{"id":333,"date":"2019-10-11T10:38:46","date_gmt":"2019-10-11T02:38:46","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=333"},"modified":"2022-03-08T14:52:50","modified_gmt":"2022-03-08T06:52:50","slug":"characterisations-of-maori-in-health-professional-education-programmes","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/","title":{"rendered":"Characterisations of M\u0101ori in health professional education programmes"},"content":{"rendered":"<p style=\"text-align: justify\">Published online: 3 September, TAPS 2019, 4(3), 91-98<br \/>\r\nDOI:\u00a0<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2019-4-3\/OA2091\">https:\/\/doi.org\/10.29060\/TAPS.2019-4-3\/OA2091<\/a><\/p>\r\n<p style=\"text-align: justify\">Caitlin Harrison<sup>1<\/sup>, Rhys Jones<sup>2\u00a0<\/sup>&amp; Marcus A. Henning<sup>3<\/sup><\/p>\r\n<p style=\"text-align: justify\"><em><sup>1<\/sup><\/em><em>The University of Auckland, Aotearoa, New Zealand;\u00a0<\/em><em><sup>2<\/sup><\/em><em>Te Kupenga Hauora M\u0101ori, The University of Auckland, Aotearoa, New Zealand;<span>\u00a0<\/span><sup>3<\/sup>Centre for Medical and Health Sciences Education, The University of Auckland, Aotearoa, New Zealand<\/em><\/p>\r\n<p style=\"text-align: center\"><strong>Abstract<\/strong><\/p>\r\n<div class=\"page\" title=\"Page 1\" style=\"text-align: justify\">\r\n<div class=\"layoutArea\">\r\n<div class=\"column\">\r\n<p>Formal Indigenous health curricula often exist in institutional contexts that tacitly condone racist discourses that are at odds with the goal of developing culturally safe health professionals. Recognition of the impact of informal and hidden curricula on learners has increased, yet few studies have provided empirical evidence about this aspect of health professional education. This study sought to examine characterisations of M\u0101ori (Indigenous New Zealanders) in learning environments at the University of Auckland\u2019s Faculty of Medical and Health Sciences. A cross-sectional study design based on the Stereotype Content Model elicited student perceptions (<em>n<span>\u00a0<\/span><\/em>= 444) of stereotype content in undergraduate nursing, pharmacy and medical programmes. The Stereotype Content Model identifies interpersonal and intergroup perceptions in relation to warmth and competence. These perceptions are considered fundamental and universal to the impressions people form when meeting one another. Stereotyping is associated with distinct affective and behavioural responses that can lead to discrimination. In this study, students rated perceived warmth and competence characterisations pertaining to four target ethnic groups (M\u0101ori, Pacific Nations, Asian and P\u0101keh\u0101\/European). Characterisations of M\u0101ori warmth were rated lower than Pacific Nations peoples, comparable to P\u0101keh\u0101\/European and higher than characterisations of Asian peoples. In reference to competence characterisations, M\u0101ori were rated equal to Pacific Nations peoples and lower than both Asian and P\u0101keh\u0101\/European peoples. This study\u2019s results highlight a degree of incongruence between the University of Auckland\u2019s formal M\u0101ori Health curricula and messages conveyed in the broader institutional context, with implications for educational outcomes and students\u2019 future clinical practice.<\/p>\r\n<p><strong>Keywords:<\/strong>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<span>\u00a0<\/span><em>Indigenous Health, Health Professional Education, Stereotype Content Model, Informal\/Hidden Curriculum<\/em><\/p>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<p style=\"text-align: center\"><strong>Practice Highlights<\/strong><\/p>\r\n<ul class=\"ul-inner-format\" style=\"text-align: justify\">\r\n\t<li>Undergraduate nursing, pharmacy and medical students\u2019 perceptions of ethnic group stereotype content in the University of Auckland\u2019s Faculty of Medical and Health Sciences\u2019 learning environments were evaluated to identify areas of incongruence with the formal Hauora M\u0101ori (M\u0101ori Health) curriculum.<\/li>\r\n\t<li>The findings indicated that characterisations of M\u0101ori are incongruent with formal curricular objectives.<\/li>\r\n\t<li>M\u0101ori students perceived characterisations of M\u0101ori in their learning environments more negatively than non-M\u0101ori students.<\/li>\r\n\t<li>The findings have implications for students\u2019 educational outcomes, their future clinical practice, and M\u0101ori workforce recruitment and retention.<\/li>\r\n<\/ul>\r\n<p style=\"text-align: center\"><strong>I. INTRODUCTION<\/strong><\/p>\r\n<p style=\"text-align: justify\">Indigenous health educators work to enact decolonised, anti-racist curriculum and pedagogies (Curtis, Reid, &amp; Jones, 2014; Jones et al., 2019). The need for transformative teaching and learning in this area is evidenced by persistent ethnic inequities in health outcomes and health care quality (Jones et al., 2010; Wilson &amp; Barton, 2012). In Aotearoa, New Zealand, the context for this study, inequities between M\u0101ori (the Indigenous peoples of Aotearoa) and non-M\u0101ori are apparent across most health measures, including life expectancy, mortality rates, disease-specific morbidity and many of the key health risk factors and determinants of health (Harris et al., 2012; Ministry of Health, 2015; Stats NZ Tatauranga Aotearoa, 2015). Access to and quality of healthcare is inequitable for M\u0101ori compared to non-M\u0101ori (Hill, Sarfati, Robson, &amp; Blakely, 2013; Jansen &amp; Jansen, 2013), and in the healthcare system, M\u0101ori experience racial discrimination by health professionals (Harris et al., 2012).<\/p>\r\n<p style=\"text-align: justify\">Formal Indigenous health curricula exist in concert with and in the context of what Hafferty (1998) identified as the \u2018informal\u2019 and \u2018hidden\u2019 curriculum. Hafferty (1998) described the \u2018informal\u2019 and \u2018hidden\u2019 curriculum as the implicit learning and teaching that take place within educational institutions and function at the interpersonal and structural levels, respectively. The resulting tacit knowledge, accrued from multiple experiences, is unexamined, taken-for-granted and tends to reproduce the unjust social orders that formal Indigenous health curricula seek to subvert (Paul, Ewen, &amp; Jones, 2014). Hauora M\u0101ori (M\u0101ori health) academics at the University of Auckland describe the broader institutional culture and context in which they work as one that often conflicts with the formal M\u0101ori health curriculum (Jones et al., 2010). Undergraduate medical students at the University of Auckland have demonstrated both explicit and implicit bias in favour of P\u0101keh\u0101\/NZ European New Zealanders (Harris et al., 2018), and M\u0101ori students in health professional and health science programs report experiences of racism (Curtis et al., 2012).