128
Original Research OPEN ACCESS Two decades in the making : reflecting on an approach to increase the participation and success of Pacific students at the Otago Medical School in New Zealand.
Faafetai SOPOAGA,1 Peter CRAMPTON,2 Tim WILKINSON,3 Tony ZAHARIC4
ABSTRACT
Introduction: Health professional institutions are required to train a health workforce to meet the needs of their increasingly diverse communities. One approach is to increase the diversity of their student cohorts. This article provides some reflections on the approach from one institution to increase the participation and success of Pacific students, an under-represented group in its medical programme.
Methods: A review of the University’s strategic documents and initiatives to improve the participation and success of Pacific students in the medical programme was conducted. The total number of Pacific students enrolled in medicine and their completion rates from 1996 to 2016 was requested from central university administration. The academic performance of Pacific students for the same period was requested from the medical school administration. The two extracts were merged and the annual performance for all Pacific students was analysed using Microsoft Excel. Interpretation of the results and perspectives discussed are shaped by the authors’ institutional knowledge.
Results: The earliest recorded efforts to increase the participation of Pacific students in the medical programme was through an affirmative action approach in 1951. Pacific student numbers however did not increase over subsequent years, until a more strategic approach was taken through the establishment of a Pacific Strategic Framework in 2011. The Framework coordinated a University-wide approach, engaged senior University leaders in the process, empowered Pacific staff, enabled targeted support for students and meaningful engagements with Pacific communities. These coordinated efforts coincided with positive outcomes for Pacific students’ in the medical programme.
Conclusions: The building of capacity and capability for under-represented groups require patience, persistence, advocacy, diplomacy and risk taking. Having a university-wide strategic approach that is endorsed at the highest levels, supported well through appropriate resourcing, including the empowerment of minority leadership within the institution is required. It is important also for senior institutional leadership to be consciously aware of institutional racism and the historical, economic and social forces that lie behind it. Last by not least, building genuine and meaningful engagements with these minority communities is vital, and will support institutional efforts to meet the needs of their diverse communities.
Key words :
diversity, affirmative action, social accountability, medical admissions, minority students, Pacific students, Pacific peoples.
INTRODUCTION
Societies are becoming increasingly diverse, presenting a challenge to health professional training institutions about how best to meet the needs of their populations. Medical training institutions are expected to train an adequate health workforce with the relevant competencies
to meet the needs of their own communities. 1-4 For example, there is a need to build a health workforce to work in underserved and socioeconomically deprived areas (or areas of high need) and rural communities where there are shortages in the health workforce. 5-9 There is some evidence to suggest that health professional trainees from lower socio-economic
129
Corresponding author: Faafetai Sopoaga [email protected]
1. Assoc Prof, Assoc Dean Pacific, Health Sciences, University of Otago (UoO), Dunedin, NZ
2. Prof, Pro-Vice-Chancellor Health Sciences, Dean of Otago Medical School, UoO, Dunedin, NZ
3. Prof, Director, Otago Medical School Programme, UoO, Christchurch, NZ
4. Assoc Dean, Medical Admissions, Otago Medical School, UoO, Dunedin, NZ
Received: 01.10.2018 Accepted 5.12.18 Published: 30.03.2019 Citation: Sopoaga F, et al. Two decades in the making:
reflecting on an approach to increase the participation and success of Pacific students at the Otago Medical School in New Zealand. Pacific Health Dialog 2019; 21(3):128-138.
DOI: 10.26635/phd.2019.608
Copyright: © 2019 Sopoaga F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
backgrounds may be more likely to end up working in low socio-economic areas at the completion of their training. 10,11 Some institutions have incorporated measures to support diversity in the intake of medical students into their programmes. 12-15 Others have developed cultural programmes in their curricula to support training, and the development of competencies for students to work across diverse communities. 16-19 Furthermore, some institutions have adopted a social accountability agenda encouraging a coordinated approach to engaging with communities. 20-24
Pacific peoples in New Zealand
Pacific peoples are a minority group in New Zealand. Historically, New Zealand had a colonial influence in the Pacific region. It is in part due to this influence and availability of work opportunities, that many from these neighbouring Pacific Islands migrated to live in New Zealand. 25,26 Most people from the Pacific Islands belong to three main groups called Polynesia, Melanesia and Micronesia. New Zealand’s engagement in the past has been in the main with Polynesian countries (for example, Samoa, Tonga and the Cook Islands).
