title: Patterns of privilege: A total cohort analysis of admission and academic outcomes for Māori, Pacific and non-Māori non-Pacific health professional students.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand.
authors.forename: Erena
authors.identifier: http://orcid.org/0000-0002-6102-1353
authors.initials: E
authors.lastname: Wikaire
authors.affiliation: Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand. e.curtis@auckland.ac.nz.
authors.forename: Elana
authors.initials: E
authors.lastname: Curtis
authors.affiliation: Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand.
authors.forename: Donna
authors.initials: D
authors.lastname: Cormack
authors.affiliation: Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92015, Auckland, New Zealand.
authors.forename: Yannan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92015, Auckland, New Zealand.
authors.forename: Louise
authors.initials: L
authors.lastname: McMillan
authors.affiliation: Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand.
authors.forename: Rob
authors.initials: R
authors.lastname: Loto
authors.affiliation: Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand.
authors.forename: Papaarangi
authors.initials: P
authors.lastname: Reid
mesh_terms: D000124:Achievement; D000328:Adult; D015331:Cohort Studies; D003099:College Admission Test; D004521:Educational Measurement; D005006:Ethnicity / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D009520:New Zealand; D012570:School Admission Criteria / Q000706:statistics & numerical data*; D012576:Schools, Health Occupations / Q000706:statistics & numerical data*
keywords: Academic success; Ethnic minority; Health professional; Indigenous; Māori; Pacific; Tertiary education; Workforce development