Aboriginal and Torres Strait Islander Cultural capability of overseas-trained doctors within a regional hospital health service

Aboriginal and Torres Strait Islander Cultural capability of overseas-trained doctors within a regional hospital health service | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Aboriginal and Torres Strait Islander Cultural capability of overseas-trained doctors within a regional hospital health service Akshay Pabary, Rachel Brimelow, Riordan Deehan Jackson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7023410/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background 32% of the medical workforce are overseas-trained doctors (OTDs), with Australia’s reliance on OTDs expected to continue. Providing culturally safe healthcare for First Peoples is crucial, highlighting the need for effective learning and delivery of culturally safe healthcare amongst OTDs. The primary aim is to explore the perceived capability of OTDs following completion of the Metro South Health ‘Aboriginal and Torres Strait Islander Capability Module’. The secondary aim is to understand OTDs’ preference on the best content and format of cultural education. Methods A pilot study consisting of surveys sent to OTDs practicing within Bayside Health Service, Queensland, Australia. Eligible participants were overseas-trained doctors employed within the Regional Health Service between 01-07-23 to 01-07-24, who had provisional registration with Australian Health Practitioner Regulation Agency (AHPRA). The survey utilised a validated 22-item Cultural Capability Measurement Tool (CCMT) to measure cultural capabilities, as well as free-text responses to elicit views on format and content of future cultural education. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS)’s statistical functions, with results presented as median, the inter-quartile range, frequencies, and percentages for each Likert score within the CCMT. Qualitative data were analysed using descriptive thematic analysis and integrated with frequency counts to highlight key patterns. Results A sample of 16 OTDs (response rate of 45.7%) were recruited. OTDs reported an understanding of people from different cultures, which extended into a shared sense of responsibility to help improve First People’s health. A lack of understanding of First People’s history has limited OTDs in their ability to provide culturally safe healthcare. OTDs expressed preference for both in-person teaching and e-learning modules to enhance their cultural capability skills. Conclusions The current ‘Aboriginal and Torres Strait Islander Capability Module’ is an effective starting tool to aid OTDs' delivery of culturally safe healthcare. Comprehensive orientation programmes represent a promising area for future development in cultural education, with potential to build on existing foundations and better equip OTDs to meet the cultural needs of First Peoples. This research contributes to broader efforts to improve health outcomes and narrow disparities between First Peoples and other Australians. cultural safety medical education foreign medical graduates Indigenous Figures Figure 1 Background In this paper, the term Aboriginal and Torres Strait Islander people are referred to as ‘First Peoples’. Of the medical workforce, 32% are overseas-trained doctors (OTDs) ( 1 ) . Australia’s reliance on OTDs is expected to continue into the future, with the Competent Authority Pathway for registration significantly improving OTDs’ employment outcomes and enhancing Australia’s global competitiveness. This is reinforced by a history of dependence on medical migration to help redress workforce issues in remote and rural areas ( 2 ) . Despite Health Workforce Australia’s goal to reach self-sufficiency by 2025, dependence on OTDs seems certain to remain with figures revealing similar numbers of OTDs and Australian medical graduates entering the annual labour force to cope to with demand ( 3 , 4 ) . However, unlike Australian medical graduates, OTDs typically have little knowledge of the social determinants of First Peoples’ health and the continuing impacts of colonialism ( 5 ) . Disparities in health outcomes persist, with First Peoples experiencing increased rates of chronic disease and poorer therapeutic outcomes compared to non-First People Australians ( 6 , 7 ) . Studies have shown First Peoples are less likely to access mainstream healthcare services due to a range of barriers including the high cost of health care, experiences of discrimination and poor communication with health care professionals ( 8 ) . It is pivotal to provide culturally safe healthcare; to allow such biological and psychosocial needs to be met, First Peoples must be supported by a team of clinicians suitably trained in cultural safety. Collectively the above research reinforces the pressing need for the evaluation and development of effective resources to support OTDs when providing culturally safe healthcare to First Peoples in their care. This study aimed to understand 1) perceived capability of OTDs following completion of the Metro South Health (MSH) ‘Aboriginal and Torres Strait Islander Capability Module’ and 2) OTDs preference on an educational resource to help develop their cultural capability skills. Methodology A validated survey was conducted across a regional hospital in Queensland, Australia to explore the perceptions of OTDs on cultural capability following completion of the MSH ‘Aboriginal and Torres Strait Islander Capability Module’. Eligible participants were