View Article PDF

The University of Otago's Division of Health Sciences aims to produce health professionals equipped to meet the needs of society; this is at the heart of the social contract between the University and society.The University strives to train health professional graduates who reflect and are responsive to the diversity within society. The sociodemographic profile of health professional students is important because, in part, these characteristics influence future career choices in terms of place of practice and types of populations served.1-3 The overarching admissions policy of the University's Division of Health Sciences states: Ideally the make-up of health professional classes should be equivalent to holding a mirror up to society. In order to achieve this we aim to attract and support the most academically able students from a wide variety of backgrounds. The gender, ethnic, socioeconomic and rural/urban composition of our graduates should, more or less, reflect the diverse communities in Aotearoa. The above statement reflects recent international consensus and calls to action from inter-country working groups.4-7,8p249,9 The Australian Medical Council also recognises the importance of encouraging and prioritising student diversity in its guidelines for the accreditation of medical schools (which apply to medical schools in New Zealand):10 In Australia and New Zealand, inequalities remain in the health status of various social and cultural groups. Medical schools have a responsibility to select students who can reasonably be expected to respond to the needs and challenges of the whole community, including the health care of these groups. This may include selection of students who are members of such groups. The medical curriculum should also provide opportunities for cultural education programs, and opportunities for training and provision of service in under-serviced communities. We believe indigenous health and Pacific health are areas of special responsibility because of New Zealand's history, demographic makeup, and location as a Pacific nation. In the case of Māori health and Māori education, New Zealand's universities have a dual obligation to honour the contractual obligations defined in the Treaty of Waitangi and the responsibility to correct the inequitable health and education outcomes experienced by Māori populations. The University's Division of Health Sciences adopts the following principles in the selection of students into its health professional programmes. Each of these programmes aims to select students who: Are committed to and capable of academic excellence; On balance reflect the gender, ethnic, socioeconomic, and rural/urban composition of society; and Are committed to serving the needs of individuals, families and communities in New Zealand or overseas. The purpose of this study is to describe the current sociodemographic characteristics of the University's health professional students in order to a) evaluate performance against our goals, b) inform policy development within the University, and c) to provide a benchmark against which to measure change. Methods Health Professional Programmes—All students (domestic and international) accepted into in the following eight health professional programmes in 2010 were included in the study (Table 1). Table 1. Eight professional programmes included in the study Professional programme School-leaver entry pathway Tertiary entry pathways Bachelor of Dental Surgery (BDS) √ Bachelor of Dental Technology (BDentTech) √ √ Bachelor of Medical Laboratory Science (BMLSc) √ Bachelor of Medicine and Bachelor of Surgery (MB ChB) √ Bachelor of Oral Health (BOH) √ √ Bachelor of Pharmacy (BPharm) √ Bachelor of Physiotherapy (BPhty) √ Bachelor of Radiation Therapy (BRT) √ √ Data sources—Student data were downloaded from the University of Otago's central student records system (which contains routinely collected data). Data were obtained in anonymous, summary form. University student data are a mix of verified and unverified fields. Age and sex are verified by the sighting of birth certificates, and data are complete for these fields. Ethnicity data are complete but unverified, and home area statistics are unverified with 0.7% missing for the student population. Home area data were analysed only for domestic students (not international). Home area statistics are collected by the University in a student's first year of study only, and are derived from the contact address provided by students when they first enrol. Student citizenship was classified into the following categories: New Zealand citizens; New Zealand permanent residents; Tokelau/Niue/Cook Island citizens; Australian citizens; international citizens. For University purposes, based on the allocation of funding by the Tertiary Education Commission, domestic students are those students who are New Zealand Citizens, or New Zealand Permanent Residents, or citizens of Tokelau, Niue, Cook Islands, or Australia. New Zealand population data were sourced from 2011 estimates provided by Statistics New Zealand.11-13 Ethnicity Classification/definitions—When students enrol at the University of Otago, they can nominate up to three ethnicities they identify with; these ethnicities are self-declared. Students can change which ethnicities they associate with at any point in time. Ethnic groups were aggregated into the following four categories: Māori; Pacific; Asian; New Zealand European and Other. As students can nominate more than one ethnicity the sum of ethnicities in the student population is greater than 100% of students. The ‘Asian' category, as used in the New Zealand health sector, includes students from East, South and Southeast Asia but excludes people from the Middle East and Central Asia. This category has acknowledged shortcomings because of the ethnic diversity within the category.14 The ‘New Zealand European and Other' category includes students who identified as New Zealand European plus students who did not fall into any of the other categories. The proportion of New Zealand European within the ‘New Zealand European and Other' category was approximately 97% for the University population and 94 % for the Health Sciences population. Other includes students who identify as Middle Eastern, Latin American and African. Socioeconomic deprivation—Socioeconomic deprivation was measured using the NZDep2006 (NZDep) index of socioeconomic deprivation for small areas. NZDep is an area-based measure combining nine variables from New Zealand's 5-yearly census that reflect eight dimensions of deprivation.15-18 Each NZDep index is created for small areas built from one or more contiguous meshblocks. Meshblocks, containing around 90 people, are the smallest geographical units defined by the central government statistics agency, Statistics New Zealand. The small areas were constructed with, as far as possible, at least 100 people usually resident. In 2006, for example, only 4% contained fewer than 100 people, while 76% contained fewer than 200 people, and just 3% had more than 300 people. The NZDep indexes were created from the proportions of people in each census-specific small area with each of nine characteristics related to deprivation. The NZDep scale runs from 1 to 10 where, for example, a value of 10 indicates that the meshblock is in the most deprived 10% of small areas in New Zealand. At a national level, the number of people in each NZDep category is roughly equal. The level of diversity increases as the geographic unit of measurement becomes smaller. In order to link the student and NZDep datasets, the meshblock associated with the home residence of students was attached to individual records in the University's student dataset (domestic students only). The corresponding NZDep value for each domestic student's home address was then added. School socioeconomic scores—The Ministry of Education uses a school rating scale to indicate the extent to which it draws its students from low socioeconomic communities. Decile 1 schools are the 10% of schools with the highest proportion of students from low socioeconomic communities, whereas decile 10 schools are the 10% of schools with the lowest proportion of these students. A school decile does not indicate the overall socioeconomic mix of the students attending a school or measure the standard of education delivered at a school.19 It is not possible to calculate decile information for students who went to correspondence school or an overseas school. Results Geographic location of home area—Auckland is home for 33.4% of the New Zealand population; in 2010 15.0% of the University of Otago's student population came from Auckland, and 22.0% of the professional programme population came from Auckland (Table 2). The four regions of Auckland, Canterbury, Otago and Wellington made up around 70% of both the University student population and the professional programme student population. Table 2. Geographic location of domestic students' home areas (2010 year) Region % of NZ population % of University population % of Health Sciences Professional Programme population Northland 3.6 2.0 1.8 Auckland 33.4 15.0 22.0 Bay of Plenty 6.3 5.0 4.9 Waikato 9.4 3.1 5.8 Gisborne 1.1 0.7 0.9 Hawkes Bay 3.5 2.5 2.5 Taranaki 2.5 1.7 1.8 Wanganui-Manawatu 5.3 2.6 4.5 Wellington 11.1 11.7 14.0 Tasman 1.1 2.8 2.4 Marlborough 1.0 1.0 1.1 West Coast 0.7 0.5 0.2 Canterbury 13.0 15.4 22.7 Otago 4.7

