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Policies for selection and admission to Otago Medical School have changed considerably over the past 50 years and are the subject of ongoing debate. In 2020, there was media coverage of the University’s attempts to introduce a cap to the current affirmative pathway for Māori students.[[1]] The purpose of this article is to document some of the changes that have occurred over past decades. The article has two specific aims. First, we describe the O’Regan report, which was commissioned in response to a complaint made in 1985 about the handling of an application by a Māori student to Otago Medical School. Second, we illustrate how the report served as a signpost to subsequent developments in policies for Māori admissions to the Otago Medical School. The article has a particular focus on the 1985 O’Regan report and its aftermath for two reasons. First, the O’Regan report provided insights into the admissions processes of the Otago Medical School and made recommendations that, while historical, remain relevant to contemporary debates. Second, it was, to the best of our knowledge, the first formal investigation into institutional racism at the Otago Medical School, and there has been little, if any, published analysis of the report and its significance. Following the report, institutional change was slow. Nevertheless, the University would over time implement effective pathways for Māori and other under-represented groups to enter health professional programmes and increase curriculum content about the health inequities faced by Māori.

By way of background, in the 1980s the issue of Māori under-representation in the health workforce was even more acute than it is now, largely due to the lack of Māori students being accepted into courses such as medicine. Between 1975 and 1984, only about 1.4% of students at Otago Medical School were Māori.[[2]] One of the University’s early attempts to correct this was the “alternative admission pathway”, sometimes referred to as the “Polynesian Preference Scheme” (PPS), which was the name of a similar scheme at The University of Auckland. In 1951, the PPS held two places for students of “50% or higher Māori blood”, and applicants from Pacific Island nations who would undertake to do compulsory five-year service in island territories.[[3]] By 1985, the programme had changed to allocate six places in total to Māori applicants, “Polynesian” applicants who were non-Māori and were citizens or permanent residents of New Zealand, and applicants who were nominated by the governments of one of seven different Pacific Island nations.[[4]] Despite the increased allocation, the University was not obliged to fill all six spots, and frequently there were fewer than six places offered under the scheme.[[5]] As discussed below, there have been subsequent changes to the affirmative action policies for admission to Otago Medical School.

The 1985 O’Regan report and the University’s initial response

In 1985, the Governor General held the statutory role of “University Visitor”. This role meant the Governor General could settle internal disputes at the University.[[6]] In response to a complaint about the case of a Māori applicant to Otago Medical School, the Governor General appointed Stephen O’Regan, a Māori lawyer based in Wellington, to investigate. Having been commissioned by the Governor General to investigate the University’s conduct, O’Regan produced a document titled Report on the complaint of Dr G.A Wall M.P that detailed his findings and spoke about the specifics of the individual complaint as well as his findings, as related to the overall admissions process at Otago Medical School.

O’Regan’s primary role was to investigate the complaint submitted to the Governor General. The applicant in question was eligible and had applied for entry via the PPS alternative entry pathway. His application was denied on academic grounds. Dr G A Wall, Mr J Wall’s father, petitioned on Mr Wall’s behalf on two grounds. First, Mr Wall’s application was rejected despite not all six places allocated to the affirmative pathway being filled and, second, the admissions committee had failed to take into account Mr Wall’s previous graduate qualification and its bearing on his likely success in medicine.

The O’Regan report substantiated Dr Wall’s assertion that proper consideration of Mr Wall’s graduate qualifications was not taken. The report recommended that the applicant should be granted admission into Otago Medical School for 1986 due to mistreatment by the University of his application as well as his capability to do well at medical school, as judged from his maturity and previous academic experience.[[5]] O’Regan reported that, in addition to the University’s contested ruling that Mr Wall’s academic record did not meet the official academic requirements, there were several other worrying aspects related to the handling of the application.[[5]] O’Regan noted that when Mr Wall attempted to appeal the outcome “his appeal was ‘written off’ in a manner verging on irresponsibility”.[[5]] The report described an environment of institutional racism within the medical school and stigmatising of students admitted through the PPS. The report drew attention to a selection process that over emphasised the merit of academic results as an indicator of a potential “good” doctor.[[5]]

The Medical Admissions Committee Minutes from December 1984 show that only five students were admitted to second year medical classes as “Polynesian Candidates”.[[7]] On 10 January 1985, the University Registrar, D W Girvan, sent a letter to the Governor General about Mr Wall’s case. The letter outlined the timeline of Mr Wall’s application and stated that his being denied had been on the grounds of “academic merit”, and it reiterated the University’s stance that “the University retains a discretion as to whether or not to admit a total of six candidates” under the PPS.[[8]]

The report was leaked to, and discussed by, several newspapers, sparking a national and institutional discussion about medical admission and healthcare inequity. Letters to the Editor in both the New Zealand Herald and the Otago Daily Times implied that those chosen through the PPS were bypassing standards, lacked competence and could not be trusted by patients.[[8,9]] The Otago Daily Times received some criticism for its coverage that glossed over much of the racism reported by O’Regan.[[10]] The national discourse reflected deeply entrenched anti-Māori sentiment in both the Pākehā media and the Pākehā public. Much of the media’s scrutiny fell on Mr Wall rather than on the University, and much of the public discourse was dominated by racist personal attacks on Mr Wall and others who entered through the PPS alternative pathway.[[11]]

