Racism and cultural safety for Indigenous general practice trainees: An exploratory study of how to support training, careers and professional wellbeing

Abstract

Purpose

Racism as a social determinant of health has known impacts on the physical and mental health of Indigenous peoples, which extends to Indigenous doctors in training and is a barrier to the growth of the Indigenous health workforce in Australia. This study aimed to explore racism and cultural safety within the professional experiences of Australian Indigenous general practice (GP) trainees, to elucidate barriers and facilitators to their training, careers and professional wellbeing.

Methods

A sequential exploratory mixed methods study was conducted in 2020 and 2021 through an initial quantitative online administered questionnaire followed by qualitative semi-structured interviews with Indigenous GP registrars, from either metropolitan or rural areas, undertaking GP training in Australia. The main outcome measures included online responses to the Measure of Indigenous Racism Experiences (MIRE) questionnaire, which measures several dimensions of racism, and data from thematic analysis of semi-structured interviews undertaken following the online questionnaire.

Main findings

The MIRE questionnaire responses revealed experiences of racism across multiple levels. These findings were integrated and expanded with the central themes drawn from the interviews. Themes focused on GP training and training environments and operated across interactions with peers, supervisors and patients. The identified themes were i) cultural identity, with the subthemes of professional wellbeing and professional goals and identity; ii) training challenges, including racism and career development; and iii) training facilitators, including specific support and mentorship.

Principal conclusions

Australian Indigenous GP trainees value their cultural identity in relation to their professional goals and wellbeing. However, challenges for trainees centre around the lack of cultural safety and presence of racism, which is pervasive across their professional life. Strategies to address this could include further provision of specific support, specific culturally safe training placements, networking and mentorship.