overseas-trained doctors employed within the Regional Health Service between 01-07-23 to 01-07-24, who had provisional registration with Australian Health Practitioner Regulation Agency (AHPRA) (Supplementary Table 1). Details on recruitment can be found in Supplementary Methods. Sample size determination This was a pilot study with an unpowered, opportunistic sample, given the limited number of OTDs available. Sample size rationale is provided in Supplementary Methods. Survey A questionnaire was distributed using REDCap, an electronic tool used to build and collect data for surveys. Additional information on survey procedure is provided in Supplementary Methods. Part 1. Demographic information including age, gender and country of medical licencing was asked. Additionally, questions about completion of Aboriginal and Torres Strait Islander Capability Module and any prior cultural competency training was also included. Part II. A validated 22-item Cultural Capability Measurement Tool (CCMT) was used - a questionnaire that has been developed to measure cultural capabilities according to The Aboriginal and Torres Strait Islander Health Curriculum Framework ( 9 ) . It has been originally validated in a previous study amongst midwifery students by West et al., where it has benefitted from decolonising, First Peoples-led input ( 10 ) . Further to this, the CCMT has undergone several reviews, including validation with a large cohort of undergraduate health students ( 11 ) . Given the CCMT was validated in the study with midwives of a similar sample size, this original 22-item CCMT was used. Further details of the tool and its rationale are provided in Supplementary Methods. Part III. Respondents were asked on their preference on the best content and format of educational resources to enhance their capability to provide culturally safe healthcare. Ethical Considerations Ethical considerations can be found in Supplementary Methods. Analysis Data were analysed using the IBM Statistical Package for the Social Sciences (SPSS) 29.0.0.0. Negatively worded items on the CCMT were reverse coded within SPSS. In addition, CCMT results were analysed in relation to the five factors found within the Framework: Respect, Communication, Safety and Quality, Advocacy and Reflection (Supplementary Table 2). In a previous pilot study with West et al, principal components analysis with varimax rotation revealed five components within the CCMT that reflected the capability constructs within the Framework ( 10 ) . Good internal reliability for the factor analysis, by way of three different measurement types, was also demonstrated. Descriptive statistics included median, interquartile range, frequencies and percentages for each Likert score. Results Participant characteristics/sample A sample of 21 out of 35 OTDs completed the survey. One participant completed the survey despite having obtained their medical degree from Australia, whilst four participants completed the survey having not completed the mandatory e-learning module. As a result, these responses were excluded from data analysis, resulting in a response rate of 45.7%. There was approximately equal male (n = 7, 43.8%) and female (n = 9, 56.3%) participants, with a mean age of 28.3 ± 4.54 years). The majority of OTDs obtained their medical degree in the UK (n = 12, 75%). Other countries in which medical licencing was obtained included India (n = 2), Qatar (n = 1) and Iran (n = 1). Only a minority of OTDs (n = 2, 12.5%) had previously completed some form of cultural training in addition to the mandatory Aboriginal and Torres Strait Islander e-learning module for all staff at Metro South Health. Participant flow is represented in Fig. 1 . Cultural Capability Measurement Tool Scores Factor 1 - Respect Factor 1 contained 11 items of the CCMT. Analysis of individual items revealed that participants strongly agreed that acknowledging the existence of cultural differences was the first step to becoming culturally capable [Mdn = 5 (IQR = 4–5)], but did not agree that reflecting on their own cultural values would help them become culturally aware [Mdn = 4 (IQR = 4–4)]. When participants were asked, ‘I find it difficult to understand the beliefs of different cultural group,’ participants responded with a median score of 3 (IQR = 2.25 to 4)], and felt comfortable working with people from different cultures [Mdn = 4.50 (IQR = 3.25 to 5)]. Participants agreed that understanding First Peoples social practices was applicable to their practice [Mdn = 4 (IQR = 4 to 5)]. Participants agreed that evidence from research could help them in their practice of First People’s health [Mdn = 4 (IQR = 4 to 4.75)] and that their relationship with First Peoples had an impact on clinical outcomes [Mdn = 4 (IQR = 3.25 to 4.75)]. Participants also acknowledged it was the responsibility of all health professionals to improve First People’s health [Mdn = 4, (IQR = 4 to 5)], agreeing that a holistic approach [Mdn = 4.50 (IQR = 4 to 5)], comprehensive primary health care services [Mdn = 5 (IQR = 4 to 5)] and visible Indigenous culture in healthcare settings [Mdn = 4 (IQR = 4 to 5)] were important in improving First Peoples health. Factor 2 - Communication Factor 2 comprised of 4 items of the CCMT. Analysis of individual items revealed that participants neither agreed or disagreed whether First Peoples received special treatment from government [Mdn = 3 (IQR = 2 to 3)]. Participants reported that they did not agree First Peoples had the same level of access to health services as