Tātou Tātou: Success For All. Improving Māori student success in health professional degree level programmes.Dr Elana Curtis, AP Papaarangi Reid, Dr Mark Barrow, Dr AiriniUniversity of Auckland, Aotearoa - New Zealand

Ako Aotearoa ColloquiumWellington, 4h May, 2011

Presentation summary• Tātou Tātou Project

• Faculty of Medical and Health Sciences

• Methods/Methodology

• Nursing findings

• Challenges/lessons

Tātou Tātou Project• 18-month qualitative project

– Builds on TLRI project “Success For All”

• Māori student “success” in health professional programmes at FMHS– Nursing, Medicine, Pharmacy, Health Sciences– Involves academic representatives and MAPAS

staff (working together)– Unique, novel research project

• Non-lecture based teaching and learning, includes clinical contexts– tutorials/seminars/workshops/laboratories, small group clinical

teaching (e.g. ward rounds, bed-side), case studies/Problem Based Learning (PBL), work based placement / internships

Research Questions

• What teaching practices in non-lecture contexts help or hinder Māori success?

• What changes does research suggest are needed to teaching/higher education to best support Māori success in degree-level study health professions?

Faculty of Medical and Health Sciences• 4 degree programmes

– Nursing – 3 years, clinical placements Y2/3– Pharmacy – 4 years, clinical Y4– Medicine – 6 years, clinical Y4-6– Health Sciences – 3 years, non-clinical,

work experience

• Limited exploration/research within faculty to date

• Supported by MAPAS– Māori and Pacific Admission Scheme

MAPAS• Eligibility is whakapapa based• Admission process

– MMI (multiple mini-interview), Maths/English testing, whānau feedback, recommendations post NCEA

• Academic support– Tutorials, study weeks/retreats, space

• Pastoral support– Co-ordinator, wānanga, cohort meetings

• Academic representation– Board of Examiners, Faculty Committees

Methods• Student interviews

– Aimed for 10 per programme• Critical Incident Technique

– Can you describe a time when the teaching and learning practices has helped (or hindered) your success in X?

– Trigger, Action, Outcome– Collaboratively group incidents into

categories, sub-categories• 3 contexts

– Non-clinical, Clinical, MAPAS• Validation/Reliability Testing• Focus Groups

Methodology• Kaupapa Māori

– Research design, implementation, analysis, report writing and dissemination

– Māori-led, Māori input all stages– Culturally appropriate, safe– Give way rule (acknowledge limitations)– Rejection of victim blame/cultural deficit theories

Progress to Date • 41 interviews (transcribed, categorised)

– Medicine – 17– Health Sciences – 14 – Nursing – 7– Pharmacy - 3

• Progress made (VRT and Focus groups)- Conducted but not ideal

• Second phase of data analysis in progress– Re-categorisation– Nursing data most developed

Overall results - preliminary

• BHSc data provided nearly double no. of incidents• Similar proportions of help and hinder across programmes• Likely to change as data fully reviewed

No. of interviews

No. of incidents

No. of Incidents/IV Help % Hinder %

MBChB 17 393 23 264 67 129 33

BNurs 7 201 29 137 68 64 32

BHSc 14 644 46 415 64 229 36

BPharm 3 114 38 76 67 38 33

Nursing - preliminaryCategories (n = 13)

Totals (per category)

Percentage (of total)

