Background

The Royal Australian College of General Practitioners (RACGP) is committed to developing and supporting a culturally safe and reflective general practitioner (GP) workforce that works effectively with Aboriginal and Torres Strait Islander patients and communities. The RACGP Reconciliation Action Plan (RAP) vision for reconciliation is an organisation and GP profession free from racism, where all GPs can, and do provide culturally safe healthcare, grounded in mutual respect and trust.

During the development of the RACGP Training Program, which includes Aboriginal and Torres Strait Islander Cultural and Health Training, it was identified that a comprehensive framework was needed at a national level to cohesively underpin all the work required in relation to Aboriginal and Torres Strait Islander Cultural and Health Training as well as training and workforce pipeline development.
 
As a key partner in the Joint Colleges Training Services Pty Ltd (JCTS), a joint venture of the Australian College of Rural and Remote Medicine (ACRRM) and the RACGP, ACRRM has played a valuable role in the Steering Committee and development of the Aboriginal and Torres Strait Islander Cultural and Health Training Framework (the Framework). The Framework outlines an approach to how the principles underpinning it can shape the shared GP training activities for our respective Fellowship training programs. Through the Joint Colleges Training Services funding, the development and implementation of the Aboriginal and Torres Strait Islander health strategic plans will reflect this approach.
 
All general practice and rural generalist registrars, of both colleges, through key collaborations on areas such as training sites, placements and cultural education, will have the opportunity to engage with the Framework as it provides an ongoing process to reflect on, and embed Aboriginal and Torres Strait Islander values and ways of knowing, being and doing throughout the training programs.
 
The RACGP values ACRRM’s ongoing role in the implementation and evaluation of the Framework.

Aims

The Aboriginal and Torres Strait Islander Cultural and Health Training Framework brings an approach to educational structure and delivery that incorporates deconstructing colonial-driven educational concepts and recognises Aboriginal and Torres Strait Islander Peoples’ leadership, values and priorities in health and health training.
 
The Framework puts Aboriginal and Torres Strait Islander sovereignty and self-determination at the forefront of approaches to general practice training. This broadens the Aboriginal and Torres Strait Islander health discourse by paying attention to historical and political determinants of health and well-being, as well as the social and cultural determinants.
 
Aboriginal and Torres Strait Islander ways of knowing, being and doing are embedded in every part of the Framework and its
application from design, implementation and importantly governance. This is part of the structural reorientation needed for transformative change for the RACGP’s training programs.
 
The Framework is principles-based and provides a nationally consistent approach to the RACGP Aboriginal and Torres Strait Islander Cultural and Health Training programs. It provides focus and direction, and a way of working together, while remaining flexible enough to be contextualised at a local level. By not being prescriptive, it allows local cultural and language differences, histories, and relationships to be considered, reflecting the strong connection to Country unique to every Aboriginal and Torres Strait Islander community. Acknowledging and honouring the strength in the diversity of Aboriginal and Torres Strait Islander cultures is an important part of the Framework.

As a principles-based Framework, it is a ‘lens’ through which all parts of the Training Program are considered.

Through the principles, a structure is provided that can be used to interrogate our underlying assumptions and
existing approaches. The Framework, through the process of decolonisation, requires emphasising critical thinking and reflexivity skills to challenge existing western/scientific/bio medical assumptions and constructs about Aboriginal and Torres Strait Islander Peoples, culture, and knowledge plus the underlying pedagogy of teaching and learning.
 
The RACGP recognises the rights of Aboriginal and Torres Strait Islander Peoples to sovereignty and self- determination, and by embedding Aboriginal and Torres Strait Islander governance, aims to use this Framework to ensure the Indigenisation of the training program. This is an RACGP-wide change process. Which works towards acknowledging and incorporating Aboriginal and Torres Strait Islander knowledge systems, cultures, values, interests, aspirations, and epistemologies (Rigney, 2017).

The key distinction with a process of Indigenisation is that it is focused on ‘learning from’ Aboriginal and Torres Strait Islander Peoples, rather than only ‘learning about’ Aboriginal and Torres Strait Islander Peoples (Guerzoni, 2020).

Aboriginal and Torres Strait Islander People engaged in this work have all endured the impact of colonisation. This impact is reflected in the dismal health statistics often quoted, literature and media - and in the ongoing negative interactions that Aboriginal and Torres Strait Islander People continue to experience. The impact of this sits very close to the surface at all times. There is an urgent need to shift the burden of addressing the impact of colonisation from just those most affected, to making it a responsibility for all.
 
This Framework is a core pillar of the RACGP education governance structure. It sits alongside the Educational Framework, Progressive Capability Profile of the General Practitioner, Curriculum, Syllabus, policies and training standards. The Framework is a guiding instrument for all who are involved in the training journey including: registrars, supervisors, medical educators, cultural educators, and cultural mentors, as well as the RACGP staff supporting this work.
 
The Framework itself is dynamic and will continue to evolve throughout its implementation, application, and evaluation, ensuring it enhances training and remains cognisant of Aboriginal and Torres Strait islander values and needs.