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RACS acknowledges its social responsibility to address health inequity, through its levers of selecting, training, retaining and collaborating for rural surgical services and rural communities. It’s well known that rural people have poorer health outcomes than urban people. They have all kinds of surgical problems which need the care of all kinds of surgeons. The RACS Rural Health Equity Strategy aims to improve health equity for remote, rural and regional/provincial people in Australia and Aotearoa New Zealand. The strategy embeds actions for rural health equity in all RACS activities and across all specialties. The strategy addresses the goals to:
- Increase the rural surgical workforce and reduce workforce maldistribution, through the Select for Rural, Train for Rural and Retain for Rural Strategies.
- Build sustainable surgical services in Australia and Aotearoa New Zealand, through the Collaborate for Rural Strategy.
The Rural Surgery Section Committee was instrumental in developing this key RACS strategic action plan. RACS Council has approved the implementation of the overarching strategy for rural health equity across all RACS portfolios as well as establishing a Rural Health Equity Steering Committee for managing the principles outlined in the action plan and prioritising the actions for implementation.
Rural Health Equity Strategic Action Plan
The following four supplementary papers were written by the Rural Surgery Section to support the development of the Rural Health Equity Strategy Action Plan, and were approved in principle by the relevant Committees or Boards. Each paper provides the evidence base for the Action Plan’s recommendations and sets out proposals for consideration, engagement and collaboration.
RACS Rural Health Equity Steering Committee
The RACS Rural Health Equity Steering Committee is responsible for overseeing the implementation of the Rural Health Equity Strategic Action Plan. Associate Professor Kerin Fielding, Chair, and Dr Bridget Clancy, Vice Chair, presented updates on the strategy implementation at the 2023 RACS Annual Scientific Conference. Dr Clancy gave the ANZJS Lecture at the 2022 RACS Annual Scientific Conference. View their presentations below.
RACS STP remote video-based coaching intervention for surgeon non-technical skills in rural hospitals
In surgery, shortcomings in non-technical skills (NTS) have been identified as a significant contributor to adverse events, patient harm, and increased complaints. Surgeons working, supervising, or training in rural areas are disadvantaged by a paucity of professional development opportunities, particularly for non-technical skills. This STP support project investigated a remote asynchronous video-based coaching program for training and assessing the NTS of surgeons working in rural healthcare settings. 18 surgeons were recruited across five rural hospitals in two Australian states.
The program was demonstrated to be a feasible, acceptable, and valuable strategy, providing a unique opportunity to deliver high-quality NTS improvement strategies to specialists in rural communities.
The results have been published in the ANZ Journal of Surgery.
Read the full report (PDF 1.98MB).
This project was funded by the Australian Government Department of Health, Disability and Ageing as a Specialist Training Program (STP) support project. For more information, visit the STP page on the RACS website
National Rural Surgeons’ Training and Retention Workshop
On 9 February 2024, RACS and the Office of the National Rural Health Commissioner held the National Rural Surgeons’ Training and Retention Workshop. Chaired by Professor Brendan Murphy AC, the workshop served to identify the levers and barriers impacting rural surgical training and retention throughout Australia. The workshop represented a significant milestone in the implementation of the Rural Health Equity Strategic Action Plan, advancing RACS’ commitment to enhancing rural surgical training and retention, and bridging the health equity gap for rural communities. The workshop also served to support the FATES Rural Training Models project currently being undertaken by RACS in consortium with Royal Australasian College of Medical Administrators (RACMA), Royal Australian and New Zealand College of Ophthalmologists (RANZCO), Royal Australasian College of Physicians (RACP), and Australian & New Zealand College of Anaesthetists (ANZCA).
RACS STP Rural Surgery Professional Skills Curriculum
The RACS Remote, rural and regional professional skills curriculum (PDF 761.77KB) is now available.
The RACS Remote, rural and regional professional skills eLearning course, including a guide for supervisors, is available and is free for Trainees, Surgeons and Specialist International Medical Graduates to access.
Development of the curriculum and eLearning course was funded by the Australian Department of Health, Disability and Ageing Specialist Training Program (STP). Development occurred in three phases.
Phase 1: Developing a rural curriculum
Rural training with an aligned rural curriculum enables surgeons to develop rural practice capability and rural self efficacy. A rural-facing curriculum is a key action identified in the Rural Health Equity Strategic Action Plan. The RACS Rural Curriculum Project is an ongoing activity fully funded by the Australian Government Specialist Training Program (STP).