all other Australians [Mdn = 4 (IQR = 2 to 4)]. Participants agreed understanding First Peoples history [Mdn = 4.50 (IQR = 4 to 5)] and cultural values [Mdn = 4.50 (IQR = 4 to 5)] would inform their practice as a health professional. Factor 3 - Safety and Quality Factor 3 comprised of 2 items of the CCMT. Analysis of individual items revealed that participants disagreed that First Peoples were all the same [Mdn = 2 (IQR = 1 to 2.75)], acknowledging that history has an impact on First Peoples health [Mdn = 4 (IQR = 3.25 to 5)]. Factor 4 - Advocacy Factor 4 comprised of 3 items of the CCMT. Analysis of individual items revealed that participants were neutral on any difficulty advocating for improvements in First Peoples health [Mdn = 3 (IQR = 2 to 4)], but did report some ability being cultural inclusive towards First Peoples [Mdn = 4, (IQR = 3 to 4)]. In addition, participants acknowledged their social responsibility to work for changes in First Peoples [Mdn = 4 (IQR = 4 to 4)]. Factor 5 - Reflection Factor 5 comprised of 2 items of the CCMT. Analysis of individual items revealed that participants neither agreed nor disagreed on whether First Peoples are treated equally by health professionals [Mdn = 3.00 (IQR = 2 to 4)]. Participants agreed about their responsibility to challenge the way things are done in health practice [Mdn = 4 (IQR = 3 to 4.75)]. Responses to the CCMT are outlined in Table 1 Table 1 CCMT Responses 22-item CCMT Questions Q1 a Q2 Q3 Q4 a Q5 Q6 Q7 a Q8 Q9 a Q10 Q11 Q12 a Q13 Q14 a Q15 a Q16 Q17 a Q18 a Q19 a Q20 a Q21 a Q22 a Median 4.00 4.50 4.50 4.00 4.00 2.00 3.00 4.50 4.00 5.00 5.00 4.00 4.00 4.00 4.00 4.50 3.00 3.00 4.00 3.00 4.00 4.00 Standard deviation 1.38 0.81 0.81 0.78 1.03 1.06 1.11 0.98 0.83 1.09 0.82 0.79 0.62 0.89 0.85 1.01 0.97 0.96 1.30 1.16 0.81 0.85 Inter-quartile range 3.25 to 5.00 4.00 to 5.00 4.00 to 5.00 4.00 to 5.00 4.00 to 5.00 1.00 to 2.75 2.25 to 4.00 3.25 to 5.00 4.00 to 4.00 4.00 to 5.00 4.00 to 5.00 4.00 to 5.00 4.00 to 4.75 3.00 to 4.75 3.25 to 4.75 4.00 to 5.00 2.00 to 4.00 2.00 to 3.00 2.00 to 4.00 2.00 to 4.00 3.00 to 4.00 4.00 to 4.00 Likert Scores N (%) 1 2 (9.5) 0 (0) 0 (0) 0 (0) 0 (0) 7 (43.8) 1 (6.3) 0 (0) 0 (0) 1 (6.3) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (6.3) 1 (6.3) 1 (6.3) 1 (4.8) 2 (12.5) 0 (0) 0 (0) 2 1 (6.3) 1 (6.3) 1 (6.3) 1 (6.3) 2 (12.5) 5 (31.3) 3 (18.8) 1 (6.3) 2 (12.5) 0 (0) 1 (6.3) 1 (4.8) 0 (0) 1 (6.3) 1 (6.3) 0 (0) 4 (25.0) 4 (25.0) 5 (31.3) 3 (18.8) 2 (12.5) 2 (12.5) 3 1 (6.3) 0 (0) 0 (0) 0 (0) 1 (6.3) 2 (12.5) 6 (37.5) 3 (18.8) 1 (6.3) 1 (6.3) 0 (0) 0 (0) 2 (12.5) 4 (25.0) 3 (18.8) 0 (0) 5 (31.3) 8 (50.0) 1 (6.3) 5 (31.3) 4 (25.0) 0 (0) 4 6 (37.5) 7 (43.8) 7 (43.8) 9 (56.3) 6 (37.5) 2 (12.5) 4 (25.0) 4 (25.0) 11 (68.8) 4 (25.0) 5 (31.3) 8 (50.0) 10 (62.5) 7 (43.8) 8 (50.0) 7 (43.8) 6 (37.5) 2 (12.5) 6 (37.5) 5 (31.3) 9 (56.3) 11 (68.8) 5 6 (37.5) 8 (50.0) 8 (50.0) 6 (37.5) 7 (43.8) 0 (0) 2 (12.5) 8 (50.0) 2 (12.5) 10 (62.5) 10 (62.5) 7 (43.8) 4 (25.0) 4 (25.0) 4 (25.0) 8 (50.0) 0 (0) 1 (6.3) 3 (18.8) 1 (6.3) 1 (6.3) 3 (18.8) Impact on Practice A small number of participants (n = 3, 18.75%) reported the e-learning modules had no impact on their practice, whilst a quarter of participants (n = 4, 25%) reported increased awareness of First Peoples ‘‘ culture’’ , ‘‘ behaviour’’ and ‘‘ potential customs ’’. A larger proportion of OTDs (n = 6, 37.5%) reported a change in practice following completion of the e-learning. I am more aware of socio-economic inequalities and challenges related to access of healthcare, so try to provide a holistic approach and plan follow-up with the patient. (Participant 4, UK Graduate) Changes in practice included altered communication styles, in which two participants (n = 2, 12.5%) commented specifically on avoiding eye contact. More aware of asking if they would like a HLO (Health Liaison Officer) present, avoiding intense eye contact, respecting how they may like to be treated. (Participant 8, UK Graduate) Other participants commented on a more holistic approach (n = 2, 12.5%), increased family involvement (n = 1, 6.25%) and involvement of a same sex clinician (n = 1, 6.25%) as a result of the e-learning module. Sometimes offering same sex clinician if performing sensitive examinations to those who identify as Aboriginal or Torres Strait Islander. (Participant 6, UK Graduate) 2 participants (n = 2, 12.5%) chose not to comment on the e-learning module’s impact on their practice. When asked explicitly, more than half of participants (n = 9, 56.3%) reported asking First Nations People if they wanted a hospital liaison officer present. Educational resource intervention preference Overall, participants were more interested in in-person teaching (n = 7, 43.57%) than e-learning modules (n = 5, 31.25%), with a few specifically preferencing teaching from First Peoples themselves. In-person teaching, learning directly from First Peoples if able to learn about their experiences and learn from this. (Participant 4, UK Graduate) One participant mentioned ‘‘ site visits and immersion into local groups/culture’’ would be helpful, whilst a few OTDs (n = 2, 12.5%) preferred education from the hospital’s liaison officers. Some participants expressed preference on content based around First Peoples history (n = 3. 18.75%) as well as information on ‘‘ cultural differences’’ and ‘‘ common pitfalls while caring for this set of patients’’ . 