Following the O’Regan report: the ongoing development of admission policies

In response to the O’Regan report, the Otago Māori Executive, an elected group representing the University’s Māori community, wrote a letter to the University urging for reforms to be made to the admission process to address the culture the report had identified.[[12]] The letter, sent in December of 1985, stated that the Executive was extremely concerned by the findings of the report around “unfair processes” and “institutional racism”. It also highlighted the discrepancy between the number of Māori medical students and the proportion of Māori in the population. The letter called for the adoption of the report’s recommendations, not only in the Medical School but also in the Dental and Law Schools.[[13]] D W Girvan, the University Registrar, wrote a letter in response to these claims stating that O’Regan “went far beyond his terms of reference in his report” and attempted to justify existing measures to achieve health workforce equity, by stating that “the number of applications is increasing and we hope it will increase even more”. Beyond this statement, the letter did not address the issues, nor did it indicate any intention to change the University’s approach to the “alternative admission pathway”.[[14]]

Despite the initial, significant disregard for most of the O’Regan report’s recommendations, there was change on the horizon for the University. In September of 1985, the University Senate approved the creation of a “Working Party for the discussion of Medical Admissions”. The Working Party included: the Dean elect of the Faculty of Medicine, Dr J D Hunter; nominees from each of the three medical campuses; one senior medical student from the Otago University Students’ Association; and two nominees of the University Senate.[[15]] The Working Party began advertising for submissions in 1986 and received input from many parties.

In October of 1985, Chairman of the Department of Physiology, Professor A D C Macknight, wrote a letter to the Dean, Professor G L Brinkman, advocating for an increase in the intake of Māori and Pacific Island students. Macknight pointed out that an increase in such students would lead to a better cultural awareness among all medical students and would make a “real contribution to the delivery of health care to all New Zealanders.” [[16]]

In December of that year, Macknight, along with the Associate Dean for Undergraduate Studies at Otago Medical School, Dr C J Heath, wrote a joint letter to Professor Brinkman. The letter strongly recommended that a further twenty places be allocated to “properly qualified Māori and Pacific Island students”. The benefits of such a move were laid out in the letter, as well as addressing the “problems of identity” present for Māori and Pacific Island students at the time, and how a significant contribution could be made to the healthcare needs of the Māori and Pacific Island communities. [[17]]

The Working Party received many submissions including from the Medical Council of New Zealand, a verbal submission from the Otago Māori Executive, and the three divisions of the Otago Medical School. The Dunedin Faculty, led by Divisional Dean Professor R D H Stewart, summarised their concerns in three main points, the first of which was that “academic merit must remain the major criterion for selection.” This was at odds with the findings of the O’Regan report, as well as statements made by senior members of the faculty that highlighted the limiting nature of focussing on academic grades. Despite the recent controversy and the O’Regan report’s criticism of the alternative pathway system, the submission did not address Māori or Pasifika applicants at all.[[18]]

The Working Party published their findings in February 1987, and breifly touched on Māori and Pacific Island student entry. The findings stated that there was support for increased numbers of Māori applicants on the basis of cultural needs. The report also stated that potentialy instating a pathway that differentiated between “Polynesian Applicants” and Māori applicants was something that may require further consideration. The report’s summary of findings highlighted that, despite calls for academic merit to no longer be the primary indicator of acceptability, the University was unwilling to move away from this process. The report recommended that “academic merit remain(s) the sole criterion for selection”, except for alternative pathways. The report also recommended a change in quota for alternative entry, such as Māori and Pacific Island student entry, to a “target maximum of 10%”.[[15]] Changes around this quota can be seen in the 1988 University Calendar, which broke from previous editions by no longer specifiying a set number of places available for the alternative pathway.[[19]]

Affirmative action policies have continued to evolve. In 1999, a “Medical Admissions Review Working Group” was established. Noted in their documentation was a suggestion that “mature and other graduate” pathways, including “Māori/ Polynesian”, be granted 20 of the available 170 places.[[20]] In 2012, the current policy, the Mirror on Society Policy, was adopted by the University’s Division of Health Sciences, in acknowledgement of the obligations that Te Tiriti o Waitangi places on the Crown, the healthcare needs of Aotearoa New Zealand’s diverse communities, and the value of a diverse health workforce. The policy aimed to increase the intake of students from groups under-represented in the health workforce into the health professional programmes at the University of Otago. These groups include Māori, Pacific Island, refugee background, rural background and low socio-economic background applicants. There has been a consistent year-on-year increase in the number of Māori medical graduates over the past decade, with a 124% increase in Māori students between 2010 and 2016.[[21]] This increase has been the result of a number of inter-dependent factors including, but not limited to, well-theorised strategic work by Māori academics in the University, empowered Māori leadership, effective programme development and implementation, and tailored investment from the Ministry of Health.[[22]]

In 2016, a milestone 45 Māori doctors graduated in one graduating class, thirty years after the O’Regan enquiry into the Otago Medical School.[[23]] In 2020, attempts to reform the Mirror on Society Policy were met with significant professional and public opposition, and the University was accused of failing to consult with Māori and Pacific Island groups on proposed changes to the policy—which aimed to introduce a cap on the number of students who could enter through the affirmative pathways.[[1]] In 2021, at the time of writing, the Mirror on Society Policy is being reviewed.

