Medical education

Women comprise the majority of Australia's healthcare workforce yet remain underrepresented in leadership. This structural inequity has direct consequences for workforce sustainability and patient outcomes. Australia's new gender equality target-setting requirements, which create binding obligations for large employers, including major healthcare services, offer a timely mechanism to address this structural inequity. In this article, we explain why gender equality targets matter for healthcare, outline who must comply and what is required and describe how health services and training settings can embed targets within governance, clinical accountability and workforce systems. We introduce the Monash Learning Health System Maturity Matrix as a practical tool for aligning targets with organisational maturity and argue that, when implemented well, gender equality targets go beyond compliance, building the institutional resilience and culture that retains talent and delivers better care.

Belinda Garth, Nicole Pope, Jenny Proimos, Helena J. Teede

Culturally safe, racism-free healthcare is essential in Australia, yet Aboriginal and Torres Strait Islander people continue to face inequitable access, experiences and outcomes. Although cultural safety is widely cited, implementation remains shallow and disconnected from patients' realities. We argue that meaningful cultural safety requires Aboriginal and Torres Strait Islander governance, robust measurement and institutional accountability. Evidence shows that culturally unsafe care, including racism, creates psychological distress, leads to care avoidance and results in poorer outcomes, whereas Indigenous-led models perform considerably better. We propose a framework to strengthen cultural safety through Aboriginal and Torres Strait Islander community-governed assessment, greater accountability, data sovereignty and mandated cultural safety and anti-racism standards.

Elissa Elvidge, Roianne West, Karen Nicholls, Kiara Harvey, Yeena Thompson, Geraint B. Rogers, Yin Paradies

Aboriginal and Torres Strait Islander doctors remain under-represented in non-general practice specialties. Although parity is often used as a benchmark for workforce reform, targets alone cannot address the structural challenges that constrain entry, progression and retention. Specialist training systems must be redesigned through Indigenous leadership, shared authority, culturally safe workplaces, protected mentorship and recognition of cultural labour. Parity is not the goal; it is the consequence of systems that are equitable, accountable and grounded in Aboriginal and Torres Strait Islander self-determination. Building such systems will strengthen specialist care and improve outcomes for Aboriginal and Torres Strait Islander patients and communities.

Ryan Dashwood

In Reply: We thank Hugh for his comments [1] on our article [2] and the opportunity to reply.The monthly morbidity and mortality meetings have been central to surgical quality since the founding of the American College of Surgeons in 1913. However, as Hugh notes, their quality is highly variable and their conclusions not robustly reported. Further, many are inwardly focused and do not assess care against external evidence-based or peer benchmarks....

Robert J. Aitken, Julian A. Smith, Guy J. Maddern

To the Editor, I read with interest the perspective by Aitken and colleagues on the role of medical colleges in ensuring participation in Clinical Quality Registries [1]. The authors should be commended for discussing this issue and for calling for stronger accountability. Although they highlighted the importance of clinical audit, the reality is that, despite long-standing guidelines from the Royal Australasian College of Surgeons (RACS) and state health departments [2, 3], clinical audit is performed inconsistently and often poorly. Morbidity and mortality meetings, although universally endorsed, vary widely in quality and many fail to deliver genuine quality improvement. High-quality, effective clinical audit meetings (surgical mortality and morbidity meetings) are rare, notwithstanding RACS guidelines or the administrative box-ticking exercises often done by clinical governance departments [4]....

Thomas J. Hugh

In response to the revised Australian Medical Council Standards for Assessment and Accreditation of Primary Medical Programs, many medical education providers are adapting to meet increased expectations regarding First Nations Health and Cultural Safety. Rather than a competency-based approach, which is prevalent throughout medical education, the revised expectations require a fundamental shift in institutional ideological, ontological and epistemological function. To meaningfully engage in this transformation, medical education providers must consider principles and qualities that enable development in these focus areas. To realise progress, an ongoing, personal and collective critical self-reflexive process that centres First Nations self-determination, and that is underpinned by humility, courage, accountability, responsiveness and perseverance, is beneficial for providers and their staff. Conversely, those institutions and individuals who omit such practise, risk inertia in their development.

Sophie Pitt, Ashlee Williams-Barnes, Ryan Dashwood, Keira Edwards, Paul Saunders

There is consistent evidence of who is more likely to practise in a rural location; however, current selection criteria used by most specialty colleges do not reflect this. In fact, our evidence-based perspective article shows how specialty selection is likely driving many rural interested graduates away from rural pathways, perhaps never to return post-fellowship. The Australian Government has strongly invested in rural training, with greatly increased opportunities for end-to-end pathways and raised awareness of social accountability of training programs. However, specialty training pathways have been slow to change the selection criteria, which should align with supporting workforce diversity and distribution into rural areas. We highlight potentially untapped opportunities to directly address workforce distribution that require negligible financial costs to change criteria and processes.

Matthew R. McGrail, Jenny May AM, Katherine Logan

Samuel J White

Laura Ross · Jessica Day

Paulina Stehlik · Caitlin Brandenburg · David A Henry

Changing employment conditions and providing additional support beyond information needs of medical and forensic examiners can help improve workforce participation

Natalie Edmiston · Sam Sperring · Rosalie Power · Samantha Ryan · Kathryn Evans · Jane Ussher · Ellie Freedman

An Aboriginal desktop review team evaluated the preliminary self-assessments of primary medical education providers to gauge how they are currently positioned to meet the new standards pertaining to First Nations health, cultural safety, and equity

Paul Saunders · Nicole Mercer · Maria Mackay · Ian Lee · Madelyne Hudson‐Buhagiar · Miriam Cavanagh · Emma Milliss · Melody Muscat · Kathleen Martin · Adam Shipp · Melissa Johnson · Belinda Gibb

An outline of changes to prevocational training that are intended to improve learning and support for prevocational doctors, and better align the prevocational years with the health needs of the Australian population

Brendan Crotty · Nicholas J Glasgow · Jo Burnand · Georga Cooke · Katrina Anderson · Kirsty White · Sarah Vaughan · Madeleine Novak · Andrew H Singer

Guideline developers should consider the role of sex and gender to enable equity and inclusiveness in health care

Maggie Kirkman · Tomoko Honda · Steve J McDonald · Sally Green · Karen Walker‐Bone · Ingrid Winship · Jane R W Fisher

The RVTS grows and sustains doctors already working in rural, remote and First Nations communities for three to four years while they progress towards general practice and rural generalist fellowship

Patrick Giddings · Belinda G O'Sullivan · Matthew R McGrail · Marlene Drysdale · Tony T Trevaskis · Jacki Mein

Service continuity outcomes can be improved in challenging settings by using place-based retention-focused programs like the RVTS

Matthew R McGrail · Belinda G O'Sullivan · Patrick Giddings

Understanding how to deliver holistic supervision and support for the challenges doctors face when training as general practitioners in rural, remote and First Nations communities, can support interventions which build personal and professional resilience for rural practice

Belinda G O'Sullivan · Patrick Giddings · Ronda Gurney · Matthew R McGrail · Tiana Gurney

The Targeted Recruitment Strategy is a proactive collaborative approach to attract and support doctors to train as general practitioners in high need rural and remote areas

Belinda G O'Sullivan · Veeraja Uppal · Ronda Gurney · Patrick Giddings

The RVTS model of training doctors continuously in the same practice improves access to safe and high quality longitudinal care and contributes to service enhancements in rural, remote and First Nations communities that otherwise lack stable doctors

Belinda G O'Sullivan · Patrick Giddings · Matthew R McGrail