<\/p>\r\n<p style=\"text-align: justify\">The main purpose of this study was to identify areas of incongruence between the University of Auckland\u2019s Faculty of Medical and Health Sciences\u2019 (FMHS) undergraduate medical, nursing, and pharmacy degree programme learning environments (i.e. a \u2018hidden\/informal,\u2019 institutional curriculum) and the formal Hauora M\u0101ori curriculum. Although it has been reported that attitudes among students in health professional training programmes are sensitive to the values of their educational contexts (Howe, 2002), comparable group-level studies have not been conducted in other educational institutions.<\/p>\r\n<p style=\"text-align: justify\">This study employs the Stereotype Content Model (SCM) as an analytical tool to investigate student perceptions of ethnic group stereotype content pertaining to M\u0101ori in the University of Auckland\u2019s health professional education programmes. The SCM synthesised research on interpersonal and intergroup perception processes with patterns of stereotype content, revealing that warmth and competence perceptions are fundamental and universal to the impressions people form when met with an \u201cother\u201d (Fiske, Cuddy, Glick, &amp; Xu, 2002). \u201cOthers\u201d who are perceived as having positive intentions toward the perceiver are evaluated as high in warmth. Perceived capability(ies) of an \u201cother\u201d to carry out her\/his intentions correlate to perceptions of competence. According to Fiske et al. (2002), warmth and competence\u2019s fundamental positioning is a result of humans\u2019 innate concerns regarding status and competition. If the \u201cother\u201d is perceived as a competitive threat to one\u2019s social status, they will be evaluated as low in warmth but highly competent. People(s) perceived as non-threatening are typically characterised as high in warmth, but low in competence. When applied to populations clear patterns emerge, hence the SCM theorises that socio-structural conditions shape intergroup relations, giving rise to patterns of warmth and competence perceptions (Cuddy, Fiske, &amp; Glick, 2008). All social groups\u2019 stereotype content profiles can be linked to their relative social positioning and the degree to which they are perceived as competing with the dominant group (P\u0101keh\u0101\/NZ Europeans in the context of this study; Cuddy et al., 2008).<\/p>\r\n<p style=\"text-align: justify\">Stereotype content was identified as a salient construct for enquiry due to racial stereotypes\u2019 role in creating and maintaining ethnic and racial disparities in health care (van Ryn et al., 2011). In healthcare settings, stereotypes impact the perceptions and behaviours of both patients and clinicians. Stereotype activation, an automatic process in which awareness of relevant stereotypes is triggered during an interpersonal interaction, has been identified as a principal component of provider-mediated unconscious bias (Williams &amp; Mohammed, 2013).<\/p>\r\n<p style=\"text-align: justify\">When people receive interpersonal or environmental signals, both explicit and implicit, that aspects of their perceivable identity (e.g. skin colour) could trigger negative judgments or mistreatment, the resulting psychological state is defined as \u2018stereotype threat\u2019 (Aronson, Burgess, Phelan, &amp; Juarez, 2013). In healthcare interactions, stereotype threat influences clinician and patient behaviour. Clinician behaviours may trigger stereotype threat, which is likely to impact patient behaviours, which then influences clinicians\u2019 subsequent behaviours (Aronson et al., 2013). The endorsement of negative stereotypes is understood to result in discrimination (Dovidio &amp; Fiske, 2012).<\/p>\r\n<p style=\"text-align: justify\">A range of common stereotypes about M\u0101ori exist in broader New Zealand society (Sibley et al., 2011), and among health care professionals (McCreanor &amp; Nairn, 2002). For example, Penney, Barnes, and McCreanor (2011) revealed a commonplace practice of stereotyping M\u0101ori patients as \u2018non-compliant,\u2019 a label with significant implications for the patient-provider relationship. Health professional education and training programmes can reinforce stereotypes and influence racial and ethnic bias among learners (Jones et al., 2019; van Ryn et al., 2015). The aim of the present study was to explore student perceptions of stereotype content in the University of Auckland\u2019s FMHS health professional education environments\u2019 characterisations of M\u0101ori. The primary research question was, \u2018How do undergraduate nursing, pharmacy and medical students perceive characterisations of M\u0101ori in their educational environments?\u2019<\/p>\r\n<p style=\"text-align: center\"><strong>II. METHODS<\/strong><\/p>\r\n<p style=\"text-align: justify\"><em>A. Participants<\/em><\/p>\r\n<p style=\"text-align: justify\">A purposive sample of undergraduate nursing, pharmacy and medical students (<em>N<span>\u00a0<\/span><\/em>= 628) in the University of Auckland\u2019s FMHS were invited to participate.<\/p>\r\n<p style=\"text-align: justify\"><em>B. Procedure<\/em><\/p>\r\n<p style=\"text-align: justify\">Ethics approval for the study was obtained from the University of Auckland Human Participants Ethics Committee. Students were sent an email invitation one week prior to data collection via paper survey. The principal researcher visited each of the five student cohorts\u2019 lectures during Semester One of the 2014 Academic Year to conduct the cross-sectional survey.<\/p>\r\n<p style=\"text-align: justify\"><em>C. Measures<\/em><\/p>\r\n<p style=\"text-align: justify\"><em>1) Stereotype content in learning environments:<\/em>The questionnaire was based on the SCM (Fiske et al., 2002) and a New Zealand-based study examining societal stereotypes of M\u0101ori, Pacific Nations, P\u0101keh\u0101\/European and Asian New Zealanders (Sibley et al., 2011).<\/p>\r\n<p style=\"text-align: justify\">The questionnaire was organised into four sections: 1) M\u0101ori New Zealanders, 2) Pacific Nations New Zealanders, 3) Asian New Zealanders, and 4) P\u0101keha\/European New Zealanders. For each section, students were asked to complete eight stereotype content ratings on a five-point Likert scale of 1 (not at all) to 5 (extremely) that were presented in the following question stem:<\/p>\r\n<p style=\"text-align: justify\">How \u2026(warm, likeable, sincere, good-natured, tolerant, competent, intelligent, confident) is this group, as characterised in your learning environments?<\/p>\r\n<p style=\"text-align: justify\">The SCM surveys and Sibley et al.