Approximately 90% of Pacific peoples living in New Zealand have heritage from these three Pacific countries. 27 Māori, the indigenous people of New Zealand are Polynesians. They arrived and settled in New Zealand prior to European colonisation, much earlier than the more recent migration of Pacific peoples.
For the purpose of this paper, Pacific Islanders or Pacific peoples refer to migrants from the Pacific region (excluding Māori). Pacific peoples currently make up 7.4% of the total New Zealand population. 27 They are disproportionately over- represented in poor health and educational outcomes compared to the total New Zealand population. 28,29 The government identified this as an important concern, and a number of strategic policies and guidelines have attempted to address the disparity 30,31. Māori, share similar health inequities compared to the total New Zealand population. The University is also working in the Māori space to enhance outcomes for the indigenous population. Health training institutions can support the overall efforts to decrease health and other disparities in society, through contributions in their areas of influence.
32
Otago Medical School
New Zealand has two medical schools (Otago and Auckland), both with a similar overall structure.
The Otago Medical School established in 1875 was the first medical school in New Zealand.
Years two and three are predominantly foundational and science based while years four and five are more experiential and clinical. The sixth or trainee intern year is characterised by a series of less structured apprenticeship attachments akin to those experienced in the immediate postgraduate years. The clinical years (four to six) are located across three campuses in Dunedin, Christchurch and Wellington.
Increasingly however, both the Otago and Auckland medical schools are placing students in a variety of rural and regional settings across many parts of New Zealand. Following graduation, doctors must complete at least one further postgraduate year in order to gain registration with the Medical Council of New Zealand. Thereafter, vocational training can take a variety of forms, with many being administered by the various postgraduate training colleges.
There are three main admission pathways into the medical programme at the University of Otago: Health Sciences First Year (HSFY), Competitive Graduate (Graduate) and the Alternative category. Applicants may be further eligible for three sub-categories: Maori, New Zealand Resident Indigenous Pacific Origins (NZRIPO) and Rural. A brief description of the three sub-categories including the NZRIPO category are outlined below:
Health Sciences First Year (HSFY) - this category contributes to approximately 70% of the second- year intake. HSFY is a prescribed course of study
130 in foundational sciences/health sciences at the
first-year level. Entry from this category is competitive (with exceptions described below), with ranking scores generated from the marks obtained in the prescribed course of study and an aptitude test (UMAT) 33 covering logical reasoning/problem solving, understanding people, and non-verbal reasoning.
Graduate - this category contributes to approximately 20% of the second-year intake.
Eligibility is via a first undergraduate degree (Bachelors, or Bachelors plus Honours) from a New Zealand University. Entry is competitive using a ranking score generated from a weighted Grade Point Average across the qualifying degree.
A UMAT threshold is also required for this category.
Alternative category - this category contributes to approximately 10% of the second-year intake.
The Alternative category provides an opportunity to enter medicine for graduates that do not meet the criteria of the Graduate category.
Typically, these are older individuals (aged 25 years and over) who have already progressed in a career (professional or otherwise) who wish to pursue entry into medicine. UMAT is not required.
NZRIPO - the key feature of this category is that it is not competitive. There is neither a quota nor cap for entrants via this category. All applicants who meet the eligibility and academic criteria are offered a place. Eligibility is based on indigenous Pacific ancestry [see Additional File 1]. Academic criteria are based on the regulations governing entry into the medical programme.
