2018 Keynote Speakers

Professor Karen Adams

Monash University, Australia

Creating equity in Indigenous Australian selection into the health professions

Australian Indigenous peoples have the oldest continuing culture in the world, some 60,000 years old. A component of this continuing culture is, and was, a vibrant health care system with selection into this system involving older people choosing to pass on knowledge to younger people using a complex oral method. At the onset of colonisation settlers were initially reliant on this system accessing midwives and medical treatment. As settler numbers and cultural genocide of Indigenous peoples increased this system was eroded and replaced by a new imperialist health care system. Indigenous peoples were effectively excluded from participating in the health professions and it is only in recent decades that access was allowed with the first Indigenous doctor graduating in 1983. Indigenous graduate numbers have increased since this time, however, equity has yet to be realised. Meanwhile, in New Zealand, population parity has been achieved for Maori people in many health profession courses. We know what works, so why are we still struggling to equitably select Indigenous Australian people into the health professions? In this keynote address Karen will discuss the practicalities of selection for Indigenous people into the health professions and share learning of what works and what doesn't.

Professor Jennifer Cleland

University of Aberdeen, United Kingdom

Does disadvantage continue? Examining the fairness and rigour of post-graduate training selection processes

Over the last 20 years or so there has been increasing scholarly interest in selection and widening access into medicine.  However, entry to medical school is only the first hurdle in medical education and training.  In most contexts, those who successfully graduate as doctors then face numerous other selection challenges: for example, to obtain an internship, a specialty training place and, ultimately, their first fully qualified post.  Yet relatively little is known about postgraduate selection processes generally, or about the relationship between individual characteristics, such as socio-economic background, and outcomes on selection for postgraduate medical training. In this talk, I will draw on work from my own team and other researchers, to examine the fairness and rigour of post-graduate training selection processes.

5 Minutes with Jennifer Cleland

Professor Des Gorman

University of Auckland, New Zealand

Student selection as a tool in re-shaping health workforces

A core function of any health service is to match the supply of health workers with community ‘needs’. However, most jurisdictions do not measure unmet health need such that these ‘needs’ are usually unknown.  The matching is made even more difficult by the inherent healthcare paradox – that is, an unpredictable flux in specific models of healthcare at the same time that the core operating model (i.e., passive consumer, transactional, doctor-led and hospital based) is both recidivist and increasingly anachronistic. Available intelligence suggests that most OECD nations’ health services are increasingly unaffordable, decreasingly fit-for-purpose and that the make-up and distribution of their health workforces are often poorly configured to address health issues that have a broad social impact and to meet the health requirements of currently under-served communities.  Increasing the uptake of desirable professions and trades, practices and work locations requires an inclusive suite of: targeted high face-validity student selection processes; undergraduate pedagogy and immediate postgraduate exposures that ‘showcase’ desirable career options; the application of sound behavioural economics in both training investment and health service purchasing and commissioning; attention to important career factors such as career progression, scope, status and remuneration, reward and recognition schema; and, social ‘engineering’ to address lifestyle factors such as work/life balances, partner employment, affordability of housing and quality of schools.  It is probable that only a commitment to all the components of this suite will be successful in appropriately re-shaping health workforces.

5 Minutes with Des Gorman

Professor Sandra Nicholson

Queen Mary University of London, United Kingdom

Why selecting for a more diverse medical workforce requires a step change in widening participation

Worldwide there is a call for diversity within the healthcare workforce which necessitates a greater diversity in recruitment and selection policies and practices. However this is advocated without a well understood conceptualisation of widening participation (WP) or consensus between stakeholders.

Employers, and patients, require a medical workforce that is both caring and competent but also accessible. This presents a significant challenge for most countries, healthcare professions, and especially some areas of healthcare in particular. For example Australia and NZ have long struggled to recruit healthcare workers to remote and rural parts of their countries, whilst currently general practice within the UK, is in crisis due to under recruitment and low morale.

Higher Education institutions wish to recruit the best students but it is not clear who the “best students” are and who will go on to best fulfil future workforce requirements. Globally universities are concerned by market forces and face significant financial constraints often directly competing with widening participation policies. Furthermore an established culture of meritocracy, schemes to “top-up” perceived deficits within certain student groups, and fears surrounding the performance of non-traditional students once at university, deter both would be students and the institutions themselves from increasing diversity.

Whilst much money has been spent in attempting to widening access to medicine research confirms a paucity of robust evidence that any initiatives have made a significant difference in terms of social class inequalities. Whilst medical schools may aspire to the aims of social justice and fair opportunities such a trajectory is plagued with difficulties, such as university tariff leagues tables, and concerns with student attrition and differential attainment. Indeed many of these concerns are partially justified with some students from under-represented groups lacking the aspiration and attainment compatible with a medical career, but we do not fully understand why.

Bearing in mind the aforementioned workforce issues it is timely to look afresh at who we are selecting for the future medical workforce and what should be our priorities. There is some evidence to suggest that health professional trainees from lower socio-economic backgrounds may be more likely to end up working in lower socio-economic areas at the completion of their training, and are more likely to choose to work in a community setting or psychiatry.  Better understanding the available evidence would help us to select a more appropriate medical workforce and deal with the issues that we need to consider in successfully making this step change. Finally we also need to evaluate the effects of any possible changes in the light of stakeholders’ stated concerns.

Partially sponsored by Deakin University

5 Minutes with Sandra Nicholson

Professor Ian Puddey

University of Western Australia, Australia

Selecting medical students - origins matter.

There is a mal-distribution of the medical workforce in Australia and internationally, with fewer graduating physicians electing to serve in traditionally underserved rural and outer urban communities despite high population doctor to patient ratios. Part of the solution lies in the initial selection of students into medical school, with evidence that widening participation in medical school to students from more diverse socio-educational backgrounds increases the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum. This evidence will be reviewed with a focus on the outcomes seen for both those students recruited from socially disadvantaged metropolitan areas within cities or from underserved rural areas. The rural background effect in particular has been widely studied in Australia. General practitioners who spend at least 6 years of their childhood in a rural area are more than 2-fold more likely to be practicing in a rural area while students with a rural background recruited into our medical schools are up to 4 times more likely to be practicing rurally. This rural background effect is additive to the additional considerations of student intent to practice rurally at entry to medical school as well as the influence of rural immersion through rural clinical school experiences. This evidence aside, strategies to enhance recruitment and retention of such students into our medical schools are mandated by equity considerations alone, the ultimate objective being that our students will be representative of all aspects of our society and will graduate to serve the whole of our community.  Such strategies need to focus on increasing aspiration, motivation and self-efficacy in those from socio-educationally disadvantaged backgrounds as well as enhancing support during medical school application, aptitude testing and the interview process. Affirmative action through specific quotas for students from socio-educationally disadvantaged backgrounds needs wider implementation.