Defining rurality: evaluating the options for the development of a new regional–rural admission scheme for professional medical programmes at the University of Auckland

Early Abstract:

Introduction: Pathways aimed at increasing the medical workforce in regional and rural areas in New Zealand have been implemented in universities, such as the Regional and Rural Admission Scheme (RRAS) at Waipapa Taumata Rau | The University of Auckland, to address urban-rural variations in health outcomes. A recent review of the university’s scheme suggested the programme was not providing equitable opportunities for students from a rural background as originally intended. Therefore, an updated RRAS was required to be developed that will address these inequities, creating a more genuine scheme that may more strongly contribute to developing the regional and rural workforce in New Zealand.
Method: We developed a methodological framework to identify and evaluate candidate rural definitions for the purposes of developing a new RRAS for the university. Following an extensive literature review, we utilised two sets of criteria to select candidate rural definitions, which were then evaluated using visual evaluation (mapping) and exploratory analysis. Candidate definitions were modified to use a three-group (rural/regional/urban) version to be suitable for use as an updated RRAS. We used a de-identified student dataset of applicants enrolled for the MBChB from The University of Auckland from 2017 to 2023 (inclusive) and population counts from the 2018 Census to investigate differences in potential admission numbers under each candidate definition. The New Zealand Index of Multiple Deprivation 2018 was used to assess the distribution of potential admission numbers by socioeconomic status. We also examined the suitability of the candidate definitions by ethnicity, specifically for students of Māori ethnicity.
Results: We selected two candidate definitions for exploratory analysis: Geographic Classification for Health (GCH) developed by the University of Otago, and the Urban Accessibility classification (UA) 2020 by Stats NZ. We found that the ternary version of the UA definition consistently classified a higher proportion of students as regional and rural compared to the current RRAS and the alternative candidate definition, the three-group GCH. The UA was found to classify a higher number of Māori students and those in lower areas of deprivation as rural when compared to the other definitions. Therefore, our final recommendation is to update the existing RRAS using a modified three-group version of the Urban Accessibility classification 2020 by Stats NZ. Our proposed version will re-focus attention to address the under-representation of rural students admitted to professional health programmes at The University of Auckland, while not disadvantaging regional students. 
Conclusion: The updated RRAS will assist in supplementing the future professional rural medical workforce, and subsequently help to reduce health outcome variations between rural and urban areas in New Zealand. The UA is likely to be updated regularly by Stats NZ, and therefore the RRAS can be kept up-to-date in the future.
Keywords: access, defining rural, medical programme entrance, New Zealand, rural admission scheme, rural health, urban/rural health.