Affirmative approach
The first indigenous Pacific medical graduate from the Otago Medical School was Ratu Jione Dovi from Fiji who graduated in 1935, and the first Māori graduate was Te Rangi Hiroa (Sir Peter Buck) in 1904. Currently Pacific health professionals make up 1% of all medical doctors working in New Zealand. 34 To increase diversity in the medical programme, the Otago Medical School established an affirmative action approach to increase the participation of Maori and Pacific peoples in the workforce. The earliest record of this was in 1951 where two places were designated for Maori or Pacific students [see Additional File 1]. Initially the criteria focussed on students from the Pacific region countries. In 1975, the number of students eligible for entry under the Maori and Pacific category was increased to six, and in 1988 the designated limit was removed. In the same year, Pacific eligibility
was amended to include Polynesian students who were resident only in New Zealand. In 2006, the criteria was changed to include New Zealand Resident Melanesians, and was further revised in 2012 to include also New Zealand Resident Micronesians. The latest revision introduced in 2013, targets indigenous Pacific students who are resident in New Zealand. The latest revision stipulates that students from Pacific countries either on a government scholarship or as private international students can be granted entry at the discretion of the Medical Admissions Committee.
Since its establishment, there were only a handful of Pacific students admitted through a Pacific government scholarship and none as private international students into the medical programme. Significant increases in the number of Pacific students enrolling in medicine were observed in more recent years. We explored the factors likely to be contributing to these positive changes and provide in this paper our reflections.
METHODS
We obtained and reviewed all University strategic documents and initiatives with targeted efforts to improve the participation and success of Pacific students in the medical programme.
The total number of Pacific students enrolled in medicine and their completion rates from 1996 to 2016 was requested from central university administration. The academic performance of Pacific students for the same period was requested from the medical school administration. The two extracts were merged and the annual performance for all Pacific students was analysed using Microsoft Excel.
Descriptive summaries of that analysis, including historic time series of enrolment and completion rates are presented. The results from the analyses together with the institutional knowledge of the authors, shaped the reflections provided.
RESULTS
Impetus for change
For decades the number of Pacific students in the Otago Medical School programme did not increase (ranging from 2-5 students per year).
There were internal discussions about what could be done, however there were no strategies to enact change. The impetus for change started with support from Pacific community leaders. In 1996, a Pacific network of local community leaders, staff and medical students began to advocate for the University to prioritise the concerns raised. Agitation for change continued
131 over the next eight years resulting in a significant
meeting in 2004 between senior Pacific national health sector leaders and senior academic leaders in the University’s Division of Health Sciences. Although this was not viewed favourably initially by senior management, the process for transformative change in the culture of the University had begun, where the voice of the Pacific community was beginning to be heard and valued.
Pacific students in medicine formed a Pacific Islands Health Professional Student Association (PIHPSA) in 2006. Pacific staff sought to identify all Pacific students who would be eligible to join PIHPSA. Access to information to identify these students for targeted support was initially denied, as there was no designated Pacific role with authority to access official student data across Health Sciences. In 2009, the Division of Health Sciences established a senior Pacific leadership role, Division Associate Dean (Pacific), reporting directly to the Pro-Vice-Chancellor Health Sciences, who is also the Dean of the Otago Medical School. The Associate Dean (Pacific) was then granted access to official student information data.
Figure 1. Pacific student numbers, and as a proportion of the total OMS student enrolments (1996 - 2016)
The Pacific Islands Research & Student Support Unit (PIRSSU) was established in 2010 under the leadership of the Associate Dean (Pacific) for
coordinating and monitoring support for all Pacific students in Health Sciences. PIRSSU works closely with mainstream support services and PIHPSA (student organisation) for the provision of timely support for Pacific students. The coordination of support across the medical school has continued to grow in strength with institutional and Pacific community support.
There are now three additional Associate Deans (Pacific) across the Otago Medical School campuses, who provide leadership for Pacific developments in their designated areas. There are also high-level Pacific advisory groups that advise the medical school, and the wider health sciences leadership on Pacific matters.
Strategic approach
The University of Otago Division of Health Sciences, in its efforts to increase the participation of Pacific students in its health professional programmes, endorsed a Pacific Strategic Framework (2011-2015). One of the goals of this Framework was to increase the capacity and capability of Pacific students. The University of Otago launched a University-wide Pacific Strategic Framework (2013 – 2020) three years later. The six goals outlined in the Division of Health Sciences Framework were adopted into the University-wide Pacific Strategic Framework.