Conclusion

While the recommendations in the O’Regan report may have been initially, largely put to one side, many of the issues raised have since been addressed. Even though it has taken many years for the lessons of the O’Regan report to be heeded, we hope that the very high personal price paid in 1985, by a Māori applicant to the Otago Medical School, has counted for something. He was not lost to the health system. Subsequent to the episode described in this paper, he was admitted to the School of Dentistry, and has had a long and successful career as a dentist. He has gained postgraduate qualifications in Oral Medicine and Public Health and has played, and continues to play, a significant role in promoting equitable oral health outcomes for Māori, and promoting Māori oral health provider development. The alternative pathway system criticised by O’Regan has shifted away from “blood-quantum” and quota-based criteria to an affirmative system that seeks to achieve a health workforce that is representative of Aotearoa New Zealand’s diverse communities. The affirmative policy reflects an understanding of the benefits that Māori health professionals bring to the health system in general and to the health of Māori in particular, and seeks to challenge racist assumptions about the abilities of Māori students. We hope that admissions policies will continue to evolve in response to the changing needs of society.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Indira Fernando: Kōhatu Centre for Hauroa Māori University of Otago, New Zealand. ferin702@student.otago.ac.nz Peter Crampton: Kōhatu, Centre for Hauora Māori University of Otago, New Zealand. peter.crampton@otago.ac.nz

Acknowledgements

We acknowledge the valuable data sources and insights provided by Emeritus Professor John Broughton, Tā Tipene O’Regan and Dr Justin Wall—without their assistance this article could not have been researched or published. We are grateful for the helpful and insightful comments made by colleagues on earlier drafts of this paper, and by the anonymous reviewers of the paper. We take full responsibility for any errors or omissions in, or for the correctness of, the information contained in this paper.

Correspondence

Indira Fernando: Kōhatu Centre for Hauroa Māori University of Otago, New Zealand.

Correspondence Email

ferin702@student.otago.ac.nz

Competing Interests

There was no external funding source for preparing this article. The views, opinions, findings and conclusions or recommendations expressed in this paper are strictly those of the authors. They do not necessarily reflect the views of the institutions where the authors currently work. The paper is presented not as policy, but with a view to inform and stimulate wider debate.

1) Hurihanganui TA. Otago Medical School admission cap debate: 'It has come a bit out of the blue'. Radio New Zealand, 2020.

2) Morrison A. Med School Racism Slammed. New Zealand Herald 1985 August 18.

3) University of Otago. The University of Otago Calender: Otago University Press 1951:219.

4) University of Otago. The University of Otago Calender: Otago University Press 1985:289-290.

5) O'Regan S. Report on the complaint of Dr G A Wall M.P1985.

6) Blundell D. Some Reflections upon the Office of Governor-General in New Zealand, 1977.

7) Commitee MA. December Minutes 1984.

8) 'Concerned-Patient'. Medical Entry. New Zealand Herald 1985 August 24.

9) 'Tuhi'. Maori Issues. Otago Daily Times 1985 August 27.

10) Jensen K. Behind the Scenes in Medical School. The Critic 1985 17 September.

11) 'Tama-tu-tama-ora'. Maori Issues. Otago Daily Times 1985 27 August.

12) University Urged to Reform Entry. Otago Daily Times 1985 4 December.

13) Kapa A. Letter to the Vice Chancellor and Council 1985.

14) Girvan D. Response to A. Kapa 1985.

15) Senate Working Party. Senate Working Party Report on Selection of Medical Students 1987.

16) Macknight AD. Increased Medical Intake 1985.

17) Macknight AD. Increased Medical Student Intake. 1985

18) Stewart RDH. Faculty Submission to the Senate Working Party on Medical Admission. 1986

19) Otago University Calender 1988: Otago University Press 1988.

20) Group MARW. Medical Admissions Review Working Group 1999

21) Crampton P, Weaver N, Howard A. Holding a mirror to society? Progression towards achieving better sociodemographic representation among the University of Otago’s health professional students. NZ Med J 2018;131(1476):59-69.

22) Crampton P, Baxter J, Bristowe Z. Selection of Māori students into medicine : re-imagining merit. Exploring some of the sociological reasons that might explain the exclusion of Māori from the medical workforce. NZ Med J 2021;134(1543):59-68.

23) Newsroom. The facts about Otago’s Mirror on Society. 17 September ed, 2020.

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

View Article PDF

Policies for selection and admission to Otago Medical School have changed considerably over the past 50 years and are the subject of ongoing debate. In 2020, there was media coverage of the University’s attempts to introduce a cap to the current affirmative pathway for Māori students.[[1]] The purpose of this article is to document some of the changes that have occurred over past decades. The article has two specific aims. First, we describe the O’Regan report, which was commissioned in response to a complaint made in 1985 about the handling of an application by a Māori student to Otago Medical School. Second, we illustrate how the report served as a signpost to subsequent developments in policies for Māori admissions to the Otago Medical School. The article has a particular focus on the 1985 O’Regan report and its aftermath for two reasons. First, the O’Regan report provided insights into the admissions processes of the Otago Medical School and made recommendations that, while historical, remain relevant to contemporary debates. Second, it was, to the best of our knowledge, the first formal investigation into institutional racism at the Otago Medical School, and there has been little, if any, published analysis of the report and its significance. Following the report, institutional change was slow. Nevertheless, the University would over time implement effective pathways for Māori and other under-represented groups to enter health professional programmes and increase curriculum content about the health inequities faced by Māori.

By way of background, in the 1980s the issue of Māori under-representation in the health workforce was even more acute than it is now, largely due to the lack of Māori students being accepted into courses such as medicine. Between 1975 and 1984, only about 1.4% of students at Otago Medical School were Māori.[[2]] One of the University’s early attempts to correct this was the “alternative admission pathway”, sometimes referred to as the “Polynesian Preference Scheme” (PPS), which was the name of a similar scheme at The University of Auckland. In 1951, the PPS held two places for students of “50% or higher Māori blood”, and applicants from Pacific Island nations who would undertake to do compulsory five-year service in island territories.[[3]] By 1985, the programme had changed to allocate six places in total to Māori applicants, “Polynesian” applicants who were non-Māori and were citizens or permanent residents of New Zealand, and applicants who were nominated by the governments of one of seven different Pacific Island nations.[[4]] Despite the increased allocation, the University was not obliged to fill all six spots, and frequently there were fewer than six places offered under the scheme.[[5]] As discussed below, there have been subsequent changes to the affirmative action policies for admission to Otago Medical School.