Summary

Abstract

Aim

To describe the sociodemographic characteristics of students accepted into eight health professional programmes at the University of Otago.

Method

Student data were obtained from the University of Otagos central student records system. Data were obtained in anonymous, summary form. New Zealand population data were obtained from Statistics New Zealand. Descriptive statistics were calculated.

Results

In 2010 health professional students at the University of Otago were largely from outside the Otago region (88.1%). 59.6% were female and 84.8% were either New Zealand citizens or permanent residents. Within the domestic student cohort, 65.0% of students self-identified as being within the New Zealand European & Other category (compared with 75.3% of the national population), 34.2% as Asian (compared with 11.1%), 6.3% as M ori (compared with 15.2%), and 2.3% as Pacific (compared with 7.7%). A large proportion of students came from high socioeconomic areas and only 3.4% of students had attended secondary schools with a socioeconomic decile of less than 4.

Conclusion

Schools and Faculties within the University of Otagos Division of Health Sciences do not achieve the sociodemographic mirror of society we hope for, and we strive to improve both our selection processes, within the constraints and limitations of the available selection tools, and our student support mechanisms. We will continue to refine these policies and work with other key stakeholders in better preparing school leavers for health professional programmes.

Author Information

Peter Crampton, Pro-Vice-Chancellor, Division of Health Sciences, University of Otago, Dunedin; Naomi Weaver, Planning and Institutional Research Analyst, University of Otago, Dunedin; Andrea Howard, Director, Policy and Programmes, Division of Health Sciences, University of Otago, Dunedin

Acknowledgements

We are grateful for comments made on earlier drafts by Professor Tim Wilkinson, Associate Professor Jo Baxter and by the anonymous NZMJ reviewers.

Correspondence

Professor Peter Crampton, Pro-Vice-Chancellor, Division of Health Sciences, PO Box 56, University of Otago, Dunedin, New Zealand.

Correspondence Email

peter.crampton@otago.ac.nz

Competing Interests

None known.