Figure 1 shows the dramatic increase in the number of Pacific students entering the medical programme since adopting a strategic approach
0 10 20 30 40 50 60 70 80 90
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Total number Pacific Students
Pacific as % of total Otago Medical Student (OMS) enrolments
132 in 2011. This increase in numbers will eventually
flow through to the number of completions.
Figure 2. Pacific student completions, and as a proportion of the total OMS student completion (1996 - 2016)
Figure 2 shows the number of Pacific student completion as being variable over time, suggesting that without a strategic approach, sustained improving trends is unlikely to be realised.
Tables 1 and 2 outline the academic performance of Pacific students across all years and the reasons for withdrawal. The pass rate for students over the twenty year period across all years ranged from 88% to 90%, with around 5%
achieving distinction. Less than 1% of students withdrew from the medical programme.
Table 1. Student academic outcomes by year of study from 1996 to 2016
Year 2 N (%)
Year 3 N %)
Year 4 N %)
Year 5 N %)
Year 6 N %) Distinction 6 (4) 6 (5) 6 (6) 4 (4) 4 (5) Passed 130
(90) 107 (88) 93
(88) 81
(89) 73 (90) Failed 9 (6) 8 (7) 7 (7) 6 (7) 4 (5)
Total 145 121 106 91 81
Table 2. Reasons for withdrawal of students from 1996 to 2016
Stude
nt Year 2 of
study Outcome Reason
1 1996 Withdrew Year 4 Not known 2 1998 Withdrew Year 3 Not Known 3 2003 Failed Year 2 Not Known 4 2011 Failed Year 4 Medical 5 2014 Failed Year 2 Medical 6 2016 Withdrew Year 2 Medical 7 2016 Withdrew Year 2 Medical
Community engagement
One of the goals of the Pacific Strategic Framework is focused on effective community engagement. The improved educational outcomes of Pacific students at the Otago Medical School is in part due to the significant support from Pacific communities and organisations. This support has been in the form of advice, engagement in programmes, and involvement where they are able, in the life and activities of the
0 1 2 3 4 5 6 7 8 9 10
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Total number Pacific student completion
Pacific as % of total Otago medical student completions
133 University. Tertiary institutions are unfamiliar
spaces for Pacific communities, and there are activities to encourage community participation in the academic environment. For example, the local Cook Islands mothers (mamas) are invited to decorate the hall for the Division of Health Science’s Pacific Welcome on campus at the beginning of each academic year. This is very well received and it results in the strengthening of relationships. The incorporation of an immersion programme into the curriculum where medical students stay with Pacific families, and learn through immersion about the health of these communities, is highly valued by both parties.
17,35 These opportunities for engagements reflect a long journey in the creation of a culture of inclusiveness, and gives confidence to Pacific communities that the University is a welcoming and culturally safe environment.
DISCUSSION
Social accountability approach
In 2012 the Division of Health Sciences stated its commitment to social accountability. The World Health Organization (WHO) defines socially accountable health education as:
"the obligation [for universities] to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public. 36
In response to this commitment, the Division adopted an overarching student selection policy that 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 not only the University’s commitment, but also recent international consensus and calls to action from inter-country working groups. 37. 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). 38 The University of Otago has experienced significant growth (121% increase)
of Pacific students across its health professional programmes, with 133% increase in medicine and dentistry between 2010 and 2016. 39
In summary, the University’s Division of Health Sciences adopts the following principles in the selection of students into its nine 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.
Key success factors
Several factors are essential in ensuring successful institutional change and achieving increased numbers of Pacific students in medical classes. Each factor in itself is necessary but not sufficient — all factors must be addressed simultaneously. These factors include:
• Effective and empowered Pacific leaders with access to the necessary resources.
• A clearly articulated Pacific strategy underpinned by Pacific values.
• A clear institutional commitment to social accountability and diversity within health professional student cohorts.
• A clear institutional commitment to a strengths-based approach to recruiting and supporting Pacific students.
• A clear institutional commitment to persistence, risk taking, rigorous evaluation and evidence-informed approaches.
• Pacific staff who feel supported to pursue actions aligned with the Pacific strategy.
• All academic and professional staff understanding and supporting the Pacific strategy.
• Senior institutional leadership that is consciously aware of institutional racism and the historical, economic and social forces that lie behind it.
