DEVELOPING A POLICY AND FRAMEWORK FOR ABORIGINAL
ADMISSIONS AND SUPPORTS AT THE UNIVERSITY OF CALGARY
FACULTY OF MEDICINE
DRAFT ONLY
Dr. Lynden (Lindsay) Crowshoe and Ms. Sarah Jacobs
Building Aboriginal Health Teaching and Learning Capacity project
Department of Family Medicine
University of Calgary
December 13, 2005

EXECUTIVE SUMMARY
The poor health of Aboriginal Peoples is well-documented. This fact, coupled with the chronic under-representation of Aboriginals in the health professions, poses significant social justice and human rights issues. Recent trends in post-secondary education include programs aimed at recruiting and training Aboriginal health professionals in Canada, the
United States and Australia. This trend is endorsed by, among others, the World Health
Organization (WHO), the National Aboriginal Health Organization (NAHO), the Report of the Royal Commission on Aboriginal Peoples (RCAP) and Alberta Learning. In 2005, the Aboriginal Task Group within the Social Accountability of Medical Schools Initiative of the AFMC made key recommendations regarding Aboriginal student admissions and support to the Council of Deans.
Several Canadian medical schools have programs which include admissions policies, designated seats and support programs that are specifically designed to develop
Aboriginal physicians. The University of Calgary, Faculty of Medicine currently grants interviews to Aboriginal applicants whom meet the minimum admissions criteria. We recommend that this policy be reevaluated and propose the following Aboriginal admissions policy and program be developed and implemented that would meet the emerging standards of excellence for Canadian medical schools.
1) That the Faculty of Medicine adopts and adapts the University of Calgary
General Faculties Council new Aboriginal Student policy.
2) That the Faculty establishes an Aboriginal Careers in Medicine (ACM) program with the following aspects. a.
A focus on developing an applicant pool, recruiting students, facilitating the admissions process and providing supports to students throughout their medical education. b.
An ACM program office c.
An ACM staff that includes a program director, student recruitment and support manager and administrative assistant. d.
An Aboriginal Admissions Committee
3) That the Faculty adopts the following admissions process recommendations. a.
Utilize the existing University of Calgary Aboriginal Student Policy definition of an Aboriginal person for purpose of determining
Aboriginal ancestry. b.
Reserve 5 seats over quota for Aboriginal applicants. c.
Qualified Aboriginal applicants compete within a separate applicant stream for these seats. d.
Aboriginal applicants will be considered Alberta residents and offered an interview providing a GPA of 3.2 and MCAT. e.
Aboriginal applicants will be required to produce an essay demonstrating their connection to the Aboriginal community. f.
Aboriginal applicants will be interviewed according to the standard admissions process. g.
Aboriginal applicants will undergo an additional interview with an
Aboriginal interview panel.
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h.
Aboriginal applications will be reviewed by the Aboriginal
Admissions Committee which will make recommendations for admission to the Admissions Committee. i.
The target for admissions is 5 seats per year. Any seats that are not utilized will be carried over for one year. Aboriginal applicants who are competitive within the general stream may be offered a general seat.
4) That the Faculty work to build partnerships with local Aboriginal communities.
5)
That a process be put in place to evaluate the Faculty’s policy and programs regarding Aboriginal students.
The ACM program will develop and recruit a local applicant pool by liaison with secondary and post secondary institutions in southern Alberta and will work in collaboration with Alberta Education, Treaty 7, Metis Nation and Urban Aboriginal organizations. The program will offer opportunities for development through summer science camps. The program will offer guidance and prepare potential applicants through a pre-admissions program and counseling. The ACM program will provide support to
Aboriginal medical students through cultural, social and educational activities such as elder counseling, community speakers, retreats and sponsorship of involvement within the Indigenous Physicians of Canada organization. The approximate first year cost for the
ACM program is $613,000.
Table: The Aboriginal Careers in Medicine Program First Year Budget
Salaries Program director 0.2 FTE
Student Recruitment Manager 1.0 FTE
Administrative Assistant 1.0 FTE
Existing Salary
$ 60,000
$ 35,000
$ 10,000 Office
Infrastructure
Travel
Expenses
Computers (4), printer, fax, phones, stationary
Staff attending conferences
Student recruitment
Students attending conference
Elder consultant Cultural
Events Aboriginal student and faculty retreat
Community speaker series
Aboriginal graduate convocation
Advertising Posters, web page, commercials
Student
Supports
Tutoring and counseling
$ 7,000
$ 10,000
$ 8,000
$ 10,000
$ 9,000
$ 2,000
$ 7,000
$ 50,000
$ 5,000
Applicant
Pool
Development
Educational
Costs
TOTAL
Pre-admission program (20 students)
Summer Science camp (20 students)
Aboriginal medical student education - $75, 000 x 5
$ 5,000
$ 20,000
$375,000
$613,000
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A GUIDE TO TERMINOLOGY
Aboriginal: A noun or adjective for the first inhabitants of a land and those recognized as their descendents.
Aboriginal Peoples: A collective name for the original peoples of Canada and their descendents. This includes status and non-status Indian/First Nations, Inuit and Métis
Nations.
Aboriginal People: Refers to more than one Aboriginal person, but not the collective group of Aboriginal peoples. In this document, the term “Aboriginals” is meant as synonymous.
Inuit: One of the three Aboriginal Peoples of Canada, as recognized by the C onstitution
Act of 1982. This term refers to the Aboriginal Peoples of Artic Canada and the circumpolar region.
Métis:
Similarly refers to one of the three groups of Aboriginal Peoples recognized by the constitution. The Royal Commission Report defines Métis as: every person who (1) identifies himself or herself as Métis, and (2) is accepted as such by the nation of Métis people with which that person wishes to be associated, on the basis of the criteria and procedures determined by that nation be recognized as a member of that nation for the purposes of nation-to-nation negotiations as a Métis for that purpose.
Non-Status Indian/First Nations: People who consider themselves to be Indians or members of a First Nation, but who are not recognized as such by the Federal
Government.
Status Indian/First Nations: People who are entitled to have their names included on the Federal Government’s Indian Register.
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RATIONALE
The health status of Canadian Aboriginal Peoples is consistently shown to be below that enjoyed by members of the general population, even though Canada retains a fiduciary responsibility to its Aboriginal Peoples
1
. At present there are approximately 1.3 million
Aboriginal Peoples in Canada, which amounts to roughly 4% of the Canadian population
2
; in Alberta, Aboriginals constitute 5% of the population
3
. The number of
Aboriginal physicians in Canada is estimated to be between 100 and 150. This corresponds to an Aboriginal physician to patient ratio of 1:30,000. In comparison, the physician to patient ratio for the general population is about 1:500
1
. This suggests a severe under-representation of Aboriginals within medicine, which may contribute to
Aboriginal Peoples being underserved by the medical field. It has been shown that increasing the number of underrepresented minorities within medicine can serve to ameliorate minority health disparities
4-6
. Doing so would also answer human rights concerns over equal access to training opportunities within the Canadian education sector.
These issues – Aboriginal representation in medicine and improved health status – fall under the auspices of social justice and social accountability, and the rationale to redress these inequities can be drawn from diverse sources. For instance, the WHO recognizes the social accountability of medical schools as: the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public.
7
4

