Addressing the underrepresentation of indigenous health professionals is recognised internationally as being integral to overcoming indigenous health inequities. This literature review aims to identify 'best practice' for recruitment of indigenous secondary school students into tertiary health programmes with particular relevance to recruitment of Māori within a New Zealand context.

Tertiary institutions aim to provide high quality teaching and learning that meet the academic needs for an increasingly diverse student body including indigenous students. Tātou Tātou is a qualitative research project utilising Kaupapa Ma¯ori research methodology and the Critical Incident Technique interview method to investigate the teaching and learning practices that help or hinder Ma¯ori student success in non-lecture settings within undergraduate health programmes at the University of Auckland. Forty-one interviews were completed from medicine, health sciences, nursing and pharmacy. A total of 1346 critical incidents were identified with 67% helping and 33% hindering Ma¯ori student success. Thirteen sub-themes were grouped into three overarching themes representing potential areas of focus for tertiary institutional undergraduate health programme development: Māori student support services, undergraduate programme, and Ma¯ori student whanaungatanga. Academic success for indigenous students requires multi-faceted, inclusive, culturally responsive and engaging teaching and learning approaches delivered by educators and student support staff.

Tertiary institutions internationally aim to increase student diversity, however are struggling to achieve equitable academic outcomes for indigenous and ethnic minority students and detailed exploration of factors that impact on success is required. This study explored the predictive effect of admission variables on academic outcomes for health professional students by ethnic grouping. Kaupapa Māori and Pacific research methodologies were used to conduct a quantitative analysis using data for 2686 health professional students [150 Māori, 257 Pacific, 2279, non-Māori non-Pacific (nMnP)]. The predictive effect of admission variables: school decile; attending school in Auckland; type of admission; bridging programme; and first-year bachelor results on academic outcomes: year 2–4 grade point average (GPA); graduating; graduating in the minimum time; and optimal completion for the three ethnic groupings and the full cohort was explored using multiple regression analyses. After adjusting for admission variables, for every point increase in first year bachelor GPA: year 2–4 GPA increased by an average of 0.46 points for Māori (p = 0.0002, 95% CI 0.22, 0.69), 0.70 points for Pacific (p < 0.0001, CI 0.52, 0.87), and 0.55 points for nMnP (p < 0.0001, CI 0.51, 0.58) students. For the total cohort, ethnic grouping was consistently the most significant predictor of academic outcomes. This study demonstrated clear differences in academic outcomes between both Māori and Pacific students when compared to nMnP students. Some (but not all) of the disparities between ethnic groupings could be explained by controlling for admission variables.

Achieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce. This study explores a tertiary admission programme targeting Māori and Pacific applicants to nursing, pharmacy and health sciences (a precursor to medicine) at the University of Auckland (UoA), Aotearoa New Zealand (NZ). Application of cognitive and non-cognitive selection tools, including a Multiple Mini Interview (MMI), are examined. Indigenous Kaupapa Māori methodology guided analysis of the Māori and Pacific Admission Scheme (MAPAS) for the years 2008–2012. Multiple logistic regression models were used to identify the predicted effect of admission variables on the final MAPAS recommendation of best starting point for success in health professional study i.e. ‘CertHSc’ (Certificate in Health Sciences, bridging/foundation), ‘Bachelor’ (degree-level) or ‘Not FMHS’ (Faculty of Medical and Health Sciences). Regression analyses controlled for interview year, gender and ancestry. Of the 918 MAPAS interviewees: 35% (319) were Māori, 58% (530) Pacific, 7% (68) Māori/Pacific; 71% (653) school leavers; 72% (662) females. The average rank score was 167/320, 40–80 credits below guaranteed FMHS degree offers. Just under half of all interviewees were recommended ‘CertHSc’ 47% (428), 13% (117) ‘Bachelor’ and 38% (332) ‘Not FMHS’ as the best starting point. Strong associations were identified between Bachelor recommendation and exposure to Any 2 Sciences (OR:7.897, CI:3.855-16.175; p < 0.0001), higher rank score (OR:1.043, CI:1.034-1.052; p < 0.0001) and higher scores on MAPAS mathematics test (OR:1.043, CI:1.028-1.059; p < 0.0001). MMI stations had mixed associations, with academic preparation and career aspirations more consistently associated with recommendations. Our findings raise concerns about the ability of the secondary education sector to prepare Māori and Pacific students adequately for health professional study. A comprehensive tertiary admissions process using multiple tools for selection (cognitive and non-cognitive) and the provision of alternative entry pathways are recommended for indigenous and ethnic minority health workforce development. The application of the MMI within an equity and indigenous cultural context can support a holistic assessment of an applicant’s potential to succeed within tertiary study. The new MAPAS admissions process may provide an exemplar for other tertiary institutions looking to widen participation via equity-targeted admission processes.

