Aboriginal and Torres Strait Islanders in 2020. [Australian Government Department of Health], compared with 3.3 per cent of the national population [ABS]; 3.5 per cent of medical practitioners identified as Māori [2019 Medical Council of New Zealand], compared with 16.7 per cent national population [2020 NZ stats, NZ Government].
 Results of Ahpra’s 2021 Medical Training Survey show that 52% of Aboriginal and Torres Strait Islander trainees reported experiencing and/or witnessing bullying, harassment and/or discrimination (compared with 35% of trainees nationally), and of those experiencing bullying, harassment and or discrimination, 49% reported a moderate or major impact on their training (compared with 38% nationally).