A tertiary approach to improving equity in health: quantitative analysis of the Māori and Pacific Admission Scheme (MAPAS) process, 2008–2012

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.

What you can't see can hurt you: How do stereotyping, implicit bias and stereotype threat affect Māori health?

“…Although significant efforts are being made to increase the number of Mäori healthcare providers at the current time (Curtis et al, 2015), Mäori are a minority in the healthcare workforce, meaning the vast majority of interactions Mäori have are with healthcare providers who are non-Mäori. Social identity theory posits that because Mäori are likely to be perceived as outgroup members in most of their dealings with healthcare professionals, they are more likely to be vulnerable to stereotyping and implicit biases that may arise.…”

Predictors of academic success for Māori, Pacific and non-Māori non-Pacific students in health professional education: a quantitative analysis

“…In addition, quantitative analyses in some studies have been limited by small numbers of enrolled students from ethnic minority groups, a focus on first-year academic outcomes, and a lack of direct comparison between ethnic groups. Quantifying differences in exposure to helping and hindering factors for different ethnic groups is expected to contribute to enhanced targeted support (Curtis et al 2015a).…”

Quantitative analysis of a Māori and Pacific admission process on first-year health study

“…Unfortunately, students from underserved populations are less likely to receive access to science-rich subjects and are more likely to leave high school with lower qualifications than their peers [ 5 , 10 , 13 ]. Providing an admissions process that can determine whether indigenous and ethnic minority applicants are academically (and socially) ready to achieve success in pre-medical degree pathways and the provision of alternative entry pathways is recommended for tertiary institutions committed to widening participation [ 14 , 15 ].…”