2 participants (n = 2, 12.5%) chose not to comment on content or format of educational resources. Discussion Main finding of this study OTDs reported experience and a perceived understanding of people from different cultures, which extended into a shared sense of responsibility and desire to help improve First Peoples health. However, despite completion of the e-learning module, a lack of understanding of First Peoples' history and the implications for health outcomes limited OTDs in their ability to provide culturally safe healthcare. OTDs expressed preference for both in-person teaching and e-learning modules as means of enhancing their cultural capability skills. What is already known on this topic Concerns around recruitment of OTDs as a solution for medical workforce shortages have been reflected in reports stretching back to 2000, with issues around insufficient orientation to the Australian healthcare system and culture cited as common problems ( 12 ) . Whilst studies have demonstrated the utility of cultural education amongst healthcare professionals such as nursing, midwifery, and medical students ( 13 – 15 ) , there is relatively little known about the responses of OTDs to other health professional education programs. Given studies have shown treatment adherence ( 16 ) , patient satisfaction ( 17 , 18 ) and information seeking ( 18 ) and sharing have been improved by culturally safe health care ( 19 ) , , the importance of culturally safe OTDs in providing appropriate healthcare for First Peoples cannot be understated. What this study adds By structuring our discussion in relation to each of the five interconnected Framework factors, this study provides a clearer understanding of how OTDs’ levels of cultural knowledge, awareness, and preparedness align with national cultural capability expectations. This approach helps identify where targeted educational interventions may be most beneficial for OTDs in the future. Respect and communication According to the Framework, the factor of respect involves recognising First Peoples’ ways of knowing, being and doing in the context of history, culture and diversity. This is complemented by the factor of communication, which focuses on culturally appropriate, safe and sensitive communication to facilitate impactful relationships ( 9 ) . Our findings showed that OTDs reported an understanding and familiarity with people from different cultures, alongside a willingness to improve First Peoples health. Notably, previous studies among OTDs have not explored their willingness and sense of responsibility to improve First Peoples health. In this regard, our findings indicate that OTDs represent a promising cohort through which significant improvements in First People health can be made. On the other hand, OTDs understanding and awareness around First Peoples’ culture was limited. Our findings showed that OTDs were unaware that First Peoples are less likely to access healthcare services than all other Australians. These findings are consistent among OTDs working in rural and remote Australia, who reported a similar lack of awareness of First People-related health and cultural challenges ( 20 , 21 ) . Existing research has explored the institutional and cultural barriers impeding progress in this area, all of which serves to emphasise the need for ongoing research in this field ( 22 ) . Safety and Quality The role of safety and quality involves applying evidence-based best practices in First People health care. Knowledge of First Peoples’ demographic and health statistics, as well as policies and strategies regarding ‘Closing the Gap’ are required for the provision of effective healthcare ( 23 ) . Participants in our study confidently acknowledged the inherent differences in individual health needs among First People patients, in keeping with a general understanding that people from different cultures will require unique and tailored healthcare. Advocacy As per the Framework, the role of advocacy is seen as paramount in helping recognise that the whole health system is responsible for improving First Peoples’ health. This is directly supported by health practitioners in First People settings, who have recognised advocacy skills as part of an extended repertoire of attributes required by doctors ( 24 ) . Findings from this study indicated that OTDs acknowledged their social responsibility to work for change but did not feel strongly enough about actively advocating for improvements in First Peoples health. It could be that the insufficient orientation of OTDs to First Peoples' history and culture may result in a lack of understanding about the social injustices faced by this demographic, including the ongoing struggle for equitable outcomes. This lack of awareness may account for a diminished motivation among OTDs to actively advocate for improved healthcare for First Peoples. At present, there is no available data assessing the advocacy skills of OTDs in Australia, making these findings both novel and significant. Reflection The factor of reflection is referred to as the ability to examine and reflect on one’s own cultural paradigms in the context of the healthcare challenges faced by First Peoples. Consistent with previous findings, our study indicated that OTDs shared a general awareness around health injustices, but lacked the contextual understanding needed to grasp the specific disadvantages faced by First Peoples. Educational resource intervention preference Regarding content and format of appropriate cultural education, participants reported preference for in-person teaching, followed by e-learning modules. Despite the flexibility of e-learning, four OTDs who