Drawing on Māori Values to Inform Medical Education - Dr. Joanne Baxter, Dean of the Dunedin School of Medicine at the University of Ōtākou in New Zealand

Lindsey Smith: I'm Lindsey Smith, Director of Engagement at Osmosis from Elsevier. I've had the true privilege to interview this year's Raise the Line Faculty Award winners. Earlier in 2022, Osmosis asked for nominations of top faculty members around the world. We received over 1,000 faculty nominations from over 377 institutions globally. Our panel combed through and selected just a handful of teachers out of the hundreds of nominations we received. The winners received many nominations with their students and colleagues submitting videos and testimonials telling us how they embody the Osmosis values. 

I am pleased to be joined today by Professor Joanne Baxter, who is one of our winners in the DEI category. First of all, thank you so much for joining us here today, Joanne, and congratulations on your award. 

Joanne Baxter: Thank you. It's great to be here. 

Lindsey Smith: Before we jump in, I would love to get a little bit of background on you, where you're working and some of your career highlights, perhaps.

Joanne Baxter: Well, kia ora koutou and warmest greetings. I'm Jo Baxter. I'm currently the Dean of the Dunedin School of Medicine. By way of background, I am Māori. My mother has whakapapa to tribal areas in the west coast of the South Island, so Poutini Ngāi Tahu, and also in the upper South Island, Ngāti Apa ki te Rā Tō. 

I suppose in terms of background, I trained in medicine. I went to medical school in the 1980s and then went on a bit of a journey. I trained as a psychiatrist initially before changing my specialty area of interest to public health medicine. One of the reasons I did that was because I got really interested in not just how we could best support the care for patients and their whanau, or their families, but also thinking about what were the reasons we were ending up with the health issues that we had and also ways of making a difference with services. 

So, eventually, through a whole range of things, I trained as a public health physician. I am currently a practicing public health physician, and ended up working here at the University of Ōtākou starting out in teaching in epidemiology and then in Māori health. I have really had a twenty-year journey teaching medical students and other health and health science and health professional students in Māori health, but as well as that, doing a range of other things including establishing -- along with a really great team of people -- the Māori Health Workforce Development Unit supporting pathways for indigenous Māori students into and through a full range of health professional and health science programs. 

I was the Associate Dean Māori as well for our wider division of health sciences. I became the Dean of the Dunedin School of Medicine in July of last year. So, that's taken me into a new role, which is really supporting our organization to really grow and develop, including, for me, really supporting our goals and aspirations for growing and developing Māori, Pacific and wider equity groups as part of that journey. 

Lindsey Smith: Thank you so much for that background, Jo. It's very clear that your teaching has inspired a lot of young health care professionals who nominated you for this wonderful award. Can you talk a little bit about what inspired you to get into education? 

Joanne Baxter: When I was at high school, one of the main reasons I ended up in medical school was because I had the support of particularly one of my teachers, who was my Māori teacher at the time and he was really encouraging and supportive of us. I went to a school where it wasn't usual for people to go to university. He was very supportive of us and I think for me, I have long held a view that education provides an amazing platform to really make a difference, to get some transformational outcomes. 

As I travelled through and eventually ended up working for the University of Ōtākou, and started to have opportunities of working with students and staff on how we could best teach and engage them in some challenging areas. In the earlier times, teaching Māori health and indigenous health, it was less well recognized as something that was as important as it is today. 

So, I had to do a lot of relationship building and a lot of development of ways of teaching that made it safe for our Māori students in the class, but as well as that was able to engage and take a wide, diverse range of students and staff with us. Although the journey was challenging, I really started to enjoy the creative side of that. How do you develop techniques, strategies, tools and content that will allow people to grapple with some quite challenging material but do it in such a way that leaves them feeling empowered to go on and utilize what they've learned, maybe in practice or in their own teaching? I found it really satisfying to do that. 

The other thing that has been really helpful and has been a real pleasure has been to be part of a network of colleagues, both in the university -- I've got some amazing colleagues, Māori health teaching colleagues -- as well as well as wider colleagues who've really supported our teaching and learning and equity, diversity, Māori health.  I’m also part of an international group called the Leaders in Indigenous Medical Education that brings together people from Australia, New Zealand, Canada, Hawaii, the States and Taiwan all with a real interest in how do we really embrace and support indigenous education within health professional training. So, it's been a very positive collegial experience. It has been challenging.

I have also really enjoyed watching the students and this next generation of young people coming through really embrace and engage with conversations about equity, diversity, cultural safety, indigenous rights and anti-racism in a way that is, I think, much more open and progressive than potentially what we've had in previous generations. Partly that's because there's a lot more work and exposure and support much earlier on for people to be engaging with these issues. So, not only has it been a really positive thing to start to see shifts in people where there may have been quite a lot of resistance to this, but to actually work with people that are very open and see what they're able to do with what they're learning and knowing that they're going to take this learning out into the various roles that they have and will build on and work with that.

