This paper presents an alternative method of determining eligibility for rural and regional admissions at Auckland medical school. 

The move to a tighter definition of ‘rural’ is a positive one for Auckland. Otago and Waikato, however, have chosen to use the GCH; providing an  even tighter and more targeted definition.

Perhaps the biggest difference between the two definitions is the inclusion of communities on the immediate outskirts of provincial cities in the Auckland definition. These communities have overall higher socioeconomic status, which is evident in the socioeconomic profile of the population defined as rural by the two definitions.

Strengths of the GCH include:

• Its adoption by government and the sector as the preferred method of defining rurality for health.
• Its validity, including its ‘on the ground’ validity.
• Its ability to identify a rural population that has poorer health outcomes and lower levels of health service utilisation.
• Its ability to update over time with changes in population.
• Tighter more targeted definitions of rural origin are more predictive of joining the rural workforce.

The adoption of the GCH will make it harder for Otago and Waikato to fill their rural equity group places. But it will ensure that they are targeted at students who come from the most rural and remote communities, who face the greatest barriers to entering medical school, and are more likely to enter the rural medical workforce. 

Garry Nixon and Jesse Whitehead

OPEN ACCESS here

ABSTRACT

Introduction: Pathways aimed at increasing the medical workforce in regional and rural areas in Aotearoa New Zealand have been implemented in universities, such as the Regional and Rural Admission Scheme (RRAS) at Waipapa Taumata Rau |The University of Auckland, to address urban–rural variations in health outcomes. A recent review of the university’s scheme suggested the program was not providing equitable opportunities for students from a rural background as originally intended. Therefore, an updated RRAS was required to be developed to address these inequities, creating a more genuine scheme that may more strongly contribute to developing the regional and rural workforce in New Zealand. 

Methods: We developed a methodological framework to identify and evaluate candidate rural definitions for the purposes of developing a new RRAS for the university. Following an extensive literature review, we utilised two sets of criteria to select candidate rural definitions, which were then evaluated using visual evaluation (mapping) and exploratory analysis. Candidate definitions were modified to use a three-group (rural–regional–urban) version to be suitable for use as an updated RRAS. We used a de-identified student dataset of applicants enrolled for the MBChB medical program at the University of Auckland from 2017 to 2023 (inclusive) and population counts from the New Zealand 2018 Census to investigate differences in potential admission numbers under each candidate definition. The New Zealand Index of Multiple Deprivation 2018 was used to assess the distribution of potential admission numbers by area-level socioeconomic status. We also examined the suitability of the candidate definitions by ethnicity, specifically for students of Māori ethnicity. 

Results: We selected two candidate definitions for exploratory analysis: Geographic Classification for Health (GCH) developed by the University of Otago, and the urban accessibility classification 2020 (UA 2020) by Stats NZ. We found that the three-group modified version of the UA 2020 definition consistently classified a higher proportion of students as regional and rural compared to the current RRAS and the alternative candidate definition, the three-group GCH. The modified UA 2020 was found to classify a higher number of Māori students and those living in less-deprived neighbourhoods as rural when compared to the other definitions. Therefore, our final recommendation is to update the existing RRAS using a three-group modified version of the UA 2020 by Stats NZ. Our proposed version will refocus attention to address the under-representation of rural students admitted to professional health programs at the University of Auckland, while not disadvantaging regional students. 

Conclusion: The updated RRAS will assist in supplementing the future professional rural medical workforce, and subsequently help to reduce health outcome variations between rural and urban areas in New Zealand. The modified UA 2020 is likely to be updated regularly by Stats NZ, and therefore the RRAS can be kept up to date in the future.