\u2019s (2011) survey asked respondents \u201cHow\u2026 is this group, as viewed by society?\u201d This research project modified the question stem in order to reflect the specific research question and aims.<\/p>\r\n<p style=\"text-align: justify\"><em>2) Demographic information:<\/em>The questionnaire included several items pertaining to participants\u2019 programme of study and demographic characteristics: 1) Programme of study (nursing, pharmacy or medicine); 2) Year of programme; 3) Age in years; 4) Sex; 5) Ethnicity. For data analysis purposes, five participant ethnicity groups were categorised: M\u0101ori, Pacific Nations, Asian, P\u0101keh\u0101\/NZ European, and Other. It is important to note that the categories Pacific Nations, Asian, and Other are not ethnic groups in themselves, but aggregations of a number of ethnic identities.<\/p>\r\n<p style=\"text-align: center\"><img decoding=\"async\" class=\"aligncenter wp-image-7521 size-full\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/02\/OA2091_Table-1.jpg\" alt=\"\" width=\"100%\" \/>\u00a0<span lang=\"EN-GB\">Table 1. Study design<\/span><\/p>\r\n<p style=\"text-align: justify\"><em>D. Data Analysis<\/em><\/p>\r\n<p style=\"text-align: justify\">First, the response rate (<em>n\/N<\/em>) and participants\u2019 demographic characteristics were presented with descriptive statistics. The internal reliability of the five items measuring warmth and the three items measuring competence, respectively, were assessed using Cronbach\u2019s alpha. Measures of central tendency in reference to M\u0101ori, Pacific Nations, Asian and P\u0101keh\u0101\/European New Zealanders\u2019 relative warmth and competence characterisations were determined. In accordance with the study design (Table 1), a 4 (racial\/ethnic group: M\u0101ori, Pacific Nations, Asian, P\u0101keh\u0101\/Europeans) x 2 (stereotype dimension: warmth, competence) repeated measures analysis of variance (ANOVA) was conducted. Post hoc analyses were conducted to examine the extent to which ethnic group characterisations were viewed consistently among participants from each student cohort, various ethnic identities, age group, and sex.<\/p>\r\n<p style=\"text-align: center\"><strong>III. RESULTS<\/strong><\/p>\r\n<p style=\"text-align: justify\"><em>A. Response Rate and Participant Data<\/em><\/p>\r\n<p style=\"text-align: justify\">A total of 444 (response rate = 71%) student surveys were completed and analysed. The nursing, pharmacy and medical student cohorts each contributed approximately one-third of all responses (<em>n<\/em><sub>nursing<\/sub>= 160, 36%;<span>\u00a0<\/span><em>n<\/em><sub>pharmacy<\/sub>= 149, 34%;<span>\u00a0<\/span><em>n<\/em><sub>medicine<\/sub>= 135, 30%). A majority of participants were 24 years old or younger (<em>n<span>\u00a0<\/span><\/em>= 389, 88%). A majority of the participants identified themselves as female (<em>n<span>\u00a0<\/span><\/em>= 318, 72%). Participants who identified as belonging to Asian ethnicities comprised 44% (<em>n<span>\u00a0<\/span><\/em>= 197) of the total sample. P\u0101keh\u0101\/NZ European participants were the second most represented ethnic group at 34% (<em>n<span>\u00a0<\/span><\/em>= 150). M\u0101ori participants comprised 7% (<em>n<span>\u00a0<\/span><\/em>= 31) of all respondents. 5% (<em>n<span>\u00a0<\/span><\/em>= 22) of participants identified as Pacific Nations peoples, and 10% of participants made up the \u2018Other\u2019 category, which included Middle Eastern and African ethnicities. The sample was representative of the student population that was invited to participate. The 71% response rate and sample representativeness indicate that non-response bias was effectively minimised.<\/p>\r\n<p style=\"text-align: justify\"><em>B. Internal Consistency Measures<\/em><\/p>\r\n<p style=\"text-align: justify\">The Cronbach\u2019s alpha (\u03b1) internal reliability coefficients for the items assessing warmth-related characterisations of M\u0101ori (\u03b1 = .86), Pacific Nations peoples (\u03b1 = .90), Asian peoples (\u03b1 = .87) and P\u0101keh\u0101\/European (\u03b1 = .86), were acceptable (Field, 2005). Internal reliability coefficients for the items assessing competence-related characterisations were generally acceptable, with coefficients of M\u0101ori (\u03b1 = .76), Pacific Nations peoples (\u03b1 = .83), Asians peoples (\u03b1 = .65) and P\u0101keh\u0101\/European (\u03b1 = .79). The coefficient for Asian New Zealanders was lower than the recommended .7 cut-off score.<\/p>\r\n<p style=\"text-align: justify\"><em>C. Warmth and Competence Characterisations<\/em><\/p>\r\n<p style=\"text-align: justify\">The 4 (target ethnic group: M\u0101ori; Pacific Nations; Asian; P\u0101keh\u0101\/European) x 2 (stereotype dimension: warmth, competence) repeated measures ANOVA generated some significant findings. An overall significant interaction was observed, Wilks\u2019 Lambda = .47,<span>\u00a0<\/span><em>F<\/em>(3,441) = 168.40,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001.<\/p>\r\n<div class=\"table-responsive\" style=\"text-align: justify\">\r\n<table class=\"table table-bordered\">\r\n<tbody>\r\n<tr>\r\n<td rowspan=\"2\"><strong>Target Ethnic Group<\/strong><\/td>\r\n<td colspan=\"2\"><strong>Warmth<\/strong><\/td>\r\n<td colspan=\"2\"><strong>Competence<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Mean<\/strong><\/td>\r\n<td><strong><em>SD<\/em><\/strong><\/td>\r\n<td><strong>Mean<\/strong><\/td>\r\n<td><strong><em>SD<\/em><\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>\u00a0M\u0101ori<\/td>\r\n<td>3.55<\/td>\r\n<td>.64<\/td>\r\n<td>3.31<\/td>\r\n<td>.72<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>\u00a0Pacific Nations<\/td>\r\n<td>3.73<\/td>\r\n<td>.69<\/td>\r\n<td>3.32<\/td>\r\n<td>.73<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>\u00a0Asian<\/td>\r\n<td>3.28<\/td>\r\n<td>.71<\/td>\r\n<td>3.90<\/td>\r\n<td>.65<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>\u00a0P\u0101keh\u0101\/European<\/td>\r\n<td>3.57<\/td>\r\n<td>.61<\/td>\r\n<td>4.02<\/td>\r\n<td>.57<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<p style=\"text-align: center\">Note: The mean score reflects participants\u2019 ratings on a 5-point Likert scale.<br \/>\r\nTable 2. Mean and standard deviation (<em>SD<\/em>) ratings for the variables warmth and competence by target ethnic group<br \/>\r\n(N = 444)<\/p>\r\n<p style=\"text-align: justify\">Two one-way ANOVAs were conducted to assess perceptions of warmth and competence characterisations by target ethnic group separately. The overall Wilks\u2019 Lambda tests of significance yielded several significant findings. First, differences in mean levels of perceived competence characterisations by target ethnic group were significant, Wilks\u2019 Lambda = .52,<em>F<\/em>(3,441) = 135.25,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001. Second, mean levels of perceived warmth characterisations for each ethnic group were significantly different, Wilks\u2019 Lambda = .77,<span>\u00a0<\/span><em>F<\/em>(3,441) = 42.91,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001. The mean warmth and competence ratings are presented in Table 2.