Likewise the Canadian Charter of Rights and Freedoms , under section 15 on equality rights, indicates that:
15. (1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.
(2) Subsection (1) does not preclude any law, program or activity that has as its object the amelioration of conditions of disadvantaged individuals or groups including those that are disadvantaged because of race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.
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Within this framework, the Report of the Royal Commission on Aboriginal
Peoples
1
has recommended that Canada “train 10,000 Aboriginal professionals over a 10year period in health and social services, including medicine, nursing, mental health, psychology, social work, dentistry, nutrition, addictions, gerontology, public health, community development, planning, health administration, and other priority areas identified by Aboriginal people.” And the Final Report of the Commission on the Future of Health Care in Canada
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argues that “efforts to expand the number of Aboriginal health care providers through training and partnerships are essential,” and that “this requires a concerted effort to recruit health care providers from Aboriginal communities.”
Moreover the AFMC recently launched the “Social Accountability of Medical
Schools Initiative”, the recommendations of which are appended to this document
(Appendix I). Lastly, a June 2005 AFMC “Workshop on Admissions and Support of
Aboriginal Students in Medicine” was endorsed by all 17 Canadian medical schools.
Directing special programs towards developing Aboriginal physicians is fast becoming the status quo, a fact the University of Calgary must consider in light of its current
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Aboriginal admissions policy and the absence of a program specifically targeting
Aboriginal students.
CURRENT PROGRAMS AT CANADIAN NEDICAL SCHOOLS
Several Canadian medical schools have garnered reputations as leaders in Aboriginal medical education. These include the University of Manitoba, the University of Alberta and the University of British Columbia. This section will briefly review some of the philosophical underpinnings and pragmatic actions undertaken by these schools.
The University of Manitoba (U of M)
The U of M began its ACCESS Programs in 1975. These programs were formed on the principle of “equality of condition”, which means that access to the institution must be accompanied by the types of supports that are likely to give motivated, but under-resourced and poorly prepared students, a realistic opportunity to succeed.
10
There are three ACCESS Programs directed at developing health professionals: the Special Premedical Studies Program, the Nursing ACCESS Program, and the Professional Health
Program. These programs strive to increase student success through systematic recruitment, admissions, and retention strategies, which include a Summer Health
Science Program for junior high and high school students; Pre-Health Science Transition
Programs; a Bachelor of Health Science program; a one-month orientation program for first year students; academic advising; personal counseling; student loan advising; financial aid, especially in the form of ACCESS bursaries; and tutoring. Together these programs have graduated 152 students since 1979.
10
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In regard to admissions into the Faculty of Medicine, there is a “Special
Considerations Category” for Aboriginal applicants. Within this admissions stream, selection is based more on the outcome of the interview, and less on GPA and MCAT scores. Applicants deemed acceptable are offered admission. In recent years, this has translated into Special Consideration applicants accounting for about 5% of the incoming class. The costs of operating the ACCESS Program, which are bourn by both the
University and the provincial government, run over $1 million per year. The three programs specific to health careers cost about $400,000 annually.
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The University of Alberta (U of A)
The Office of the Aboriginal Health Care Careers Program was instituted by the
Faculty of Medicine and Dentistry in 1988, staffed by a coordinator to assist Aboriginal students to gain admission and graduate from the Faculty of Medicine and Dentistry, and the other Professional Health Sciences Faculties at the University of Alberta. This program was founded on the Equality Rights section of the Charter of Rights and
Freedoms ; it was created to ameliorate the disadvantaged status of Aboriginal students wanting to enter the health professions, and to improve the health status of Aboriginal
Canadians through the creation of more Aboriginal physicians.
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Within the MD program, a separate Aboriginal admissions stream makes up to three “over quota” positions available to Aboriginal students each year (the quota class size is 125). These positions cannot be filled by applicants from the general pool. If the seats are not filled by Aboriginal applicants in a current academic year, they are not carried over to the following academic year. All applicants must provide proof of
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Aboriginal ancestry and meet all of the prerequisites for admission outlined in the calendar, including a personal interview. At least one person on the interview team for
Aboriginal applicants is of Aboriginal ancestry. During the admissions process,
Aboriginal applicants are not assessed relative to the general pool, but rather, they compete amongst themselves for the three available positions. Based on the student’s individual merits, an Aboriginal Selections Committee makes recommendations for admission. Basic running costs for the Office of Aboriginal Health Careers Program are approximately $100,000 annually.
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The University of British Columbia (UBC)
The University of British Columbia’s Aboriginals into Medicine (ABMED) program was created after consultations with other UBC First Nations programs, faculty,
Aboriginal communities, and residents and physicians. The rationale behind the program is similar to that underlying the U of A’s program: there are startlingly few Aboriginal physicians, and Aboriginal physicians may provide medical care in their communities.
13
The program, which involves a separate stream for Aboriginal applicants, has been running since 2002. Thus far, 19 Aboriginal students have been accepted through this process. This program costs approximately $230,000/year.
14
To be considered for admission, self-declared Aboriginal applicants must provide satisfactory proof of ancestry; they must be Canadian citizens (though they are considered BC residents), have an overall GPA ≥70%, and have completed 90 university credits. They must also produce an additional essay that demonstrates their connection to the Aboriginal community, and undergo an additional interview with an Aboriginal
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interview panel. The MCAT is required, but there is no minimum score. Admissions decisions are made by an Aboriginal Admissions Sub-Committee that makes recommendations to the main selections committee. The program has set a target of 5% of the incoming class to be comprised of Aboriginal student seats. These seats cannot be folded into the general pool, but can be carried over for one academic year.
THE ABORIGINAL CAREERS IN MEDICINE POLICY
The Faculty of Medicine’s present policy regarding Aboriginal applicants was adopted over a decade ago. Currently, self-declared Aboriginal applicants are considered Alberta residents; if they meet the minimum admissions criteria, these applicants are granted an interview. That is, they are invited to an interview regardless of their competitiveness amongst the general applicant pool. Recent developments at the University of Calgary and other Canadian schools, however, suggest that a new policy is required. In 2005 the
Faculty of Medicine’s Executive Faculty Council endorsed a proposal for the development of a program targeting the recruitment and support of Aboriginal students
(Appendix II). Furthermore, the AFMC recently held a workshop on Aboriginal admissions, a summary of which is attached. (Appendix III). Lastly, in February 2003,
General Faculties Council approved a new policy pertaining to Aboriginal students. The issues it addresses that are especially pertinent to our purposes are as follows.
The University of Calgary acknowledges a collective responsibility to support and implement this policy. This policy is in accordance with the recommendations put forth in the Report of the Royal commission on Aboriginal Peoples (Minister of
Supply and Services Canada, 1996) ( sic ) as well as the First Nations, Métis, and Inuit
Education Policy Framework (Alberta Learning, February 2002)…Through this policy, the University of Calgary commits:
1.
To establish the administration of an Aboriginal Student Policy Standing
Committee.
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2.
To address equitable access and participation of Aboriginal people in all faculties, programs, and services associated with the University of Calgary.
3.
To continue to provide programs and initiatives that strive to increase the admission, retention and completion rates of qualified Aboriginal students registered at the University of Calgary.
4.
To increase the overall awareness of and sensitivity to Aboriginal students and cultures within the University of Calgary community.
5.
To continue to provide culturally appropriate support services, a service facility, and a gathering place for Aboriginal students and other community members.
6.
To continue to provide University activities that encourages personal, social, intellectual, and cultural interactions between Aboriginal people and the
University of Calgary community.
7.
To promote collaborative research and learning partnerships between the
University of Calgary, and the First Nations, Métis, and Inuit communities.
Appropriate efforts will be made to acknowledge Aboriginal cultures, values, languages, and ways of knowing.
8.
To promote the teaching of Aboriginal perspectives and content in courses and programs where appropriate.
9.
To develop and promote international indigenous relations.
The Aboriginal Student Policy Standing Committee will be responsible for the overall implementation, periodic review, and evaluation of the Aboriginal Student Policy.
Accordingly, we recommend that the Faculty of Medicine similarly adopt a policy that states the Faculty’s commitment:
1) To recruit and train Aboriginal medical students.
2) To recognize the need for heightened knowledge about Aboriginal cultures and health among all learners in the Faculty of Medicine through on-going curriculum development
3) To promote activities that increase cultural competence among faculty, staff and students, and ensure the cultural safety of Aboriginal people in the
Faculty.
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4) To encourage mutually rewarding relationships between the Faculty of
Medicine, other programs and services at the University of Calgary, and the local Aboriginal community (Treaty 7 area).
THE ABORIGINAL CAREERS IN MEDICINE PROGRAM
In this section we outline how the Faculty can address the education of Aboriginal physicians. Although we present a model for a program that addresses many aspects of physician training, for the purposes of this document we will only elaborate on those aspects pertinent to admissions. That said, we propose that the Faculty meet the objectives of such a policy through the creation of the “Aboriginal Careers in Medicine
Program” that concentrates on developing an applicant pool, recruiting students, facilitating the admissions process, and providing supports to students throughout their medical education. The program would require the involvement of Aboriginal people through either the creation of an “Aboriginal Admissions Committee”.
An Aboriginal Admissions Committee would ideally have 10 members, five of whom would be non-Aboriginals, including one medical student, two practicing physicians (a specialist and general practitioner), one community member, and an appropriate faculty representative. The Aboriginal members of the committee would include three Treaty 7 community members (at least one of whom has extensive experience in education), an Aboriginal student and an Aboriginal physician. The committee would strive for representation from the Treaty 7 reserves as well as the urban population. This committee would oversee all areas of concern regarding Aboriginal
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admissions, liaising with other faculty standing committees and the Aboriginal Careers in
Medicine Program.
The proposed program is loosely modeled after the American “Centers of
Excellence in Minority Education”.
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The Centers of Excellence is a designation granted to schools, along with special funding, if they meet specific standards in developing an applicant pool, matriculating graduates, faculty development and research. We propose the creation of two full time equivalent positions to direct and administer the Aboriginal
Careers in Medicine Program. The work would likely be distributed as follows:

