Abstract
IntroductionAchieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce. This study explores a tertiary admission programme targeting Māori and Pacific applicants to nursing, pharmacy and health sciences (a precursor to medicine) at the University of Auckland (UoA), Aotearoa New Zealand (NZ). Application of cognitive and non-cognitive selection tools, including a Multiple Mini Interview (MMI), are examined.MethodsIndigenous Kaupapa Māori methodology guided analysis of the Māori and Pacific Admission Scheme (MAPAS) for the years 2008–2012. Multiple logistic regression models were used to identify the predicted effect of admission variables on the final MAPAS recommendation of best starting point for success in health professional study i.e. ‘CertHSc’ (Certificate in Health Sciences, bridging/foundation), ‘Bachelor’ (degree-level) or ‘Not FMHS’ (Faculty of Medical and Health Sciences). Regression analyses controlled for interview year, gender and ancestry.ResultsOf the 918 MAPAS interviewees: 35% (319) were Māori, 58% (530) Pacific, 7% (68) Māori/Pacific; 71% (653) school leavers; 72% (662) females. The average rank score was 167/320, 40–80 credits below guaranteed FMHS degree offers. Just under half of all interviewees were recommended ‘CertHSc’ 47% (428), 13% (117) ‘Bachelor’ and 38% (332) ‘Not FMHS’ as the best starting point. Strong associations were identified between Bachelor recommendation and exposure to Any 2 Sciences (OR:7.897, CI:3.855-16.175; p < 0.0001), higher rank score (OR:1.043, CI:1.034-1.052; p < 0.0001) and higher scores on MAPAS mathematics test (OR:1.043, CI:1.028-1.059; p < 0.0001). MMI stations had mixed associations, with academic preparation and career aspirations more consistently associated with recommendations.ConclusionsOur findings raise concerns about the ability of the secondary education sector to prepare Māori and Pacific students adequately for health professional study. A comprehensive tertiary admissions process using multiple tools for selection (cognitive and non-cognitive) and the provision of alternative entry pathways are recommended for indigenous and ethnic minority health workforce development. The application of the MMI within an equity and indigenous cultural context can support a holistic assessment of an applicant’s potential to succeed within tertiary study. The new MAPAS admissions process may provide an exemplar for other tertiary institutions looking to widen participation via equity-targeted admission processes.
Highlights
Achieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce
Increasing the number of indigenous and ethnic minority health professionals has been hypothesised to: increase healthcare delivery to under-represented and low-income populations [7,13]; enhance patient satisfaction associated with patient preference for ethnically-concordant physician interactions [14,15]; and, potentially reduce physician bias that can contribute to ethnic inequities in access to high quality healthcare services [16]
In this instance it aims to provide: a commitment to ensuring that the research outputs will have positive benefits for Māori and Pacific students and communities; an explicit challenge to reject ‘victim blame’ and ‘cultural deficit’ analyses when interpreting data [53]; promoting a structural analysis that rejects findings that suggest the culture of Māori or Pacific students are to blame for their educational failure and ensuring that any recommendations made from the research aim to facilitate Māori and Pacific student success
Summary
Achieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce. A key component in achieving health equity for Māori and Pacific peoples includes the development of a diverse health workforce that reflects the population and society it aims to serve [7]. Pacific peoples make up 7.4% of the NZ population but only 1% of doctors, 0.2% of pharmacists, 0.6% of dentists and 2.2% of nurses [10,11,12]. Increasing the number of indigenous and ethnic minority health professionals has been hypothesised to: increase healthcare delivery to under-represented and low-income populations [7,13]; enhance patient satisfaction associated with patient preference for ethnically-concordant physician interactions [14,15]; and, potentially reduce physician bias that can contribute to ethnic inequities in access to high quality healthcare services [16]
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