<\/p>\r\n<p style=\"text-align: justify\">Using Bonferroni-adjusted alpha levels of .008 (.05\/6) to minimise type I error, paired-samples<span>\u00a0<\/span><em>t<\/em>-tests were conducted and are presented in Table 3 (Bland &amp; Altman, 1995).<\/p>\r\n<p style=\"text-align: justify\"><em>D. Influence of Participant Demographic Variables<\/em><\/p>\r\n<p style=\"text-align: justify\"><em>1) Programmes of study:<span>\u00a0<\/span><\/em>Multivariate analyses (MANOVA) indicated that students within different programmes of study made different warmth and competence (domains) attributions across the questionnaire\u2019s four target ethnic groups (sections). The overall multivariate analysis results showed significant main effects for sections,<span>\u00a0<\/span><em>F<\/em>(3,439) = 50.16,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001 and domains,<span>\u00a0<\/span><em>F<\/em>(1,441) = 41.46,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001. Two-way significant interaction effects were noted for sections and course of study,<span>\u00a0<\/span><em>F<\/em>(6,878) = 5.61,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001, domains and course of study,<span>\u00a0<\/span><em>F<\/em>(2,441) = 5.54,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .01 and domains and sections,<span>\u00a0<\/span><em>F<\/em>(3,439) = 172.30,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001. A three-way significant interaction effect was noted for sections, domains, and course of study,<span>\u00a0<\/span><em>F<\/em>(6,878) = 2.43,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .05.<\/p>\r\n<p style=\"text-align: justify\"><em>2) Ethnicity:<\/em>Overall the results showed significant main effects for sections,<span>\u00a0<\/span><em>F<\/em>(3,437) = 21.02,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001 and domains,<span>\u00a0<\/span><em>F<\/em>(1,439) = 31.25,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001. Two-way significant interaction effects were noted for sections and student ethnicity,<span>\u00a0<\/span><em>F<\/em>(12,1156) = 6.56,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001, domains and student ethnicity,<span>\u00a0<\/span><em>F<\/em>(4,439) = 2.56,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .05 and domains and sections,<span>\u00a0<\/span><em>F<\/em>(3,437) = 108.77,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .001. A three-way significant interaction effect was noted for sections, domains and student ethnicity,<span>\u00a0<\/span><em>F<\/em>(12,1156) = 2.01,<span>\u00a0<\/span><em>p<span>\u00a0<\/span><\/em>&lt; .05. The findings suggest that participant ethnicity affected perceptions of warmth and competence ratings across the four sections. The descriptive data for M\u0101ori warmth and competence ratings by participant ethnicity are illustrated in Table 4.<\/p>\r\n<p style=\"text-align: justify\">The descriptive statistics (Table 4) indicated that characterisations of M\u0101ori were perceived differently among students from different ethnic groups. M\u0101ori students rated characterisations of M\u0101ori warmth lower than students belonging to Pacific Nations, P\u0101keha\/NZ European and Other ethnicities. M\u0101ori students rated characterisations of M\u0101ori competence as lower than those of the four other participant groups. Students who self-identified as belonging to Pacific Nations ethnicities rated warmth and competence characterisations of Pacific Nations peoples higher than characterisations of M\u0101ori. Students belonging to Asian ethnicities rated characterisations of M\u0101ori warmth higher than characterisations of Asian peoples, but rated characterisations of Asian peoples\u2019 competence higher than M\u0101ori. P\u0101keh\u0101\/NZ European students rated characterisations of M\u0101ori warmth and P\u0101keha warmth similarly, but rated P\u0101keh\u0101\/NZ European competence characterisations higher than those of M\u0101ori.<\/p>\r\n<div class=\"table-responsive\" style=\"text-align: justify\">\r\n<table class=\"table table-bordered\">\r\n<tbody>\r\n<tr>\r\n<td width=\"78\"><strong>\u00a0<\/strong><\/td>\r\n<td width=\"187\"><strong>\u00a0<\/strong><\/td>\r\n<td colspan=\"5\" width=\"260\"><strong>Paired Differences<\/strong><\/td>\r\n<td width=\"40\"><strong><em>\u00a0<\/em><\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><strong>\u00a0<\/strong><\/td>\r\n<td rowspan=\"2\" width=\"187\"><strong>\u00a0<\/strong><\/td>\r\n<td rowspan=\"2\" width=\"48\"><strong>Mean<\/strong><\/td>\r\n<td rowspan=\"2\" width=\"40\"><strong><em>SD<\/em><\/strong><\/td>\r\n<td colspan=\"3\" width=\"172\">\r\n<p><strong>95% Confidence Interval<span>\u00a0<\/span><\/strong><strong>of the Difference<\/strong><\/p>\r\n<\/td>\r\n<td width=\"40\"><strong>\u00a0<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><strong>\u00a0<\/strong><\/td>\r\n<td width=\"62\"><strong>Lower<\/strong><\/td>\r\n<td width=\"62\"><strong>Upper<\/strong><\/td>\r\n<td width=\"48\"><strong><em>t<\/em><\/strong><\/td>\r\n<td width=\"40\"><strong><em>df<\/em><\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\">Competence<\/td>\r\n<td width=\"187\">M\u0101ori vs. Asian*<\/td>\r\n<td width=\"48\">-0.59<\/td>\r\n<td width=\"40\">0.86<\/td>\r\n<td width=\"62\">-0.67<\/td>\r\n<td width=\"62\">-0.51<\/td>\r\n<td width=\"48\">-14.46<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">M\u0101ori vs. P\u0101keh\u0101\/NZ European*<\/td>\r\n<td width=\"48\">-0.71<\/td>\r\n<td width=\"40\">0.78<\/td>\r\n<td width=\"62\">-0.78<\/td>\r\n<td width=\"62\">-0.63<\/td>\r\n<td width=\"48\">-19.03<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">M\u0101ori vs. Pacific Nations<\/td>\r\n<td width=\"48\">-0.01<\/td>\r\n<td width=\"40\">0.52<\/td>\r\n<td width=\"62\">-0.06<\/td>\r\n<td width=\"62\">0.04<\/td>\r\n<td width=\"48\">-0.37<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">Asian vs. P\u0101keh\u0101\/NZ European*<\/td>\r\n<td width=\"48\">-0.12<\/td>\r\n<td width=\"40\">0.73<\/td>\r\n<td width=\"62\">-0.18<\/td>\r\n<td width=\"62\">-0.05<\/td>\r\n<td width=\"48\">-3.40<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">Asian vs. Pacific Nations*<\/td>\r\n<td width=\"48\">0.58<\/td>\r\n<td width=\"40\">0.89<\/td>\r\n<td width=\"62\">0.50<\/td>\r\n<td width=\"62\">0.66<\/td>\r\n<td width=\"48\">13.76<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">P\u0101keh\u0101\/NZ European vs. Pacific Nations*<\/td>\r\n<td width=\"48\">0.70<\/td>\r\n<td width=\"40\">0.80<\/td>\r\n<td