Zoë Bristowe’s research while affiliated with University of Otago and other places

aim: To provide a socio-demographic profile of Asian students enrolled in their first year of a health professional programme in polytechnics and universities in Aotearoa New Zealand and to explore differences in enrolment rates (ERs) within Asian sub-groups and by socio-economic deprivation, citizenship status, urban/rural location and gender. methods: Ethnic group/sub-group and socio-demographic characteristics of students enrolling within 21 health professional programmes were collected and averaged over 5 years (2016–2020). Age- and ethnicity-matched denominator data from the 2018 Census were used to calculate yearly ERs and ratios (ERR) using generalised linear modelling with the European ethnic group as the reference. results: The overall ER for Asian students was higher than for Europeans (ERs [95% confidence interval: 280 [269–292] per 100,000 population aged 18–29 per year vs 149 [144–154]). However, Indian, Chinese and Southeast Asian students were under-represented in occupational therapy (ERR: 0.33–0.67, p=<0.017), midwifery (ERR: 0.46–0.61, p=<0.002) and paramedicine (ERR: 0.23–0.29, p<0.001). There were proportionately fewer female Asian students compared with European students (68% vs 82%, p<0.001). conclusion: This novel research provides detailed information on Asian sub-group representation in health professional programmes in Aotearoa. Taken in the context of known health needs of different Asian sub-groups, these data may facilitate health workforce planning and targeted policies within health professional programmes in order to better match the health workforce to population health needs.

Objective To determine the socio-demographic profile of all students enrolled to study medicine in Aotearoa New Zealand (NZ). Design and setting Observational, cross-sectional study. Data were sought from the Universities of Auckland and Otago, the two NZ tertiary education institutions providing medical education, for the period 2016–2020 inclusive. These data are a subset of the larger project ‘Mirror on Society’ examining all regulated health professional enrolled students in NZ. Variables of interest: gender, citizenship, ethnicity, rural classification, socioeconomic deprivation, school type and school socioeconomic scores. NZ denominator population data (18–29 years) were sourced from the 2018 census. Participants 2858 students were enrolled to study medicine between 2016 and 2020 inclusive. Results There were more women (59.1%) enrolled to study medicine than men (40.9%) and the majority (96.5%) were in the 18–29 years age range. Māori students (rate ratio 0.92; 95% CI 0.84 to 1.0) and Pacific students (rate ratio 0.85; 95% CI 0.73 to 0.98) had lower overall rates of enrolment. For all ethnic groups, irrespective of rural or urban origin, enrolment rates had a nearly log-linear negative relationship with increasing socioeconomic deprivation. Enrolments were lower for students from rural areas compared with those from urban areas (rate ratio 0.53; 95% CI 0.46–0.61). Overall NZ’s medical students do not reflect the diverse communities they will serve, with under-representation of Māori and Pacific students and students who come from low socioeconomic and rural backgrounds. Conclusions To meaningfully address these issues, we suggest the following policy changes: universities commit and act to Indigenise institutional ways of knowing and being; selection policies are reviewed to ensure that communities in greatest need of doctors are prioritised for enrolment into medicine (specifically, the impact of low socioeconomic status should be factored into selection decisions); and the government fund more New Zealanders to study medicine.

Objectives To provide a sociodemographic profile of students enrolled in their first year of a health professional pre-registration programme offered within New Zealand (NZ) tertiary institutions. Design Observational, cross-sectional study. Data were sought from NZ tertiary education institutions for all eligible students accepted into the first ‘professional’ year of a health professional programme for the 5-year period 2016–2020 inclusive. Variables of interest: gender, citizenship, ethnicity, rural classification, socioeconomic deprivation, school type and school socioeconomic scores. Analyses were carried out using the R statistics software. Setting Aotearoa NZ. Participants All students (domestic and international) accepted into the first ‘professional’ year of a health professional programme leading to registration under the Health Practitioners Competence Assurance Act 2003. Results NZ’s health workforce pre-registration students do not reflect the diverse communities they will serve in several important dimensions. There is a systematic under-representation of students who identify as Māori and Pacific, and students who come from low socioeconomic and rural backgrounds. The enrolment rate for Māori students is about 99 per 100 000 eligible population and for some Pacific ethnic groups is lower still, compared with 152 per 100 000 for NZ European students. The unadjusted rate ratio for enrolment for both Māori students and Pacific students versus ‘NZ European and Other’ students is approximately 0.7. Conclusions We recommend that: (1) there should be a nationally coordinated system for collecting and reporting on the sociodemographic characteristics of the health workforce pre-registration; (2) mechanisms be developed to allow the agencies that fund tertiary education to base their funding decisions directly on the projected health workforce needs of the health system and (3) tertiary education funding decisions be based on Te Tiriti o Waitangi (the foundational constitutional agreement between the Indigenous people, Māori and the British Crown signed in 1840) and have a strong pro-equity focus.