The 1985 O’Regan report and the University’s initial response

In 1985, the Governor General held the statutory role of “University Visitor”. This role meant the Governor General could settle internal disputes at the University.[[6]] In response to a complaint about the case of a Māori applicant to Otago Medical School, the Governor General appointed Stephen O’Regan, a Māori lawyer based in Wellington, to investigate. Having been commissioned by the Governor General to investigate the University’s conduct, O’Regan produced a document titled Report on the complaint of Dr G.A Wall M.P that detailed his findings and spoke about the specifics of the individual complaint as well as his findings, as related to the overall admissions process at Otago Medical School.

O’Regan’s primary role was to investigate the complaint submitted to the Governor General. The applicant in question was eligible and had applied for entry via the PPS alternative entry pathway. His application was denied on academic grounds. Dr G A Wall, Mr J Wall’s father, petitioned on Mr Wall’s behalf on two grounds. First, Mr Wall’s application was rejected despite not all six places allocated to the affirmative pathway being filled and, second, the admissions committee had failed to take into account Mr Wall’s previous graduate qualification and its bearing on his likely success in medicine.

The O’Regan report substantiated Dr Wall’s assertion that proper consideration of Mr Wall’s graduate qualifications was not taken. The report recommended that the applicant should be granted admission into Otago Medical School for 1986 due to mistreatment by the University of his application as well as his capability to do well at medical school, as judged from his maturity and previous academic experience.[[5]] O’Regan reported that, in addition to the University’s contested ruling that Mr Wall’s academic record did not meet the official academic requirements, there were several other worrying aspects related to the handling of the application.[[5]] O’Regan noted that when Mr Wall attempted to appeal the outcome “his appeal was ‘written off’ in a manner verging on irresponsibility”.[[5]] The report described an environment of institutional racism within the medical school and stigmatising of students admitted through the PPS. The report drew attention to a selection process that over emphasised the merit of academic results as an indicator of a potential “good” doctor.[[5]]

The Medical Admissions Committee Minutes from December 1984 show that only five students were admitted to second year medical classes as “Polynesian Candidates”.[[7]] On 10 January 1985, the University Registrar, D W Girvan, sent a letter to the Governor General about Mr Wall’s case. The letter outlined the timeline of Mr Wall’s application and stated that his being denied had been on the grounds of “academic merit”, and it reiterated the University’s stance that “the University retains a discretion as to whether or not to admit a total of six candidates” under the PPS.[[8]]

The report was leaked to, and discussed by, several newspapers, sparking a national and institutional discussion about medical admission and healthcare inequity. Letters to the Editor in both the New Zealand Herald and the Otago Daily Times implied that those chosen through the PPS were bypassing standards, lacked competence and could not be trusted by patients.[[8,9]] The Otago Daily Times received some criticism for its coverage that glossed over much of the racism reported by O’Regan.[[10]] The national discourse reflected deeply entrenched anti-Māori sentiment in both the Pākehā media and the Pākehā public. Much of the media’s scrutiny fell on Mr Wall rather than on the University, and much of the public discourse was dominated by racist personal attacks on Mr Wall and others who entered through the PPS alternative pathway.[[11]]

Following the O’Regan report: the ongoing development of admission policies

In response to the O’Regan report, the Otago Māori Executive, an elected group representing the University’s Māori community, wrote a letter to the University urging for reforms to be made to the admission process to address the culture the report had identified.[[12]] The letter, sent in December of 1985, stated that the Executive was extremely concerned by the findings of the report around “unfair processes” and “institutional racism”. It also highlighted the discrepancy between the number of Māori medical students and the proportion of Māori in the population. The letter called for the adoption of the report’s recommendations, not only in the Medical School but also in the Dental and Law Schools.[[13]] D W Girvan, the University Registrar, wrote a letter in response to these claims stating that O’Regan “went far beyond his terms of reference in his report” and attempted to justify existing measures to achieve health workforce equity, by stating that “the number of applications is increasing and we hope it will increase even more”. Beyond this statement, the letter did not address the issues, nor did it indicate any intention to change the University’s approach to the “alternative admission pathway”.[[14]]

Despite the initial, significant disregard for most of the O’Regan report’s recommendations, there was change on the horizon for the University. In September of 1985, the University Senate approved the creation of a “Working Party for the discussion of Medical Admissions”. The Working Party included: the Dean elect of the Faculty of Medicine, Dr J D Hunter; nominees from each of the three medical campuses; one senior medical student from the Otago University Students’ Association; and two nominees of the University Senate.[[15]] The Working Party began advertising for submissions in 1986 and received input from many parties.