width=\"62\">0.62<\/td>\r\n<td width=\"62\">0.77<\/td>\r\n<td width=\"48\">18.28<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\">Warmth<\/td>\r\n<td width=\"187\">M\u0101ori vs. Asian*<\/td>\r\n<td width=\"48\">0.27<\/td>\r\n<td width=\"40\">0.83<\/td>\r\n<td width=\"62\">0.19<\/td>\r\n<td width=\"62\">0.34<\/td>\r\n<td width=\"48\">6.75<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">M\u0101ori vs P\u0101keh\u0101\/ NZ European<\/td>\r\n<td width=\"48\">-0.02<\/td>\r\n<td width=\"40\">0.75<\/td>\r\n<td width=\"62\">-0.09<\/td>\r\n<td width=\"62\">0.05<\/td>\r\n<td width=\"48\">-0.68<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">M\u0101ori vs. Pacific Nations*<\/td>\r\n<td width=\"48\">-0.18<\/td>\r\n<td width=\"40\">0.57<\/td>\r\n<td width=\"62\">-0.24<\/td>\r\n<td width=\"62\">-0.13<\/td>\r\n<td width=\"48\">-6.78<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">Asian vs. P\u0101keh\u0101\/NZ European*<\/td>\r\n<td width=\"48\">-0.29<\/td>\r\n<td width=\"40\">0.81<\/td>\r\n<td width=\"62\">-0.37<\/td>\r\n<td width=\"62\">-0.21<\/td>\r\n<td width=\"48\">-7.54<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">Asian vs. Pacific Nations*<\/td>\r\n<td width=\"48\">0.45<\/td>\r\n<td width=\"40\">0.90<\/td>\r\n<td width=\"62\">0.37<\/td>\r\n<td width=\"62\">0.53<\/td>\r\n<td width=\"48\">10.58<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"78\"><\/td>\r\n<td width=\"187\">P\u0101keh\u0101\/NZ European vs. Pacific Nations*<\/td>\r\n<td width=\"48\">0.16<\/td>\r\n<td width=\"40\">0.84<\/td>\r\n<td width=\"62\">0.08<\/td>\r\n<td width=\"62\">0.24<\/td>\r\n<td width=\"48\">4.01<\/td>\r\n<td width=\"40\">443<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<p style=\"text-align: center\">Note: *<em>p<span>\u00a0<\/span><\/em>&lt; .008<br \/>\r\nTable 3. Paired-samples<span>\u00a0<\/span><em>t<\/em>-test: Differences in and ratings among target ethnic groups<\/p>\r\n<div class=\"table-responsive\" style=\"text-align: justify\">\r\n<table class=\"table table-bordered\">\r\n<tbody>\r\n<tr>\r\n<td><strong>\u00a0<\/strong><\/td>\r\n<td colspan=\"5\"><strong>Participant Ethnicity<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong>Domains<\/strong><\/td>\r\n<td><strong>M\u0101ori<\/strong><\/td>\r\n<td><strong>Pacific Nations<\/strong><\/td>\r\n<td><strong>Asian<\/strong><\/td>\r\n<td><strong>P\u0101keh\u0101\/NZ European<\/strong><\/td>\r\n<td><strong>Other<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td>M\u0101ori Warmth<\/td>\r\n<td>3.48 (.66)<\/td>\r\n<td>3.62 (.63)<\/td>\r\n<td>3.45 (.60)<\/td>\r\n<td>3.67 (.64)<\/td>\r\n<td>3.60 (.67)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>M\u0101ori Competence<\/td>\r\n<td>3.04 (.81)<\/td>\r\n<td>3.61 (.83)<\/td>\r\n<td>3.25 (.63)<\/td>\r\n<td>3.39 (.75)<\/td>\r\n<td>3.38 (.75)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Pacific Nations Warmth<\/td>\r\n<td>3.67 (.59)<\/td>\r\n<td>4.08 (.64)<\/td>\r\n<td>3.50 (.72)<\/td>\r\n<td>3.97 (.59)<\/td>\r\n<td>3.80 (.63)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Pacific Nations Competence<\/td>\r\n<td>3.00 (.80)<\/td>\r\n<td>3.65 (.93)<\/td>\r\n<td>3.21 (.68)<\/td>\r\n<td>3.46 (.72)<\/td>\r\n<td>3.40 (.72)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Asian Warmth<\/td>\r\n<td>3.01 (.72)<\/td>\r\n<td>3.52 (.83)<\/td>\r\n<td>3.41 (.65)<\/td>\r\n<td>3.17 (.72)<\/td>\r\n<td>3.17 (.72)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Asian Competence<\/td>\r\n<td>3.87 (.69)<\/td>\r\n<td>4.32 (.67)<\/td>\r\n<td>3.94 (.60)<\/td>\r\n<td>3.79 (.69)<\/td>\r\n<td>3.92 (.61)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>P\u0101keh\u0101\/ NZ European Warmth<\/td>\r\n<td>3.48 (.60)<\/td>\r\n<td>3.53 (.63)<\/td>\r\n<td>3.57 (.61)<\/td>\r\n<td>3.67 (.60)<\/td>\r\n<td>3.34 (.54)<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>P\u0101keh\u0101\/ NZ European Competence<\/td>\r\n<td>4.05 (.51)<\/td>\r\n<td>4.11 (.58)<\/td>\r\n<td>4.04 (.59)<\/td>\r\n<td>4.01 (.55)<\/td>\r\n<td>3.89 (.55)<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<p style=\"text-align: center\">Table 4. Target ethnic group mean (<em>SD<\/em>) ratings for warmth and competence by participant ethnicity<\/p>\r\n<p style=\"text-align: center\"><strong>IV. DISCUSSION<\/strong><\/p>\r\n<p style=\"text-align: justify\"><em>A. Main Finding<\/em><\/p>\r\n<p style=\"text-align: justify\">This study\u2019s main finding is that undergraduate nursing, pharmacy and medical students perceived unequal warmth and competence characterisations (stereotype content) based on target ethnicity (M\u0101ori, Pacific Nations, Asian and P\u0101keh\u0101\/European) in their learning environments. Curtis et al. (2012) reported M\u0101ori students\u2019 perspectives on the University of Auckland\u2019s FMHS, and negative stereotypical caricatures were one aspect. This study\u2019s main finding expands this point, demonstrating that a broad sample of students, both M\u0101ori and non-M\u0101ori, detect differential stereotype content pertaining to M\u0101ori in their FMHS learning environments. This finding is significant and has implications for three interrelated aspects of medical and health sciences education at the University of Auckland: 1) students\u2019 Hauora M\u0101ori educational outcomes, 2) graduates\u2019 subsequent clinical practice and their capacity to provide equitable care, and 3) M\u0101ori student recruitment, retention and impacts on the M\u0101ori health workforce.<\/p>\r\n<p style=\"text-align: justify\">First, an educational environment that expresses low to moderate warmth and competence characterisations of M\u0101ori in formal instruction sites (e.g. lecture theatres) or tacitly endorses these attitudes in more informal learning sites (e.g. conversations in student study groups) is fundamentally incongruent with the (formal) Hauora M\u0101ori curriculum, a core component of health professional education programmes (Jones, 2011). One curricular objective at the University of Auckland is that all FMHS graduates will actively challenge racism (Jones, 2011). If the University\u2019s learning spaces are complicit in the maintenance of racist ideologies, students and graduates will be less well equipped to challenge racism.<\/p>\r\n<p style=\"text-align: justify\">An educational environment that conveys low to moderate warmth and competence among M\u0101ori may influence future healthcare providers\u2019 expectations and subsequent behaviours\/actions during clinical encounters. Moskowitz, Stone and Childs (2012, p. 997) advise that stereotypes \u201carm\u201d healthcare providers with expectations about patients and that unconscious stereotype activation has been demonstrated to influence perception, judgement, evaluation and behaviour. Harris et al.