Medical education

Objectives Develop a roadmap of contextualised strategies to support international medical graduates (IMGs) on the pathway into satisfying rural general practitioner careers in Australia.DesignRealist evaluation approach.Setting, ParticipantsOnline semi-structured interviews, focus groups and intermittent feedback cycles developed, refined and confirmed a contextualised roadmap of strategies between 1 November 2024 and 27 July 2025. Participants were purposefully selected for IMG background and different pathways into rural general practice careers across Australia. This included a 10-person project advisory group and 31 external participants covering decision-makers, training teams, supervisors and trainees. Questions explored practical strategies to drive comfort, confidence, competence, belonging and bonding.Main Outcome MeasuresContextualised strategies for IMGs to achieve satisfying rural general practice careers.ResultsThe roadmap identified that when migrating and acclimatising, providing IMGs with centralised resources and information on rural general practice training and careers promotes comfort and empowerment. When moving to new workplaces and communities, providing IMGs with supportive workplaces for early supervised practice, skill bridging and opportunities to connect with other doctors', families and communities stimulates IMG confidence, competence and sense of community belonging. When training to become a general practitioner rurally, providing IMGs with family-focused, equitable training matched to the IMG and the community, and training that builds on IMG capabilities, promotes a sense of professional belonging and bonding. We identified that early intervention and a continuity of supports are important for more comprehensively supported IMGs.ConclusionsOngoing timely support, when multi-layered, tailored and integrated, may assist IMGs to gain specialist general practice qualifications, feel valued and to settle in rural general practice roles. The roadmap provides a basis for planning coordinated longitudinal support by distributed agencies.

Belinda G. O'Sullivan, Kim J. Omond, Neysan Sedaghat

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

Simple training programs for senior physicians can change self-reported behaviour that may support the mental health of their staff

Aimée Gayed · Jessica Strudwick · Nathasha Kugenthiran · Anthony D LaMontagne · Andrew Mackinnon · Helen Christensen · Nicholas Glozier · Samuel Harvey

Cardiologists require competency and confidence in managing not only deteriorating but also end of life, heart failure

Dominica Zentner · Vithoosharan Sivanathan · Jennifer Philip · Natasha Smallwood