An equity-oriented admissions model for Indigenous student recruitment in an undergraduate medical education program.

BACKGROUND: With the 2015 publication of the Truth and Reconciliation Commission of Canada's calls to action, health professional schools are left grappling with how to increase the recruitment and success of Indigenous learners. Efforts to diversify trainee pools have long looked to quota-based approaches to recruit students from underserved communities, though such approaches pose dilemmas around meaningfully dismantling structural barriers to health professional education. Lessons shared here from developing one multi-layered admissions strategy highlight the importance of equity-rather than equality-in any recruitment for learners from medically underserved communities. SUMMARY: The promotion of fairness in the recruitment of future practitioners is not just a question of equalizing access to, in this case, medical school; it involves recognizing the wider social and structural mechanisms that enable privileged access to the medical profession by members of dominant society. This recognition compels a shift in focus beyond merely giving the disadvantaged increased access to an unfair system, towards building tools to address deeper questions about what is meant by the kind of excellence expected of applicants, how it is to be measured, and to what extent these recruits may contribute to improved care for the communities from which they come. CONCLUSION: Equity-based approaches to student recruitment move health professional schools beyond the dilemma of recruiting students from marginalized backgrounds who happen to be most similar to the dominant student population. Achieving this requires a complex view of the target population, recognizing that disadvantage is experienced in many diverse ways, that barriers are encountered along a spectrum of access, and that equity may only emerge when a critically, socially conscious approach is embedded throughout institutional practices.

BACKGROUND: Depuis la publication en 2015 d'un appel à l'action de la Commission de vérité et réconciliation du Canada, les établissements de formation en sciences de la santé sont à la recherche de moyens d'accroître le recrutement et la réussite des apprenants autochtones. Les efforts visant à diversifier le bassin d'apprenant ont longtemps été axés sur la mise en place de quotas pour les étudiants issus de communautés mal desservies, mais de telles approches entraînent des choix difficiles quant au démantèlement approprié des obstacles structurels à la formation professionnelle dans le domaine de la santé. Les leçons tirées de l'élaboration d'une stratégie d'admission à plusieurs niveaux montrent l'importance de l'équité ­ plutôt que de l'égalité ­ dans tout recrutement d'apprenants issus de communautés défavorisées. CORPS DU TEXTE: : La promotion de l'équité dans le recrutement des futurs praticiens va bien au-delà de la garantie d'un accès égal, dans ce cas, à l'école de médecine; elle passe par la reconnaissance des mécanismes sociaux et structurels plus larges qui donnent aux membres des couches dominantes de la société un accès privilégié à la profession médicale. Cette reconnaissance exige de ne plus se contenter de donner aux personnes défavorisées un meilleur accès à un système injuste, mais à mettre en place des outils permettant de s'attaquer aux problématiques sous-jacentes liées au type d'excellence attendu des candidats, à la manière dont elle doit être mesurée et à la contribution que ces recrues peuvent apporter à l'amélioration des soins pour les communautés dont elles sont issues. CONCLUSION: Les approches fondées sur l'équité permettent aux écoles professionnelles de santé de dépasser le dilemme du recrutement d'étudiants issus de milieux marginalisés qui se trouvent être les plus semblables à la population étudiante dominante. Pour y parvenir, il faut adopter une vision complexe de la population cible et reconnaître que les désavantages sont vécus de nombreuses manières différentes, qu'il y a tout un éventail d'obstacles à l'accès, et, enfin, que l'équité ne sera pas établie tant qu'on n'aura pas intégré une approche critique et socialement consciente à l'ensemble des pratiques institutionnelles.