A program Director would be nominated within the Faculty. This individual would liaise between the Faculty, the program and main campus (i.e. the
Aboriginal Student Centre), and budget for program expenses.

A full-time position would be created for a Student Recruitment and Support
Manager. This individual would be the frontline contact for students; serve as an ambassador for the program, visiting high schools, job fairs and so forth; run mentoring and peer-support programs; and be knowledgeable about how to access supports for students such as tutoring, counseling, and funding. The development of an applicant pool would be achieved, in part, through the creation of summer science camps, other programs designed to enhance candidacy, and collaborations with secondary and post-secondary programs
(such as Aboriginal high schools and undergraduate faculties within the
University of Calgary). This position may also involve securing monies from government and other sources to fund specific initiatives. Candidates would hold a minimum of a Bachelor’s or Master’s degree in a field relevant to
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health administration. Familiarity with the local aboriginal community is also necessary. Once again, preference would be given to qualified Aboriginal applicants.

Lastly, it is recommended that a full-time administrative assistant be hired to assist the Director and program Manager.
We suggest that such a program could be funded by the University and the provincial government. Other forms of support may include Health Canada and other national sources. Although by no means definitive, we propose the following budget for first year start-up and operating costs.
Budget
Salaries Program director 0.2 FTE
Student Recruitment Manager 1.0 FTE
Administrative Assistant 1.0 FTE
Computers (4), printer, fax, phones, stationary Office
Infrastructure
Travel
Expenses
Cultural
Events Aboriginal student and faculty retreat
Community speaker series
Aboriginal graduate convocation
Advertising Posters, web page, commercials
Student
Supports
Tutoring and counseling
Pre-admission program (20 students) Applicant
Pool
Development
Educational
Costs
Staff attending conferences
Student recruitment
Students attending conference
Elder consultant
Summer Science camp (20 students)
Monies for supporting the education of 5 Aboriginal medical students - $75, 000 x 5
Existing Salary
$ 60,000
$ 35,000
$ 10,000
$ 7,000
$ 10,000
$ 8,000
$ 10,000
$ 9,000
$ 2,000
$ 7,000
$ 50,000
$ 5,000
$ 5,000
$ 20,000
$375,000

Approximate first year cost – $613 ,000
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The estimated cost of this program is on par with programs at UBC, less than that spent at U of M and approximately double the budget for U of A. The budget outlined is needed in order to develop a program of excellence and is also based on the premise that this program would match the standards set out by the best Aboriginal health careers programs in the country.
THE ADMISSIONS PROCESS
Throughout the following we offer a series of recommendations which we propose be examined by the Faculty of Medicine in collaboration with the membership of the
Aboriginal Health Committee and any other Aboriginal persons or bodies identified to be necessary for consultation.
Aboriginal Ancestry
As is now the case on main campus, the application form for medical school should contain two questions pertaining to Aboriginal ancestry. The first asks the student if he or she wishes to self-declare as a member of the Aboriginal community (as Status or
Non-Status First Nations, Métis or Inuit). The second question asks whether the student would like this information to be taken into consideration in the application process.
Students that check “yes,” will be considered Aboriginal applicants. It would be irresponsible for any program targeting Aboriginal students to not require proof of ancestry. A laser copy of a Status or Métis treaty card would suffice. Other universities also accept letters of support from an Aboriginal organization on official letterhead. In
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addition, some schools have a process for students to appeal if their proof of ancestry is not found to be acceptable.
R ecommendations:
1) Establish acceptable forms of proof of ancestry;
2) Decide whether an appeal process will be put into place and what that process will entail.
Qualified Versus Competitive Applicants
In thinking about solutions to the chronic shortage of Aboriginal physicians, it is important to remember that medical schools have created a highly competitive admissions process that can discourage some students from ever considering a career in medicine. That is, the admissions process itself constitutes a barrier. The exclusivity of the admissions process is especially germane to the issue of Aboriginal applicants. Put simply, many would-be Aboriginal applicants are drawn from economically and socially disadvantaged backgrounds. This means that some Aboriginal people with the potential to be excellent physicians may not apply or may not be successful with their application, because their credentials differ from those held by other applicants. One solution to this problem is to differentiate between competitive and qualified applicants.
Whereas competitive applicants are those students who are ranked highly relatively to the application pool on the basis of academic and non-academic recommendations, qualified students are those who meet the minimum admissions criteria deemed necessary for future success in the medical program, though they may not rank competitively among the general applicant pool. Qualified applicants would be
15