I think in te ao Māori, or in the Māori world, the concept of ako -- which is learning and teaching -- means the same thing. Teaching and learning is the same word for both teacher and learner, and I think for me, that concept that we get as much from the people we're teaching as they get from us very much has been my experience. Which isn't to say that there aren't some really challenging times where you strike resistance or it's hard to get through to the next phase for some people or some groups, but on the whole, there's a whole lot of positive outcomes from it that is inherently rewarding.

Lindsey Smith: Yeah, absolutely. And one thing I wanted to double click on is it seems like it's kind of come full circle for you. You were inspired by a faculty member and it appears that you're doing a lot of that in your day to day today. The second thing is that the work that you're doing in the DEI space to create this more culturally diverse, competent, inclusive community is such important work and only getting more important.

Joanne Baxter: Thank you. 

Lindsey Smith: So, in order to win this award, you had to receive many nominations from students and colleagues and there’s one testimonial we wanted to go ahead and read to you to get your reaction. “Joanne has always been a forward thinker in terms of her teaching. She is constantly exploring various resources, shining light on ethnic health inequalities and therefore inspiring so many in her work. She provides exceptional support to students who struggle with academic and mental health issues, and it aligns with the Osmosis value of having our backs.”

How does that make you feel, Joanne? 

Joanne Baxter: Well, I feel very flattered by that. And I suppose I feel very heartened because for me -- as someone who's got a medical background but ended up in an educational area -- my passion for health and well-being and for supporting not just what people know in their heads, but also their hearts as well...it really makes me feel good that that is what people are experiencing, and so I feel very humbled by that feedback. 

Lindsey Smith: Absolutely. So, at Osmosis, we have these core values and maybe you've had a chance to look at them in the testimonial from one of your students. They said that you had the Osmosis value of “having our backs” but we wanted to see of those the values, which one you felt like you resonated with the most? 

Joanne Baxter: I think I would agree with “have each other's backs.” I think possibly “start with the heart” would be if I was to find something that overarches a lot of the different values and that again, really fits with my values personally, but also Māori values. There's some really cool concepts in there that I perhaps live by. One is a concept of manaakitanga, which is a concept of looking after and caring for and being really active in support and care. The other one is aroha, which is probably more that sense of heart or very much that personal caring for people. 

I think also in terms of heart, I'm aware that what we teach will be much more impactful if the students and those who are teaching not only have this in their head space, but it is in their heart space as well. So, I think that's one that resonates particularly for me. 

Lindsey Smith: Yes, absolutely, and “start with the heart”is one of my favorite values as well. I wanted to understand what's next for you personally and professionally, and what's next your institution in the coming year?

Joanne Baxter: So, as I said earlier, I've taken on a really big and new role this past year, starting as the dean of the Dunedin School of Medicine. I'm the first female dean in 148 years. It's a really big school. We have a whole lot of students and staff. Some of them are medical students. We've got a whole range of programs. We've got a number of eight departments. We've got relationships with the health sector and communities, and I suppose for me, we've also been coming through a time of a lot of change. 

We've obviously had COVID, which in both the health and education sector has had a lot of impact on just people's stress levels and things. Also, we've had a whole new restructure of our health services here. So in my first while in the job, I've really been focusing on building and strengthening my understanding of what are the needs of the school. But now heading forward for this following year and onwards, I'm really keen to strengthen our strategy and culture related to things like equity, inclusion and diversity. I‘m really keen to identify if there are areas that we can really strengthen in that regard and obviously, Māori health, indigenous health and Pacific health is important. I really want to look at how we can grow and develop Māori and Pacific staff and students. 

There's a whole range of other areas in the equity inclusion space that I'm keen to wrap more of a strategic lens around. One is disability. We have a really important role in supporting and working with and partnering with our students and staff who are living with disability, but also what we offer in terms of teaching and learning around disability. So, that's an area that I'm really keen to support. We have some real challenges with regards to supporting a workforce who works in rural areas so I’m really keen to support some of the kind of wider strategic goals. 

But also for me is having a clear sense of culture and values for the school that brings in actually many of the core values that sit there on this piece of paper that are reflected in Osmosis. I've got them printed out here. I might have some different words or terminology, but it’s about really helping everyone feel valued and supported and knowing that they have a role to go on and value and support others. I feel very privileged that there's a great team of people who work in the school, a really diverse group of people. 