This paper aims to describe a number of sociological and theoretical foundations that underpin selection into tertiary health education in New Zealand and that have historically served to limit the participation of Māori students in restricted-entry health professional programmes. It further describes practical steps that can be taken to promote pro-equity changes within tertiary institutions. First, we discuss the sociological concept of meritocracy as a dominant approach to student selection and pedagogy in universities, and we describe the consequences of this approach for Māori students. Second, we discuss the concepts of white supremacy and privilege as two organising sets of values that interplay with each other and shape the tertiary environment. Third, we discuss possible alternative theoretical and ethical approaches based on Rawls' theory of justice, mana motuhake and strengths-based assumptions. Finally, we illustrate these alternative approaches, which are fundamentally committed to Te Tiriti o Waitangi, with an example of their successful application.

Background The lack of diversity in the health workforce is partly due to selection criteria for health professional programmes that have not selected students from a wide range of backgrounds. Consequently, health care professionals from minority groups and lower socio-economic backgrounds are under-represented in the workforce. Approach The Socioeconomic Equity (EQ) support programme aims to increase the participation, retention and academic success of students from low socio-economic communities studying in health professional programmes at the University of Otago. At the start of the academic year, students who had attended a secondary school from a low socio-economic community were invited to take part in the EQ Programme. This includes group workshops on study skills, guidance from peer mentors, subject specific academic support, one-on-one course advice and pastoral support and activities to enhance self-esteem and self-efficacy. Evaluation Comparing the first two years of the EQ project with the previous year, there was an increase in the percentage of students from schools in low socio-economic communities that passed HSFY. It was also found that more EQ students were offered places in health professional programmes than in the previous year. Implications The percentage of students passing HSFY has increased, and importantly, the percentage of students from low socio-economic backgrounds entering professional health programmes has doubled. This is a small start to building a health workforce that fairly reflects people from all communities.

Aotearoa New Zealand is a small, island nation located on the rim of Oceania. Since colonisation by British settlers in the mid-1800s, the internationalisation of higher education (HE) in Aotearoa New Zealand has reflected shifting notions of nationhood – from an extension of Great Britain, to a (separate) bicultural nation, to a player in the global knowledge economy. Since the late 1980s, internationalisation policy has reflected the primacy of market concerns; the internationalisation of HE has been imagined primarily as a means to attract export revenue and human capital to Aotearoa New Zealand, and to increase brand recognition. However, internationalisation, as the movement of people and knowledge between places, can also be seen as pre-dating the development of nations, particularly in the Oceania context.Within mātauranga Māori, or Māori (indigenous) epistemological traditions, place is central to identity. To be human is to be part of something bigger than oneself; care for the land is care both for ancestors and the wellbeing of future generations. In this paper, we (re)consider internationalised HE in light of three questions that are central to mātauranga Māori: “Who am I? What is this world that I exist in? What am I to do?” (Royal, 2012, p. 35). After tracing the connections between internationalisation, colonisation, and nationhood in Aotearoa New Zealand,we consider how attention to Māori place-based epistemologies and values drawn from mātauranga Māori might challenge, stretch and ground contemporary internationalisation policies and practices in Aotearoa New Zealand.

Care has received relatively little attention in higher education (HE) literature. However, literature alluding to care reveals contrasting perspectives. Some scholars diminish care concerns as a product of the marketised university, where students-as-consumers insist on ‘safe’ teaching and the avoidance of ‘troublesome knowledge’. Others position care as an ethical pedagogical stance, given the power asymmetries inherent in university life. Some suggest that attention to care in HE is risky, since it troubles gendered boundaries between public and private life, and rationality and emotion. In this article, we discuss a research project that explored diverse students’ conceptions of good teaching and effective learning at a research-intensive university in Aotearoa New Zealand, using focus group discussions, critical incident technique and photovoice. Participants included 55 Māori, Pacific, international and (other) local students enrolled in Health Science and Humanities subjects. Although care was not the focus of the study, all cohorts of students represented care as a key marker of good teaching. They described good teachers as people who care about their discipline, care about teaching and care about students, powerfully influencing students’ engagement with subject matter, enthusiasm for learning and aspirations for the future. While some students acknowledged and lamented their position as consumers in marketised HE, they also revealed an awareness of the factors that constrain teachers’ capacity to care and expressed gratitude for teachers’ investment in students. We argue for the need to recognise teaching in HE as cognitive, emotional and embodied work; to acknowledge teachers’ powerful influence on students; and to avoid simplistic representations of both teachers and students in contemporary HE.