completed the survey did not finish the mandatory e-learning modules. This raises the question of whether in-person teaching may be more effective in ensuring engagement compared to e-learning. Existing research has demonstrated that appropriate training interventions can effectively enhance the delivery of culturally safe healthcare among OTDs. A comprehensive literature review of OTDs in the United Kingdom revealed effective cultural interventions should form part of a rigorous and mandatory induction, last between 3 to 5 days in length, and involve ongoing evaluation of OTDs’ adjustment ( 25 ) . Interestingly, despite the importance of programme content and delivery, an organisational culture that creates a social support network and a feeling of being welcomed was considered more important for an OTDs transition into a new healthcare system ( 26 ) . For incoming OTDs in Australia, Sullivan and colleagues developed a 4-week programme consisting of core-group teaching and hospital attachments centred around communication, culture and workplace skills ( 27 ) . Encouragingly, OTDs reported a greater understanding of staff and communication issues following this intervention, highlighting the benefit of a more comprehensive, in-person approach to cultural education. Based on the literature and our findings, future interventions should aim to be more comprehensive, including a detailed orientation to First Peoples’ history and culture. Limitations The nature of the study predisposes responses to selection bias, in which OTDs with previous cultural experience may be more inclined to participate within the study. To account for this, participants were asked about any previous cultural competency training prior to completing the survey. Only two participants indicated they had undertaken previous cultural competency training. Similar to the previous validation study by West and colleagues ( 10 ) , there was a predominance of a single demographic in this study - specifically, the majority of OTDs had obtained their licensing in the UK. OTDs educated in other countries may have responded differently to the CCMT and helped minimise sampling bias. However, given the CCMT had previously been piloted with midwives and later with a larger sample of health professional students, the results from this survey with OTDs addresses a potential gap and helps ensure the tools applicability across varying health professions. Conclusion This study highlights gaps in OTD awareness of First Nations health needs, informing the development of culturally appropriate education for incoming OTDs in Australia. Comprehensive orientation and stronger engagement with First Peoples represent promising areas for targeted future intervention, with further research needed to evaluate the impact of such programmes on improving health outcomes for First Peoples. Abbreviations OTD Overseas Trained Doctor MSH Metro South Health AHPRA Australian Health Practitioner Regulation Agency CCMT Cultural Capability Measurement Tool SPSS Statistical Package for the Social Sciences Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki for research involving human participants and received ethics approval from the Metro South Human Research Ethics Committee, reference number - HREC/2024/QMS/108020. All participants read a ‘participant information sheet’ prior to taking part, and informed consent was implied through completion of the survey. Participants were informed of the aims of the study and that submission of the survey would mean they could no longer withdraw their data. No identifying information was collected from the participants to assure confidentiality. This process was clearly outlined for all participants in both the email advert and the ‘participant information sheet’. Clinical trial number Not applicable Consent for publication Not applicable Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due ethical and institutional data protection policies but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research project was conducted without any external funding or financial contributions. Authors' contributions RDJ and AP designed the survey and collected subsequent data. AP analysed and interpreted the data and wrote the main manuscript text. RB contributed to the final version of the manuscript and supervised the project. All authors read and approved the final manuscript. Acknowledgements Many thanks are given to Dr Rachel Brimelow (Main Supervisor) and Dr Kirsten Strudwick (Research Assistance). This project would not have been possible without their assistance in study design, data collection, analysis and interpretation, project progression and write-up. Authors’ information Akshay Pabary is first author OCCRID ID: https://orcid.org/0009-0004-0285-2183 References Welfare AIOHa. Health Workforce. Australian Institute Of Health and Welfare. 2022. Available from: https://www.aihw.gov.au/reports/workforce/health-workforce . Accessed 10 Dec 2024. Hawthorne L. International medical migration: what is the future for Australia? Med J Aust. 2013;199(Suppl 5):18–21. OECD. Health Workforce. Health workforce migration. 2023. Available from: https://www.oecd-ilibrary.org/content/data/3ed4148b-en . Accessed 10 Dec 2024. Murray RB, Craig H. A sufficient pipeline of doctors for rural communities is vital for Australia's overall medical workforce. Med J Aust. 2023;219(Suppl 3):5–7. Gatwiri K, Rotumah D, Rix E. BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia. Int J Environ Res Public Health. 