\u2019s (2018) recent study indicates that it is yet unclear the degree to which formal and informal learning inform students\u2019 conscious and unconscious racial bias and clinical decision making with respect to M\u0101ori, however further investigations are necessary.<\/p>\r\n<p style=\"text-align: justify\">Third, the University of Auckland has made commitments to increase recruitment and training of M\u0101ori health professionals (Curtis et al., 2014). The presence of negative racial stereotypes in tertiary education has a direct impact on the experiences and performance of students and faculty belonging to marginalised racial and ethnic populations (Diggs, Garrison-Wade, Estrada, &amp; Galindo, 2009; Massey &amp; Fischer, 2005; Mayeda, Keil, Dutton, &amp; Ofamo\u00a2Oni, 2014; Rankin &amp; Reason, 2005).<\/p>\r\n<p style=\"text-align: justify\"><em>B. Comparison to National Stereotype Content Study<\/em><\/p>\r\n<p style=\"text-align: justify\">Sibley et al. (2011) applied the SCM to the New Zealand racial and ethnic context. Sibley et al.\u2019s (2011) results aligned with SCM-derived hypotheses. When the national study results are compared to the present study, two divergent findings are evident, indicating that student perceptions of stereotype content in the University of Auckland\u2019s FMHS learning environments differ from the wider New Zealand context.<\/p>\r\n<p style=\"text-align: justify\">The SCM predicts that society\u2019s dominant social groups are portrayed as highly warm and competent compared to traditionally marginalised populations (Fiske et al., 2002). Student perceptions of M\u0101ori warmth (as characterised in FMHS learning environments) were not significantly different from perceptions of P\u0101keh\u0101\/NZ European warmth. When this study\u2019s relative warmth ratings (based on perceptions of characterisations) are viewed by participant ethnicity, M\u0101ori and P\u0101keh\u0101\/NZ European participants\u2019 ratings of M\u0101ori and P\u0101keh\u0101\/NZ European New Zealanders are equivalent. This indicates that M\u0101ori and P\u0101keh\u0101\/NZ European students perceive that characterisations of M\u0101ori warmth and P\u0101keh\u0101 warmth in their learning environments are the same. Further investigations are required before inferences or conclusions may be drawn with respect to this finding.<\/p>\r\n<p style=\"text-align: justify\">Participants\u2019 comparable ratings of M\u0101ori and Pacific Nations competence characterisations are also noteworthy in view of the national study results and SCM predictions that M\u0101ori competence would be rated as higher than Pacific Nations competence (Sibley et al., 2011). This finding may be connected to frequent referrals in New Zealand health literature to \u2018M\u0101ori and Pacific\u2019 as a pair. The pairing is reiterated within the University of Auckland\u2019s FMHS with respect to the M\u0101ori and Pacific Admission Scheme (MAPAS), the restorative justice programme initiated in the 1970s that aims to increase the M\u0101ori and Pacific Nations health workforce (Curtis et al., 2014). \u2018MAPAS\u2019 is used as an adjective on campus to describe both individuals (e.g. MAPAS coordinator) and groups (e.g. MAPAS students; The University of Auckland, 2018). While Curtis et al. (2014) clarify a historically and culturally contextualised rationale for discussing M\u0101ori and Pacific Nations peoples\u2019 health together, an unintended consequence of the repetitive pairing may be the conflation or homogenisation of M\u0101ori and Pacific Nations peoples and priorities.<\/p>\r\n<p style=\"text-align: justify\">Literature pertaining to unconscious bias in health care argues that clinicians\u2019 capacity to perceive and connect with patients as unique individuals, rather than group members, is key to combating discriminatory practices (Burgess, van Ryn, Dovidio, &amp; Saha, 2007). A repeated conflation or homogenisation of M\u0101ori and Pacific Nations peoples, when discussing population health and racial disparities in health\/health care, may be at odds with developing students\u2019 skills for overcoming personal bias and reducing discrimination during interpersonal clinical encounters. This tension is interesting because educators delivering health equity curricula to medical and health science students state that it is important for students to understand the structural and social determinants of population health disparities (Betancourt, 2006), determinants that cause similar vulnerabilities among M\u0101ori and Pacific Nations peoples.<\/p>\r\n<p style=\"text-align: justify\"><em>C. M\u0101ori Student Perspectives<\/em><\/p>\r\n<p style=\"text-align: justify\">M\u0101ori students were the only participant group to rate warmth and competence characterisations of their own identity group lower (on average) than members of other groups. Acute awareness among M\u0101ori students of the presence of negative attitudes in their learning environments may account for this result. This finding aligns with several articles that identify New Zealand universities as spaces with institutional norms and values that reflect the P\u0101keh\u0101\/NZ European hegemony and marginalise M\u0101ori (Mayeda et al., 2014; Santamar\u00eda, Lee, &amp; Harker, 2014).<\/p>\r\n<p style=\"text-align: center\"><strong>V. CONCLUSION<\/strong><\/p>\r\n<p style=\"text-align: justify\">Jones et al. (2019) articulate clear directives for medical education institutions to enact \u201cindigenised,\u201d decolonised, anti-racist health professional education, training and health system transformation. Developing localised knowledge of institutions\u2019 \u2018informal\u2019 and \u2018hidden\u2019 curricula and the ways in which they function in opposition to formal Indigenous health curricula is key to developing an aligned institutional curriculum. In addition to Jones et al.\u2019s (2019) recommendation that structured frameworks such as the Critical Reflection Tool be used to facilitate institutional reflexivity, criticality and reform, investigations into student perceptions of stereotype content could serve as an educational tool to aid students in recognising and taking responsibility for the ways in which colonisation, racism and privilege function in their educational environments.<\/p>\r\n<p style=\"text-align: justify\">The study\u2019s sample size (<em>n<span>\u00a0<\/span><\/em>= 444) and response rate (71%) were strengths of the study. The cross-sectional survey design was both a strength and limitation of the study. The design\u2019s strength lay in the anonymous questionnaire\u2019s capacity to minimise social desirability bias while capturing a broad range of student perspectives. A limitation of the design was that data collection occurred during a distinct moment in time. Students participated in the study during the first few weeks of Semester One, 2014. If students had been surveyed following longer periods of exposure to the language and attitudes of their learning environments, the results may have been quite different. Another limitation of the study is its inability to ascertain whether students\u2019 choices on the quantitative questionnaire items were influenced most by formal learning environments or students\u2019 experiences in other settings.