In October of 1985, Chairman of the Department of Physiology, Professor A D C Macknight, wrote a letter to the Dean, Professor G L Brinkman, advocating for an increase in the intake of Māori and Pacific Island students. Macknight pointed out that an increase in such students would lead to a better cultural awareness among all medical students and would make a “real contribution to the delivery of health care to all New Zealanders.” [[16]]

In December of that year, Macknight, along with the Associate Dean for Undergraduate Studies at Otago Medical School, Dr C J Heath, wrote a joint letter to Professor Brinkman. The letter strongly recommended that a further twenty places be allocated to “properly qualified Māori and Pacific Island students”. The benefits of such a move were laid out in the letter, as well as addressing the “problems of identity” present for Māori and Pacific Island students at the time, and how a significant contribution could be made to the healthcare needs of the Māori and Pacific Island communities. [[17]]

The Working Party received many submissions including from the Medical Council of New Zealand, a verbal submission from the Otago Māori Executive, and the three divisions of the Otago Medical School. The Dunedin Faculty, led by Divisional Dean Professor R D H Stewart, summarised their concerns in three main points, the first of which was that “academic merit must remain the major criterion for selection.” This was at odds with the findings of the O’Regan report, as well as statements made by senior members of the faculty that highlighted the limiting nature of focussing on academic grades. Despite the recent controversy and the O’Regan report’s criticism of the alternative pathway system, the submission did not address Māori or Pasifika applicants at all.[[18]]

The Working Party published their findings in February 1987, and breifly touched on Māori and Pacific Island student entry. The findings stated that there was support for increased numbers of Māori applicants on the basis of cultural needs. The report also stated that potentialy instating a pathway that differentiated between “Polynesian Applicants” and Māori applicants was something that may require further consideration. The report’s summary of findings highlighted that, despite calls for academic merit to no longer be the primary indicator of acceptability, the University was unwilling to move away from this process. The report recommended that “academic merit remain(s) the sole criterion for selection”, except for alternative pathways. The report also recommended a change in quota for alternative entry, such as Māori and Pacific Island student entry, to a “target maximum of 10%”.[[15]] Changes around this quota can be seen in the 1988 University Calendar, which broke from previous editions by no longer specifiying a set number of places available for the alternative pathway.[[19]]

Affirmative action policies have continued to evolve. In 1999, a “Medical Admissions Review Working Group” was established. Noted in their documentation was a suggestion that “mature and other graduate” pathways, including “Māori/ Polynesian”, be granted 20 of the available 170 places.[[20]] In 2012, the current policy, the Mirror on Society Policy, was adopted by the University’s Division of Health Sciences, in acknowledgement of the obligations that Te Tiriti o Waitangi places on the Crown, the healthcare needs of Aotearoa New Zealand’s diverse communities, and the value of a diverse health workforce. The policy aimed to increase the intake of students from groups under-represented in the health workforce into the health professional programmes at the University of Otago. These groups include Māori, Pacific Island, refugee background, rural background and low socio-economic background applicants. There has been a consistent year-on-year increase in the number of Māori medical graduates over the past decade, with a 124% increase in Māori students between 2010 and 2016.[[21]] This increase has been the result of a number of inter-dependent factors including, but not limited to, well-theorised strategic work by Māori academics in the University, empowered Māori leadership, effective programme development and implementation, and tailored investment from the Ministry of Health.[[22]]

In 2016, a milestone 45 Māori doctors graduated in one graduating class, thirty years after the O’Regan enquiry into the Otago Medical School.[[23]] In 2020, attempts to reform the Mirror on Society Policy were met with significant professional and public opposition, and the University was accused of failing to consult with Māori and Pacific Island groups on proposed changes to the policy—which aimed to introduce a cap on the number of students who could enter through the affirmative pathways.[[1]] In 2021, at the time of writing, the Mirror on Society Policy is being reviewed.

Conclusion

While the recommendations in the O’Regan report may have been initially, largely put to one side, many of the issues raised have since been addressed. Even though it has taken many years for the lessons of the O’Regan report to be heeded, we hope that the very high personal price paid in 1985, by a Māori applicant to the Otago Medical School, has counted for something. He was not lost to the health system. Subsequent to the episode described in this paper, he was admitted to the School of Dentistry, and has had a long and successful career as a dentist. He has gained postgraduate qualifications in Oral Medicine and Public Health and has played, and continues to play, a significant role in promoting equitable oral health outcomes for Māori, and promoting Māori oral health provider development. The alternative pathway system criticised by O’Regan has shifted away from “blood-quantum” and quota-based criteria to an affirmative system that seeks to achieve a health workforce that is representative of Aotearoa New Zealand’s diverse communities. The affirmative policy reflects an understanding of the benefits that Māori health professionals bring to the health system in general and to the health of Māori in particular, and seeks to challenge racist assumptions about the abilities of Māori students. We hope that admissions policies will continue to evolve in response to the changing needs of society.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Indira Fernando: Kōhatu Centre for Hauroa Māori University of Otago, New Zealand. ferin702@student.otago.ac.nz Peter Crampton: Kōhatu, Centre for Hauora Māori University of Otago, New Zealand. peter.crampton@otago.ac.nz

Acknowledgements

We acknowledge the valuable data sources and insights provided by Emeritus Professor John Broughton, Tā Tipene O’Regan and Dr Justin Wall—without their assistance this article could not have been researched or published. We are grateful for the helpful and insightful comments made by colleagues on earlier drafts of this paper, and by the anonymous reviewers of the paper. We take full responsibility for any errors or omissions in, or for the correctness of, the information contained in this paper.

Correspondence

Indira Fernando: Kōhatu Centre for Hauroa Māori University of Otago, New Zealand.

Correspondence Email

ferin702@student.otago.ac.nz

Competing Interests

There was no external funding source for preparing this article. The views, opinions, findings and conclusions or recommendations expressed in this paper are strictly those of the authors. They do not necessarily reflect the views of the institutions where the authors currently work. The paper is presented not as policy, but with a view to inform and stimulate wider debate.

1) Hurihanganui TA. Otago Medical School admission cap debate: 'It has come a bit out of the blue'. Radio New Zealand, 2020.

2) Morrison A. Med School Racism Slammed. New Zealand Herald 1985 August 18.

3) University of Otago. The University of Otago Calender: Otago University Press 1951:219.