assessed relative to these criteria, but may not necessarily have, for instance, a competitive GPA. A qualified applicant approach can take many forms. For instance, the University of Alberta’s admissions process uses a mixed qualified and competitive approach, in which qualified Aboriginal applicants compete amongst themselves. At present, it may be determined that it is so important for the University to increase the number of Aboriginal medical students, that it will offer admission to all qualified applicants.
Recommendations:
1) Adopt a separate applicant stream for qualified Aboriginal applicants;
2) Determine whether these applicants will compete amongst themselves for a set number of seats or whether all qualified applicants will be offered admission.
Special Admissions Committee
Schools such as UBC and U of A have Aboriginal admissions committees that review applications to the Aboriginal admissions stream and make recommendations to the main selections committee. At the University of Calgary, this job could fall to the
Aboriginal Health Committee. It could also require a separate committee be struck for selections purposes. Lastly, Aboriginal applications may be reviewed by the same selections committee as all other applications.
Recommendation:
1) Determine what type of committee will review Aboriginal student applications.
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Flexible Admissions Criteria
In order to successfully recruit Aboriginal applicants and increase the number of
Aboriginal students admitted into the program, the Faculty of Medicine needs to identify the criteria paramount in determining medical student success. It would be foolhardy, not to mention detrimental to the program and students, to admit those who are unlikely to succeed. Nevertheless, we must recognize that some current admissions criteria have been established not necessarily because they serve to predict future success in medical school or the profession of medicine, but simply to limit the applicant pool to a more manageable size. The MCAT, for instance, though once, in the face of widely divergent pre-medical programs, a necessary standard, may currently serve an overtly exclusionary purpose, and is regarded by some to be a racially-biased test.
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Some schools do not require that students take the MCAT. Likewise, it is necessary to recognize different forms of extra-curricular activities. Many Aboriginal applicants will not have had the same opportunities to partake in organized sport and formal volunteering when compared to their non-Aboriginal counterparts. Moreover, it may be helpful to consider the minimum GPA required for medical school success.
Recommendations:
1) Review current admissions criteria in order to identify fixed standards and areas in which flexibility is possible; and
2) Make explicit selections criteria known to potential applicants as well as those areas in which consideration may be granted to students who do not meet these criteria.
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Additional Admissions Criteria
Many Aboriginal admissions programs require Aboriginal applicants to meet additional admissions criteria such as an additional essay, letter of reference or interview.
These ancillary criteria may enable admissions committees to better assess an applicant’s non-academic merits, but can also constitute an additional barrier in applying to medical school.
Recommendation:
1) Determine whether additional admissions criteria are warranted and, if so, what these would be.
Preferential Interview Status
As previously discussed, the University currently offers preferential interview status to self-declared Aboriginal applicants. This interview would be maintained for all qualified Aboriginal applicants.
Recommendation:
1) Examine the current policy regarding preferential interview status.
The Interview Process
Aboriginal applicants may undergo an additional interview - as is the case at
UBC, or, mirroring U of A’s approach - in which an Aboriginal person from the community would be present on the interview panel. If the Faculty wants to assert it’s commitment to Aboriginal health, cultural competence and cultural safety, then perhaps all applicants to the medical school should be interviewed by a panel with Aboriginal representation. The interview day also provides a social opportunity. All Aboriginal
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students applying to the U of A are interviewed on the same day and served a meal after the interviews have been completed. This provides an opportunity for prospective students to get to know one another and develop peer-support networks.
Recommendation:
1) Decide upon the interviewing structure for Aboriginal students.
Admissions and Matriculation Targets
Reserved seats, affirmative action and quotas have an awkward history, and are generally associated with a specter of undue special treatment or unfair opportunity. We want to be clear that (1) this is not the objective of setting targets, and (2) programs specifically aimed at eradicating conditions of disadvantage are supported by the Charter of Rights and Freedoms . We propose that the Faculty set population-based targets as a means of demonstrating responsibility and accountability to the community it serves.
A crude population-based approach to reconciling the shortage of Aboriginal physicians would suggest that, if there are currently over 1 million Aboriginal Peoples in
Canada, and we should strive for one Aboriginal physician for every 500 people, then we would ideally hope to have 2000 practicing Aboriginal physicians. We could achieve this number in a decade if Canadian universities graduated 200 Aboriginal physicians each year. Granted, given the current state of affairs, this seems a highly unlikely occurrence.
Nonetheless, let us think about the number of physicians this estimate implies should matriculate from the two medical schools in Alberta. Let us suppose, rather reasonably, that the present number of Aboriginal physicians in Alberta is negligible. The Alberta population is around 3 million, approximately 5% of which are Aboriginal.
3
How many
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Aboriginal physicians, then, are needed in Alberta? Some quick math suggests that around 300 would be an appropriate number. Again, when thinking over a decade, that equates to approximately 15 graduates from each school, per year. We propose that we think of this as a “striving target”: an ideal.
Considering the myriad obstacles facing Aboriginal students, it may not be realistic to expect the University of Calgary to receive 15 applications from Aboriginal students per year, let alone have 15 qualified applicants. Accordingly, we propose an
“expectation target” of 5% of the medical class. Because Aboriginal students are considered Alberta residents, this means that we can expect 5% of 85 seats, or 4 positions, to be filled by Aboriginal students. These are not reserved seats and this is not a quota number. Rather, this target serves to provide a framework for thinking about how the University is addressing its obligation to the Aboriginal community. Meeting the expectation target could suggest the program is doing well; exceeding the expectation target might translate into better success; while achieving the striving target may indicate program excellence.
We recognize that the creation of targets can be an especially sensitive issue for many reasons, not the least of which is because it inevitably conjures the “slippery slope” argument. If Aboriginal students are granted this privilege, the argument goes, then who next will lay claim to a need for special considerations? In truth, we doubt any other group can offer the same compelling case for admissions targets – a case founded on a call to redress long-standing wrongs in relation to human rights and social justice.
Canada’s Aboriginal Peoples have endured political and institutional prejudice. In this prosperous and liberal country, Aboriginals experience sub-par health status and service
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delivery, and are dramatically underrepresented in the health professions.
1
And these problems point to the urgent need for unconventional solutions, such as admissions targets.
Recommendations:
1) Establish acceptable targets for admission;
2) Determine whether these constitute floor or ceiling targets (i.e. should be meet or cannot be exceeded);
3) Decide whether targets will be realized in the form of reserved seats and, if so, whether these seats can be carried over from one year to the next.
Building Partnerships
The preceding framework for an “Aboriginal Careers in Medicine Program” is predicated upon the importance of sustained relationships with various stakeholders.
Building partnerships with the Aboriginal community and other learning institutions is seen as integral to achieving our goals. Consultations have already begun with the
University of Calgary Native Centre, members of the Treaty 7 Band Council and the
Director of the Treaty 7 Health Organization. Further consultation is planned with local
Friendship Centre’s, the Public and Separate Board of Education, and Aboriginal organizations at SAIT, Mount Royal College, the University of Lethbridge and Medicine
Hat College. At present, numerous opportunities for partnership exist. For instance, the following, taken directly from the Treaty 7 webpage
17
, outlines community-based plans to increase the number of students choosing health careers.
Overview: “There is an ongoing concern regarding the lack of First Nation
Health professionals and trained health care workers at the local level and the national level as well and funds available under Health Careers are inadequate to effectively address this concern. Due to the lack of adequate
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funds, this creates a dilemma in achieving favourable results in capacity building that satisfies the communities. With this in mind Health Careers is expected to fulfill the problem of shortages in health care workers with a limited budget, thus the challenge arises in developing a Health Careers program that is both effective and at same time fulfilling all expectations.
Hence all projects are tailored to fit into available funds to achieve the fullest potential in working towards an effective program.”
The goals and objectives of the Health Careers program are to provide assistance towards developing a learning environment designed to overcome many barriers that currently inhibit the First Nation students educational achievements; to stimulate interest in health related careers by partnering with educational institutes in promoting Health Careers through an orientation process; to assist communities towards capacity building by preparing students in building foundations that foster a career in health and to provide support for students in health studies. The primary focus of the Health Careers program has been aimed at the youth, in particular the junior and senior high school level for this is where there is the greatest potential of future health care workers/professionals and the need to prepare these students into careers in the health field is equally as important while they are still in school.
Clearly, these objectives point to an untapped opportunity for the Faculty of Medicine to partner with Treaty 7. We cannot over emphasize our position that consultations with chiefs and elders should take place early in the “formalizing” phase of this program and be continued throughout the tenure of such a program.
To this end, the Aboriginal Health Standing Committee should be viewed as a valuable resource, providing entrée and advice for many forms of collaboration.
Making collaboration a key component from the get-go ensures a program that can continuously monitor how well it is addressing the obligations entailed by social accountability.
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EVALUATION PLAN
As a final recommendation, we contend that the program proposed must be sensitive to the changing needs of its stakeholders and the communities it serves (i.e. the Faculty,
Aboriginal communities, etc.). We feel that continuous evaluation is essential to the program’s success, most likely in the form of annual reports to relevant Treaty 7 bodies and the Executive Faculty Council. In addition, we recommend that a process be put in place to evaluate to effectiveness of the “Aboriginal Careers in Medicine Program”, in terms of recruitment and matriculation success, and feedback from students. This should take place within three years of the implementation date.
23