2021;18:4399. AIHW, The Health, and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. 2015. 2015. Available from: https://www.aihw.gov.au/getmedia/584073f7-041e-4818-9419-39f5a060b1aa/18175.pdf?v=20230605181240&inline=true . Accessed 15 Dec 2024. Gardiner FW, Rallah-Baker K, Dos Santos A, Sharma P, Churilov L, Donnan GA, et al. Indigenous Australians have a greater prevalence of heart, stroke, and vascular disease, are younger at death, with higher hospitalisation and more aeromedical retrievals from remote regions. EClinicalMedicine. 2021;42:101181. Aspin C, Brown N, Jowsey T, Yen L, Leeder S. Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC Health Serv Res. 2012;12:143. Department of Health. Aboriginal and Torres Strait Islander health curriculum framework. Canberra: Australian Government. 2014. https://www.health.gov.au/sites/default/files/documents/2020/12/aboriginal-and-torres-strait-islander-health-curriculum-framework.pdf . Accessed 10 Jan 2025. West R, Wrigley S, Mills K, Taylor K, Rowland D, Creedy DK. Development of a First Peoples-led cultural capability measurement tool: A pilot study with midwifery students. Women Birth. 2017;30:236–44. West R, Mills K, Rowland D, Creedy DK. Validation of the first peoples cultural capability measurement tool with undergraduate health students: A descriptive cohort study. Nurse Educ Today. 2018;64:166–71. Postgraduate Medical Council of Victoria. AMC candidates in the Victorian public hospital system. Melbourne: PMCV. 2002. https://catalogue.nla.gov.au/catalog/2225683 . Accessed 10 Jan 2025. Thackrah RD, Thompson SC, Durey A. Exploring undergraduate midwifery students' readiness to deliver culturally secure care for pregnant and birthing Aboriginal women. BMC Med Educ. 2015;15:77. Paul D, Carr S, Milroy H. Making a difference: the early impact of an Aboriginal health undergraduate medical curriculum. Med J Aust. 2006;184:522–5. Gradellini C, Gómez-Cantarino S, Dominguez-Isabel P, Molina-Gallego B, Mecugni D, Ugarte-Gurrutxaga MI. Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. Scoping Rev Front Psychol. 2021;12:682920. Wall W, Tucker CM, Roncoroni J, Allan BA, Nguyen P. Patients' perceived cultural sensitivity of health care office staff and its association with patients' health care satisfaction and treatment adherence. J Health Care Poor Underserved. 2013;24:1586–98. Paez KA, Allen JK, Beach MC, Carson KA, Cooper LA. Physician cultural competence and patient ratings of the patient-physician relationship. J Gen Intern Med. 2009;24:495–8. Castro A, Ruiz E. The effects of nurse practitioner cultural competence on Latina patient satisfaction. J Am Acad Nurse Pract. 2009;21:278–86. Jongen C, McCalman J, Bainbridge R. Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res. 2018;18:232. Arkles R, Hill P, Jackson Pulver L. Overseas-trained doctors in Aboriginal and Torres Strait Islander Health Services: many unanswered questions. Med J Aust. 2007;186:528–30. Marcus K, Purwaningrum F, Short S. Towards more effective health workforce governance: The case of overseas-trained doctors. Aust J Rural Health. 2021;29:52–60. Durey A, Hill P, Arkles R, Gilles M, Peterson K, Wearne S, et al. Overseas-trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains. Aust N Z J Public Health. 2008;32:512–8. Agency NIA, CTG Annual Report and Implementation Plan. 2024. Available from: https://www.niaa.gov.au/sites/default/files/documents/2024-02/ctg-annual-report-and-implementation-plan.pdf . Accessed 11 Dec 2025. Gruen RL, Yee TF. Dreamtime and awakenings: facing realities of remote area Aboriginal health. Med J Aust. 2005;182:538–40. Kehoe A, McLachlan J, Metcalf J, Forrest S, Carter M, Illing J. Supporting international medical graduates' transition to their host-country: realist synthesis. Med Educ. 2016;50:1015–32. Kalliath T, O'Driscoll M, Gillespie D, Bluedorn A. A test of the Maslach Burnout Inventory in three samples of health professionals. Work Stress. 2000;14:35–50. Sullivan EA, Willcock S, Ardzejewska K, Slaytor EK. A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997-99. Med Educ. 2002;36:614–21. Additional Declarations No competing interests reported. Supplementary Files SupplementaryInformationBMCRevised.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7023410","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495015549,"identity":"36b8aa49-2995-4a52-9e58-4b8e07702602","order_by":0,"name":"Akshay Pabary","email":"data:image/png;base64,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","orcid":"","institution":"Redland Hospital","correspondingAuthor":true,"prefix":"","firstName":"Akshay","middleName":"","lastName":"Pabary","suffix":""},{"id":495015554,"identity":"885456a5-c352-47e7-ad44-f2b412126522","order_by":1,"name":"Rachel Brimelow","email":"","orcid":"","institution":"Redland Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"","lastName":"Brimelow","suffix":""},{"id":495015557,"identity":"f744a54d-22a1-47ea-a172-a10c4621e6f1","order_by":2,"name":"Riordan Deehan Jackson","email":"","orcid":"","institution":"Redland Hospital","correspondingAuthor":false,"prefix":"","firstName":"Riordan","middleName":"Deehan","lastName":"Jackson","suffix":""}],"badges":[],"createdAt":"2025-07-01 20:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7023410/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7023410/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88406767,"identity":"f13a0047-9548-48b2-bb4d-4fc94e519fd6","added_by":"auto","created_at":"2025-08-06 08:00:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":115494,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant recruitment and eligibility\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7023410/v1/b26f202c109d535038f6c36c.jpg"},{"id":98377050,"identity":"67bd8914-50aa-455c-8ae9-206cf241881a","added_by":"auto","created_at":"2025-12-17 07:09:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":904016,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7023410/v1/6a512130-d2cf-451e-94ef-661293b13c46.pdf"},{"id":88406763,"identity":"34b9b7ea-b04b-4566-a1b4-b7c2e26153ff","added_by":"auto","created_at":"2025-08-06 08:00:30","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":28062,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryInformationBMCRevised.docx","url":"https://assets-eu.researchsquare.com/files/rs-7023410/v1/6741aa169064ff0011e13c92.