Entry to the Medical School
A recent article published in the Herald on Sunday was critical of policies for entry of students to The University of Auckland Medical School.
Here we publish a letter of response, as submitted to the Herald on Sunday by the Vice-Chancellor, Professor Stuart McCutcheon, and an article written by Craig Riddell, a current fifth-year medical student and President of the University of Auckland Medical Students’ Association. Slightly edited versions of both were published in the Herald on Sunday on 24 June.
The Vice-Chancellor’s letter to the New Zealand Herald
"Rodney Hide’s article (17 June) on entrance to The University of Auckland’s Medical School is both disingenuous and ill-informed. The University certainly supports Māori and Pacific students to enter and succeed in the medical programme. This is simply a recognition that students of ability, through a variety of personal circumstances, do not all have the same opportunity to exhibit that ability in secondary school and that Māori and Pacific students are under-represented in the university (and medical) sector. The University also operates a scheme designed to attract young people from rural communities who are more likely to return to those communities to practice medicine. Mr Hide apparently has no difficulty with that. Irrespective of their origins all students, once admitted, have to pass the same exams to qualify.
Admission to the medical programme has since its inception in 1968 always included components other than academic achievement in order to ensure that we graduate well rounded doctors. The suggestion that these other components were introduced later as a form of covert discrimination against Asians is simply wrong. The proportion of Asian students in the programme reflects the demographic of the students who apply, and the diverse population that exists in our city, including the fact that two thirds of the country’s Asian population resides in Auckland."
Medical Admissions Designed to Improve Health Outcomes
Craig Riddell in his 5th year of Medicine and currently based at Middlemore Hospital writes:
"As a medical student I found Rodney Hide’s article (“Racial quotas let down med school talent pool”) incredibly ill-informed. He does medical student admissions a grave disservice by attempting to drag it down to the level of racial politics. The University of Auckland produces excellent medical graduates and is regularly ranked within the world’s top 50 biomedical faculties. As a public institution the University’s medical faculty is tasked with producing a workforce to meet New Zealand’s health needs. It has been doing this job admirably for 50 years and should be trusted to fulfil these objectives.
It is fallacious to assume we are getting poorer quality doctors due to quotas. All medical students are held to the same academic standards once admitted. Moreover, grades are not a perfect predictor of excellence. Medicine is a mixture of art and science; excellent doctors are confidantes, advisors and friends as much as they are scientists. An interview for general admissions has been present since the University of Auckland established a medical school. It has always taken interpersonal skills and extra-curricular activities into account – these criteria are not new changes to act as a “stealth quota” for white students. Thus, it does not necessarily follow that by passing over some students with higher grades we end up with worse doctors.
Even the notion of labelling the Māori and Pacific Island Admissions Scheme (MAPAS) a quota separating the “brown” from the “yellow” and “white” students is reductionist. I am Māori, and did not enter medicine via the MAPAS scheme. I’m also pale-skinned. Where would I fit in among Mr Hide’s categories? These admissions are not based on a crude calculus relating to skin colour, but rather a holistic process that assesses a candidate’s engagement with Te Ao Māori/Pasifika culture. These qualities are rightly valued as precisely the factors that lead to the next generation of doctors who can stand as leaders within health systems and their communities.
Ensuring more Māori and Pacific doctors via admissions schemes is not simply about being “high and noble” as Mr Hide asserts, but rather a sincere attempt to address the glaring and damaging health inequalities within New Zealand. Māori and Pacific peoples have worse health outcomes compared with other ethnic groups, even after accounting for differences in incomes. This persisting gap, rightly criticized by international organisations, is due to many factors. Unfortunately one factor negatively influencing outcomes for Māori and Pacific patients is cultural differences impacting care provision by well-meaning doctors. For example, research has shown that Māori and Pacific Island children are less likely to receive optimal asthma treatment, resulting in higher hospitalisations and deaths. These gaps are objectionable and demand redress, especially given Māori status as tangata whenua.
While all medical students are thoroughly trained in relating to patients from all cultures, this alone is insufficient. To solve this problem we need to increase Māori and Pacific Islanders’ participation in the health workforce. Through this we can train doctors who are culturally fluent and not merely culturally aware, and who can act as agents of change toward better health for marginalized groups. The University of Auckland’s actions toward these goals are laudable, not lamentable.
Māori and Pacific students are not even the only group with different admission standards. Similar logic underpins the Regional-Rural Admissions Scheme, which provides places for rural students to enter medicine based on an assessment of their connection to their local community. Through this we hope they will return to practice medicine in rural settings. This is to counteract inequalities in care for rural versus urban patients and a dearth of domestically-trained doctors servicing our rural communities.
I admit that there may be students who miss out on a place in medicine due to these schemes. While important to acknowledge, this small injustice is necessary in the face of wider societal injustices regarding health outcomes. Besides, entering the medical profession is a privilege, not a right earned by getting straight A’s. Addressing rural and ethnic inequalities in care is a key component towards training a health workforce suited to our county’s needs. This consideration is paramount, and justly trumps any one student’s right to a place in medicine.
On a personal level, I am privileged to have trained alongside Māori and Pacific students admitted under the scheme. They are intelligent, hard-working, and dedicated. They will continue to achieve gains for Māori and Pakeha health irrespective of the criticisms of those such as Mr Hide.
Examining the wider health context it seems clear to me that while some small injustice may be done to the few students who lose out under a quota the far more important injustice is being addressed. If Rodney was to broaden his scope to wider inequalities New Zealanders face in achieving better health outcomes I hope he would agree."