REFERENCES
1. Report of the Royal Commission on Aboriginal Peoples . (1996). (Indian and Northern
Affairs Canada). Retrieved February 15, 2005 from http://wwww.ainc-inac.gc.ca/ ch/rcap/sg/sgmm_e.html.
2. National Aboriginal Health Organization(NAHO)/ Organisation nationale de la santé autochtone (ONSA), Analysis of Aboriginal Health Careers Education and
Training Opportunities , January 2003.
3. The 2001 Canada Census. (Statistics Canada). Retrieved July 19, 2005 from http://www.statcan.ca.
4. Kington R., Tisnado D. Carlisle DM. (2001). Increasing racial and ethnic diversity among physicians: an intervention to address health disparities? In: Smedley BD,
Colburn L, Evans CH, eds.
The Right Thing to Do, the Smart Thing to Do:
Enhancing Diversity in the Health Professions , pp. 64-68 .
Washington, DC:
National Academy Press.
5. Cantor JC, Miles EL, Baker LC, Barker DC. (1996). Physician service to the uninsured: implications for affirmative action in medical education. Inquiry
33:167-180.
6. Komaromy M, Grumbach K, Drake M, et al. (1996). The role of black and Hispanic physicians in providing health care for underserved populations. The New
England Journal of Medicine 334:1305-1310.
7. World Health Organization, Department of Human Resources in Health, Defining and
Measuring the Social Accountability of Medical Schools , 1995.
8. The Canadian Charter of Rights and Freedoms , Enacted as Schedule B to the
Canada Act 1982 (U.K.) 1982. (Department of Justice Canada). Retrieved
May 04, 2005 from http://laws.justice.gc.ca/en/charter.
9. Romanow RG. Building on Values. The Future of Health Care in Canada. (2002).
(Health Canada). Retrieved March 3, 2005, from http://www.hc-sc.gc.ca/english/ pdf/romanow/pdfs/HCC_Final_Report.pdf.
10. Nunoda, P. “ACCESS Programs at the University of Manitoba”. Presentation given at the AFMC Workshop on Admissions and Support of Aboriginal Students in
Medicine , June 13, 2005.
11. Personal communication, Dr. Peter Nunoda, Director, Access Programs, University of
Manitoba.
24

12. Personal communication, Ms. Anne-Marie Hodes, Program Director, Aboriginal
Health Careers Program, University of Alberta.
13. Andrew J. (Fall 2003). Admissions and Selections for Aboriginal Students into UBC’s
Faculty of Medicine.
14. Personal Communication, Mr. James Andrew, Aboriginal Programs Coordinator,
University of British Columbia.
15. Centers of Excellence. (U.S. Department of Health and Human Resources). Retrieved
March 14, 2005 from http://bhpr.hrsa.gov/diversity/coe/default.htm
16. Waldman B. (1977). Economic and racial disadvantage as reflected in traditional medical school selection factors. Journal of Medical Education 52(12):961-70.
17. Health Careers, Treaty 7 Management Corp. (Treat 7 Management Corp.) Retrieved
June 24, 2005 from http://www.treaty7.org/Article.Asp?ArticleID=10.
25

APPENDIX I
A SSOCIATION OF F ACULTIES OF M EDICINE OF C ANADA
S OCIAL A CCOUNTABILITY OF M EDICAL S CHOOLS I NITIATIVE
Aboriginal Health Task Group
Recommendations to the Council of Deans
Concerning Social Accountability and Aboriginal Health
May 1, 2005
I.
B ACKGROUND
The World Health Organization has defined the social accountability of medical schools as the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public.
1
Over the past five years, the Association of Faculties of Medicine of Canada (AFMC) has demonstrated its commitment to social accountability by: 1) collaborating on the development of a vision paper, Social Accountability: A Vision for Canadian Medical Schools ; 2) forming a working group on social accountability; 3) hosting a Partner’s Forum; and 4) establishing a
Steering Committee and three task groups – an Aboriginal Health Task Group, a Public Health
Task Group and a Young Leaders Vision 2025 Group. AFMC remains committed to supporting the efforts of Canadian faculties of health sciences and medicine to respond to community needs and priorities.
2
II.
A BORIGINAL H EALTH T ASK G ROUP P URPOSE AND O BJECTIVES
The Aboriginal Health Task Group was formed in December 2004 (Appendix A contains a list of members). The Task Group met in person on January 30 to February 1 and has held seven teleconferences to date. The purpose of the Aboriginal Health Task Group was to provide recommendations to the deans of medicine that address the health needs of
Aboriginal people. Identified core areas of action were education, research,
Aboriginal professional training and community service.
1 World Health Organization, Department of Human Resources in Health, Defining and Measuring the
Social Accountability of Medical Schools, 1995.
2 For more information on the AFMC Social Accountability Initiative, visit www.afmc.ca
.
26

The objectives of the Task Group were to:
 explore and define the health needs of Aboriginal people that must be addressed within the realm and scope of medical schools;
 explore and define methods, resources and strategies to increase the number of Aboriginal medical students, residents and physicians, and enhance the cultural competence of non-
Aboriginal and Aboriginal medical graduates, to address these health needs;
 develop and prioritize a framework for recommendations;
 determine where, within the AFMC, ongoing Aboriginal health initiatives should be situated; and
 identify and provide input to the development of potential national collaborative projects.
III.
O VERARCHING P RINCIPLES AND V ALUES IN A DDRESSING A BORIGINAL H EALTH
The Aboriginal Health Task Group agreed on the following principles or values that should guide all activities to better address Aboriginal health in medical education.
 Academic institutions need to be flexible, culturally-responsive and innovative in their approaches to recruiting and then retaining their Aboriginal student body.

Indigenous processes can be used in a consultative and integrated fashion with current western processes to effect change, with recognition of the value of each.

Elders should be involved at each step of the development of an Aboriginal program.

Medical schools need to take direction from and form ongoing relationships with local
Aboriginal communities.
 Educational institutions should value First Nations, Inuit and Métis traditional and contemporary knowledge, and develop means of integrating this knowledge into medical education, as one way to foster mutual respect.

Medical schools need to understand the impact of western assumptions about Aboriginal health for patients, communities, medical students and faculty.

Efforts to maintain a high standard of medical education related to Aboriginal health need to be sustainable within the current resource base of the program, and not be dependent on project-based funding.
IV.
G ENERAL R ECOMMENDATIONS
Recommendation 1: In order to better address the needs of Aboriginal communities, faculties of health sciences and medicine should: a.
establish an Aboriginal Advisory Committee composed of representatives of local First
Nations, Métis and Inuit communities, and Aboriginal leaders in education, health and community and economic development, who will provide ongoing consultation for the development, implementation and evaluation of culturally appropriate curriculum content and admissions policies; b.
create an Aboriginal program office with administrative and financial support to: advise and support Aboriginal students; coordinate the development of admissions policies and programs; and develop, implement and evaluate curriculum related to Aboriginal issues; c.
actively recruit and promote Aboriginal faculty members; and d.
support Aboriginal faculty development by providing: 1) access to mentors; 2) capacity building related to research, admissions and curriculum development; 3) a culturally safe
27

environment; and 4) the time and resources to network with other professional schools and Aboriginal colleagues at the national and international level.
V.
A
DMISSIONS AND
S
TUDENT
S
UPPORT
R
ECOMMENDATIONS
Recommendation 2: Drawing on the knowledge and resources available through AFMC, medical schools should develop and implement each of the following to increase the number of
Aboriginal medical graduates, and report their models and approaches to AFMC for sharing with others: a.
a strategy and policies to increase enrollment of Aboriginal medical students, including outreach to Aboriginal students at early stages of education (junior high, high school and undergraduate university); b.
an Aboriginal student selection sub-committee; c.
a strategy and policy on Aboriginal community partnerships; d.
programs to provide support and encouragement to Aboriginal students; e.
ways to explore and address institutional bias/barriers to Aboriginal admissions; and f.
linkages to other institutions and Aboriginal organizations in order to understand and address barriers to post-secondary education, especially programs leading to health careers, among Aboriginal people.
Recommendation 3: AFMC should host a national forum to share strategies to increase
Aboriginal enrollment in medical schools
VI.
C URRICULUM D EVELOPMENT R ECOMMENDATIONS
Recommendation 4: Medical schools should undertake each of the following initiatives to enhance the cultural competence of non-Aboriginal and Aboriginal physicians in addressing
Aboriginal health needs, and report their models and approaches to AFMC for sharing with others: a.
make a commitment to increase content of undergraduate curriculum related to
Aboriginal health; b.
strive for Aboriginal health curricula that respects principles of cultural competence and particularly emphasizes skill-based and attitudinal themes; c.
develop, implement and evaluate core and elective curriculum that has both discrete and integrated elements and is apparent within course and clinical teaching; d.
recognize that Aboriginal health is a specialist area and requires experts such as
Aboriginal faculty, local Aboriginal community members and national Aboriginal resources to develop and teach culturally appropriate Aboriginal curriculum content and context; and e.
utilize appropriate teaching methods such as experiential and interactive methods to facilitate cultural competence.
Recommendation 5: Until additional Canadian resources are developed, medical schools should utilize the following documents as resources in the development of
Aboriginal health curriculum:
28