4) University of Otago. The University of Otago Calender: Otago University Press 1985:289-290.

5) O'Regan S. Report on the complaint of Dr G A Wall M.P1985.

6) Blundell D. Some Reflections upon the Office of Governor-General in New Zealand, 1977.

7) Commitee MA. December Minutes 1984.

8) 'Concerned-Patient'. Medical Entry. New Zealand Herald 1985 August 24.

9) 'Tuhi'. Maori Issues. Otago Daily Times 1985 August 27.

10) Jensen K. Behind the Scenes in Medical School. The Critic 1985 17 September.

11) 'Tama-tu-tama-ora'. Maori Issues. Otago Daily Times 1985 27 August.

12) University Urged to Reform Entry. Otago Daily Times 1985 4 December.

13) Kapa A. Letter to the Vice Chancellor and Council 1985.

14) Girvan D. Response to A. Kapa 1985.

15) Senate Working Party. Senate Working Party Report on Selection of Medical Students 1987.

16) Macknight AD. Increased Medical Intake 1985.

17) Macknight AD. Increased Medical Student Intake. 1985

18) Stewart RDH. Faculty Submission to the Senate Working Party on Medical Admission. 1986

19) Otago University Calender 1988: Otago University Press 1988.

20) Group MARW. Medical Admissions Review Working Group 1999

21) Crampton P, Weaver N, Howard A. Holding a mirror to society? Progression towards achieving better sociodemographic representation among the University of Otago’s health professional students. NZ Med J 2018;131(1476):59-69.

22) Crampton P, Baxter J, Bristowe Z. Selection of Māori students into medicine : re-imagining merit. Exploring some of the sociological reasons that might explain the exclusion of Māori from the medical workforce. NZ Med J 2021;134(1543):59-68.

23) Newsroom. The facts about Otago’s Mirror on Society. 17 September ed, 2020.

For the PDF of this article,
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Policies for selection and admission to Otago Medical School have changed considerably over the past 50 years and are the subject of ongoing debate. In 2020, there was media coverage of the University’s attempts to introduce a cap to the current affirmative pathway for Māori students.[[1]] The purpose of this article is to document some of the changes that have occurred over past decades. The article has two specific aims. First, we describe the O’Regan report, which was commissioned in response to a complaint made in 1985 about the handling of an application by a Māori student to Otago Medical School. Second, we illustrate how the report served as a signpost to subsequent developments in policies for Māori admissions to the Otago Medical School. The article has a particular focus on the 1985 O’Regan report and its aftermath for two reasons. First, the O’Regan report provided insights into the admissions processes of the Otago Medical School and made recommendations that, while historical, remain relevant to contemporary debates. Second, it was, to the best of our knowledge, the first formal investigation into institutional racism at the Otago Medical School, and there has been little, if any, published analysis of the report and its significance. Following the report, institutional change was slow. Nevertheless, the University would over time implement effective pathways for Māori and other under-represented groups to enter health professional programmes and increase curriculum content about the health inequities faced by Māori.

By way of background, in the 1980s the issue of Māori under-representation in the health workforce was even more acute than it is now, largely due to the lack of Māori students being accepted into courses such as medicine. Between 1975 and 1984, only about 1.4% of students at Otago Medical School were Māori.[[2]] One of the University’s early attempts to correct this was the “alternative admission pathway”, sometimes referred to as the “Polynesian Preference Scheme” (PPS), which was the name of a similar scheme at The University of Auckland. In 1951, the PPS held two places for students of “50% or higher Māori blood”, and applicants from Pacific Island nations who would undertake to do compulsory five-year service in island territories.[[3]] By 1985, the programme had changed to allocate six places in total to Māori applicants, “Polynesian” applicants who were non-Māori and were citizens or permanent residents of New Zealand, and applicants who were nominated by the governments of one of seven different Pacific Island nations.[[4]] Despite the increased allocation, the University was not obliged to fill all six spots, and frequently there were fewer than six places offered under the scheme.[[5]] As discussed below, there have been subsequent changes to the affirmative action policies for admission to Otago Medical School.

The 1985 O’Regan report and the University’s initial response

In 1985, the Governor General held the statutory role of “University Visitor”. This role meant the Governor General could settle internal disputes at the University.[[6]] In response to a complaint about the case of a Māori applicant to Otago Medical School, the Governor General appointed Stephen O’Regan, a Māori lawyer based in Wellington, to investigate. Having been commissioned by the Governor General to investigate the University’s conduct, O’Regan produced a document titled Report on the complaint of Dr G.A Wall M.P that detailed his findings and spoke about the specifics of the individual complaint as well as his findings, as related to the overall admissions process at Otago Medical School.

O’Regan’s primary role was to investigate the complaint submitted to the Governor General. The applicant in question was eligible and had applied for entry via the PPS alternative entry pathway. His application was denied on academic grounds. Dr G A Wall, Mr J Wall’s father, petitioned on Mr Wall’s behalf on two grounds. First, Mr Wall’s application was rejected despite not all six places allocated to the affirmative pathway being filled and, second, the admissions committee had failed to take into account Mr Wall’s previous graduate qualification and its bearing on his likely success in medicine.