Ranmuthugala G, Humphreys J, Solarsh B, et al. Where is the evidence that rural exposure increases uptake of rural medical practice? Australian Journal of Rural Health 2007;5:285-8.Rabinowitz H, Diamond J, Markham F, Paynter N. Critical factors for designing programs to increase the supply and retention of rural primary care physicians. JAMA 2001;286(9):1041-48.Moy E, Bartman B. Physician race and care of minority and medically indigent patients. JAMA 1995;273(19):1515-20.Frenk J, Chen L, Bhutta Z, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet 2010;376:1923-58.Global Consensus for Social Accountability of Medical Schools. Global Consensus for Social Accountability of Medical Schools: Global Consensus for Social Accountability of Medical Schools, 2010. http://healthsocialaccountability.org/The Training for Health Equity Network. THEnet's Social Accountability Evaluation Framework Version 1. Monograph 1.: The Training for Health Equity Network, 2011.Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Medical Education 2009;43:887-94.Cooke M, Irby M, O'Brien B. Educating Physicians, A Call for Reform of Medical School and Residency. San Francisco: Jossey-Bass, 2010British Medical Association. Equality and diversity in UK medical schools: British Medical Association, 2009Australian Medical Council. Assessment and Accreditation of Medical Schools: Standards and Procedures, 2002. Kingston, ACT: Australian Medical Council, 2002Statistics New Zealand. Subnational Population Estimates: At 30 June 2010 Wellington: Statistics New Zealand.http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/SubnationalPopulationEstimates_HOTP30Jun10.aspxStatistics New Zealand. Projected Population of New Zealand by Age and Sex, 2009 (base) - 2061. Wellington: Statistics New Zealand, Table Builderhttp://www.stats.govt.nz/tools_and_services/tools/tablebuilder.aspxStatistics New Zealand. Projected Ethnic Population of New Zealand, by Age and Sex, 2006 (base) - 2026 Update. Wellington Statistics New Zealand.http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/NationalPopulationProjections_HOTP09base-61.aspxRasanathan K, Craig D, Perkins R. The novel use of 'Asian' as an ethnic category in the New Zealand health sector. Ethnicity and Health 2006;11:211-27.Crampton P, Salmond C, Sutton F. NZDep91: a new index of deprivation. Social Policy Journal of New Zealand 1997;9:186-93.Salmond C, Crampton P. Heterogeneity of deprivation within very small areas. Journal of Epidemiology and Community Health 2002;56:669-70.Salmond C, Crampton P, Atkinson J. NZDep2006 Index of Deprivation. Wellington: Department of Public Health, University of Otago Wellington, 2007.http://www.wnmeds.ac.nz/academic/dph/research/socialindicators.htmlSalmond C, Crampton P, Sutton F. NZDep91: a new index of deprivation. Australian and New Zealand Journal of Public Health 1998;22:95-97.Ministry of Education. Our Education System. Wellington: Ministry of Education,http://www.minedu.govt.nz/NZEducation/EducationPolicies/Schools/SchoolOperations/Resourcing/ResourcingHandbook/Chapter1/DecileRatings.aspxJames D, Yates J, Nicholson S. Comparison of A level and UKAT performance in students applying to UK medical and dental schools in 2006: cohort study. British Medical Journal 2010;349:c478 doi:10.1136/bmj.c748.Poole P, Moriarty H, Wearn A, et al. Medical student selection in New Zealand: looking to the future. New Zealand Medical Journal 2009;122(1306):88-100. http://journal.nzma.org.nz/journal/122-1306/3884/content.pdfPrideaux D, Roberts C, Eva K, et al. Assessment for selection for the health care professions and specialty training: consensus statement and recommendations from the Ottawa 2010 Conference. Medical Teacher 2011;33:215-23.Dhalla I, Kwong J, Streiner D, et al. Characteristics of first-year students in Canadian medical schools. Canadian Medical Association Journal 2002;166(8):1029-35.Marino R, Morgan M, Winning T, et al. Sociodemographic backgrounds and career decisions of Australian and New Zealand dental students. Journal of Dental Education 2006;70(2):169-78.Mathers J, Sitch A, Marsh J, Parry J. Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6. British Medical Journal 2012;341:d918.Brown C, Lilford R. Selecting medical students (editorial). British Medical Journal 2008;336:786.Gorman D, Monigatti J, Poole P. On the case for an interview in medical student selection. Internal Medicine Journal 2008;38:621-23.Wilkinson D, Zhang J, Parker M. Predictive validity of the Undergraduate Medicine and Health Sciences Admission Test for medical students' academic performance. Medical Journal of Australia 2011;194(7):341-44.Shelker W, Belton A, Glue P. Academic performance and career choices of older medical students at the University of Otago. New Zealand Medical Journal 2011;124(1346):64-68. http://journal.nzma.org.nz/journal/124-1346/4965/content.pdfMathers J, Parry J. Why are there so few working-class applicants to medical schools? Learning from the success stories. Medical Education 2009;43:219-228.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

