In a historic measure, the University of Alberta is eliminating a quota system that limited the number of Indigenous students admitted to its MD program through the Indigenous Health Initiatives Program (IHIP) process.



During the next admissions application cycle, starting in fall 2019, all Indigenous students who meet all eligibility requirements through IHIP will be offered a place in the medical school.

The faculty previously held an upper limit of five Indigenous students admitted to the MD program per year through the IHIP process. Indigenous applicants could also apply and be accepted through the regular stream. The medical school accepts 165 new students every year and receives more than 1,400 applications.

"Thirty years ago, Indigenous post-secondary enrollment was nowhere near where it is now, so holding five spots out of the total MD Program seat allotment was a meaningful measure," said Tibetha Kemble, director of the Indigenous Health Initiatives Program in the Faculty of Medicine & Dentistry. "Over time, we know it's become a limitation. With the national conversation focused around reconciliation, it was important for us to take a closer look at ways to advance the Calls to Action in ways that moved beyond incrementalism."

The approved motion to remove the upper limit entirely arose from the Faculty of Medicine & Dentistry's Division of Community Engagement who view Indigenous student recruitment through the lens of understanding Canadian history to better inform present approaches.

"By prioritizing Indigenous students in the U of A's Faculty of Medicine & Dentistry, we increase our potential for transformative change and the possibility for redressing the legacy of colonial policy that for so long has deterred Indigenous enrollment," said Kemble.



"With the removal of any upper limit, the University of Alberta becomes one of the few universities in Canada to open admissions up to all Indigenous candidates who meet the requirements to medical school," said Shirley Schipper, Vice-Dean, Education. "This is a step forward to respond to the Truth and Reconciliation Calls to Action, specifically number 23 which calls on all levels of government to increase the number of Indigenous professionals working in the health-care field. Our faculty is committed to address the Calls to Action across our education programs as part of a larger mandate-to meet the health needs of our communities."

In addition, beginning in September 2019 and for each of the next four years, the MD program will award four new full-tuition scholarships to entering Indigenous students.



Breaking down barriers of past colonial policies to walk toward reconciliation



Kemble explains that a history of colonial policies has affected Indigenous peoples' experiences with the health system, where interactions between Indigenous peoples and medical professionals were based in mistrust, anxiety and fear. She points to Indigenous peoples' experiences in Indian Residential school, as well as the 1880 amendment to the Indian Act to demonstrate how Canadian medical schools have previously, unknowingly or knowingly, been participants in the larger colonial practice of assimilating Indigenous peoples.

"The 1880 amendment made it so if you entered into medical school, you lost your status as an Indian person and, in many cases, you lost your ability to ever return home. This legislation was in place for more than 80 years, so from that perspective, it's not surprising there were so few of us who dared to enter into this professional program," said Kemble.





In 1996, the Royal Commission on Aboriginal Peoples (RCAP) reported distressing health outcomes among Indigenous populations-Indigenous life expectancy at birth was about seven to eight years less than non-Indigenous Canadians generally. A federal report released in 2018 indicates that despite new funding and initiatives to support improved Indigenous health outcomes, very little progress has been made. In terms of life expectancy, for example, Indigenous peoples now have a 15-year shorter life expectancy than non-Indigenous peoples-nearly two times the gap reported more than 20 years ago.

Kemble says more Indigenous physicians are vital to close that health gap because they understand the lived reality of Indigenous patients and are able to provide culturally-safe care and influence the health system broadly.

MD admission process for Indigenous candidates

For an Indigenous student applying to the U of A's MD program, the academic eligibility requirements remain the same as those for non-Indigenous students―all applicants must meet the required MCAT scores and cumulative GPA. Once applicants successfully meet the minimum academic requirements, they must also submit a secondary medicine application and complete an online assessment. A short list of applicants are invited for interviews. Only at this point in the application process does the admission process differ for Indigenous applicants, who are invited to undergo an additional interview with a panel comprised of elders and Indigenous community members and physicians. The Indigenous Admissions Subcommittee makes recommendations to the MD Admissions Committee for admission.

"That interview is an opportunity for Indigenous candidates to reaffirm their cultural connection to community and reflect back to us that they are entering the medical school wanting to contribute to the Indigenous community through the special place they would hold as a health professional," said Kemble.

Opening the doors to build a shared vision of Indigenous health

The Indigenous Health Initiative Program (IHIP) is designed to support Indigenous students in their journey to becoming Indigenous health professionals who work with their communities of origin by providing direct service to First Nation, Inuit and Metis people.





The IHIP has supported more than 180 Indigenous Peoples from their admission to graduation in the Faculty of Medicine & Dentistry's undergraduate programs at the U of A. Currently, there are Indigenous students enrolled in the medicine, dentistry, dental hygiene and medical laboratory science programs. There are 16 Indigenous students enrolled in the MD program in all four class years.

Elder Rick Lightning, from Maskwacîs, praises Indigenous university students as survivors who have beat the odds of suicide, alcoholism and more. "Like when turtles are born and race to the ocean with predators around, those students are like the few turtles that made it through."



"There are more and more turtles coming up onto the sand," said Kemble. "The challenges remain but for those who are eligible and who seek out admission, we can now say yes to many more candidates. Given our mandate to increase the number of Indigenous health professionals, this initiative enables us to be more responsive. With more Indigenous students admitted, we create a critical mass of peers working together to address issues while supporting each other in the process."

Kemble says it is important for other U of A faculties and other medical schools across Canada to see themselves in advancing similar admission changes.

"In order to support system-level change, it's important to ask 'What can we do to help shift the landscape to allow greater space and place and presence for Indigenous peoples across campus?' If we approached changes to Indigenous admissions incrementally, we wouldn't get to where we need to be. These system-level shifts don't happen four or five students at a time," said Kemble. "But a critical mass of Indigenous university students will eventually lead to a critical mass of Indigenous faculty, teachers and other staff to help move and shift the landscape inside and outside institutions."

Kemble says a profound shift occurs when a critical mass of Indigenous physicians, educators and other professionals start working in communities at that direct service level and more broadly across systems. "Through their work, they become important change agents in their communities and across their professions. That's really the long-term vision."