a.
A Guide for Health Care Professionals Working with Aboriginal Peoples , Society of
Obstetricians and Gynaecologists of Canada, 2001; b.
Indigenous Health Curriculum Framework, Committee of Deans of Australian Medical
Schools, 2004 (with the caution that the document is not reflective of the Canadian context); and c.
A Strategic Framework to Increase the Participation of First Nations, Inuit and Métis
Peoples in Health Careers, National Aboriginal Health Organization, (January 21, 2005 draft).
Recommendation 6: AFMC should support the development of a multi-stakeholder National
Aboriginal Health Curriculum Framework to act as a guiding document for Aboriginal health curriculum in each medical school.
Recommendation 7: AFMC should further explore the use of accreditation standards and learning objectives in influencing curriculum.
VII.
L
ONGER
-T
ERM
R
ECOMMENDATIONS
Recommendation 8: AFMC should develop an ongoing Aboriginal Health Committee to advise on and oversee activities related to Aboriginal health and medical education at the national level, including but not limited to: a.
longer-term efforts to increase Aboriginal admissions and student support; b.
longer-term efforts to create a national Aboriginal Health Curriculum Framework (see
Appendix B for more information); c.
implementation of a process to evaluate progress in admissions and curriculum initiatives; d.
support for a network of Aboriginal program staff; e.
development of resources for faculty development; and f.
exploration of a “centres of excellence” approach to better integrate these strategies.
29

A
PPENDIX
A – A
BORIGINAL
H
EALTH
T
ASK
G
ROUP
M
EMBERS
Dr. Linden (Lindsay) Crowshoe, Co-chair
Primary Care Research & Development Group
Department of Family Medicine - University of Calgary
1635, 1632 - 14 th Avenue NW
Calgary AB T2N 1M7
Tel.: 403) 210-9223
E-mail: crowshoe@ucalgary.ca
Dr. Evan Adams
Chief Resident, Aboriginal Family Practice
St. Paul’s Hospital, UBC
#1-3859 West 2 nd Avenue
Vancouver BC V6R 1K1
Tel.: ( 604) 633-9776
E-mail: eladams@interchange.ubc.ca
Dr. Francis Chan
Associate Dean, Admissions & Student Affairs
Faculty of Medicine & Dentistry
University of Western Ontario
Medical Science Bldg. – Room 417
London ON N6A 5C1
Tel.: 519) 661-2111 Ext.: 86803
E-mail: francis.chan@fmd.uwo.ca
Ms. Bernice Downey
Executive Officer
National Aboriginal Health Organization
56 Sparks Street – Suite 400
Ottawa ON K1P 5A9
Tel.: 613) 237-9462 Ext.: 507
E-mail: bdowney@naho.ca
Alternate: Roberta Stout; E-mail: rstout@naho.ca
Dr. Marcia Anderson, Co-chair
PGY3, Department of Internal Medicine
University of Saskatchewan
925 Avenue C North
Saskatoon SK S7L 1J9
Tel.: 306) 343-6146
E-mail: marciaanderson@sasktel.net
Mr. James Andrew
Aboriginal Programs Coordinator
Faculty of Medicine
University of British Columbia
Room 317, 2194 Health Sciences Mall
Vancouver BC V6T 1Z3
Tel : (604) 822-3236
E-mail: james.andrew@ubc.ca
Dr. Lorne Clearsky
Assistant Professor/Medical Officer of Health
Univ. of Manitoba/Nor-Man Reg. Hlth Authority
Dept. Of Community Hlth Scs - Faculty of Medicine
S112B-750 Bannatyne Avenue
Winnipeg MB R2E 0W2
Tel.: (204) 789-3387
E-mail: clearsky@cc.umanitoba.ca
Dr. Dan Hunt
Campus Dean West
Vice Dean UGME
Northern Ontario School of Medicine
955 Oliver Road
Thunder Bay ON P7B 5E1
Tel.: (807) 766-7300
E-mail: dan.hunt@normed.ca
Dr. Malcolm King
Aboriginal Health Care Careers Committee
University of Alberta
Faculty of Medicine & Dentistry
173 HMRC
Edmonton AB T6G 2S2
Tel.: 780) 492-6703
E-mail: malcolm.king@ualberta.ca
Dr. Alan Neville
Assistant Dean, MD Program
Faculty of Health Sciences – HSC – 1E18
McMaster University
1200 Main Street West
Hamilton ON L8N 3Z5
Tel.: 905) 525-9140 Ext.: 22141
E-mail: neville@mcmaster.ca
Dr. Barry Lavallee
Aboriginal Health and Wellness Centre
Suite 215, 181 Higgins Avenue
Winnipeg MN R3B 3G1
Tel.: (204) 925-3700
E-mail: bdalaval@excite.com
Dr. Stanley Vollant
1237 de la pulpe
Chicoutimi QC
G7J 4X8
Tel.: (418) 543-4590
E-mail: stanvol@videotron.ca
30

A PPENDIX B
–
C URRENT AFMC A CTIVITIES R ELATED TO A BORIGINAL H EALTH
National Aboriginal Health Curriculum Framework
As a result of the January 2005 AFMC Aboriginal Health Task Group meeting in
Vancouver, a sub-committee was created to develop a strategic plan for the creation of a national Aboriginal health curriculum framework. The curriculum framework will assist medical schools in creating curriculum that is culturally competent; reflective of the diverse history, experiences and knowledge of Inuit, Métis and First Nations Peoples; and relevant to Aboriginal community health needs. Currently, there is no framework or standard for developing Aboriginal health curricula in Canada.
The development of a national framework for Indigenous curricula in Australia serves as an example for Canada. The Australian project was a joint venture between the
Committee of Deans of Australian Medical Schools (CDAMS), the Office of Aboriginal and Torres Strait Islander Health, and the University of Melbourne’s VicHealth Koori
Health Research and Community Development Unit. In 2004, an Indigenous Health
Curriculum Framework was adopted by the Australian Medical Council for use in its accreditation process.
The curriculum framework sub-committee will hold a stakeholders planning meeting on
June 11-12, 2005 to ensure the AFMC framework development process reflects Canadian
Aboriginal peoples and engages key stakeholders, including Aboriginal physicians, medical educators and students, and medical school faculty. It is expected that the framework will then be developed and refined over a 12 month period.
National Forum on Aboriginal Admissions and Student Support
Also as a result of the Vancouver meeting, AFMC is organizing a workshop to address, at the level of Faculties of Medicine, health human resource issues affecting Aboriginal communities. An admissions and student support sub-committee has been formed to oversee development of the three day workshop being held June 12-14 in Vancouver.
The goal of this workshop is to bring together key individuals to discuss admissions strategies and support for Aboriginal students in medical schools in Canada. Objectives for the workshop are to:
 provide information on Canadian programs and policies to increase the number of Aboriginal medical students;
 discuss issues and strategies related to pre-admissions programs, the admissions process and student support for Aboriginal students; and
 provide opportunities for networking and information exchange among medical schools.
Approximately 60 people will attend the workshop, including three representatives of each of the medical schools, as well as Aboriginal physicians, medical educators and medical students.
31