• Provide culturally appropriate academic and pastoral support 58 29%

• Use best practice teaching and learning methods 37 18%

• Provide a supportive learning environment 29 14%

• Recognise the importance of Nursing cohort cohesion 14 7%

• Address stigma regarding MAPAS quota 13 6%

• Provide opportunities to link theory to practice 10 5%

• Ensure clinical staff understand their impact on student learning 9 4%

• Support whakawhanaungatanga 9 4%

• Understand the complexities of student life 8 4%

• Provide a well organised programme 7 3%

• Provide a separate/safe cultural space 4 2%

• Provide culturally appropriate clinical placements 2 1%

• Support independent learning 2 1%

Provide culturally appropriate academic and pastoral support

• MAPAS tutorials/study groups• MAPAS Coordination

Trigger: what’s really great about MAPAS you know [is that] always everything that they do for students is in order to really get them to succeed. Action: the more you kind of you go down the studying track you know with MAPAS the more good you feel you know, cause there are these people there and they’re really routing for you, you know, and they’re always really approachable and you know if you’ve got any problems, they’re always there for you and are willing to, you know, give you extra help if you need it. Outcome: I guess confidence is probably the biggest thing when you’re studying ... its quite good to have someone standing there, you know, well don’t worry just try it from a different angle for next time you know and we’ll get you through and I think that’s always been really good.

MAPAS domain, Help, Year 1 Nursing student.

Use best practice teaching and learning methods

• Māori Health Week • Nursing tutorials (content/size)

Trigger: I think Māori Health week Action: I mean, you know I heard a lot of people during Māori health week say oh you guys get a whole week you know what about Somalian health week or you know Indian health week and yeah I think that that’s what kind of promoted a lot of the angst between other cultures and Māori students. Outcome: I think that that’s what aggravates the, it aggravates the hate or the kind of, it just promotes this idea that we get special opportunities.

Non-clinical Domain, Hinder, Recent Graduate Nursing.

Provide a supportive learning environment

• Resources• Awareness of tertiary study

Trigger: So I like to study at the university Action: my house isn’t particularly, I don’t know it’s got too many distractions so I find it really hard to study at my house. But when there isn’t like, cause I don’t have internet at my house either, when there isn’t a computer I can find at the university that’s annoying. And when there isn’t a text book I can borrow. Outcome: for the last exam I sat, I don’t know, cause I probably didn’t do enough of the study that I should have and that had a lot of, that had a lot to do with not having a text book to borrow at the university

Non-clinical Domain, Hinder, Year 1 Nursing student.

Recognise the importance of Nursing cohort cohesion

• Group learning

Trigger: if you don’t have that support network in place to begin with Action: You know, you don’t have a “go to” person who you feel comfortable with to say you know, “Shoot, I’m really struggling, what do I do? Can you help me?” Outcome: It’s really important, oh absolutely important.

Non-clinical Domain, Help, Year 1 Nursing student.

Address stigma regarding MAPAS quota

• Awareness of MAPAS support

Trigger: not knowing how to access MAPAS and all that stuff. Action: So, like, just not having that support, not knowing what to do, who to go see to help out, you know, in that first semester, was really hard, you know Outcome: then at the end of the year I had my interview and I got in....I realised that MAPAS was there to help, and that they offered all these things

MAPAS Domain, Hinder, Year 3 Nursing student.

Ensure clinical staff understand their impact on student learning

• Staff characteristics

Trigger: I just don’t understand why a lot of the preceptors are like that towards student nurses Action: a lot of times they just ignore you, like you hear a lot of people in our class – I just stood there. I didn’t do anything. I’ve done that, because they just ignore me, and if you just stand there and you’re not doing anything, you’re not going to learn. Outcome: because it really does affect the way you learn

Clinical Domain, Hinder, Year 3 Nursing student.

Challenges/Lessons • Get student recruitment right

– Know/use your denominator

• Get interviewers on track– Invest in training/tracking (++++)

• Invest in research administration

• Overestimate time/resources required to complete analysis

• Avoid going on maternity leave!

Summary• Need to ensure quality analysis

– Need to fully review categories/sub-categories within and across the 4 programme

– Explore domains – what have we learnt about clinical contexts etc?

• Next steps– Repeat VRT– Develop QTTe toolkit– Draft papers/present findings

Acknowledgments•Students

•Tātou Tātou TeamMBChB – AP Philipppa Poole, Dr Myra RukaBHSc – Dr Bridget KoolNursing – Michelle HoneyPharmacy – Fiona KellyMAPAS – William Nepia, Dwain Hindricksen, Torise Lualua, Fa’asou ManuResearch Asssistant – Erena Wikaire

•PIDr Elana Curtis

•Ako Aotearoa