POLICY DOCUMENT –
Indigenous and Torres Strait Islander students and their
experiences of medical school

BACKGROUND
The New South Wales Medical Students’ Council (NSWMSC) is the peak
representative body for medical students in New South Wales (NSW).
NSWMSC promotes the importance of indigenous health, which is a
significant Australian concern with far-reaching historical, cultural,
geographical and social impacts, and one that has been consistently highly
prioritised by the Committee of Deans of Australian Medical Schools. This
document approaches the topic of indigenous health from the perspective of
1. Prospective Aboriginal and Torres Strait Islander students who have
not yet started their medical education, which is anchored to the
intake of Aboriginal and Torres Strait Islander students; and
2. Aboriginal and Torres Strait Islander medical students, which is
anchored to the retention of these students. This allows us to address
the critical shortage of indigenous practitioners, which is one of the
most crucial steps towards improving indigenous health.
Furthermore, NSWMSC promotes general well-being for all medical
students, and recognises that the quality and accessibility of support systems
can greatly influence one’s experiences of medical school. According to
AIDA’s findings, this is especially true for Aboriginal and Torres Strait
Islander students, who are more likely to thrive in learning environments
that demonstrate cultural safety and sensitivity. These students have unique
needs borne of unique circumstances that are wholly different from non-
indigenous students, and the support that are given to them must reflect
these needs.

Section 1: Increase the recruitment and retention of Aboriginal and

Torres Strait Islander students by medical schools
In 2016, 35 indigenous students graduated from an Australian medical
school, accounting for 1.1% of total Australian domestic graduates; this is
an increase of 133% over the last five years. In 2017, 78 indigenous students
enrolled into year one of medicine in Australia; this is a 6.0% decrease
compared to 2016, and accounts for 2.4% of all commencing Australian
domestic medical students. [1] To put these figures into perspective, there
are 333 583 Aboriginal and/or Torres Strait Islanders residing in Australia,
making up for 3.0% of the total population. In NSW, there are 103 907
indigenous residents, which make up for 2.9% of the total state population.
[2]
As per the AMSA Aboriginal and Torres Strait Islander Health Policy, there
is a chronic underrepresentation of ATSI people within the medical
workforce; currently, up to 1% of all health workers identify as being
Aboriginal and/or Torres Strait Islander. [3]
Increasing the number of Aboriginal and Torres Strait Islander practitioners
is an essential aspect of responding to the issue of Indigenous health, due to
  

their irreplaceable knowledge and insight into Indigenous communities that

are otherwise very difficult for non-Indigenous health workers to reach. The
low number of Aboriginal and Torres Strait Islander medical practitioners,
who made up for approximately 0.2% of all employed practitioners in 2008,
indicate that achieving parity in the number of Indigenous medical students
is a pressing issue that requires attention.
This is achieved by increasing the recruitment and retention of Aboriginal
and Torres Strait Islander students, which will involve a careful analysis of
the complex interplay of issues that act as barriers against accessing medical
education. These issues are centred around the literal and metaphorical
distance between prospective students and medical schools: many
indigenous communities reside in areas that are geographically and
culturally very distant from medical schools. This leads to a huge vacuum of
information regarding special entry schemes, scholarships, and general
advocacy for prospective Aboriginal and Torres Strait Islander students.
The Healthy Futures report, released by the Australian Indigenous Doctors
Association (AIDA) [4] outlines some of the recommended methods to
increase the recruitment of Indigenous medical students. These can include
bridging programs, alternate entry pathways, mentoring, outreach programs,
and most notably, the establishment of Indigenous Health Units at each
university that will be responsible for providing support services to
Indigenous students.

Section 2: Supporting Aboriginal and Torres Strait Islander students in

medical school

While it is important that all medical students have access to a safe learning
environment, there is a special kind of urgency in providing this for
Indigenous students due to the extreme dearth of Aboriginal and Torres
Strait Islander doctors across the country, and the positive health outcomes
that are associated with training Indigenous doctors who are able to connect
with Aboriginal and Torres Strait Islander communities.
Furthermore, Aboriginal and Torres Strait Islander students must often
overcome significant disadvantages that may include, but are not limited to
socioeconomic, geographic and negative attitudes towards higher education.
These can include: [4]

1. Unfamiliarity with the roles and responsibilities of health

professionals
2. Consistently lower level of academic achievement compared with
the general student population
3. Insufficient information regarding gaining entry into medicine,
including alternate entry schemes and university preparation courses
4. Acceptance by the general medical school community for those who
were accepted into medicine through alternate entry programs
5. Impacts on family and community responsibilities and obligations
from leaving home/community to study
6. Isolation within university and from family/community
7. Adapting to the academic and structural rigours of medicine
8. Lack of Indigenous recognition within medical curricula
9. Discrimination and stereotypes within medical school
  