The O’Regan report substantiated Dr Wall’s assertion that proper consideration of Mr Wall’s graduate qualifications was not taken. The report recommended that the applicant should be granted admission into Otago Medical School for 1986 due to mistreatment by the University of his application as well as his capability to do well at medical school, as judged from his maturity and previous academic experience.[[5]] O’Regan reported that, in addition to the University’s contested ruling that Mr Wall’s academic record did not meet the official academic requirements, there were several other worrying aspects related to the handling of the application.[[5]] O’Regan noted that when Mr Wall attempted to appeal the outcome “his appeal was ‘written off’ in a manner verging on irresponsibility”.[[5]] The report described an environment of institutional racism within the medical school and stigmatising of students admitted through the PPS. The report drew attention to a selection process that over emphasised the merit of academic results as an indicator of a potential “good” doctor.[[5]]

The Medical Admissions Committee Minutes from December 1984 show that only five students were admitted to second year medical classes as “Polynesian Candidates”.[[7]] On 10 January 1985, the University Registrar, D W Girvan, sent a letter to the Governor General about Mr Wall’s case. The letter outlined the timeline of Mr Wall’s application and stated that his being denied had been on the grounds of “academic merit”, and it reiterated the University’s stance that “the University retains a discretion as to whether or not to admit a total of six candidates” under the PPS.[[8]]

The report was leaked to, and discussed by, several newspapers, sparking a national and institutional discussion about medical admission and healthcare inequity. Letters to the Editor in both the New Zealand Herald and the Otago Daily Times implied that those chosen through the PPS were bypassing standards, lacked competence and could not be trusted by patients.[[8,9]] The Otago Daily Times received some criticism for its coverage that glossed over much of the racism reported by O’Regan.[[10]] The national discourse reflected deeply entrenched anti-Māori sentiment in both the Pākehā media and the Pākehā public. Much of the media’s scrutiny fell on Mr Wall rather than on the University, and much of the public discourse was dominated by racist personal attacks on Mr Wall and others who entered through the PPS alternative pathway.[[11]]

Following the O’Regan report: the ongoing development of admission policies

In response to the O’Regan report, the Otago Māori Executive, an elected group representing the University’s Māori community, wrote a letter to the University urging for reforms to be made to the admission process to address the culture the report had identified.[[12]] The letter, sent in December of 1985, stated that the Executive was extremely concerned by the findings of the report around “unfair processes” and “institutional racism”. It also highlighted the discrepancy between the number of Māori medical students and the proportion of Māori in the population. The letter called for the adoption of the report’s recommendations, not only in the Medical School but also in the Dental and Law Schools.[[13]] D W Girvan, the University Registrar, wrote a letter in response to these claims stating that O’Regan “went far beyond his terms of reference in his report” and attempted to justify existing measures to achieve health workforce equity, by stating that “the number of applications is increasing and we hope it will increase even more”. Beyond this statement, the letter did not address the issues, nor did it indicate any intention to change the University’s approach to the “alternative admission pathway”.[[14]]

Despite the initial, significant disregard for most of the O’Regan report’s recommendations, there was change on the horizon for the University. In September of 1985, the University Senate approved the creation of a “Working Party for the discussion of Medical Admissions”. The Working Party included: the Dean elect of the Faculty of Medicine, Dr J D Hunter; nominees from each of the three medical campuses; one senior medical student from the Otago University Students’ Association; and two nominees of the University Senate.[[15]] The Working Party began advertising for submissions in 1986 and received input from many parties.

In October of 1985, Chairman of the Department of Physiology, Professor A D C Macknight, wrote a letter to the Dean, Professor G L Brinkman, advocating for an increase in the intake of Māori and Pacific Island students. Macknight pointed out that an increase in such students would lead to a better cultural awareness among all medical students and would make a “real contribution to the delivery of health care to all New Zealanders.” [[16]]

In December of that year, Macknight, along with the Associate Dean for Undergraduate Studies at Otago Medical School, Dr C J Heath, wrote a joint letter to Professor Brinkman. The letter strongly recommended that a further twenty places be allocated to “properly qualified Māori and Pacific Island students”. The benefits of such a move were laid out in the letter, as well as addressing the “problems of identity” present for Māori and Pacific Island students at the time, and how a significant contribution could be made to the healthcare needs of the Māori and Pacific Island communities. [[17]]

The Working Party received many submissions including from the Medical Council of New Zealand, a verbal submission from the Otago Māori Executive, and the three divisions of the Otago Medical School. The Dunedin Faculty, led by Divisional Dean Professor R D H Stewart, summarised their concerns in three main points, the first of which was that “academic merit must remain the major criterion for selection.” This was at odds with the findings of the O’Regan report, as well as statements made by senior members of the faculty that highlighted the limiting nature of focussing on academic grades. Despite the recent controversy and the O’Regan report’s criticism of the alternative pathway system, the submission did not address Māori or Pasifika applicants at all.[[18]]

The Working Party published their findings in February 1987, and breifly touched on Māori and Pacific Island student entry. The findings stated that there was support for increased numbers of Māori applicants on the basis of cultural needs. The report also stated that potentialy instating a pathway that differentiated between “Polynesian Applicants” and Māori applicants was something that may require further consideration. The report’s summary of findings highlighted that, despite calls for academic merit to no longer be the primary indicator of acceptability, the University was unwilling to move away from this process. The report recommended that “academic merit remain(s) the sole criterion for selection”, except for alternative pathways. The report also recommended a change in quota for alternative entry, such as Māori and Pacific Island student entry, to a “target maximum of 10%”.[[15]] Changes around this quota can be seen in the 1988 University Calendar, which broke from previous editions by no longer specifiying a set number of places available for the alternative pathway.[[19]]