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Aboriginal and Torres Strait Islander Cultural capability of overseas-trained doctors within a regional hospital health service","fulltext":[{"header":"Background","content":"\u003cp\u003eIn this paper, the term Aboriginal and Torres Strait Islander people are referred to as \u0026lsquo;First Peoples\u0026rsquo;.\u003c/p\u003e\u003cp\u003eOf the medical workforce, 32% are overseas-trained doctors (OTDs)\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. Australia\u0026rsquo;s reliance on OTDs is expected to continue into the future, with the Competent Authority Pathway for registration significantly improving OTDs\u0026rsquo; employment outcomes and enhancing Australia\u0026rsquo;s global competitiveness. This is reinforced by a history of dependence on medical migration to help redress workforce issues in remote and rural areas\u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. Despite Health Workforce Australia\u0026rsquo;s goal to reach self-sufficiency by 2025, dependence on OTDs seems certain to remain with figures revealing similar numbers of OTDs and Australian medical graduates entering the annual labour force to cope to with demand\u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, unlike Australian medical graduates, OTDs typically have little knowledge of the social determinants of First Peoples\u0026rsquo; health and the continuing impacts of colonialism\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e. Disparities in health outcomes persist, with First Peoples experiencing increased rates of chronic disease and poorer therapeutic outcomes compared to non-First People Australians\u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. Studies have shown First Peoples are less likely to access mainstream healthcare services due to a range of barriers including the high cost of health care, experiences of discrimination and poor communication with health care professionals\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. It is pivotal to provide culturally safe healthcare; to allow such biological and psychosocial needs to be met, First Peoples must be supported by a team of clinicians suitably trained in cultural safety.\u003c/p\u003e\u003cp\u003eCollectively the above research reinforces the pressing need for the evaluation and development of effective resources to support OTDs when providing culturally safe healthcare to First Peoples in their care.\u003c/p\u003e\u003cp\u003eThis study aimed to understand 1) perceived capability of OTDs following completion of the Metro South Health (MSH) \u0026lsquo;Aboriginal and Torres Strait Islander Capability Module\u0026rsquo; and 2) OTDs preference on an educational resource to help develop their cultural capability skills.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e A validated survey was conducted across a regional hospital in Queensland, Australia to explore the perceptions of OTDs on cultural capability following completion of the MSH \u0026lsquo;Aboriginal and Torres Strait Islander Capability Module\u0026rsquo;.\u003c/p\u003e\u003cp\u003eEligible participants were overseas-trained doctors employed within the Regional Health Service between 01-07-23 to 01-07-24, who had provisional registration with Australian Health Practitioner Regulation Agency (AHPRA) (Supplementary Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eDetails on recruitment can be found in Supplementary Methods.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size determination\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a pilot study with an unpowered, opportunistic sample, given the limited number of OTDs available. Sample size rationale is provided in Supplementary Methods.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurvey\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA questionnaire was distributed using REDCap, an electronic tool used to build and collect data for surveys. Additional information on survey procedure is provided in Supplementary Methods.\u003c/p\u003e\u003cp\u003ePart 1. Demographic information including age, gender and country of medical licencing was asked. Additionally, questions about completion of Aboriginal and Torres Strait Islander Capability Module and any prior cultural competency training was also included.