10. (The lack of) financial support

11. Pressure to practice only in Indigenous communities following
graduation

Attending medical schools that are not properly equipped to provide support
for these students may lead to deleterious experiences for them very early in
their medical career. For instance, unintentional racism from staff, students
and within the curriculum may occur, which greatly impacts indigenous
students’ mental health and well-being. This can affect their studies and
ability to engage with materials, particularly those with racist contents. This
also affects their ability to form connections with non-indigenous students,
which can have far-reaching impacts all throughout their professional
careers.
Yet, many Indigenous medical students have expressed dissatisfaction with
the available support services provided by their universities. [4]
Currently, only four medical schools provide direct access to medicine-
specific scholarships, bursaries or grants for Indigenous medical students.
[4] Limited tutorial support is available in some universities, but only one
university to date employs a medically trained tutor to work part time with
Indigenous medical students. [4] Collegiate support is available through the
Indigenous support unit in some universities, but medicine-specific
collegiate support is limited; some medicine faculties provide social and
learning opportunities for Indigenous students, and one university holds
extra clinical tutorial sessions for Indigenous students on the weekends. [4]
As per AIDA’s position statement, which states that cultural safety refers to
the accumulation and application of knowledge of Aboriginal and Torres
Strait Islander values, principles and norms, the ideal medical school
curriculum will include cultural safety training for its staff and support
programs. In addition to this, evidence of indigenous engagement in medical
curricula will demonstrate that indigenous health is included in the broadest
possible terms, where both specific subjects and areas and Problem Based
Learning (and its variations) cases about indigenous people are taught.
Indigenous-specific subject areas that can be incorporated into medical
curricula, as suggested by CDAMS Indigenous Health Curriculum
Framework [5] include history; population health; models of health service
delivery; culture; self and diversity; indigenous societies, cultures and
medicines; working with Indigenous people (ethics, protocols, research);
clinical presentation of disease; and communication skills.
Achieving a curriculum that is well rounded and is an accurate response to
the unique challenges posed by indigenous health will produce practitioners
who are culturally aware and competent, and provide a safe learning
environment for aboriginal and Torres Strait Islander students.

 
  

POSITION STATEMENT

This policy statement reaffirms NSWMSC’s commitment in improving

indigenous health by outlining the challenges faced by Aboriginal and
Torres Strait Islander students before and during medical school.
Addressing these challenges will lead to an increase in indigenous
practitioners, which is a crucial step that must be taken as part of the
addressing of the topic of indigenous health. Currently, medical schools,
which are solely responsible for the recruitment and education of future
practitioners, do not address these challenges adequately despite the
curricula framework and guidelines that have already been published.

POLICY

NSWMSC calls upon:

1. The NSW State Government to:

1.1. Prioritise the increase of recruitment and retention of
Aboriginal and Torres Strait Islander medical students
1.2. Enforce a regular inspection of all medical schools to ensure
that the CDAMS Indigenous Health Curriculum Framework
[5] is reflected in individual medical curricula
1.2.1. Each inspection should include anonymous reviews
submitted by students selected at random, to assess the
impact and efficacy of the curriculum

2. NSW medical schools to:

2.1. Increase their efforts in reaching out to prospective Aboriginal
and Torres Strait Islander students
2.2. Incorporate the CDAMS Indigenous Health Curriculum
Framework [5] into its medical curricula
2.3. Identify the unique challenges faced by its Aboriginal and
Torres Strait Islander students
2.4. Provide adequate support for the challenges as mentioned in
2.3. above
  

REFERENCES:

[1] Medical Deans Australia and New Zealand Inc. (2017). Workforce
Data Report 2017. Retrieved from
http://www.medicaldeans.org.au/wp-
content/uploads/2017_Snapshot_Data_Report.pdf
[2] Australian Bureau of Statistics, 2013, Estimates of Aboriginal and
Torres Strait Islander Australians, June 2011, cat. no.
3238.0.55.001, viewed 2 September 2017,
<http://www.abs.gov.au/ausstats/abs@.nsf/mf/3238.0.55.001>
[3] [Australian Medical Students’ Association. (2015). Aboriginal and
Torres Strait Islander Health Policy. Place, AU: Author.
[4] Minniecon, D., & Kong, K. (2005). Healthy Futures: Defining best
practice in the recruitment and retention of Indigenous medical
students. Australian Indigenous Doctors' Association. Retrieved
from http://www.aida.org.au/wp-content/uploads/2015/05/AIDA-
Healthy-Futures-Report.pdf
[5] Philips, G. (2004). CDAMS Indigenous Health Curriculum
Framework. Committee of Deans of Australian Medical Schools.
Retrieved from http://www.medicaldeans.org.au/wp-
content/uploads/CDAMS-Indigenous-Health-Curriculum-
Framework.pdf  
  

This policy was ratified at the NSWMSC Council 3 meeting on October 15th
2017.
_____________________________________________________________
Authored by:

Sara Kim
The University of New South Wales

Under the supervision of:

Liam Mason
NSWMSC Advocacy Officer 2017
_____________________________________________________________
Media Contacts:

Liam Mason Ashna Basu

Advocacy Officer 2017 President 2017
NSWMSC NSWMSC
M: +61 432 949 086 M: +61 452 568 694
E: advocacy@nswmsc.org.au E: president@nswmsc.org.au
 

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