Tertiary institutions are struggling to ensure equitable academic outcomes for indigenous and ethnic minority students in health professional study. This demonstrates disadvantaging of ethnic minority student groups (whereby Indigenous and ethnic minority students consistently achieve academic outcomes at a lower level when compared to non-ethnic minority students) whilst privileging non-ethnic minority students and has important implications for health workforce and health equity priorities. Understanding the reasons for academic inequities is important to improve institutional performance. This study explores factors that impact on academic success for health professional students by ethnic group. Kaupapa Māori methodology was used to analyse data for 2686 health professional students at the University of Auckland in 2002–2012. Data were summarised for admission variables: school decile, Rank Score, subject credits, Auckland school, type of admission, and bridging programme; and academic outcomes: first-year grade point average (GPA), first-year passed all courses, year 2 – 4 programme GPA, graduated, graduated in the minimum time, and composite completion for Māori, Pacific, and non-Māori non-Pacific (nMnP) students. Statistical tests were used to identify significant differences between the three ethnic groupings. Māori and Pacific students were more likely to attend low decile schools (27 % Māori, 33 % Pacific vs. 5 % nMnP, p < 0.01); complete bridging foundation programmes (43 % Māori, 50 % Pacific vs. 5 % nMnP, p < 0.01), and received lower secondary school results (Rank Score 197 Māori, 178 Pacific vs. 231 nMnP, p < 0.01) when compared with nMnP students. Patterns of privilege were seen across all academic outcomes, whereby nMnP students achieved higher first year GPA (3.6 Māori, 2.8 Pacific vs. 4.7 nMnP, p < 0.01); were more likely to pass all first year courses (61 % Māori, 41 % Pacific vs. 78 % nMnP, p < 0.01); to graduate from intended programme (66 % Māori, 69 % Pacific vs. 78 % nMnP, p < 0.01); and to achieve optimal completion (9 % Māori, 2 % Pacific vs. 20 % nMnP, p < 0.01) when compared to Māori and Pacific students. To meet health workforce and health equity goals, tertiary institution staff should understand the realities and challenges faced by Māori and Pacific students and ensure programme delivery meets the unique needs of these students. Ethnic disparities in academic outcomes show patterns of privilege and should be alarming to tertiary institutions. If institutions are serious about achieving equitable outcomes for Māori and Pacific students, major institutional changes are necessary that ensure the unique needs of Māori and Pacific students are met.

Bridging/foundation programmes are often provided by tertiary institutions to increase equity in access and academic performance of students from under-served communities. Little empirical evidence exists to measure the effectiveness of these bridging/foundation programmes on undergraduate academic outcomes. This research identifies the predictive effect of academic outcomes achieved within a bridging/foundation programme, targeted towards indigenous and ethnic minority students, on first-year degree-level outcomes. Overall performance within the bridging/foundation programme was positively associated with increasing Grade Point Average (GPA), ‘Core 4’ GPA and passing all courses in first year. However, mixed associations were identified between feeder bridging/foundation courses and their intended first year course counterparts. These findings support the continued provision of bridging/foundation education; however, curricular reform within the bridging/foundation programme was required. Key developments included: restructuring course delivery; increasing constructive alignment across the curriculum; increasing cultural content within western science-orientated courses; introduction of cross-curricular assessment and use of additional innovative teaching and learning activities. Additional challenges remain for degree programmes to explore how they can change in order to better support indigenous and ethnic minority student success within first-year tertiary study.