Waikato Medical School FAQs
What is being proposed?
The University, in partnership with the Waikato District Health Board, has submitted a business case to the New Zealand Government proposing the establishment of a new Community-Engaged Graduate Entry Medical School at the University of Waikato, the third medical school in New Zealand.
The Waikato Medical School will offer a medical degree programme which reflects international best practice and is unique in New Zealand. Specifically it will be:
- Graduate entry only (requiring an undergraduate degree from any University in any subject, compared to the current requirement to take health sciences at Auckland or Otago Universities to have the option to enter medicine)
- Four years in length rather than the six years currently required at Auckland and Otago Universities
- Community engaged, involving communities outside the tertiary hospital centres in the design of the programme, selection of students, and training of students
- Proactive in adding to, rather than utilising existing clinical placement opportunities for medical students across the Midland region (Bay of Plenty, Lakes, Tairawhiti and Waikato District Health Board)
- An opportunity to build a new medical school in genuine partnership with Māori and with other high health needs communities.
Why do we need a third medical school?
With one medical school for every 2.35 million people, New Zealand has among the lowest ratios of medical schools to population in the OECD. The relevant ratios are 1: 1.7 million in the UK, 1:1.6 million in the US and Canada, and 1:1.2 million in Australia. Based on any of those comparators New Zealand should be well advanced in developing a third medical school, and against Australian standards we would already have a third medical school and be considering a fourth.
New Zealand’s need for a third medical school is increased by the similarity in the medical education provided by the two existing New Zealand medical schools compared to the diversity of approach in medical training available internationally. The key lesson learned from Australia, North America and the UK is that the provision of additional medical schools needs to be about increasing both capacity and diversity in medical education and training models. The proposed Waikato Medical School complements the work of the two existing medical schools in New Zealand, providing the diversity of training and workforce outcomes that is necessary to meet New Zealand’s challenges with the geographical location and specialist choices of its health care workforce.
We need a third medical school because there is a shortage of doctors in particular specialities and regions. To address these shortages we need to recruit a different sort of student, and train a different sort of doctor.
Each year New Zealand currently imports 1100 doctors trained in other countries (IMGs - International Medical Graduates) to meet our health workforce needs. Most of those doctors stay for a short time, and only 25% are still here three years after their arrival. Psychiatry, palliative medicine, obstetrics, rehabilitation, and care of the elderly are main specialties where IMGs make up around 60% of the workforce. In addition, only 15% of the graduates from Auckland and Otago elect to be General Practitioners (GPs) and as a consequence 60% of GPs outside the main cities are IMGs. Despite this, the vacancy rate in rural general practice is 20-25% and 40% of our current GPs plan to retire by 2025 (that is 1850 GPs who will need to be replaced). The shortage of primary care doctors and specialists in provincial centres and hospitals increases costs to the health system as a whole (eg not seeking treatment early, using the emergency department as a general practice).
The development of the School will be supported by the existing research strengths of the University of Waikato, and by the medical practitioners and facilities at Waikato Hospital which is not only the tertiary hospital for a population of over 900,000 people, but also the largest tertiary hospital in New Zealand.
The Waikato region is experiencing rapid population growth which is putting pressure on health services that are already struggling to provide health services to the large geographical area and high proportion of Māori and other high health needs communities.
The greatest shortages of doctors are in provincial and high health needs communities. The Midland region is the most doctor-deprived region in New Zealand with 13% fewer doctors than the rest of the country (253 per 100,000 compared with 292 doctors per 100,000). Yet this is the region of New Zealand that also happens to have the highest proportion of Māori and is undergoing rapid population growth.
What do we mean by community-engaged medical school?
Integral to the creation of a community-engaged medical school is the concept of establishing partnerships with the communities where the greatest health needs exist. Creating a Waikato Medical School provides the potential for the University of Waikato and the Waikato DHB to build partnerships with communities from the outset, learn about community needs, and develop the curriculum with this information in mind. These are essential components in the foundation of the medical school that is proposed.
The Waikato Medical School’s structure will reflect the partnership between three parties needed to achieve the potential for the Waikato Medical School; the University of Waikato, the Waikato DHB and the iwi of the central North Island.
Key components of partnership that are essential for the operation of the medical school are:
- Community support for the investment in clinical education sites in each community
- Community support for the selection of students and the funding of scholarships for students to study in the medical training programme
- Community support for training (by serving as standardised patients) and mentoring programmes when students undertake clinical placements in the communities
- Ongoing mechanisms to obtain community feedback about the success of the programme and their alignment with community needs.
