Belinda O'SUllivan

The Australian College of Rural and Remote Medicine (ACRRM) trains general practitioners in and for smaller rural and remote communities to work as rural generalists. Measured in 2025, about 58% of ACRRM fellows were retained working in Modified Monash Model 4–7 communities, including 17% in remote communities. Rurality distribution of rural generalist fellows was very similar across each of the first 10 years post‐fellowship.

Introduction: Rural areas require tailored rural health research capacity building aligned to the local needs and interests. To set the directions for a rural health research capacity building strategy, we aimed to conduct a needs assessment of rural health research interests, barriers and enablers across rural health stakeholders. Methods: We conducted mixed methods research that included an anonymous online survey of Australian rural health stakeholders from hospitals, primary care and rural health agencies and qualitative interviews with those who consented from two rural regions in Victoria, Australia. Results: Forty individuals completed the survey and twenty-six individuals participated in interviews. The aggregate data suggested that there is strong interest in rural health research although many survey respondents preferred to be aware about research that is underway and which they could get involved in, rather than to lead it. Interview findings suggested that rural health research is considered useful for driving rural health investments, promoting quality healthcare and recruiting and retaining rural health workforces. Barriers to rural health research included higher workloads in smaller clinical teams, limited funding, under-developed research structures, organisation, time and tools. Enablers included having a research strategy aligned with the community's needs, research governance/planning processes for research teams, research tools and academic networks. The balance of interests, barriers and enablers for rural health research capacity building varied between rural health executives and clinicians but was consistent across hospitals and other rural health services. Conclusions: Rural health research is valued for driving more investment, demonstrating rural healthcare service quality and recruiting and retaining health workforce. However, strategies to build research capacity may need to focus on helping rural health services formulate research strategies, structures, governance and funding and to embed tools and planning processes in collaboration with research teams at rural universities. Such capacity could facilitate engagement and participation of diverse rural stakeholders in flexible ways. Addressing rural health research needs also requires robust place-based academic and practice networks across rural regions.

Objectives: Develop a roadmap of contextualised strategies to support international medical graduates (IMGs) on the pathway into satisfying rural general practitioner careers in Australia. Design: Realist evaluation approach. Setting, Participants: Online 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 Measures: Contextualised strategies for IMGs to achieve satisfying rural general practice careers. Results: The 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. Conclusions: Ongoing 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.

Aims: This commentary explores the evidence and experience of the Remote Vocational Training Scheme (RVTS) to reflect on the long‐term training of general practitioners (GPs) and rural generalists (RGs) within rural Aboriginal Medical Services (AMS). Context: Aboriginal Community Controlled Health Organisations (ACCHOs) and their AMSs provide culturally informed, holistic health services that directly and indirectly address a breadth of primary and preventative healthcare for First Nations communities. However, commonly only short‐term and specialised GP/RG training posts are available in these settings, which contrasts with the continuity of care and stable workforce often required in First Nations communities. The Remote Vocational Training Scheme (RVTS) has over 10 years of evidence and experience in implementing a rural AMS training stream, providing 3–4 years of continuous training for GPs/RGs based in the same AMS. Approach: This paper reflects on the lessons learnt by the RVTS leadership team and the evidence from an independent evaluation to inform longer‐term training of GP/RGs in rural AMSs across the sector. At the time of the evaluation in November 2023, the AMS stream had enrolled 71 doctors, 36 of whom had completed training in the same AMS, with 14 participants still in training. The commentary offers valuable insights into the design, delivery and outcomes of the program, providing guidance for broader implementation of longer‐term training. Conclusion: Longer‐term rural AMS training provides valuable learning to trainees whilst ensuring continuity of care and medical workforce stability for First Nations communities. It could be enhanced by incorporating selection and training conditions that prioritise holistic, retention‐focused support for trainees.