Affirmative action policies have continued to evolve. In 1999, a “Medical Admissions Review Working Group” was established. Noted in their documentation was a suggestion that “mature and other graduate” pathways, including “Māori/ Polynesian”, be granted 20 of the available 170 places.[[20]] In 2012, the current policy, the Mirror on Society Policy, was adopted by the University’s Division of Health Sciences, in acknowledgement of the obligations that Te Tiriti o Waitangi places on the Crown, the healthcare needs of Aotearoa New Zealand’s diverse communities, and the value of a diverse health workforce. The policy aimed to increase the intake of students from groups under-represented in the health workforce into the health professional programmes at the University of Otago. These groups include Māori, Pacific Island, refugee background, rural background and low socio-economic background applicants. There has been a consistent year-on-year increase in the number of Māori medical graduates over the past decade, with a 124% increase in Māori students between 2010 and 2016.[[21]] This increase has been the result of a number of inter-dependent factors including, but not limited to, well-theorised strategic work by Māori academics in the University, empowered Māori leadership, effective programme development and implementation, and tailored investment from the Ministry of Health.[[22]]

In 2016, a milestone 45 Māori doctors graduated in one graduating class, thirty years after the O’Regan enquiry into the Otago Medical School.[[23]] In 2020, attempts to reform the Mirror on Society Policy were met with significant professional and public opposition, and the University was accused of failing to consult with Māori and Pacific Island groups on proposed changes to the policy—which aimed to introduce a cap on the number of students who could enter through the affirmative pathways.[[1]] In 2021, at the time of writing, the Mirror on Society Policy is being reviewed.

Conclusion

While the recommendations in the O’Regan report may have been initially, largely put to one side, many of the issues raised have since been addressed. Even though it has taken many years for the lessons of the O’Regan report to be heeded, we hope that the very high personal price paid in 1985, by a Māori applicant to the Otago Medical School, has counted for something. He was not lost to the health system. Subsequent to the episode described in this paper, he was admitted to the School of Dentistry, and has had a long and successful career as a dentist. He has gained postgraduate qualifications in Oral Medicine and Public Health and has played, and continues to play, a significant role in promoting equitable oral health outcomes for Māori, and promoting Māori oral health provider development. The alternative pathway system criticised by O’Regan has shifted away from “blood-quantum” and quota-based criteria to an affirmative system that seeks to achieve a health workforce that is representative of Aotearoa New Zealand’s diverse communities. The affirmative policy reflects an understanding of the benefits that Māori health professionals bring to the health system in general and to the health of Māori in particular, and seeks to challenge racist assumptions about the abilities of Māori students. We hope that admissions policies will continue to evolve in response to the changing needs of society.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Indira Fernando: Kōhatu Centre for Hauroa Māori University of Otago, New Zealand. ferin702@student.otago.ac.nz Peter Crampton: Kōhatu, Centre for Hauora Māori University of Otago, New Zealand. peter.crampton@otago.ac.nz

Acknowledgements

We acknowledge the valuable data sources and insights provided by Emeritus Professor John Broughton, Tā Tipene O’Regan and Dr Justin Wall—without their assistance this article could not have been researched or published. We are grateful for the helpful and insightful comments made by colleagues on earlier drafts of this paper, and by the anonymous reviewers of the paper. We take full responsibility for any errors or omissions in, or for the correctness of, the information contained in this paper.

Correspondence

Indira Fernando: Kōhatu Centre for Hauroa Māori University of Otago, New Zealand.

Correspondence Email

ferin702@student.otago.ac.nz

Competing Interests

There was no external funding source for preparing this article. The views, opinions, findings and conclusions or recommendations expressed in this paper are strictly those of the authors. They do not necessarily reflect the views of the institutions where the authors currently work. The paper is presented not as policy, but with a view to inform and stimulate wider debate.

1) Hurihanganui TA. Otago Medical School admission cap debate: 'It has come a bit out of the blue'. Radio New Zealand, 2020.

2) Morrison A. Med School Racism Slammed. New Zealand Herald 1985 August 18.

3) University of Otago. The University of Otago Calender: Otago University Press 1951:219.

4) University of Otago. The University of Otago Calender: Otago University Press 1985:289-290.

5) O'Regan S. Report on the complaint of Dr G A Wall M.P1985.

6) Blundell D. Some Reflections upon the Office of Governor-General in New Zealand, 1977.

7) Commitee MA. December Minutes 1984.

8) 'Concerned-Patient'. Medical Entry. New Zealand Herald 1985 August 24.

9) 'Tuhi'. Maori Issues. Otago Daily Times 1985 August 27.

10) Jensen K. Behind the Scenes in Medical School. The Critic 1985 17 September.

11) 'Tama-tu-tama-ora'. Maori Issues. Otago Daily Times 1985 27 August.

12) University Urged to Reform Entry. Otago Daily Times 1985 4 December.

13) Kapa A. Letter to the Vice Chancellor and Council 1985.

14) Girvan D. Response to A. Kapa 1985.

15) Senate Working Party. Senate Working Party Report on Selection of Medical Students 1987.

16) Macknight AD. Increased Medical Intake 1985.

17) Macknight AD. Increased Medical Student Intake. 1985

18) Stewart RDH. Faculty Submission to the Senate Working Party on Medical Admission. 1986

19) Otago University Calender 1988: Otago University Press 1988.

20) Group MARW. Medical Admissions Review Working Group 1999

21) Crampton P, Weaver N, Howard A. Holding a mirror to society? Progression towards achieving better sociodemographic representation among the University of Otago’s health professional students. NZ Med J 2018;131(1476):59-69.

22) Crampton P, Baxter J, Bristowe Z. Selection of Māori students into medicine : re-imagining merit. Exploring some of the sociological reasons that might explain the exclusion of Māori from the medical workforce. NZ Med J 2021;134(1543):59-68.

23) Newsroom. The facts about Otago’s Mirror on Society. 17 September ed, 2020.

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