What will the programme look like?
The Waikato Medical School will be a four-year, graduate entry programme.
A big focus will be on community healthcare and areas of (geographical and specialist) health workforce shortage, with students undertaking placements in provincial and rural community practices as part of their clinical education. Students will spend all of their third year in supervised engagement with patients in community clinical education sites.
Key features of the proposed Waikato GEM programme are:
- Entry on the basis of having an undergraduate degree in any discipline from any recognised University
- Four years (rather than the traditional 5 years of medical education and training at Auckland or Otago) focused solely on students who already have a tertiary education degree (i.e., graduates)
- Based in the Waikato and with clinical education and training centres throughout the central North Island to enable the medical students to undertake a higher proportion of their clinical placements in community settings outside the main centres
- A strong emphasis on medical specialties currently served by high proportions of International Medical Graduates (doctors not trained in New Zealand), on provincial community and rural engagement, and on general medicine
- A tailored curriculum that meets the Australian Medical Council (AMC) standards for accreditation, to be developed in conjunction with a prominent Australian medical school, but with key elements of the programme customised to address New Zealand communities and New Zealand health issues, including Māori health
- Minimising the need for capital investment through use of existing facilities and technologies; and
- Flexible learning approaches that support student participation in education and training.
Why is it only four years?
The programme follows the standard international graduate entry medical education model over four full years of study (January – December). This allows for an intensive learning model, and for longer practical placements for students.
How is this different to the current model of medical education?
The model of medical education as we know it is not meeting our current medical workforce needs.
In contrast, the key elements of the proposed Waikato education model benchmarked against best practice internationally are:
- A student selection and admissions process that reflects engagement with communities in the identification of students with appropriate academic ability, personal characteristics, and commitment to providing care in the communities from which they are drawn
- A substantial proportion of clinical learning occurring in community/clinical settings where the doctors would be expected to practice after graduation
- An ethos focussed on provincial and community-based care and on a duty to serve these populations
- A high proportion of graduates who will choose the specialisations most relevant and most highly demanded for health care outside the main centres. This means 60% of graduates choosing general practice as a specialisation with a commitment to practice outside the main centres, and a high proportion of the remaining 40% choosing specialisations and sub-specialisations relevant to provincial practice.
Why should we care about primary care in provincial and rural areas?
Provincial and rural communities are losing access to local primary care services as their existing doctors retire and it proves extremely difficult to recruit new doctors. Graduates from Auckland and Otago medical schools are unlikely to live or work in these high needs communities. Consequently, in the Midland Region in recent years more than 50% of GP posts have been filled with international medical graduates.
Lack of access to health care in provincial and rural communities places high costs on the health system resulting from higher treatment costs when treatment is delayed, increased hospital admissions and increased emergency department visits. Poor health in communities also increases the demand for allied health and social services and reduces labour productivity.
Who can apply?
Waikato Medical School will be open to all applicants with an undergraduate degree in any discipline, providing the opportunity for a wider range of students to meet the academic requirements for entry to medicine.
Will students be at a disadvantage if they haven’t studied science before?
Having a variety of educational backgrounds is an advantage for the medical profession. In the US, where graduate entry to medical school is universal, empirical evidence shows that no particular undergraduate degree best prepares students for success in medical study.
The student selection model being proposed by the Waikato Medical School will require an undergraduate degree in any discipline from any recognised University with a minimum GAMSAT (Graduate Medical School Admissions Test) score of 50, together with a minimum of 50 in paper 3 (Reasoning in Biological and Physical Sciences). Grades will be one of the entiry criteria used, alongside personal aptitude, demonstrated links with provincial, rural and high needs communities, and commitment to the ethos of a community-engaged medical school.
Why not just add extra spaces to Auckland and Otago’s medical schools?
The Universities of Auckland and Otago are highly-regarded schools of medicine. But New Zealand has specific health workforce needs in provincial and rural areas, and most other developed countries have addressed these needs by creating new medical schools rather than adding to existing medical schools. This is because a different type of medical school with different entry criteria and a different education programme is required to produce a different type of medical graduate.
Compared to this option, several advantagesaccrue from creating a new, graduate entry Waikato Medical School:
- The ability to produce medical graduates from the existing national pool of students with undergraduate degrees on a basis that will represent a lower cost and higher return on the additional government expenditure. The value of a community-engaged distributed learning model of medical education comes from looking at the whole picture and focusing on the returns arising from improved health outcomes, new economic activity associated with the medical education programme, and reduced expenditures on recruitment of doctors over time.