Professional support is an important strategy to improve the retention of rural doctors. However, it is poorly defined and understood within the context of

Continuous quality improvement of general practice learning environments is critical for training the next generation of general practitioners (GPs). An evidence-based framework (the General Practice Clinical Learning Environment Framework or GPCLE Framework) describes six elements which are important for best practice learning in general practice. However, there is no validated tool to guide the implementation of quality learning. This research aimed to draw from the GPCLE Framework to develop and validate a tool with specific criteria and evidence-based standards, one that is useful and practical for benchmarking and developing higher quality general practice learning environments for general practice registrars. This national study applied co-design methods (June 2023-June 2024) engaging various stakeholders, including practice managers, GPs and general practice supervisors (trainers), registrars (trainees), medical educators and training directors, across three stages. In phase 1, the draft tool was developed using a broad literature review, Delphi-style workshop and expert review. In phase 2, a survey involved field testing concepts across the general practice training sector to inform refinements to the criteria and standards. In phase 3, the tool was pilot tested in two general practices, comparing an online self-assessment process with an objective on-site evaluation by the research team, coupled with interview feedback to inform relevance, practicality, and feasibility. The final GPCLE tool comprised demographic questions and eleven criteria with associated evidence-based standards, self-assessed as ‘yes/no/unsure/not applicable’ based on the available evidence. These provide a performance rating on a three-point continuum, from satisfactory to commendable and then exemplary. The tool aligned with the original GPCLE Framework. When piloted, it took around 20 min to complete and practices found it relevant, practical, and feasible. The GPCLE tool could be useful for practices to undertake in-practice reviews of the quality of the learning environment for general practice registrars. This could stimulate more specific planning and improvements for practices to strive towards achieving higher performing standards, above and beyond meeting minimum requirements as a training practice. Further, it could also be applied to planning for accreditation, or identifying practices delivering best practice training which can provide exemplars to the sector. The online version contains supplementary material available at 10.1186/s12913-026-14232-8.

Background: International medical graduates (IMGs) are important to supplement domestic workforce gaps in rural general practice in Australia. However, there is no evidence about how to support IMGs longitudinally to achieve such careers. This research aimed to explore the integrated challenges for IMGs across the pathway from migrating to specialising as a general practitioner (GP) in a rural location, to inform what coordinated strategies might be needed. Methods: A qualitative participatory action research study of multi-staged one-hour semi-structured qualitative interviews and two-hour focus groups exploring IMG experiences from migration to pursuing rural GP careers in Australia. Participants had different roles across the prevocational and vocational rural general practice training system; IMGs were prioritised. An initial focus group in February 2025, consulted a 10-person Project Advisory Group. Data were transcribed and deductively and inductively coded for themes. Between March and May 2025 further focus groups and interviews were done with 31 wider participants, to deepen thematic insights. In July 2025, the Project Advisory Group we re-consulted to refine and confirm the themes. Results: Overall, 68% of respondents were IMGs; 46% from towns < 15,000 population and a range of roles across rural general practice training. We found three temporal stages representing different challenges: migrating and acclimatising; moving to new workplaces and communities; and training as a specialist GP in a rural location. Cross-cutting themes were complexity and frustration and the informal exchange of information and advice from other IMGs over these stages. Sub-themes identified specific issues at each stage including, limited access to relevant and tailored information for planning their life and career, limited GP career mentorship and tailored training advice and insecure pathways with variable quality supervised learning. IMGs also lacked recognition of past training and experience and had limited opportunities to address skills gaps through nuanced learning to help them adjust to the scope and responsibilities involved in rural GP careers. Conclusions: IMGs may experience three-staged challenges and specific issues as they navigate the pathway to establishing a rural GP career in Australia. To mitigate an overreliance on informal supports between IMGs, targeted and coordinated resources, education and training may be needed.

