Dalhousie Medical School aims to increase Indigenous student admissions

Dalhousie University is taking steps to double the number of Indigenous students admitted to its medical school.

The action is in line with the call of the Truth and Reconciliation Commission to increase the number of Indigenous professionals working in the health-care field.

Dr. Brent Young, an Anishinaabe family doctor and the academic director of Indigenous health for Dalhousie's faculty of medicine, spoke about the new initiative Thursday with Portia Clark on CBC's Information Morning Halifax.

Tell us a bit about what Dalhousie is doing to try to train more Indigenous doctors.

I started at Dalhousie a little less than a year ago, and since coming on to my position as academic director of Indigenous health, I've been working to develop a new Indigenous admissions pathway at the medical school.

What we've developed is a new program that involves the formation of an Indigenous admissions subcommittee, which is a group made up of physicians, Indigenous community members, leaders, elders, as well as some pretty strong allies in the faculty of medicine.

This will entail a subcommittee looking at applications from Indigenous folk, but also using a holistic process where we're looking at all components of an application from Indigenous applicants.

Will the criteria be different or the considerations be different? Can you walk us through that a bit?

How the previous process had worked was that Indigenous applicants were reviewed using the same criteria as all other applicants. This hasn't necessarily changed. But where it does differ is actually where now we'll be looking at the applications where we'll be able to have some flexibility around each component.

So in the past, things like the GPA and the MCAT, which is the medical college admissions test score, had a very rigid cutoff point. So where Indigenous applicants would sometimes be within striking distance of those cutoffs, or below the cutoff in some cases, they wouldn't be able to progress through the admissions process, so we wouldn't be able to offer them an interview.

This process will be a bit different where we'll be able to kind of have a bit more flexibility to get looking at all of those components.

In your view, are the MCAT, the medical school exams, are they effective or ineffective at identifying Indigenous students who would make good doctors? Are there some blind spots in that that evaluation? 

With the MCATs in particular and also to some degree the GPA, we know that there is a degree of racial bias in these tools that we use.

So when this is looked at in research studies, the organizations that developed the MCAT actually said that it's not necessarily racial bias per se, but certainly things like access to education, income inequality, certainly affect how someone can perform on the MCATs in particular. So interestingly, those factors, as we know, are certainly very tightly related to race in our society. 

So it does disadvantage Indigenous folks. And so that's why we've taken a step back and given ourselves a little bit more flexibility in taking all of those things into consideration when we're looking at an application. 

Do you have a ballpark number of people that you would like to be able to bring in through the program in a given year?

We set a very modest target based mainly on proportion of the population that identifies as Indigenous in the Maritime region.

What that means is a minimum target would be around admitting nine Indigenous folks in the faculty of medicine each year. That's kind of double what we've been doing in recent years. And certainly I would hope that we can exceed that, knowing that for many, many years now that we've had a discrepancy in the number of Indigenous folks that we've been able to admit. 

What would have been an average in previous years?

It's been around the range of four to five each year. We currently have about 18 Indigenous students studying in the faculty of medicine across four years of undergraduate studies.

What effect do you think that this could have on the quality of health care that Indigenous people get if more Indigenous doctors or doctors who have a First Nations or Inuit background are graduated through Dalhousie and other schools?

I think it can have a huge impact. I think the biggest thing is that we'll hopefully see Indigenous folks going on to practice in Indigenous communities, and that would be ideal because we know that Indigenous patients want to see physicians who understand their lived experience, whether that's with colonialism or racism, and just understanding what life is like as an Indigenous person in this country.

I think that goes a long way in improving quality of care that Indigenous folk will receive. And at a wider level the health-care system certainly can use the insight and knowledge of Indigenous folks when we're talking about things like program design, implementation and things like this type of reform that we're seeing at Dalhousie Medical School today.

Is there any anticipation of these students or these graduates or these doctors being perceived differently if they've come through the medical system under different criteria? Is that something that that your group has been discussing?  

I think that was always a concern that we had. And back when I was a medical student, I actually looked into this and it is quite common for Indigenous students to face this sort of stigma from their colleagues.

So I do worry that that could be the case. But I think the biggest thing that people need to understand about the mitigation of disadvantage is actually not equal to giving somebody an advantage to get into medical school.

It's really accounting for all of the disadvantage and adversity that Indigenous folks face on their journey to medical school, in the sense that maybe they don't have a parent who's a physician. Maybe they're the first in their family to attend university. They may not necessarily know the language or what exactly they need to do to get into medical school.

So mitigating all of those factors is a little bit different than giving somebody an overt advantage to get into medical school. 

When does this program come into effect?

It will come into effect with the upcoming application cycle that opens in June of this year. The first students who are admitted under this new pathway will actually start their studies in August of 2023.