APPENDIX II
A PROPOSAL FOR THE DEVELOPMENT OF A SPECIAL PROGRAM AIMED AT
RECRUITING ABORIGINAL STUDENTS INTO THE MD PROGRAM AT THE
UNIVERSITY OF CALGARY
In 2001, The Task Force on Admissions was established after the joint Liaison Committee on
Medical Education/Committee on Accreditation of Canadian Medical Schools (LCME/CACMS) accreditation visit suggested that a review of the admissions process was in order. The Task
Force on Admissions made a recommendation that a program be established “to assist Aboriginal applicants”. They also stated “…. a provincial network could be established in connection with the successful Aboriginal Program in Edmonton. In addition, the potential of obtaining dedicated positions province wide for this program should be advocated.”
The Admissions Committee first discussed the complete Task Force report at its June 2002 meeting. At its December meeting, it was decided to put together a group of interested individuals to begin to address the specific recommendation relating to Aboriginal recruitment.
In addition, the LCME/CACMS, in a letter received early in December 2002, requested follow-up from the Faculty of Medicine (by September 2004) on a number of issues, one of which related to the recruitment and retention of students of Aboriginal heritage.
An ad hoc committee consisting of Allan Jones, Lindsay Crowshoe, Bruce Wright, Terry Myles,
Adele Meyers and Keith Brownell met in March 2003 to discuss how to proceed to meet the Task
Force’s recommendation. The group decided to develop a formal proposal and then take it forward to the various leadership groups in the Faculty to determine if there was support to establish the program. Currently the committee has four additional members: Lanette Prediger,
(Year III student), Eric Payne (Year II student), Donald Wilson (resident in Obstetrics &
Gynecology) and Julia Bickford (a research associate working with Lindsay Crowshoe). JF
Lemay (the Director of Admissions and Student Affairs) has replaced Bruce Wright (the former
Director of Admissions and Student Affairs).
Objective of This Document
To obtain Faculty support for the concept of an Aboriginal Recruitment Program and for the necessary financial support to develop a detailed model for such a program, including a budget.
At that point, the Faculty would then have a second opportunity to review the proposed program and decide if there was going to be a long term commitment to the program.
32

There is no doubt that there is a need for more Aboriginal physicians in Canada. This need has been documented most recently in the Royal Commission on Aboriginal Peoples 3 and in the
Romanow Commission Report 4 .
As of 2001, there were approximately 1 million Aboriginal people in Canada (out of a total population of approximately 30 million). For Alberta the corresponding numbers are 156,000 and 2.94 million.
At a 2001 Symposium in British Columbia 5 , Dr. Jay Wortman, Regional Director of the First
Nations & Inuit Health Branch, Health Canada, spoke about capacity building within First
Nations communities and the inequities between the numbers of non-Aboriginal and Aboriginal health care professionals. He posed the following question: “If the number of Aboriginal people is 3% of the general population of Canada, then how many Aboriginal doctors should there be if we have approximately 50,000 doctors?” His answer was 1,500. He then went on to state that it was estimated that there were approximately 100 Aboriginal doctors practicing in Canada.
In 2003 6 , there were approximately 5,300 physicians in Alberta. Using the 3% figure quoted above would mean that we could expect to have 159 physicians of Aboriginal origin. Current data 7 indicates that approximately 5% of the Alberta population is Aboriginal. Using this figure, then we would expect to have at least 250 physicians of Aboriginal heritage within the physician work force in the province. With the total number of Aboriginal physicians for the whole of
Canada estimated to be about 100, the order of magnitude of the Alberta deficit is huge and one that will not be corrected without some dramatic action.
As a result of a new method of collecting data at the time of admission, that provided the opportunity for students to self-identify as Aboriginal, which was instituted in 1995, we know that since 1995 the University of Calgary has graduated 11 self-identified Aboriginal medical doctors. At the University of Alberta, which has had a special Aboriginal Program which first graduated MDs from the program in 1992, it has since graduated a total of 33 Aboriginal medical doctors.
Current Programs in Canada
In western Canada, there are special programs for recruitment of Aboriginal students into the
Faculties of Medicine at all medical schools except for the University of Calgary. The new
Northern Ontario Medical School has a major focus on admitting students of Aboriginal origin.
McMaster University is also intensifying its efforts in relation to recruitment of Aboriginal students. Other Faculties of Medicine in Canada have considerable interest in developing such programs.
8 As the current number of Aboriginal students who will be applying for admission to
3 Report on the Royal Commission on Aboriginal Peoples. 1996. http://www.aincinac.gc.ca/ch/rcap/sg/sgmm_e.html
4 Romanow RG. Building on Values. The Future of Health Care in Canada. 2002. http://www.hcsc.gc.ca/english/pdf/romanow/pdfs/HCC_Final_Report.pdf
5 http://www.health-sciences.ubc.ca/iah/consortium/B.html
6 http://www.cpsa.ab.ca/physicianregistration/physician_statistics.asp
7 http://www.ainc-inac.gc.ca/pr/sts/rip/rip_e.pdf
8 As expressed by Faculty representatives at the CMAE Special Interest Group on Aboriginal Health at the
2003 ACMC Meeting.
33

medical schools is limited, there is going to be intense competition from the Faculties of
Medicine to recruit these students.
A brief description and/or recruitment targets for each of the western Canadian programs follows.
University of Manitoba
There is a Special Premedical Studies Program which is part of the University of Manitoba
Access Programs which is only open to Aboriginal residents of Manitoba who have a strong interest in training as a doctor, dentist, pharmacist or physical/occupational therapist. This is a 4-year program.
In terms of admission to the Faculty of Medicine, there is a Special Consideration Category which includes applicants from Native populations of Manitoba or the Access Program. The admission criteria are somewhat different in that selection is less dependent on GPA and
MCAT scores and more dependent on the interview score. Also, at the time of the interview, all parts of the academic record are available to the interviewers. In the regular admission stream, the interviewers do not have access to the candidates GPA and MCAT scores. All candidates in the Special Consideration Category who are judged to be acceptable for admission are admitted. The number of candidates admitted by this route can vary from year to year but during recent years has been about 5% of the total number of students admitted yearly (85).
University of Saskatchewan
Their program is called the Aboriginal Equity Access Program and it is for
Saskatchewan residents only. In this program, three first year spaces are reserved for persons of Canadian Aboriginal descent. Applicants are required to meet the same requirements as outlined for other Saskatchewan residents. Applicants of
Aboriginal descent compete within this category, not against the entire applicant pool.
Applicants need to identify themselves on the application for admission.
University of Alberta
Their program is called the Aboriginal Health Care Careers Program. Up to 2 positions per year are available for Aboriginal students in the MD Program. These positions cannot be filled by applicants from the general pool. If they are not filled by Aboriginal applicants in a current academic year, they are carried over to the following academic year. All applicants must provide proof of Aboriginal ancestry. Residency requirements are waived for all
Aboriginal applicants to the University of Alberta. Preference for positions set aside for
Aboriginal students may be given to residents of Alberta.
All applicants must meet all the prerequisites for admission outlined in the calendar including a personal interview. At least one person on the interview team for
Aboriginal applicants must be of Aboriginal ancestry.
University of British Columbia
The Faculty of Medicine Aboriginal admissions process has a target of 5% of the annual complement of funded seats in the first year MD Undergraduate Program. In 2004, 200 students were admitted and it is proposed that this number will increase to 256 by 2010. This means that a minimum of 10 entry positions will be available each year for Aboriginal
34

applicants. All Aboriginal applicants are contacted directly by the Aboriginal Program
Coordinator and their application is reviewed by a separate Aboriginal Admissions
Subcommittee. Interviews are conducted by a special Aboriginal interviewing Panel.
In February 2003, General Faculties Council approved a new policy relating to Aboriginal students 9 . The statements (taken directly from the policy) that seem particularly relevant for our consideration are as follows.
 “The University of Calgary acknowledges a collective responsibility to support and implement this policy.

This policy is in accordance with the recommendations put forth in the Report of the Royal Commission on
Aboriginal Peoples (Minister of Supply and Services Canada, 1996) as well as the First Nations, Metis, and Inuit
Education Policy Framework, (Alberta Learning, February 2002). Collectively, these documents call for policies, programs, and services that address equitable access, recruitment, retention, and completion rates for Aboriginal people in the post-secondary education system.

To ensure the provision of a University learning environment that: 1) encourages full access, participation and success for Aboriginal students, and 2) enriches all aspects of the intellectual and cultural life of the University of
Calgary through full participation of Aboriginal students.