The University of Otago's Division of Health Sciences aims to produce health professionals equipped to meet the needs of society; this is at the heart of the social contract between the University and society.The University strives to train health professional graduates who reflect and are responsive to the diversity within society. The sociodemographic profile of health professional students is important because, in part, these characteristics influence future career choices in terms of place of practice and types of populations served.1-3 The overarching admissions policy of the University's Division of Health Sciences states: Ideally the make-up of health professional classes should be equivalent to holding a mirror up to society. In order to achieve this we aim to attract and support the most academically able students from a wide variety of backgrounds. The gender, ethnic, socioeconomic and rural/urban composition of our graduates should, more or less, reflect the diverse communities in Aotearoa. The above statement reflects recent international consensus and calls to action from inter-country working groups.4-7,8p249,9 The Australian Medical Council also recognises the importance of encouraging and prioritising student diversity in its guidelines for the accreditation of medical schools (which apply to medical schools in New Zealand):10 In Australia and New Zealand, inequalities remain in the health status of various social and cultural groups. Medical schools have a responsibility to select students who can reasonably be expected to respond to the needs and challenges of the whole community, including the health care of these groups. This may include selection of students who are members of such groups. The medical curriculum should also provide opportunities for cultural education programs, and opportunities for training and provision of service in under-serviced communities. We believe indigenous health and Pacific health are areas of special responsibility because of New Zealand's history, demographic makeup, and location as a Pacific nation. In the case of Māori health and Māori education, New Zealand's universities have a dual obligation to honour the contractual obligations defined in the Treaty of Waitangi and the responsibility to correct the inequitable health and education outcomes experienced by Māori populations. The University's Division of Health Sciences adopts the following principles in the selection of students into its health professional programmes. Each of these programmes aims to select students who: Are committed to and capable of academic excellence; On balance reflect the gender, ethnic, socioeconomic, and rural/urban composition of society; and Are committed to serving the needs of individuals, families and communities in New Zealand or overseas. The purpose of this study is to describe the current sociodemographic characteristics of the University's health professional students in order to a) evaluate performance against our goals, b) inform policy development within the University, and c) to provide a benchmark against which to measure change. Methods Health Professional Programmes—All students (domestic and international) accepted into in the following eight health professional programmes in 2010 were included in the study (Table 1). Table 1. Eight professional programmes included in the study Professional programme School-leaver entry pathway Tertiary entry pathways Bachelor of Dental Surgery (BDS) √ Bachelor of Dental Technology (BDentTech) √ √ Bachelor of Medical Laboratory Science (BMLSc) √ Bachelor of Medicine and Bachelor of Surgery (MB ChB) √ Bachelor of Oral Health (BOH) √ √ Bachelor of Pharmacy (BPharm) √ Bachelor of Physiotherapy (BPhty) √ Bachelor of Radiation Therapy (BRT) √ √ Data sources—Student data were downloaded from the University of Otago's central student records system (which contains routinely collected data). Data were obtained in anonymous, summary form. University student data are a mix of verified and unverified fields. Age and sex are verified by the sighting of birth certificates, and data are complete for these fields. Ethnicity data are complete but unverified, and home area statistics are unverified with 0.7% missing for the student population. Home area data were analysed only for domestic students (not international). Home area statistics are collected by the University in a student's first year of study only, and are derived from the contact address provided by students when they first enrol. Student citizenship was classified into the following categories: New Zealand citizens; New Zealand permanent residents; Tokelau/Niue/Cook Island citizens; Australian citizens; international citizens. For University purposes, based on the allocation of funding by the Tertiary Education Commission, domestic students are those students who are New Zealand Citizens, or New Zealand Permanent Residents, or citizens of Tokelau, Niue, Cook Islands, or Australia. New Zealand population data were sourced from 2011 estimates provided by Statistics New Zealand.11-13 Ethnicity Classification/definitions—When students enrol at the University of Otago, they can nominate up to three ethnicities they identify with; these ethnicities are self-declared. Students can change which ethnicities they associate with at any point in time. Ethnic groups were aggregated into the following four categories: Māori; Pacific; Asian; New Zealand European and Other. As students can nominate more than one ethnicity the sum of ethnicities in the student population is greater than 100% of students. The ‘Asian' category, as used in the New Zealand health sector, includes students from East, South and Southeast Asia but excludes people from the Middle East and Central Asia. This category has acknowledged shortcomings because of the ethnic diversity within the category.14 The ‘New Zealand European and Other' category includes students who identified as New Zealand European plus students who did not fall into any of the other categories. The proportion of New Zealand European within the ‘New Zealand European and Other' category was approximately 97% for the University population and 94 % for the Health Sciences population. Other includes students who identify as Middle Eastern, Latin American and African. Socioeconomic deprivation—Socioeconomic deprivation was measured using the NZDep2006 (NZDep) index of socioeconomic deprivation for small areas. NZDep is an area-based measure combining nine variables from New Zealand's 5-yearly census that reflect eight dimensions of deprivation.15-18 Each NZDep index is created for small areas built from one or more contiguous meshblocks. Meshblocks, containing around 90 people, are the smallest geographical units defined by the central government statistics agency, Statistics New Zealand. The small areas were constructed with, as far as possible, at least 100 people usually resident. In 2006, for example, only 4% contained fewer than 100 people, while 76% contained fewer than 200 people, and just 3% had more than 300 people. The NZDep indexes were created from the proportions of people in each census-specific small area with each of nine characteristics related to deprivation. The NZDep scale runs from 1 to 10 where, for example, a value of 10 indicates that the meshblock is in the most deprived 10% of small areas in New Zealand. At a national level, the number of people in each NZDep category is roughly equal. The level of diversity increases as the geographic unit of measurement becomes smaller. In order to link the student and NZDep datasets, the meshblock associated with the home residence of students was attached to individual records in the University's student dataset (domestic students only). The corresponding NZDep value for each domestic student's home address was then added. School socioeconomic scores—The Ministry of Education uses a school rating scale to indicate the extent to which it draws its students from low socioeconomic communities. Decile 1 schools are the 10% of schools with the highest proportion of students from low socioeconomic communities, whereas decile 10 schools are the 10% of schools with the lowest proportion of these students. A school decile does not indicate the overall socioeconomic mix of the students attending a school or measure the standard of education delivered at a school.19 It is not possible to calculate decile information for students who went to correspondence school or an overseas school. Results Geographic location of home area—Auckland is home for 33.4% of the New Zealand population; in 2010 15.0% of the University of Otago's student population came from Auckland, and 22.0% of the professional programme population came from Auckland (Table 2). The four regions of Auckland, Canterbury, Otago and Wellington made up around 70% of both the University student population and the professional programme student population. Table 2. Geographic location of domestic students' home areas (2010 year) Region % of NZ population % of University population % of Health Sciences Professional Programme population Northland 3.6 2.0 1.8 Auckland 33.4 15.0 22.0 Bay of Plenty 6.3 5.0 4.9 Waikato 9.4 3.1 5.8 Gisborne 1.1 0.7 0.9 Hawkes Bay 3.5 2.5 2.5 Taranaki 2.5 1.7 1.8 Wanganui-Manawatu 5.3 2.6 4.5 Wellington 11.1 11.7 14.0 Tasman 1.1 2.8 2.4 Marlborough 1.0 1.0 1.1 West Coast 0.7 0.5 0.2 Canterbury 13.0 15.4 22.7 Otago 4.7

Summary

Abstract

Aim

To describe the sociodemographic characteristics of students accepted into eight health professional programmes at the University of Otago.