• Senior institutional leadership that is determined to support change, and is able to secure resources and create a safe space so that Pacific leaders are able to be effective.
• Meaningful and inclusive approach to engagement with Pacific families and communities
134 CONCLUSION
The building of capacity and capability for an underrepresented community within an institution requires patience, persistence, advocacy, diplomacy and risk taking. For Pacific communities who have not had the best experience over previous generation as migrants in New Zealand, placing their confidence in the leadership of a training institution requires trust.
For the institution, providing space for growing Pacific leadership and trusting their leadership on Pacific matters within the tertiary environment also requires trust. It is a journey of exploration, built on mutual trust that has resulted in positive outcomes. There will no doubt be shortfalls along the way, but with mutual trust and respect most issues can be worked through to find the approach that works for both parties. This approach may need to be changed as new opportunities arise and as progress occurs, but the respect and trust between partners will assist in navigating the way forward that achieves positive outcomes.
With this inclusive approach, the genuine efforts to meet the needs of diverse communities are likely to bear fruit. Furthermore, health professional training institutions will be able to contribute to meeting the needs of their diverse communities through the creation of opportunities for diversity in their student cohorts.
Abbreviations
HSFY – Health Sciences First Year
NZRIPO – NZ Resident Indigenous Pacific Origins PIHPSA – Pacific Islands Health Professional Students Association
PIRSSU – Pacific Islands Research and Students Support Unit
Competing interests: Affiliations
Acknowledgments: The authors would like to acknowledge Tracey Neville who provided the data and Jesse Kokaua who assisted in data formatting.
Author contributions: All authors contributed to the analysis, interpretation, development, and revisions of this manuscript. All authors read and approved the final manuscript. Their additional specific contributions are : FS – is the lead author and was responsible for the overall structure and development of the manuscript. PC – led the strategic approach and social accountability discussions. TW and TZ led the Otago medical school component.
Ethics approval – ethics approval was not required for access to this data as it is part of monitoring for quality improvement of our work.
Appendix :
Title: Otago Medical School affirmative action approach for Maori and Pacific students (1951 to 2017)
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Appendix 1: Otago Medical School affirmative action approach for Maori and Pacific students (1951 to 2017)
Year Affirmative Action
1951 – 1969 Two candidates each satisfying the conditions laid down in regulation below, and each either being:
a) Maori applicant who is of at least 50 per cent Maori blood, or
b) b) an applicant born in the New Zealand Island Territories (compromising Cook Islands, Niue, and Tokelau), or in Western Samoa, who is not wholly of European race and who gives to the Island Territories Department an undertaking to serve in the Islands Medical Service
for five years after qualification.
(Applicants must be supported by a certificate from the Department of Maori Affairs or the Department of Island Territories.)
1970 – 1972 Two candidates, each satisfying the conditions laid down in regulation 4 below, and each being either
a) a) Maori applicant who is of at least 50 per cent Maori blood, or
b) b) An applicant born in an island territory for which New Zealand is responsible (i.e. the Cook Islands, Niue and the Tokelau Islands) who is not wholly European blood and who is bonded to either the Government of the Cook Islands, or the Government of Niue or the Tokelau Islands Administration for a period service of five years following qualification; or c) An applicant born in Western Samoa who is not wholly of European blood and who has given an undertaking to the Government of Western Samoa to return to Western Samoa following qualification and to offer himself for such employment as the Public Service Commission of Western Samoa may direct for a term equivalent to the period of his scholarship ; or
d) An applicant nominated by the Government of Fiji not wholly of European blood who has given the Fiji Government and assurance that he will serve in the Medical Department of the Fiji Government for five years following qualification.
1973-1974 Two candidates eligible under the Māori and Pacific Category.
i) a) Māori who is at least 50% Māori blood or
ii) b) applicant born in an island territory for which NZ is responsible and who is not wholly of European blood or an applicant born in Samoa who is not wholly of European blood or an applicant nominated by the government of Fiji not wholly of European blood or an applicant nominated by the government of Tonga not wholly of European blood.
