The framework was commissioned by the Committee of Presidents of Medical Colleges (CPMC) in Australia to guide its commitment to close the gap in health status between Indigenous and other Australians by specifically supporting the training of Indigenous medical specialists. This report does indeed take a ‘recruitment to specialisation’ approach, recommending initiatives to recruit and support Indigenous medical students in their pathway from junior doctors to Fellows. 

Three streams of action have been identified: recruitment and retention—and successful completion—of Indigenous medical graduates in their chosen specialist training; reform of the curricula to incorporate Indigenous health perspectives, experiences and opportunities into core training; and the pragmatics of ensuring change and implementation of strategies in these areas.  

The central legitimacy of this report rests on the contributions of 15 Indigenous medical specialists, or specialists‐in‐training, from around Australia who generously shared their insights in interviews. Also, a literature review was undertaken looking at the scope of published information related to mentoring in medicine as well as cultural competency and safety in specialist medical training. Key approaches were drawn from the Medical Deans of Australia and New Zealand (MDANZ) and Australian Indigenous Doctors Association (AIDA) collaboration agreement, which aims to increase the number of Indigenous medical students, as well as ensure that Indigenous perspectives are integrated into basic medical education.  

Australia has a poor record in the recruitment and retention of Indigenous people in medicine. In contrast to other settler colonial nations such as New Zealand, the United States and Canada, who all graduated their first Indigenous doctors in the late 1880s, Australia’s first Indigenous medical doctor graduated in 1983, and current numbers represent only approximately 0.2 per cent of the medical workforce in Australia (but Indigenous Australians represent 2.3 per cent of the total population). The reality of these relatively small numbers of Indigenous medical graduates provide an opportunity for Colleges to address needs on an individual basis in the short term, whilst putting in place a systemic approach for the future. It is anticipated that Indigenous medical graduates will increase from current numbers (an estimated 137 doctors in training) by 10 and 20 per year for the three years from 2010, with nearly double that in the following years (possibly up to 40).  

In framing the recommendations of this report, consideration has been given to the specific factors that impact on Indigenous doctors’ decision to specialise. While mentors play a significant role, an awareness of the poor state of Aboriginal health within their own families and communities and the ability to improve this with specialty skills also has an influence. The scope of impact in general practice was another emergent theme. 

The report discusses pathways into specialties, support, retention and mentoring, curriculum reform and pathways for change and concludes that existing expertise, goodwill and good intent alone do not ensure the successful execution of the necessary strategies that will ensure CPMC’s contribution to the close the gap campaign. While some of the recommendations made in this report have been made previously in different contexts, they continue to be an important part of a Medical Specialist Framework for Action.