Method

Student data were obtained from the University of Otagos central student records system. Data were obtained in anonymous, summary form. New Zealand population data were obtained from Statistics New Zealand. Descriptive statistics were calculated.

Results

In 2010 health professional students at the University of Otago were largely from outside the Otago region (88.1%). 59.6% were female and 84.8% were either New Zealand citizens or permanent residents. Within the domestic student cohort, 65.0% of students self-identified as being within the New Zealand European & Other category (compared with 75.3% of the national population), 34.2% as Asian (compared with 11.1%), 6.3% as M ori (compared with 15.2%), and 2.3% as Pacific (compared with 7.7%). A large proportion of students came from high socioeconomic areas and only 3.4% of students had attended secondary schools with a socioeconomic decile of less than 4.

Conclusion

Schools and Faculties within the University of Otagos Division of Health Sciences do not achieve the sociodemographic mirror of society we hope for, and we strive to improve both our selection processes, within the constraints and limitations of the available selection tools, and our student support mechanisms. We will continue to refine these policies and work with other key stakeholders in better preparing school leavers for health professional programmes.

Author Information

Peter Crampton, Pro-Vice-Chancellor, Division of Health Sciences, University of Otago, Dunedin; Naomi Weaver, Planning and Institutional Research Analyst, University of Otago, Dunedin; Andrea Howard, Director, Policy and Programmes, Division of Health Sciences, University of Otago, Dunedin

Acknowledgements

We are grateful for comments made on earlier drafts by Professor Tim Wilkinson, Associate Professor Jo Baxter and by the anonymous NZMJ reviewers.

Correspondence

Professor Peter Crampton, Pro-Vice-Chancellor, Division of Health Sciences, PO Box 56, University of Otago, Dunedin, New Zealand.

Correspondence Email

peter.crampton@otago.ac.nz

Competing Interests

None known.

Ranmuthugala G, Humphreys J, Solarsh B, et al. Where is the evidence that rural exposure increases uptake of rural medical practice? Australian Journal of Rural Health 2007;5:285-8.Rabinowitz H, Diamond J, Markham F, Paynter N. Critical factors for designing programs to increase the supply and retention of rural primary care physicians. JAMA 2001;286(9):1041-48.Moy E, Bartman B. Physician race and care of minority and medically indigent patients. JAMA 1995;273(19):1515-20.Frenk J, Chen L, Bhutta Z, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet 2010;376:1923-58.Global Consensus for Social Accountability of Medical Schools. Global Consensus for Social Accountability of Medical Schools: Global Consensus for Social Accountability of Medical Schools, 2010. http://healthsocialaccountability.org/The Training for Health Equity Network. THEnet's Social Accountability Evaluation Framework Version 1. Monograph 1.: The Training for Health Equity Network, 2011.Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Medical Education 2009;43:887-94.Cooke M, Irby M, O'Brien B. Educating Physicians, A Call for Reform of Medical School and Residency. San Francisco: Jossey-Bass, 2010British Medical Association. Equality and diversity in UK medical schools: British Medical Association, 2009Australian Medical Council. Assessment and Accreditation of Medical Schools: Standards and Procedures, 2002. Kingston, ACT: Australian Medical Council, 2002Statistics New Zealand. Subnational Population Estimates: At 30 June 2010 Wellington: Statistics New Zealand.http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/SubnationalPopulationEstimates_HOTP30Jun10.aspxStatistics New Zealand. Projected Population of New Zealand by Age and Sex, 2009 (base) - 2061. Wellington: Statistics New Zealand, Table Builderhttp://www.stats.govt.nz/tools_and_services/tools/tablebuilder.aspxStatistics New Zealand. Projected Ethnic Population of New Zealand, by Age and Sex, 2006 (base) - 2026 Update. Wellington Statistics New Zealand.http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/NationalPopulationProjections_HOTP09base-61.aspxRasanathan K, Craig D, Perkins R. The novel use of 'Asian' as an ethnic category in the New Zealand health sector. Ethnicity and Health 2006;11:211-27.Crampton P, Salmond C, Sutton F. NZDep91: a new index of deprivation. Social Policy Journal of New Zealand 1997;9:186-93.Salmond C, Crampton P. Heterogeneity of deprivation within very small areas. Journal of Epidemiology and Community Health 2002;56:669-70.Salmond C, Crampton P, Atkinson J. NZDep2006 Index of Deprivation. Wellington: Department of Public Health, University of Otago Wellington, 2007.http://www.wnmeds.ac.nz/academic/dph/research/socialindicators.htmlSalmond C, Crampton P, Sutton F. NZDep91: a new index of deprivation. Australian and New Zealand Journal of Public Health 1998;22:95-97.Ministry of Education. Our Education System. Wellington: Ministry of Education,http://www.minedu.govt.nz/NZEducation/EducationPolicies/Schools/SchoolOperations/Resourcing/ResourcingHandbook/Chapter1/DecileRatings.aspxJames D, Yates J, Nicholson S. Comparison of A level and UKAT performance in students applying to UK medical and dental schools in 2006: cohort study. British Medical Journal 2010;349:c478 doi:10.1136/bmj.c748.Poole P, Moriarty H, Wearn A, et al. Medical student selection in New Zealand: looking to the future. New Zealand Medical Journal 2009;122(1306):88-100. http://journal.nzma.org.nz/journal/122-1306/3884/content.pdfPrideaux D, Roberts C, Eva K, et al. Assessment for selection for the health care professions and specialty training: consensus statement and recommendations from the Ottawa 2010 Conference. Medical Teacher 2011;33:215-23.Dhalla I, Kwong J, Streiner D, et al. Characteristics of first-year students in Canadian medical schools. Canadian Medical Association Journal 2002;166(8):1029-35.Marino R, Morgan M, Winning T, et al. Sociodemographic backgrounds and career decisions of Australian and New Zealand dental students. Journal of Dental Education 2006;70(2):169-78.Mathers J, Sitch A, Marsh J, Parry J. Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6. British Medical Journal 2012;341:d918.Brown C, Lilford R. Selecting medical students (editorial). British Medical Journal 2008;336:786.Gorman D, Monigatti J, Poole P. On the case for an interview in medical student selection. Internal Medicine Journal 2008;38:621-23.Wilkinson D, Zhang J, Parker M. Predictive validity of the Undergraduate Medicine and Health Sciences Admission Test for medical students' academic performance. Medical Journal of Australia 2011;194(7):341-44.Shelker W, Belton A, Glue P. Academic performance and career choices of older medical students at the University of Otago. New Zealand Medical Journal 2011;124(1346):64-68. http://journal.nzma.org.nz/journal/124-1346/4965/content.pdfMathers J, Parry J. Why are there so few working-class applicants to medical schools? Learning from the success stories. Medical Education 2009;43:219-228.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