Through this policy, the University of Calgary commits:
1.
To establish the administration of an Aboriginal Student Policy Standing Committee.
2.
To address equitable access and participation of Aboriginal people in all faculties, programs, and services associated with the University of Calgary.
3.
To continue to provide programs and initiatives that strive to increase the admission, retention, and completion rates of qualified Aboriginal students registered at the University of Calgary.
4.
To increase the overall awareness of and sensitivity to the diversity of Aboriginal students and cultures within the University of Calgary community.
5.
To continue to provide culturally appropriate support services, a service facility, and a gathering place for
Aboriginal students and other community members.
6.
To continue to provide University activities that encourages personal, social, intellectual, and cultural interactions between Aboriginal people and the University of Calgary community.
7.
To promote collaborative research and learning partnerships between the University of Calgary, and the First
Nations, Métis, and Inuit communities. Appropriate efforts will be made to acknowledge Aboriginal cultures, values, languages, and ways of knowing.
8.
To promote the teaching of Aboriginal perspectives and content in courses and programs where appropriate.
9.
To develop and promote international indigenous relations.

The Aboriginal Student Policy Standing Committee will be responsible for the overall implementation, periodic review, and evaluation of the Aboriginal Student Policy. “
In light of the recent acceptance of an Aboriginal Student Policy for the University of Calgary, it seems particularly timely that we would be developing a special program for recruitment of
Aboriginal students into the Faculty of Medicine’s MD program. The overall objective of the program will be to attract the best Aboriginal students from the undergraduate programs (such as the ones referred to in the Aboriginal Student Policy) to apply for entry into the Faculty of
Medicine MD program. The wider objectives of getting high school students interested in obtaining higher education and pursuing health care related careers (including becoming medical doctors), are considered to be essential to increasing the pool of future Aboriginal applicants.
This will be explored in further discussions with local Aboriginal communities, and remains a
9 http://www.ainc-inac.gc.ca/pr/sts/rip/rip_e.pdf
35

possibility for a future initiative in collaboration with the Aboriginal community and the
University at large as per the initiatives outlined in the February 2002 Alberta Learning document titled First Nations, Métis, and Inuit Education Policy Framework 10 .
The specific objective for this program will be to graduate 50 Aboriginal physicians from the
Faculty of Medicine in the decade from 2007 to 2017. While this may seem to be an impossible objective to some, to others it would appear realistic. This will not be easy but unless each
Faculty of Medicine in Canada takes on some responsibility for increasing the number of
Aboriginal physicians in Canada, the problem will never be solved.
The proposed administrative structure for the program is diagrammed in the Appendix. It is also proposed that a new Faculty Standing Committee named the Aboriginal Health Committee be developed to provide policy direction for the program as well as a means of having the program report to Faculty.
Once Faculty support has been obtained for this objective, then an individual will need to be recruited (we suggest that Dr Lindsay Crowshoe be that person) to develop and bring forth, to the
Faculty, a detailed proposal, including a budget, outlining how this objective is to be met. This person will need to liaise closely with the Aboriginal Student Policy Standing Committee as well as various Aboriginal groups. In addition, liaison with the leaders of the Aboriginal programs at other Faculties of Medicine will be essential. It is anticipated that it will take up to a year to develop such a program.
In developing the program, many different areas will need to be addressed. Some of these follow.

How to get input from the Aboriginal community – including both status and non-status people?

How to recruit for the program?

How to fund? There will be a need to get government support.

Opportunities to partner with the Faculty of Medicine at the University of Alberta (initial steps have already begun in this direction) and other western Canadian Faculties of
Medicine.

How to advertise the program to high school and university students. This should include highlighting the profile of our Faculty of Medicine in Aboriginal Student Centers at the
University of Calgary, SAIT, Mount Royal, University of Lethbridge, Medicine Hat
College etc.

The different approaches to admissions for Aboriginal students that could be taken. For example, will this be a special program with a special admissions committee
P:\ADMISSIONS COMMITTEE\ABORIGINAL\2005\Aboriginal Program Proposal for EFC – February 9, 2005
10 http://www.learning.gov.ab.ca/nativeed/nativepolicy/pdfs/Framework.pdf
36

APPENDIX
PROPOSED REPORTING AND MANAGEMENT STRUCTURES FOR ABORIGINAL HEALTH PROGRAM
PSAC
Admissions
SSAC
Faculty Standing Committees
Aboriginal Health
Committee (New)
Curriculum
Recruitment Retention
Manager 0.5 FTE
Admin Assistant
Aboriginal Health Program Director
Dr. Lindsay Crowshoe (proposed)
Curriculum on
Aboriginal Health
Manager 0.5 FTE
Admin Assistant
Director Admissions and Student Affairs
Associate Dean UGME
37

APPENDIX III
Jocelyn’s summary of AFMC
38

APPENDIX IV
University of Calgary General Faculties Council Aboriginal Student Policy
I – PREAMBLE
The University of Calgary acknowledges a collective responsibility to support and implement this policy.
1.1 Rationale
This policy is in accordance with the recommendations put forth in the Report of the Royal
Commission on Aboriginal Peoples (Minister of Supply and Services Canada, 1996) as well as the First Nations, Metis, and Inuit Education Policy Framework, (Alberta Learning, February
2002). Collectively, these documents call for policies, programs, and services that address equitable access, recruitment, retention, and completion rates for Aboriginal people in the postsecondary education system.
1.2 Definition of an Aboriginal Person
The following definition of an Aboriginal person has been adopted for the purposes of the
University of Calgary Aboriginal Student Policy:
An Aboriginal Person in Canada is a member of an Indian/First Nation,
Metis, or Inuit community. Indian/First Nation includes "Status",
"Treaty", or "Registered" Indians as well as "Non-Status", and "Non-
Treaty" Indians. An individual who is not included in this definition but who wishes to self-declare should present documentation and/or evidence of community recognition to the Aboriginal Student Policy
Standing Committee of the University of Calgary.
II – MANDATE
To ensure the provision of a University learning environment that: 1) encourages full access, participation and success for Aboriginal students, and 2) enriches all aspects of the intellectual and cultural life of the University of Calgary through full participation of Aboriginal students.
III – Principal Objectives
Through this policy, the University of Calgary commits:
1.
To establish the administration of an Aboriginal Student Policy Standing Committee.
2.
To address equitable access and participation of Aboriginal people in all faculties, programs, and services associated with the University of Calgary.
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3.
To continue to provide programs and initiatives that strive to increase the admission, retention, and completion rates of qualified Aboriginal students registered at the
University of Calgary.
4.
To increase the overall awareness of and sensitivity to the diversity of Aboriginal students and cultures within the University of Calgary community.
5.
To continue to provide culturally appropriate support services, a service facility, and a gathering place for Aboriginal students and other community members.
6.
To continue to provide University activities that encourage personal, social, intellectual, and cultural interactions between Aboriginal people and the University of Calgary community.
7.
To promote collaborative research and learning partnerships between the University of
Calgary, and the First Nations, Metis, and Inuit communities. Appropriate efforts will be made to acknowledge Aboriginal cultures, values, languages, and ways of knowing.
8.
To promote the teaching of Aboriginal perspectives and content in courses and programs where appropriate.
9.
To develop and promote international indigenous relations.
IV – ABORIGINAL POLICY STANDING COMMITTEE
4.1 Mandate of the Aboriginal Student Policy Standing Committee
The Aboriginal Student Policy Standing Committee will be responsible for the overall implementation, periodic review, and evaluation of the Aboriginal Student Policy.
4.2 Committee Structure
The Associate Vice President of Student and Academic Services shall chair the Aboriginal
Student Policy Standing Committee. The Committee shall be comprised of the following members:
 the Director of The Native Centre
 the Director of the Arctic Institute or designate

 the Director of Enrollment Services or designate two undergraduate Aboriginal student representatives of the First Nation Student
Association
 one undergraduate Aboriginal student registered in a University of Calgary off campus programs
 two Aboriginal students in Graduate Studies: one Master’s student, and one Ph. D. student
 one Aboriginal community representative
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 one Aboriginal alumni member
 one Aboriginal cultural resource person
 four representatives as appointed by Dean’s Council
4.3 Responsibilities of the Aboriginal Student Policy Standing Committee
The responsibilities of the Aboriginal Student Policy Standing Committee shall include, but are not limited to, the following:
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