1975-1976 Six candidates eligible under the Māori and Pacific Category.
i) a) Māori candidate who is of at least 50% Māori blood or Polynesian (other than Māori) born or
ii) b) permanently residing in NZ and of at least 50% Polynesian blood or an applicant born in Niue/Tokelau or CI who is not wholly of European blood or
iii) an applicant born in Samoa who is not wholly of European blood or
iv) an applicant nominated by the government of Fiji not wholly of European blood or an applicant nominated by the government of Tonga not wholly of European blood.
1977-1987 Six candidates eligible under the Māori and Pacific category.
i) a) Māori applicant or
b) a Polynesian (other than Māori) born or permanently residing in NZ or ii) an applicant born in Niue/Tokelau or CI who is not wholly of European blood or
137 iii) an applicant born in Samoa who is not wholly of European blood or an applicant nominated
by the government of Fiji not wholly of European blood or an applicant nominated by the government of Tonga not wholly of European blood.
1988-1992 i) Māori or other Polynesian descent.
The Medical Admissions Committee shall have the discretion to offer a limited number of additional places to students from South Pacific countries who are sponsored by the Ministry of Foreign Affairs.
1993-1997 i) Māori or other Polynesian descent.
The Medical Admissions Committee shall have the discretion to offer additional places in second year classes to foreign students who are sponsored by a government organisation under arrangement which have been approved by the Faculty of Medicine.
1998-2005 i) Māori or other Polynesian descent.
The Medical Admissions Committee shall have the discretion to offer additional places in second year classes to international students under arrangement which have been approved by the Faculty of Medicine.
2006-2011 The University supports the participation of the following people in the health workforce.
They may be considered in one or both of these sub categories:
i) a) Māori
ii) b) NZ Resident Pacific Islander of Polynesia or Melanesian decent
All students who are classified as International Students must apply under the International student sub category. In this sub category:
i) The Medical Admissions Committee shall have the discretion to offer additional places in second year classes to international students under arrangement which have been approved by the Faculty of Medicine.
ii) Candidates must achieve a level of academic attainment to be determined by the Medical Admissions Committee and shall have all completed prerequisites.
2012 The University supports the participation of the following people in the health workforce.
They may be considered in one or both of these sub categories:
i) a) Māori
ii) b) NZ Resident Pacific Islander of Polynesia, Melanesian or Micronesian decent
An applicant in either or both of these sub categories must achieve a minimum standard to be determined by the Medical Admissions Committee from year to year.
All students who are classified as International Students must apply under the International student sub category. In this sub category:
i) The Medical Admissions Committee shall have the discretion to offer additional places in second year classes to international students under arrangement which have been approved by the Faculty of Medicine.
ii) Candidates must achieve a level of academic attainment to be determined by the Medical Admissions Committee and shall have all completed prerequisites.
2013-2017 The University of Otago is committed to initiatives that increase the number of Māori and indigenous Pacific Islands graduates. The Division of Health Sciences is focussed on ensuring that New Zealand’s health workforce needs are met, honouring the principles of the Treaty of Waitangi and promoting equity for under-represented groups. Applicants may be considered in one of both of these categories:
i) a) Māori
ii) b) Indigenous Pacific (see note)
Note: An applicant must provide verified evidence of Māori whakapapa or indigenous Pacific ancestry and be a permanent residency or citizen of NZ. Students applying under the Indigenous Pacific category need to provided verified evidence of family ancestry originating from one or more of the following Pacific nations: Samoa, American Samoa, Tonga, CI, Niue,
138 Tokelau, Fiji, Rotuma, Solomon Is, Vanuatu, New Caledonia, PNG, Kiribati, Tuvalu, Palau, Marshall Is, FSM, Wallis and Futuna, Hawaii, French Polynesia, Rapanui (Easter Islands).
An applicant in either or both of these sub categories must achieve a minimum standard to be determined by the Medical Admissions Committee from year to year.
All students who are classified as International Students must apply under the International student sub category. In this sub category:
i) The Medical Admissions Committee shall have the discretion to offer additional places in second year classes to international students under arrangement which have been approved by the Faculty of Medicine.
ii) Candidates must achieve a level of academic attainment to be determined by the Medical Admissions Committee and shall have all completed prerequisites