We also have got a lot of research that's happening, and I'm keen to understand how we can strengthen our research to be able to enhance our capacity to contribute in that equity inclusion space in terms of health inequalities. But as well as that, the kind of research that's going to help us answer questions that will make a real difference. So, perhaps a bit of everything. 

My role is to provide an environment within which hopefully all the staff and students will thrive and that we won't have people feeling excluded or non-included. Perhaps what I found really helpful over the last few years has been the growing recognition of the concept of belonging. I think having a really strong sense of belonging for everyone within the organization that we're part of is really critical. 

Lindsey Smith: Yes, absolutely. A lot of alignment with some of the Osmosis values for sure, and some of the wonderful work that you're doing. Also, congratulations on being the first woman to hold the position of Dean. That is incredible. 

Joanne Baxter: Thank you. 

Lindsey Smith: So, Osmosis is a teaching company and we love to fill knowledge gaps.

Is there any topic that you would like to educate us and our audience on that you think everyone should know about? 

Joanne Baxter: Oh, I think probably for me -- and it's quite a difficult concept but I think it possibly is one that may be helpful for anyone who's trying to grapple with understanding equity, inclusion, diversity and why we have inequalities -- is why do different groups end up with quite different outcomes from society? The concept that I think is really helpful is one that is around understanding that we haven't got to this position of big differences in inequality and big differences in outcomes from society by accident. It's not something that is an unfortunate byproduct of just the way the world is. Where we are now has been because of very purposeful strategies and approaches that have been taken politically, socially and economically that have privileged some groups and not privileged others. 

Once they're in place, it becomes very difficult to dismantle those. The justification for why we should not dismantle those things often is coming from the group who has been most privileged by those things, and it becomes, actually a belief that the world is this world. We have created it. It serves us very well. If people want special privilege or to do something differently because they can't make it, you know, that's their problem. 

I think that kind of dynamic is one that's very hard for people to grapple with because it's quite confronting, and so what I think would be really helpful, quite fundamentally, is for people to have an understanding about the system, structures, history, politics...the things that have led us to being in this situation and why it might be that way in our organizations and institutions. 

So, for instance, in my own university, around 3% of the staff here are Māori, but 15% of the population is. So, you know, that's not an accident. What are the things that we would need to do to improve that? I think that is a gap. A lot of people engage with this much more proximal to the outcome. “Gosh, we've got an inequity. Let's come up with some initiatives to undo or tackle some of those.” Those things are inherently really important and I've done a lot of work in what are some programs strategies and initiatives to turn these things around. But I also think having people having a sense of the lack of justice that sits behind the pathway to lead us there, then gives them a bit more opportunity for the why this is important to engage with, but also the strategies that can be used to do that. I think it’s important to really purposefully understand resistance to pro-equity and anti-racism. Understanding the kinds of resistances that come up and what's behind those resistances will help us develop strategies to achieve this. 

So it's uncomfortable. It's not in anyone's comfort zone to do this. But I think if we don't head into dealing with our own discomfort, dealing with power differentials, we will end up perhaps being able to do some things, but we won't crack the root causes. I've gone on a bit of a rant, but I think it is the thing that most people or many people don't actually get what's behind why we're at where we're at.

Lindsey Smith: Yeah, absolutely. And you have to understand that history to make any changes moving forward. So, I think that was a great knowledge gap to fill in. Thank you so much for that. 

I've got one final question for you and wanted to give you an opportunity to thank anyone who has helped you kind of get where you are today. It could be peers, students, family members, colleagues. Is there anyone you would like to give a special shout out to? 

Joanne Baxter: Well, I have many people to thank, but perhaps more proximally, obviously my family and the people who have been part of my collegial support crew. I'd need to mention Zoe Bristowe and the team and the Māori Health Workforce Development Unit. I've had very supportive leaders, Professor Peter Crampton being one who've really championed equity agendas and have been really positive in both their support, but as inspirational people. My colleagues in Māori health across the medical school. I've got Bridget Robson and Suzanne Pitama, very much amazing colleagues leading out Māori health and now more widely. I've already sort of mentioned my family and the communities that I come from and the ongoing support over the years from all sorts of whānau, aunties, cousins, immediate family. As I've stepped into my new role, there isn't any one person in particular, but I would like to acknowledge the very positive energy and support from the staff and the students for the direction that we're headed in, and that is greatly appreciated. 

Lindsey Smith: Amazing. Thank you so much for joining us, Professor Joanne Baxter, and congratulations again on receiving the Raise the Line Faculty Award. Obviously, this was very deserving and we had a lovely conversation with you. We are wishing you and your faculty and your students the best moving forward, and thank you for helping train the next generation of health care professionals. 

Joanne Baxter: Thank you so much. Thank you.