Kohi Maramara: The effect of tertiary recruitment, admission, bridging/foundation education and retention on indigenous health workforce development.

Abstract

Indigenous health workforce development is expected to help address indigenous health inequities. While most countries want to grow and develop an indigenous health workforce, many countries struggle with how best to achieve this outcome. Experiences within Vision 20:20 (the Faculty of Medical and Health Science’s commitment to growing an indigenous health workforce) at the University of Auckland offer some potential solutions. This thesis shares these experiences so that indigenous aspirations for an indigenous-defined future may be realised. This thesis aims to answer the following research question: What are effective practices for Māori and Pacific health workforce development associated with tertiary recruitment, admission, bridging/foundation education and retention? Using an indigenous positioning inclusive of Kaupapa Māori and Pacific research methodologies, this thesis (a) identified national and international evidence of best practice for recruitment of indigenous secondary school students into health-related tertiary programmes; (b) examined the Māori and Pacific Admission Scheme (MAPAS) to determine the effect of the admissions process on first-year academic outcomes; (c) identified factors in the teaching and learning context of a health-focused bridging/foundation programme that helped or hindered Māori and Pacific student success; and (d) identified factors in the teaching and learning context that helped and hindered Māori and Pacific student success when studying in degree-level programmes within the Faculty of Medical and Health Sciences, University of Auckland. Qualitative and quantitative evidence identified extensive secondary education disparities for Māori and Pacific students, highlighting the importance of a recruitment strategy that addresses the academic requirements of health professional study and the use of a comprehensive admissions process inclusive of alternative pathways of entry. Six broad principles are recommended for indigenous recruitment: (1) frame recruitment initiatives within an indigenous worldview that takes into account indigenous rights, realities, values, priorities and processes; (2) demonstrate a tangible institutional commitment to achieving indigenous health workforce equity via the development (and proactive support of) a mission statement/vision and appropriate policies and processes; (3) identify the barriers to indigenous health workforce development and use these to frame recruitment initiatives within your local context; (4) conceptualise and incorporate recruitment activity within a comprehensive and integrated pipeline model that operates across secondary and tertiary education sectors via the provision of early exposure, transitioning, retention/completion and post-graduation activities; (5) increase engagement with parents, families and indigenous communities (including tribal groups) within all recruitment activities but particularly early exposure; and (6) incorporate high quality data collection, analysis and evaluation of recruitment activities within programmes with the publication of results where possible. The provision of Māori and Pacific student support services, the development of a supportive learning community and the promotion of culturally safe teaching and learning across the curriculum contribute to successful Māori and Pacific health workforce development. University-based institutional change was found to be central to improving outcomes for Māori and Pacific students preparing to enter the health workforce. In summary, twelve effective practices for indigenous recruitment, admission, bridging/foundation and retention are recommended: 1. Recruitment must target academic requirements for health professional study. 2. Recruitment must offer a comprehensive suite of recruitment interventions. 3. Recruitment must be grounded in indigenous realities and contexts. 4. Recruitment should be linked to equity admissions processes that include the provision of alternative pathways. 5. Admissions processes should focus on identifying the ‘best starting point’ for success. 6. Admissions processes should assess applicants holistically using both cognitive and non-cognitive selection tools. 7. Admissions processes should be inclusive of alternative pathways and points of entry. 8. Bridging/foundation education should provide a comprehensive and holistic ‘learning community’. 9. Bridging/foundation education requires high-quality teaching and learning delivered within a constructively aligned curriculum. 10. Retention requires comprehensive student support service for Māori and Pacific students. 11. Retention requires a culturally inclusive teaching and learning environment. 12. Retention is aided by the development of cultural safety and cultural competency of non-indigenous students. The findings from this research have the potential to inform other universities in Aotearoa New Zealand, and elsewhere wishing to increase equity and support social justice for indigenous peoples.