The University of Otago's Division of Health Sciences aims to produce health professionals equipped to meet the needs of society; this is at the heart of the social contract between the University and society.The University strives to train health professional graduates who reflect and are responsive to the diversity within society. The sociodemographic profile of health professional students is important because, in part, these characteristics influence future career choices in terms of place of practice and types of populations served.1-3 The overarching admissions policy of the University's Division of Health Sciences states: Ideally the make-up of health professional classes should be equivalent to holding a mirror up to society. In order to achieve this we aim to attract and support the most academically able students from a wide variety of backgrounds. The gender, ethnic, socioeconomic and rural/urban composition of our graduates should, more or less, reflect the diverse communities in Aotearoa. The above statement reflects recent international consensus and calls to action from inter-country working groups.4-7,8p249,9 The Australian Medical Council also recognises the importance of encouraging and prioritising student diversity in its guidelines for the accreditation of medical schools (which apply to medical schools in New Zealand):10 In Australia and New Zealand, inequalities remain in the health status of various social and cultural groups. Medical schools have a responsibility to select students who can reasonably be expected to respond to the needs and challenges of the whole community, including the health care of these groups. This may include selection of students who are members of such groups. The medical curriculum should also provide opportunities for cultural education programs, and opportunities for training and provision of service in under-serviced communities. We believe indigenous health and Pacific health are areas of special responsibility because of New Zealand's history, demographic makeup, and location as a Pacific nation. In the case of Māori health and Māori education, New Zealand's universities have a dual obligation to honour the contractual obligations defined in the Treaty of Waitangi and the responsibility to correct the inequitable health and education outcomes experienced by Māori populations. The University's Division of Health Sciences adopts the following principles in the selection of students into its health professional programmes. Each of these programmes aims to select students who: Are committed to and capable of academic excellence; On balance reflect the gender, ethnic, socioeconomic, and rural/urban composition of society; and Are committed to serving the needs of individuals, families and communities in New Zealand or overseas. The purpose of this study is to describe the current sociodemographic characteristics of the University's health professional students in order to a) evaluate performance against our goals, b) inform policy development within the University, and c) to provide a benchmark against which to measure change. Methods Health Professional Programmes—All students (domestic and international) accepted into in the following eight health professional programmes in 2010 were included in the study (Table 1). Table 1. Eight professional programmes included in the study Professional programme School-leaver entry pathway Tertiary entry pathways Bachelor of Dental Surgery (BDS) √ Bachelor of Dental Technology (BDentTech) √ √ Bachelor of Medical Laboratory Science (BMLSc) √ Bachelor of Medicine and Bachelor of Surgery (MB ChB) √ Bachelor of Oral Health (BOH) √ √ Bachelor of Pharmacy (BPharm) √ Bachelor of Physiotherapy (BPhty) √ Bachelor of Radiation Therapy (BRT) √ √ Data sources—Student data were downloaded from the University of Otago's central student records system (which contains routinely collected data). Data were obtained in anonymous, summary form. University student data are a mix of verified and unverified fields. Age and sex are verified by the sighting of birth certificates, and data are complete for these fields. Ethnicity data are complete but unverified, and home area statistics are unverified with 0.7% missing for the student population. Home area data were analysed only for domestic students (not international). Home area statistics are collected by the University in a student's first year of study only, and are derived from the contact address provided by students when they first enrol. Student citizenship was classified into the following categories: New Zealand citizens; New Zealand permanent residents; Tokelau/Niue/Cook Island citizens; Australian citizens; international citizens. For University purposes, based on the allocation of funding by the Tertiary Education Commission, domestic students are those students who are New Zealand Citizens, or New Zealand Permanent Residents, or citizens of Tokelau, Niue, Cook Islands, or Australia. New Zealand population data were sourced from 2011 estimates provided by Statistics New Zealand.11-13 Ethnicity Classification/definitions—When students enrol at the University of Otago, they can nominate up to three ethnicities they identify with; these ethnicities are self-declared. Students can change which ethnicities they associate with at any point in time. Ethnic groups were aggregated into the following four categories: Māori; Pacific; Asian; New Zealand European and Other. As students can nominate more than one ethnicity the sum of ethnicities in the student population is greater than 100% of students. The ‘Asian' category, as used in the New Zealand health sector, includes students from East, South and Southeast Asia but excludes people from the Middle East and Central Asia. This category has acknowledged shortcomings because of the ethnic diversity within the category.14 The ‘New Zealand European and Other' category includes students who identified as New Zealand European plus students who did not fall into any of the other categories. The proportion of New Zealand European within the ‘New Zealand European and Other' category was approximately 97% for the University population and 94 % for the Health Sciences population. Other includes students who identify as Middle Eastern, Latin American and African. Socioeconomic deprivation—Socioeconomic deprivation was measured using the NZDep2006 (NZDep) index of socioeconomic deprivation for small areas. NZDep is an area-based measure combining nine variables from New Zealand's 5-yearly census that reflect eight dimensions of deprivation.15-18 Each NZDep index is created for small areas built from one or more contiguous meshblocks. Meshblocks, containing around 90 people, are the smallest geographical units defined by the central government statistics agency, Statistics New Zealand. The small areas were constructed with, as far as possible, at least 100 people usually resident. In 2006, for example, only 4% contained fewer than 100 people, while 76% contained fewer than 200 people, and just 3% had more than 300 people. The NZDep indexes were created from the proportions of people in each census-specific small area with each of nine characteristics related to deprivation. The NZDep scale runs from 1 to 10 where, for example, a value of 10 indicates that the meshblock is in the most deprived 10% of small areas in New Zealand. At a national level, the number of people in each NZDep category is roughly equal. The level of diversity increases as the geographic unit of measurement becomes smaller. In order to link the student and NZDep datasets, the meshblock associated with the home residence of students was attached to individual records in the University's student dataset (domestic students only). The corresponding NZDep value for each domestic student's home address was then added. School socioeconomic scores—The Ministry of Education uses a school rating scale to indicate the extent to which it draws its students from low socioeconomic communities. Decile 1 schools are the 10% of schools with the highest proportion of students from low socioeconomic communities, whereas decile 10 schools are the 10% of schools with the lowest proportion of these students. A school decile does not indicate the overall socioeconomic mix of the students attending a school or measure the standard of education delivered at a school.19 It is not possible to calculate decile information for students who went to correspondence school or an overseas school. Results Geographic location of home area—Auckland is home for 33.4% of the New Zealand population; in 2010 15.0% of the University of Otago's student population came from Auckland, and 22.0% of the professional programme population came from Auckland (Table 2). The four regions of Auckland, Canterbury, Otago and Wellington made up around 70% of both the University student population and the professional programme student population. Table 2. Geographic location of domestic students' home areas (2010 year) Region % of NZ population % of University population % of Health Sciences Professional Programme population Northland 3.6 2.0 1.8 Auckland 33.4 15.0 22.0 Bay of Plenty 6.3 5.0 4.9 Waikato 9.4 3.1 5.8 Gisborne 1.1 0.7 0.9 Hawkes Bay 3.5 2.5 2.5 Taranaki 2.5 1.7 1.8 Wanganui-Manawatu 5.3 2.6 4.5 Wellington 11.1 11.7 14.0 Tasman 1.1 2.8 2.4 Marlborough 1.0 1.0 1.1 West Coast 0.7 0.5 0.2 Canterbury 13.0 15.4 22.7 Otago 4.7