Obesity management and indigenous peoples

Exploring obesity within the context of multiple co-occurring health, socioeconomic, environmental and cultural factors, and situating these within policy/jurisdictional structures specific to Indigenous populations (e.g., federal versus provincial health funding), can facilitate emerging opportunities for obesity management. These contexts highlight a tension that providers must navigate, between drivers of obesity embedded in social- and system-level inequities and protective factors that promote healing through relationships and culturally contextualized approaches to care. Healthcare professionals should consider the following contextual factors when providing obesity care for Indigenous peoples: Structural inequities (i.e., social and systemic in origin) are embedded in health, education, social services and other systems, and they maintain social disadvantage for a large segment of the Indigenous population. These inequities influence food security, for example, through lower wages perpetuated by inaccessible education and high food costs in urban and remote areas, or through limited access to activity-based resources at individual and community levels. Indigenous people have experienced systemic disadvantage throughout their lifespan and those of their family members, producing a cumulative effect on obesity. In Indigenous contexts, obesity is therefore deeply affected by responses to pervasive stressors, as individuals navigate social and systemic barriers to meeting their goals. Overwhelming stress from social (e.g., discrimination) and systemic exclusion (e.g., poor or absent primary healthcare) can disempower Indigenous people in maintaining healthy behaviours. Patients may appear to be resistant to healthcare recommendations, where together with healthcare providers they may come to feel fatalistic toward their capacity to address obesity. Healthcare professionals often interpret such patient incongruity with recommendations in a deficit lens, labeling it as patient non-compliance or non-adherence. This non-concordance, or seeming apathy, may actually be a sense of paralysis in the face of overwhelming stress. Exploration of the patient's social reality can open opportunities for contextualized approaches to obesity management. Reflection on assumptions about seeming apathy may contextualize patient motivations, where deep exploration of one's own perceptions, attitudes and behaviours toward Indigenous patients may uncover anti-Indigenous sentiment implicit in healthcare practices or systems. Validation of a patient's experiences of inequity can empower both patients and providers to identify steps to address social factors that influence health behaviours. Culture and relationships facilitate learning of complex knowledge. The interaction of obesity with co-occurring structural factors represents complex knowledge that is critical for patients to gain deep understanding of their health. Non-Indigenous healthcare providers may have ways of knowing and doing that are inconsistent with Indigenous patient perspectives on health knowledge and how it should be exchanged. Obesity management in this context requires a longitudinal, relationship-centred approach that engages and explores interactions with co-existing factors to build both knowledge and trust, in a manner aligned with Indigenous principles for communication. Connection: When patients connect with healthcare providers around their co-occurring health needs, there are complex linkages between wider structures and their health. The therapeutic relationship may be critically supportive when knowledge is delivered in a relevant way and makes sense to the patient. Trust-building: Healing of the therapeutic relationship is itself fundamental to engaging and supporting patients within contexts of multi-generational trauma to explore complex intersections in relation to health and health behaviour change. Differing worldviews: Western concepts of healthy behaviours related to obesity management, including preferences for body size, activity and food, may be dis­cordant with Indigenous perspectives. Patients may not identify with provider perspectives, and providers must not assume that patients share provider worldviews or principles around how to communicate health knowl­edge. Discordant perspectives may involve a distinct sense of locus of control, self-efficacy and modes for speaking about the pathways into and out of obesity. An Indigenous approach to knowledge exchange in­cludes contextualizing knowledge within the world of the patient and employing a narrative-based and indi­rect approach to sharing knowledge.

Gender at the intersection with race and class in the schooling and wellbeing of immigrant-origin students.

BACKGROUND: In French-language secondary schools in Quebec, among all immigrant-origin students, those originating from South Asia have the highest dropout rate. However, girls belonging to this group consistently outperform their male peers of similar ethnic background. This stirs questions about the reasons for this relative outperformance and its linkage with overall wellbeing among these girls. METHODS: A mixed methods approach guided data collection. It involved in-depth interviews with female and male students of South Asian origin (n = 19) and with individuals holding educational roles in the lives of youth (n = 25). An additional anonymous questionnaire aggregated parent perspectives (n = 36), though this article focuses primarily on qualitative lessons. RESULTS: This article shows three main reasons for why South Asian female adolescents in Quebec French-language secondary schools outperform their male counterparts in schooling attainment: parental expectations after migration, socialization at home, and relationships at school. According to our findings, academic perseverance among these girls does not necessarily translate into their improved wellbeing or their involvement in an advantageous process of acculturation. CONCLUSIONS: This study highlights that although gender, ethnicity, and class can create an interlocking system of oppression in certain social spheres for a specific group of women, it can emerge as advantageous in other contexts for the same group. This provides educational policy makers, as well as school and community workers, with guidance and avenues for action that can promote the wellbeing of immigrant-origin girls through involvement in beneficial processes of acculturation aligned with their improved academic performance.