<\/p>\r\n<p style=\"text-align: justify\">In summary, our study demonstrated that undergraduate nursing, pharmacy, and medical students in the University of Auckland\u2019s FMHS perceive unequal characterisations of warmth and competence across four target ethnic groups in their learning environments. Student perceptions of characterisations of M\u0101ori indicate the presence of negative stereotyping, which is incongruent with the formal Hauora M\u0101ori curriculum. Our inventory of stereotype content in health professional learning environments, as perceived by students, provides empirical evidence for important aspects of hidden\/informal curricula. Future studies should attempt to identify the sources of student perceptions.<\/p>\r\n<p style=\"text-align: center\"><strong>Notes on Contributors<\/strong><\/p>\r\n<p style=\"text-align: justify\">Caitlin Harrison was a successful postgraduate student whose thesis was submitted as part of the degree of Master of Public Health at the University of Auckland, New Zealand.<\/p>\r\n<p style=\"text-align: justify\">Rhys Jones is a Senior Lecturer in Te Kupenga Hauora M\u0101ori (the Department of M\u0101ori Health) at the University of Auckland, New Zealand.<\/p>\r\n<p style=\"text-align: justify\">Marcus A. Henning is an Associate Professor in the Centre for Medical and Health Sciences Education at the University of Auckland, New Zealand.<\/p>\r\n<p style=\"text-align: center\"><strong>Ethical Approval<\/strong><\/p>\r\n<p style=\"text-align: justify\">Approval was obtained by the University of Auckland Human Participants Ethics Committee, reference number 010926.<\/p>\r\n<p style=\"text-align: center\"><strong>Acknowledgements<\/strong><\/p>\r\n<p style=\"text-align: justify\">We would like to acknowledge the University of Auckland, Faculty of Medical and Health Sciences and the study participants for making this project possible.<\/p>\r\n<p style=\"text-align: center\"><strong>Funding<\/strong><\/p>\r\n<p style=\"text-align: justify\">This is an unfunded study.<\/p>\r\n<p style=\"text-align: center\"><strong>Declaration of Interest<\/strong><\/p>\r\n<p style=\"text-align: justify\">All authors have no potential conflicts of interest.<\/p>\r\n<p style=\"text-align: center\"><strong>References<\/strong><\/p>\r\n<p style=\"text-align: justify\">Aronson, J., Burgess, D., Phelan, S. 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Beyond curriculum reform: Confronting medicine\u2019s hidden curriculum.<span>\u00a0<\/span><em>Academic Medicine, 73<\/em>(4), 403-407.<\/p>\r\n<p style=\"text-align: justify\">Harris, R., Cormack, D., Stanley, J., Curtis, E., Jones, R., &amp; Lacey, C. (2018). Ethnic bias and clinical decision-making among New Zealand medical students: An observational study.<span>\u00a0<\/span><em>BioMed Central Medical Education, 18<\/em>(1), 18-29.<\/p>\r\n<p style=\"text-align: justify\">Harris, R., Cormack, D., Tobias, M., Yeh, L., Talamaivao, N., Minster, J., &amp; Timutimu, R. (2012). The pervasive effects of racism: Experiences of racial discrimination in New Zealand over time and associations with multiple health domains.<span>\u00a0<\/span><em>Social Science &amp; Medicine, 74<\/em>(3), 408-415.<\/p>\r\n<p style=\"text-align: justify\">Hill, S., Sarfati, D., Robson, B., &amp; Blakely, T. (2013). Indigenous inequalities in cancer: What role for health care?<span>\u00a0<\/span><em>ANZ Journal of Surgery, 83<\/em>(1-2), 36-41.<span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1111\/ans.12041\">https:\/\/doi.org\/10.1111\/ans.12041<\/a><\/p>\r\n<p style=\"text-align: justify\">Howe, A. (2002). Professional development in undergraduate medical curricula \u2013 The key to the door of a new culture?<span>\u00a0<\/span><em>Medical Education, 36<\/em>(4), 353-359.<\/p>\r\n<p style=\"text-align: justify\">Jansen, P., &amp; Jansen, D. (2013). M\u0101ori and health. In I. St George (Ed.),<span>\u00a0<\/span><em>Cole\u2019s medical practice in New Zealand<\/em>(12th ed., pp. 52-65). Wellington, New Zealand: Medical Council of New Zealand.<\/p>\r\n<p style=\"text-align: justify\">Jones, R. (2011). Te Ara: A pathway to excellence in Indigenous health teaching and learning.<span>\u00a0<\/span><em>Focus on Health Professional Education, 13<\/em>(1), 23-34.<\/p>\r\n<p style=\"text-align: justify\">Jones, R., Crowshoe, L., Reid, P., Calam, B., Curtis, E., Green, M., \u2026 Ewen, S. (2019). Educating for indigenous health equity: An international consensus statement.<span>\u00a0<\/span><em>Academic Medicine, 94<\/em>(4), 512-519.<\/p>\r\n<p style=\"text-align: justify\">Jones, R., Pitama, S., Huria, T., Poole, P., McKimm, J., Pinnock, R., &amp; Reid, P. (2010). Medical education to improve M\u0101ori health.<span>\u00a0<\/span><em>The New Zealand Medical Journal, 123<\/em>(1316), 113-122.<\/p>\r\n<p style=\"text-align: justify\">Massey, D. S., &amp; Fischer, M. J. (2005). Stereotype threat and academic performance: New findings from a racially diverse sample of college freshmen.<span>\u00a0<\/span><em>Du Bois Review: Social Science Research on Race, 2<\/em>(1), 45-67.<\/p>\r\n<p style=\"text-align: justify\">Mayeda, D. T., Keil, M., Dutton, H. D., &amp; Ofamo\u00a2Oni, I. (2014). \u201cYou\u2019ve gotta set a precedent\u201d: M\u0101ori and Pacific voices on student success in higher education.<span>\u00a0<\/span><em>AlterNative: An International Journal of Indigenous Peoples, 10<\/em>(2), 165-179.<\/p>\r\n<p style=\"text-align: justify\">McCreanor, T., &amp; Nairn, R. (2002). Tauiwi general practitioners\u2019 explanations of M\u0101ori health: Colonial relations in primary healthcare in Aotearoa\/New Zealand.<span>\u00a0<\/span><em>Journal of Health Psychology, 7<\/em>(5), 509-518.<\/p>\r\n<p style=\"text-align: justify\">Ministry of Health. (2015, November 13). Mortality and demographic data 2012. Retrieved from<span>\u00a0<\/span><a href=\"https:\/\/www.health.govt.nz\/publication\/mortality-and-demographic-data-2012\">https:\/\/www.health.govt.nz\/publication\/mortality-and-demographic-data-2012<\/a><\/p>\r\n<p style=\"text-align: justify\">Moskowitz, G. B., Stone, J., &amp; Childs, A. (2012). Implicit stereotyping and medical decisions: Unconscious stereotype activation in practitioners\u2019 thoughts about African Americans.<span>\u00a0<\/span><em>American Journal of Public Health, 102<\/em>(5), 996-1001.