The development of the rural-facing curriculum framework in 2021 included input from trainees, rural and urban surgeons and external educational specialists. This comprehensive process included a literature review and a Delphi method with subject matter experts which identified how and where rural surgical practice differs from urban practice in the context of the RACS Surgical Competence and Performance Guide. The area of most divergence was considered to be the non-technical skills of judgment and clinical decision making, specifically, understanding the rural context, rural contextual decision making and Rural Focused Urban Surgical skills (RUFUS). RUFUS surgeons care for rural people through inreach, outreach, telehealth and design of surgical systems, and provide peer support to rural surgeons.
Following the completion of the rural-facing surgical curriculum framework (previous Specialist Training Program [STP] project in 2021), the project team collaborated with the Rural Health Equity Advisory Group to determine the best method for implementing the curriculum. This group recommended the development of an e-learning module.
Phase 2.1: Stakeholder needs assessment
To understand the attitudes of user towards this module, a needs assessment was performed, funded as an STP Support Project. The needs assessment investigated the perceptions of rural surgical Trainees, surgical supervisors, other rural surgeons and those involved in rural outreach, to the rural professional skills eLearning module. The survey, live between 14 March to 10 April 2024, received 114 responses to the survey. A total of 60 participants had experience in rural settings, while 48 worked exclusively in urban areas. The survey identified that most Australian surgeons and Trainees participate in some aspect of rural surgical practice. All proposed rural curriculum activities were highly rated, particularly training surgeons in rural contextual decision-making. Trainees rated all aspects of the proposed rural curriculum more highly than did surgeons. RUFUS (Rural-focused urban surgeon) activities were found to be particularly important for urban surgeons and Trainees, showing the value of the rural curriculum extends beyond the rural hospital setting.
Phase 2.2: E-learning for non-technical skills in surgery
To further inform the development of the e-learning modules, a literature review was undertaken to investigate the effectiveness of internet-based e-learning programs for improving the non-technical skills (NTS) of surgeons and surgical trainees.
A limited number of studies showed that teaching NTS through asynchronous e-learning is feasible for surgical training. This reflects the broader evidence-base for e-learning and alternative tools for NTS training, which includes a wide range of interventions and often limited supporting evidence of effectiveness. Certain themes were consistently reported. The target audience was identified; the planned training need was established; the material was developed with relevant scenarios that were storyboarded; the material was created on an appropriate platform; expert feedback was included and material aligned with relevant guidelines; and the final material was tested and validated.
E-learning as a whole, and specifically for NTS, shows promise; is well received by trainees, trainers and surgeons; and can be a valuable addition to healthcare education, particularly when the modules involve an interactive and engaging design.
Phase 3.1: RACS Remote, rural and regional professional skills curriculum and Remote, rural and regional professional skills eLearning course
A working group led by Dr Jonathan Fong oversaw development of the final curriculum framework and eLearning course, including a guide for supervisors.
Dr Bridget Clancy presented an overview of the eLearning environment at the Academy of Surgical Educators Studio Session in 2025. Watch the video
Dr Bridget Clancy will present the final curriculum and eLearning course at the Academy of Surgical Educators Studio Session and RACS Annual Scientific Congress 2026.
RACS Rural, Remote and Regional Professional Skills eLearning course
The eLearning course is in development in 2025 and will be ready for Trainees and Fellows in 2026.
A working group led by Dr Jonathan Fong is overseeing this phase of the project. Dr Bridget Clancy presented an overview of the eLearning environment at the Academy of Surgical Educators Studio Session.
Flexible Approach to Training in Expanded Settings (FATES)
Increasing rural experience for surgical trainees will contribute to growing the rural surgical workforce and delivering a geographically distributed surgical workforce with an appropriate balance of generalists and subspecialists. Accreditation of more remote, rural and regional training sites/posts is a key element of the RACS Rural Health Equity Strategic Action Plan, the RACMA Securing Australia’s Medical Workforce and Rural-Ready Medical Workforce policies and the National Medical Workforce Strategy.
The FATES 1 Project was Funded by the Australian Department of Health Disability and Ageing (The Department) as part of the Flexible Approach to Training in Expanded Settings (FATES) program. The project was conducted by RACS in partnership with RACMA.
The purpose of the project was to
- Identify barriers to rural hospitals applying for and meeting training post accreditation criteria,
- Design an administrative model that supports rural hospitals to apply for accreditation, resources to assists rural hospitals to assess their performance against hospital training post accreditation standards within a rural context, and document compliance.
- Establish a foundation for the design of a system that distributes training posts based on community need through health and workforce data sharing partnerships with jurisdictions.
The project outputs include
- FATES 1 Rural Accreditation – addressing barriers to rural specialist training final report (available soon)
- FATES 1 Literature Review Rural Accreditation – addressing barriers to rural specialist training (PDF 843.75KB)
- FATES 1 Scoping Review Impact of the quantity of supervisor oversight on specialty training outcomes (PDF 542.64KB)