Summary

Abstract

Aim

To describe the sociodemographic characteristics of students accepted into eight health professional programmes at the University of Otago.

Method

Student data were obtained from the University of Otagos central student records system. Data were obtained in anonymous, summary form. New Zealand population data were obtained from Statistics New Zealand. Descriptive statistics were calculated.

Results

In 2010 health professional students at the University of Otago were largely from outside the Otago region (88.1%). 59.6% were female and 84.8% were either New Zealand citizens or permanent residents. Within the domestic student cohort, 65.0% of students self-identified as being within the New Zealand European & Other category (compared with 75.3% of the national population), 34.2% as Asian (compared with 11.1%), 6.3% as M ori (compared with 15.2%), and 2.3% as Pacific (compared with 7.7%). A large proportion of students came from high socioeconomic areas and only 3.4% of students had attended secondary schools with a socioeconomic decile of less than 4.

Conclusion

Schools and Faculties within the University of Otagos Division of Health Sciences do not achieve the sociodemographic mirror of society we hope for, and we strive to improve both our selection processes, within the constraints and limitations of the available selection tools, and our student support mechanisms. We will continue to refine these policies and work with other key stakeholders in better preparing school leavers for health professional programmes.

Author Information

Peter Crampton, Pro-Vice-Chancellor, Division of Health Sciences, University of Otago, Dunedin; Naomi Weaver, Planning and Institutional Research Analyst, University of Otago, Dunedin; Andrea Howard, Director, Policy and Programmes, Division of Health Sciences, University of Otago, Dunedin

Acknowledgements

We are grateful for comments made on earlier drafts by Professor Tim Wilkinson, Associate Professor Jo Baxter and by the anonymous NZMJ reviewers.

Correspondence

Professor Peter Crampton, Pro-Vice-Chancellor, Division of Health Sciences, PO Box 56, University of Otago, Dunedin, New Zealand.