The Mock Academic Faculty Position Competition: A Pilot Professional and Career Development Opportunity for Postdoctoral Fellows.

PROBLEM: Medical educators face a dilemma in countries like Canada, where policy makers and strategic planners have prioritized highly qualified personnel and expanded recruitment of advanced trainees at a time when early-career specialists face prolonged job insecurity as they transition to professional employment. The University of Calgary Cumming School of Medicine hatched the Mock Academic Faculty Position competition to test the school's existing capacity to address the pressing career development needs of highly trained graduates. APPROACH: The competition was piloted in May-June 2014. Approximately 180 postdoctoral fellows were invited to compete; 34 submitted portfolios. The Postdoctoral Program Office established a longlist of 12 applicants. Through reviews, a selection committee identified 3 finalists to participate in a daylong event consisting of a research presentation and committee interview. The event was followed by approximately 70 audience members at any given time who were invited to complete anonymous evaluation forms and/or exit interviews. OUTCOMES: The selection committee deduced a vast majority of applicants did not sell their skills effectively or demonstrate research programs independent from supervisors. Exit interviews conducted with 40 audience members indicated 36 (90%) picked the same finalist as the selection committee, 34 (85%) found the process "nerve racking," and 28 (70%) had no previous idea of what goes on inside an academic committee interview. NEXT STEPS: A key recommendation for future iterations is early attention to systematizing feedback to ensure more direct impact for nonfinalists. Alternative initiatives for those gearing up for industry or public-sector work are being prepared.

'WE CAN'T GET WORMS FROM COW DUNG': REPORTED KNOWLEDGE OF PARASITISM AMONG PASTORALIST YOUTH ATTENDING SECONDARY SCHOOL IN THE NGORONGORO CONSERVATION AREA, TANZANIA.

Records at the Endulen Hospital in the Ngorongoro Conservation Area (NCA), Tanzania, reveal that soil-transmitted helminth infections and protozoa are consistently in the top ten diagnoses for Maasai pastoralists, indicating a significant public health concern. Nevertheless, Maasai pastoralist adaptations to life in close proximity to livestock and to unreliable access to water raise important questions about experiences of, and resiliency to, parasitic infections. Though these infections are particularly prevalent among youth in low- and middle-income countries (LMIC), a focus on resiliency highlights local capacity to recover from and prevent illness. For instance, how is human parasitism perceived and experienced among communities displaying behaviours that studies have associated with transmission of diarrhoeal diseases, such as open defecation? Among these communities, how is parasitism seen to impact the health and development of children? And, what resources are available to endure or mitigate this heavy disease burden among affected communities? This study draws on formative research carried out in May 2014 in anticipation of an innovative school-based and youth-driven water, sanitation and hygiene education intervention rolled out in two boarding schools in the NCA in subsequent months. The initiative is grounded in a One Health approach to health promotion, drawing on partnerships in medicine, public health and veterinary medicine to appreciate the unique interactions between humans, animals and the environment that shape well-being among pastoralist communities. Qualitative data generated through group discussions with secondary school youth (n=60), Maasai teachers (n=6) and a women's group (n=8) in the NCA convey existing knowledge of the prevalence, prevention and treatment of human parasitism. An underlying principle of the larger initiative is to engage youth as creative agents of change in developing and sustaining locally relevant health promotion strategies. Findings highlight practical knowledge around certain 'neglected tropical diseases', namely helminths, among pastoralist communities in the NCA, in turn feeding into the development of the science fair and related interventions.