First Nations knowledge and leadership must help shape how future doctors are trained, according to a new paper calling for medical education that responds to the needs, priorities and experiences of the communities it serves.
Led by Flinders University and published in the British Medical Journal, the paper identifies rural and remote medical training as an opportunity to strengthen healthcare access, build a sustainable workforce and improve health outcomes across Australia and beyond.
For Aboriginal and Torres Strait Islander communities, the paper places a clear responsibility on medical schools to recognise sovereignty, support First Nations students and embed cultural safety throughout training, recognising that our people's knowledge must help inform the systems preparing doctors to work with us.
Co-author Professor Jaquelyne Hughes, a Torres Strait Islander woman (Wagadagam), said First Nations perspectives were essential to effective healthcare systems because communities brought knowledge grounded in their own experiences and understanding of their people.
"Communities hold valuable knowledge about what works for their people," Professor Hughes said.
Explaining why those voices must help shape the decisions made across the health system, she noted.
"When First Nations voices are included in education, research and healthcare delivery, we create stronger systems that are more culturally responsive and more effective for everyone."
Heath system needs for stronger opportunities for First Nations leadership
The paper calls for stronger opportunities for First Nations leadership, alongside increased support for First Nations students entering and progressing through medical education, connecting the development of the future workforce with the expertise already held within communities.
It also identifies reconciling and recognising First Nations sovereignty as critical to advancing health and wellbeing outcomes, placing this responsibility within the work medical schools must undertake as they prepare future practitioners.
Drawing on evidence from Australia and internationally, the authors highlight the benefits of learning in place and building community partnerships, arguing that where doctors train can play a major role in where they ultimately choose to work.
'Where someone lives should not determine the quality of healthcare they receive'
Lead author Professor James Smith, a Matthew Flinders Professor (Health and Social Equity) and Co-Director of the FHMRI Health Equity Impact Program at Flinders University, said rural medical education was one of the most effective ways to strengthen regional, rural and remote healthcare.
"Where someone lives should not determine the quality of healthcare they receive," Professor Smith said.
Outlining the preparation needed to support that goal, Professor Smith said: "We need to continue building opportunities for doctors to train in rural and remote communities and ensure they are equipped with the skills, relationships and cultural understanding needed to thrive in those settings."
Australia's investment in rural medical education over the past two decades offers evidence of what targeted training can achieve, including the influence of substantial rural placements on graduates' decisions about where to practise.
Between 2016 and 2018, more than 30 per cent of government-supported medical students spent a year or more at a rural clinical school, with graduates who had substantial rural placement experience significantly more likely to enter rural medical practice.
Professor Smith said the opportunity to live and learn within a community could deepen students' understanding while influencing their future careers.
"When students spend meaningful time living and learning in rural communities, they develop a deeper understanding of local health priorities and are more likely to build their careers in those areas," he said.
'Healthcare is about more than treating illness'
Co-author Associate Professor Emma Kennedy AM described community connections as fundamental to successful healthcare, emphasising the importance of understanding the lives of the people future doctors would serve.
"Healthcare is about more than treating illness, it is also about understanding people, families and communities. Rural medical education is at its best when future doctors learn alongside the communities they will one day serve," Associate Professor Kennedy said.
The authors also highlight the importance of encouraging students from rural backgrounds to pursue medicine, noting they are often more likely to return to regional and remote communities after graduating.
For our communities, these findings bring the discussion back to who shapes medical education and whose knowledge informs the care that follows, with First Nations leadership and cultural safety central to preparing doctors who understand local priorities.
Professor Smith said investing in this approach could deliver benefits extending well beyond the students undertaking training.
"By investing in rural medical education and listening to communities, we can build a stronger workforce, reduce health inequities and improve health outcomes for future generations," he said.