Correspondence Email

peter.crampton@otago.ac.nz

Competing Interests

None known.

Ranmuthugala G, Humphreys J, Solarsh B, et al. Where is the evidence that rural exposure increases uptake of rural medical practice? Australian Journal of Rural Health 2007;5:285-8.Rabinowitz H, Diamond J, Markham F, Paynter N. Critical factors for designing programs to increase the supply and retention of rural primary care physicians. JAMA 2001;286(9):1041-48.Moy E, Bartman B. Physician race and care of minority and medically indigent patients. JAMA 1995;273(19):1515-20.Frenk J, Chen L, Bhutta Z, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet 2010;376:1923-58.Global Consensus for Social Accountability of Medical Schools. Global Consensus for Social Accountability of Medical Schools: Global Consensus for Social Accountability of Medical Schools, 2010. http://healthsocialaccountability.org/The Training for Health Equity Network. THEnet's Social Accountability Evaluation Framework Version 1. Monograph 1.: The Training for Health Equity Network, 2011.Boelen C, Woollard B. Social accountability and accreditation: a new frontier for educational institutions. Medical Education 2009;43:887-94.Cooke M, Irby M, O'Brien B. Educating Physicians, A Call for Reform of Medical School and Residency. San Francisco: Jossey-Bass, 2010British Medical Association. Equality and diversity in UK medical schools: British Medical Association, 2009Australian Medical Council. Assessment and Accreditation of Medical Schools: Standards and Procedures, 2002. Kingston, ACT: Australian Medical Council, 2002Statistics New Zealand. Subnational Population Estimates: At 30 June 2010 Wellington: Statistics New Zealand.http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/SubnationalPopulationEstimates_HOTP30Jun10.aspxStatistics New Zealand. Projected Population of New Zealand by Age and Sex, 2009 (base) - 2061. Wellington: Statistics New Zealand, Table Builderhttp://www.stats.govt.nz/tools_and_services/tools/tablebuilder.aspxStatistics New Zealand. Projected Ethnic Population of New Zealand, by Age and Sex, 2006 (base) - 2026 Update. Wellington Statistics New Zealand.http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/NationalPopulationProjections_HOTP09base-61.aspxRasanathan K, Craig D, Perkins R. The novel use of 'Asian' as an ethnic category in the New Zealand health sector. Ethnicity and Health 2006;11:211-27.Crampton P, Salmond C, Sutton F. NZDep91: a new index of deprivation. Social Policy Journal of New Zealand 1997;9:186-93.Salmond C, Crampton P. Heterogeneity of deprivation within very small areas. Journal of Epidemiology and Community Health 2002;56:669-70.Salmond C, Crampton P, Atkinson J. NZDep2006 Index of Deprivation. Wellington: Department of Public Health, University of Otago Wellington, 2007.http://www.wnmeds.ac.nz/academic/dph/research/socialindicators.htmlSalmond C, Crampton P, Sutton F. NZDep91: a new index of deprivation. Australian and New Zealand Journal of Public Health 1998;22:95-97.Ministry of Education. Our Education System. Wellington: Ministry of Education,http://www.minedu.govt.nz/NZEducation/EducationPolicies/Schools/SchoolOperations/Resourcing/ResourcingHandbook/Chapter1/DecileRatings.aspxJames D, Yates J, Nicholson S. Comparison of A level and UKAT performance in students applying to UK medical and dental schools in 2006: cohort study. British Medical Journal 2010;349:c478 doi:10.1136/bmj.c748.Poole P, Moriarty H, Wearn A, et al. Medical student selection in New Zealand: looking to the future. New Zealand Medical Journal 2009;122(1306):88-100. http://journal.nzma.org.nz/journal/122-1306/3884/content.pdfPrideaux D, Roberts C, Eva K, et al. Assessment for selection for the health care professions and specialty training: consensus statement and recommendations from the Ottawa 2010 Conference. Medical Teacher 2011;33:215-23.Dhalla I, Kwong J, Streiner D, et al. Characteristics of first-year students in Canadian medical schools. Canadian Medical Association Journal 2002;166(8):1029-35.Marino R, Morgan M, Winning T, et al. Sociodemographic backgrounds and career decisions of Australian and New Zealand dental students. Journal of Dental Education 2006;70(2):169-78.Mathers J, Sitch A, Marsh J, Parry J. Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6. British Medical Journal 2012;341:d918.Brown C, Lilford R. Selecting medical students (editorial). British Medical Journal 2008;336:786.Gorman D, Monigatti J, Poole P. On the case for an interview in medical student selection. Internal Medicine Journal 2008;38:621-23.Wilkinson D, Zhang J, Parker M. Predictive validity of the Undergraduate Medicine and Health Sciences Admission Test for medical students' academic performance. Medical Journal of Australia 2011;194(7):341-44.Shelker W, Belton A, Glue P. Academic performance and career choices of older medical students at the University of Otago. New Zealand Medical Journal 2011;124(1346):64-68. http://journal.nzma.org.nz/journal/124-1346/4965/content.pdfMathers J, Parry J. Why are there so few working-class applicants to medical schools? Learning from the success stories. Medical Education 2009;43:219-228.

Contact diana@nzma.org.nz
for the PDF of this article

Subscriber Content

The full contents of this pages only available to subscribers.
Login, subscribe or email nzmj@nzma.org.nz to purchase this article.

LOGINSUBSCRIBE