Over the last thirty years the demographics in medicine have changed with more female doctors graduating from medical schools. At the same time we are experiencing a rural health workforce shortage and a key issue is encouraging female doctors to take up rural careers. This study explores the training and work experiences of female doctors emerging from a general practice (GP) training pathway which promoted developing both primary care and additional skills to serve rural communities (Rural Generalist– RG). It further seeks to contrast perspectives of the barriers and enablers to RG training and careers between emerging and mature cohorts of RG self-identifying females. A sequential mixed method framework was undertaken. Firstly, a survey was sent to all females who had completed their GP fellowship training with a regional training provider focused on promoting RG training and career development between 2016 and 2022 (cohort one). This was followed by semi-structured interviews with this cohort and females self-identifying as RGs who were in mature careers (cohort two). Results showed that the majority of females were working less than full time. 71% of females who recently completed training (cohort one) were working in large population centres and 39% were working in rural and remote areas with the majority intending to stay in their current role. Most indicated that they were happy with the salaried parts of their role. For those working rurally (beyond large population centres) the hours of work were unpredictable. In interviews, cohort one reflected experiences of a more female-friendly work environment than those in cohort two (mature careers). However, both faced similar issues around children, family, partners and workload related to RG work and both sought mentors for practical and emotional support. This study shows the need to consider the whole person within recruitment processes and provide both personal and professional support. In addition, flexibility for part time training and less than full time work needs to be offered and become more accepted within the medical community.

Objective: Explore the barriers and enablers related to employment models to attract and sustain rural generalist (RG) doctors emerging from a state‐wide RG program.Setting: Stakeholders across five rural regions in Victoria, associated with the Victorian Rural Generalist Program (VRGP).Participants: 36 stakeholders who responded from a list of 122 potential identified by a state‐wide advisory group for the VRGP. Respondents included 13 program staff, nine people from related collaborative agencies, four state policy decision‐makers and 10 RG employees/supervisors.Design: In‐depth interviews were thematically coded through ongoing reflection and sense‐making and verified by an independent qualitatively trained researcher.Results: There were four barriers to employment models to attract and retain RGs and three enablers. Barriers included health service competition, variability in health service leadership and executive capabilities/competencies regarding the RG workforce, specialist competition and supply‐based planning. Enablers were a state‐wide vision, improving regional‐level planning and RG recognition and reward.Conclusion: The research offers insights about the need for state‐wide, coordinated regional and local levels of strategy, planning and implementation to achieve employment models that attract and sustain RGs. Further, attracting and sustaining RGs depends on establishing and implementing clinical service models for the range of RGs needed in the community, using outpatient clinics and other networked service options across the region. It also relies on appropriate pay that recognises the additional skills that RGs have. The results might inform Australia's National Rural Generalist Pathway and the state and territory RG programs and their coordination units with progressing attractive and sustainable RG employment.

Quality supervision in general practice (GP) is critical for the progress and satisfaction of GP registrars and for attracting future rural GPs. However, there is limited research to inform the implementation of feedback systems for enhancing supervision by rural supervisors, and no published evidence specific to distance education where a remote supervisor may be in a different practice and supervising from afar. This study aimed to develop and explore the outcomes of an easy-to-administer, safe and constructive, registrar-to-supervisor feedback system for a distance (or remote) supervision model. Participatory action research involved the design of a standardised short-form questionnaire and an administration, data analysis and feedback process between registrars and supervisors. The questionnaire was administered each year between 16–20 weeks of the first year of registrar training within a 3–4-year rural and remote GP training program—the Remote Vocational Training Scheme (RVTS) (2020–2022). Participation in the project was voluntary. Registrars were asked 12 standardised questions about supervision over three domains: bond strength, task agreement and goal setting. Responses were summed by domain and evaluated using set criteria of high (> 80%), medium (51% to 79%) or low (50% or lower). High- and medium-level narrative feedback reports were provided to supervisors. Low domain scores were followed up by relevant internal staff to negotiate and resolve issues. All 106 commencing registrars completed the questionnaire, of which n = 99/106 (93%) reported high performance related to the bond with their supervisor, n = 94/106 (89%) reported high performance on training tasks, and n = 53/106 (50%) reported medium or low performance for supervisor’s understanding the registrar goals. The majority of supervisors found the feedback useful. Ten registrars identified to be in need (9% of 106) were offered additional support. The system was found to be feasible, safe, and constructive for reviewing the quality of a distance supervision model for rural and remote registrars. It enabled prompt resolution of issues that would have otherwise been difficult to address and facilitated more open discussions about the quality of supervision. This process has been standardised within the RVTS.