Activities

In This Section

Rural Health Equity Strategic Action Plan

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:

1. Increase the rural surgical workforce and reduce workforce maldistribution, through the Select for Rural, Train for Rural and Retain for Rural Strategies.
2. 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.

Read the Rural Health Equity Strategic Action Plan (PDF 301.31KB).

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.

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.

A copy of the final report is here. (PDF 4.68MB)

The next step is to develop an online module for trainees to access as a non-compulsory add on to existing curricula.

Developing an eLearning rural curriculum

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.

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.

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.

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 Conference. Dr Clancy gave the ANZJS Lecture at the 2022 RACS Annual Conference. Click below to view their presentations.

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).

A copy of the final outcomes paper can be found here (PDF 381.64KB).

Activities of the Rural Surgery Section include:

Rural Surgery program at the Annual Scientific Congress
Rural Surgery Fellowship for Provincial Surgeons - This travelling Fellowship aims to assist provincial surgeons who wish to spend time away from their practice to travel and develop existing skills or acquire new skills in a field to benefit the surgeon, the College and the community. Further information.
Rural Coach Program for Surgical Trainees – This program has identified and supported more than eighty Trainees interested in a rural surgical career. This has been through ongoing support, advocacy and the opportunity to build their rural connections by offering financial assistance to Trainees who attend the Provincial Surgeons of Australia conference;
Rural Surgeons Award – An award acknowledging significant contributions to surgery in rural settings in Aotearoa New Zealand and Australia. The award, in the form of a certificate, is presented to the winner at the annual meeting of Provincial Surgeons of Australia (PSA), the RACS Annual Scientific Congress or the Aotearoa New Zealand Association of General Surgeons. Further information.
Position papers – The Rural Surgery Section provides advice and input into various College position papers such as farm injury, quad bikes, gun safety, the use of chainsaws, GP procedural surgical training and locum surgeons;
Surgical Skills Course Grant for Rural Junior Doctors - A grant for rural-based doctors to support their attendance at a surgical skills course. Further information.