<\/p>\r\n<p style=\"text-align: justify\">Paul, D., Ewen, S. C., &amp; Jones, R. (2014). Cultural competence in medical education: Aligning the formal, informal and hidden curricula.<span>\u00a0<\/span><em>Advances in Health Science Education, 19<\/em>(5), 751-758.<\/p>\r\n<p style=\"text-align: justify\">Penney, L., Barnes, H. M., &amp; McCreanor, T. (2011). The blame game:\u00a0Constructions of M\u0101ori medical compliance.<em>AlterNative: An International Journal of Indigenous Peoples, 7<\/em>(2), 73-86.<span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1177\/117718011100700201\">https:\/\/doi.org\/10.1177\/117718011100700201<\/a><\/p>\r\n<p style=\"text-align: justify\">Rankin, S. R., &amp; Reason, R. D. (2005). Differing perceptions: How students of color and white students perceive campus climate for underrepresented groups.<span>\u00a0<\/span><em>Journal of College Student Development, 46<\/em>(1), 43-61.<\/p>\r\n<p style=\"text-align: justify\">Santamar\u00eda, L. J., Lee, J. B. J., &amp; Harker, N. (2014). Optimising M\u0101ori academic achievement (OMAA): An indigenous-led, international, inter-institutional higher education initiative. In<span>\u00a0<\/span><em>M\u0101ori and Pasifika higher education<\/em><em>horizons (Volume 15)<\/em>. Emerald Group Publishing Limited, pp. 201-220.<span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1108\/S1479-364420140000015018\">https:\/\/doi.org\/10.1108\/S1479-364420140000015018<\/a><\/p>\r\n<p style=\"text-align: justify\">Sibley, C. G., Stewart, K., Houkamau, C., Manuela, S., Perry, R., Wootton, L. W., \u2026 Asbrock, F. (2011). Ethnic group stereotypes in New Zealand.<span>\u00a0<\/span><em>New Zealand Journal of Psychology, 40<\/em>(2), 25-36.<\/p>\r\n<p style=\"text-align: justify\">Stats NZ Tatauranga Aotearoa. (2015, May 8). New Zealand period life tables: 2012-14. Retrieved from<span>\u00a0<\/span><a href=\"https:\/\/www.stats.govt.nz\/information-releases\/new-zealand-period-life-tables-201214\">https:\/\/www.stats.govt.nz\/information-releases\/new-zealand-period-life-tables-201214<\/a><\/p>\r\n<p style=\"text-align: justify\">The University of Auckland. (2018). About MAPAS. Retrieved from<span>\u00a0<\/span><a href=\"https:\/\/www.auckland.ac.nz\/en\/fmhs\/study-with-us\/maori-and-pacific-at-the-faculty\/maori-and-pacific-admission-schemes.html\">https:\/\/www.auckland.ac.nz\/en\/fmhs\/study-with-us\/maori-and-pacific-at-the-faculty\/maori-and-pacific-admission-schemes.html<\/a><\/p>\r\n<p style=\"text-align: justify\">van Ryn, M., Burgess, D. J., Dovidio, J. F., Phelan, S. M., Saha, S., Malat, J., \u2026 Perry, S. (2011). The impact of racism on clinician cognition, behavior, and clinical decision making.<span>\u00a0<\/span><em>Du Bois Review: Social Science Research on Race, 8<\/em>(1), 199-218.<\/p>\r\n<p style=\"text-align: justify\">van Ryn, M., Hardeman, R., Phelan, S. M., Burgess, D. J., Dovidio, J. F., Herrin, J., \u2026 Przedworski, J. M. (2015). Medical school experiences associated with change in implicit racial bias among 3547 students: A medical student CHANGES study report.<span>\u00a0<\/span><em>Journal of General Internal Medicine, 30<\/em>(12), 1748-1756.<\/p>\r\n<p style=\"text-align: justify\">Williams, D. R., &amp; Mohammed, S. A. (2013). Racism and health II: A needed research agenda for effective interventions.<span>\u00a0<\/span><em>American Behavioral Scientist, 57<\/em>(8), 1200-1226.<\/p>\r\n<p style=\"text-align: justify\">Wilson, D., &amp; Barton, P. (2012). Indigenous hospital experiences: A New Zealand case study.<span>\u00a0<\/span><em>Journal of Clinical Nursing, 21<\/em>(15-16), 2316-2326.<\/p>\r\n<p style=\"text-align: justify\">*Caitlin Harrison<br \/>\r\n155 North Road, St Andrews,<br \/>\r\nBristol BS6 5AH, United Kingdom<br \/>\r\nE-mail: ctlnharrison@gmail.com<\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":10,"template":"","issues_category":[12],"archive_category":[],"issue_type":[],"volume_category":[39],"class_list":["post-333","issues","type-issues","status-publish","hentry","issues_category-original-articles","volume_category-volume-4-number-3-september-2019"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Characterisations of M\u0101ori in health professional education programmes - The Asia Pacific Scholar<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Characterisations of M\u0101ori in health professional education programmes - The Asia Pacific Scholar\" \/>\n<meta property=\"og:description\" content=\"Published online: 3 September, TAPS 2019, 4(3), 91-98 DOI:\u00a0https:\/\/doi.org\/10.29060\/TAPS.2019-4-3\/OA2091 Caitlin Harrison1, Rhys Jones2\u00a0&amp; Marcus A. Henning3 1The University of Auckland, Aotearoa, New Zealand;\u00a02Te Kupenga Hauora M\u0101ori, The University of Auckland, Aotearoa, New Zealand;\u00a03Centre for Medical and Health Sciences Education, The University of Auckland, Aotearoa, New Zealand Abstract Formal Indigenous health curricula often exist in institutional [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/\" \/>\n<meta property=\"og:site_name\" content=\"The Asia Pacific Scholar\" \/>\n<meta property=\"article:modified_time\" content=\"2022-03-08T06:52:50+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/02\/OA2091_Table-1.jpg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"26 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/\",\"name\":\"Characterisations of M\u0101ori in health professional education programmes - The Asia Pacific Scholar\",\"isPartOf\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/02\/OA2091_Table-1.jpg\",\"datePublished\":\"2019-10-11T02:38:46+00:00\",\"dateModified\":\"2022-03-08T06:52:50+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/#primaryimage\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/02\/OA2091_Table-1.jpg\",\"contentUrl\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/02\/OA2091_Table-1.jpg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/medicine.nus.edu.sg\/taps\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Characterisations of M\u0101ori in health professional education programmes\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/\",\"name\":\"The Asia Pacific Scholar\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Characterisations of M\u0101ori in health professional education programmes - The Asia Pacific Scholar","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/characterisations-of-maori-in-health-professional-education-programmes\/","og_locale":"en_US","og_type":"article","og_title":"Characterisations of M\u0101ori in health professional education programmes - The Asia Pacific Scholar","og_description":"Published online: 3 September, TAPS 2019, 4(3), 91-98 DOI:\u00a0https:\/\/doi.org\/10.29060\/TAPS.2019-4-3\/OA2091 Caitlin Harrison1, Rhys Jones2\u00a0&amp; Marcus A. 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