- Based on international evidence from medical schools such as Flinders and Northern Ontario School of Medicine (and also from others around the world), the model of medical education proposed by the University of Waikato should produce medical graduates who are different in kind but not in quality from those who the University of Auckland and the University of Otago produce, and whose choices of medical specialty and geographical location would far better address current and prospective health workforce needs.
- The partnership between the University of Waikato and the Waikato DHB creates a unique opportunity to align the interests of the Waikato Medical School with that of Waikato Hospital and the health care and health workforce needs of the region and nation. Co-operation between the University and the DHB as a foundational principle ensures an alignment of strategy and implementation.
- The opportunity to build a new medical school from the ground up, in partnership with the communities in the central North Island and in partnership with Māori.
- The potential to train technology-savvy doctors who can integrate new virtual health care technologies with the cultural knowledge appropriate to the communities they serve through the newly established Centre for Virtual Health between the University of Waikato and the Waikato DHB.
- The opportunity to create a medical school in which engagement with communities with high health needs will be central to the ethos and a substantial part of the training of all of the students in the school. The Waikato Medical School would be developed with a focus on specialist and generalist provincial and rural health needs, underpinned by an ethos of social accountability.
When will the first lot of students be admitted?
It is anticipated that the first intake of students will be in 2020.
Are there other Schools of Medicine like this elsewhere?
Community-engaged distributed medical education (CEDME) is now considered to be best practice in Australia, Canada and the US for addressing modern health workforce issues, and for providing health care to provincial and rural communities.
The health workforce issues are not unique to New Zealand - indeed they are challenging the health care systems in most developed countries. As a guide to how New Zealand should address these issues, we can look to overseas exemplars. The model we propose is already in operation and is working in other developed countries.
Will the school cost the taxpayer any money?
Funding for the school, as with all other tertiary programmes and qualifications, will operate under the current tertiary funding model which includes Government funding of domestic student places.
Will there be scholarships available?
The University will be working with the community to provide scholarships for outstanding students entering the Waikato Medical School.
Are there any incentives for students coming from the regions to study then going back to the regions to practice?
The commitment to practice in the regions from which they are drawn will be a key part of the selection criteria for Waikato medical students and will be reinforced by the ethos of the Waikato Medical School and the large amount of time that students spend in clinical placements in those communities as part of their training.
Is there a preferred undergraduate pathway to ensure my selection to the programme?
No. The student selection and admissions process will reflect engagement with communities in the identification of students with appropriate academic ability, personal characteristics, and commitment to providing care in the communities from which they are drawn. The student selection model emphasises a calling to medical education and the expectation that the students will go back to serve their communities.
Will graduates be guaranteed a job at the end of their studies?
Because of the severe shortage of doctors in provincial and rural communities, and New Zealand’s growing population, it is unlikely that there will not be jobs when students graduate.
Where will the teaching staff come from?
Many of the teaching staff required are already employed at the Waikato DHB and the University, but additional staff will be recruited over the next three to four years as the School becomes operational.
Will the qualification stack up overseas?
The Waikato Medical School will follow best international practice in community-engaged medical education. The School will be supported by the existing research strengths of the University of Waikato, and by the medical practitioners and facilities at Waikato Hospital which is not only the tertiary hospital for a population of over 900,000 people but also the largest tertiary hospital in New Zealand. It will be accredited by the Australian Medical Council following the many graduate entry medical programmes successfully established in Australia in the past 20 years.
It will be 2024 before students start graduating. How will we solve the shortage of rural GPs in the meantime?
We recognise the shortage of GPs, particularly in rural communities, is one that will take time to solve. However, the proposed investment in community medical education centres across the central North Island will have a positive health, social and economic impact on rural communities from the time that the Waikato Medical School is operational.
How confident are you that you will get the green light from Government to progress this?
The University of Waikato and Waikato District Health Board have prepared the case at the request of Government, but having submitted the case it will now be up to Government to evaluate the case and make a decision.
What has been the feedback from stakeholders you have engaged so far?
Very positive. The stakeholders we have engaged with, across a wide variety of groups, all share our concerns about current community health needs – particularly in the greater Waikato region.
Where will the Waikato Medical School be based? On both University and DHB Campuses?
Combining both the University and DHB’s resources in teaching and learning, we anticipate that the primary home of the Waikato Medical School will be at Waikato Hospital, but that it will also make substantial use of community medical education centres around the central North Island.