\u003c/p\u003e\u003cp\u003ePart II. A validated 22-item Cultural Capability Measurement Tool (CCMT) was used - a questionnaire that has been developed to measure cultural capabilities according to The Aboriginal and Torres Strait Islander Health Curriculum Framework\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e. It has been originally validated in a previous study amongst midwifery students by West et al., where it has benefitted from decolonising, First Peoples-led input\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. Further to this, the CCMT has undergone several reviews, including validation with a large cohort of undergraduate health students\u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e. Given the CCMT was validated in the study with midwives of a similar sample size, this original 22-item CCMT was used. Further details of the tool and its rationale are provided in Supplementary Methods.\u003c/p\u003e\u003cp\u003ePart III. Respondents were asked on their preference on the best content and format of educational resources to enhance their capability to provide culturally safe healthcare.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEthical considerations can be found in Supplementary Methods.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were analysed using the IBM Statistical Package for the Social Sciences (SPSS) 29.0.0.0. Negatively worded items on the CCMT were reverse coded within SPSS. In addition, CCMT results were analysed in relation to the five factors found within the Framework: Respect, Communication, Safety and Quality, Advocacy and Reflection (Supplementary Table\u0026nbsp;2). In a previous pilot study with West et al, principal components analysis with varimax rotation revealed five components within the CCMT that reflected the capability constructs within the Framework\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. Good internal reliability for the factor analysis, by way of three different measurement types, was also demonstrated. Descriptive statistics included median, interquartile range, frequencies and percentages for each Likert score.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eParticipant characteristics/sample\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA sample of 21 out of 35 OTDs completed the survey. One participant completed the survey despite having obtained their medical degree from Australia, whilst four participants completed the survey having not completed the mandatory e-learning module. As a result, these responses were excluded from data analysis, resulting in a response rate of 45.7%. There was approximately equal male (n\u0026thinsp;=\u0026thinsp;7, 43.8%) and female (n\u0026thinsp;=\u0026thinsp;9, 56.3%) participants, with a mean age of 28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.54 years). The majority of OTDs obtained their medical degree in the UK (n\u0026thinsp;=\u0026thinsp;12, 75%). Other countries in which medical licencing was obtained included India (n\u0026thinsp;=\u0026thinsp;2), Qatar (n\u0026thinsp;=\u0026thinsp;1) and Iran (n\u0026thinsp;=\u0026thinsp;1). Only a minority of OTDs (n\u0026thinsp;=\u0026thinsp;2, 12.5%) had previously completed some form of cultural training in addition to the mandatory Aboriginal and Torres Strait Islander e-learning module for all staff at Metro South Health. Participant flow is represented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCultural Capability Measurement Tool Scores\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFactor 1 - Respect\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFactor 1 contained 11 items of the CCMT. Analysis of individual items revealed that participants strongly agreed that acknowledging the existence of cultural differences was the first step to becoming culturally capable [Mdn\u0026thinsp;=\u0026thinsp;5 (IQR\u0026thinsp;=\u0026thinsp;4\u0026ndash;5)], but did not agree that reflecting on their own cultural values would help them become culturally aware [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;4\u0026ndash;4)].\u003c/p\u003e\u003cp\u003eWhen participants were asked, \u0026lsquo;I find it difficult to understand the beliefs of different cultural group,\u0026rsquo; participants responded with a median score of 3 (IQR\u0026thinsp;=\u0026thinsp;2.25 to 4)], and felt comfortable working with people from different cultures [Mdn\u0026thinsp;=\u0026thinsp;4.50 (IQR\u0026thinsp;=\u0026thinsp;3.25 to 5)]. Participants agreed that understanding First Peoples social practices was applicable to their practice [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;4 to 5)].\u003c/p\u003e\u003cp\u003eParticipants agreed that evidence from research could help them in their practice of First People\u0026rsquo;s health [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;4 to 4.75)] and that their relationship with First Peoples had an impact on clinical outcomes [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;3.25 to 4.75)]. Participants also acknowledged it was the responsibility of all health professionals to improve First People\u0026rsquo;s health [Mdn\u0026thinsp;=\u0026thinsp;4, (IQR\u0026thinsp;=\u0026thinsp;4 to 5)], agreeing that a holistic approach [Mdn\u0026thinsp;=\u0026thinsp;4.50 (IQR\u0026thinsp;=\u0026thinsp;4 to 5)], comprehensive primary health care services [Mdn\u0026thinsp;=\u0026thinsp;5 (IQR\u0026thinsp;=\u0026thinsp;4 to 5)] and visible Indigenous culture in healthcare settings [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;4 to 5)] were important in improving First Peoples health.\u003c/p\u003e\u003cp\u003e\u003cem\u003eFactor 2 - Communication\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFactor 2 comprised of 4 items of the CCMT. Analysis of individual items revealed that participants neither agreed or disagreed whether First Peoples received special treatment from government [Mdn\u0026thinsp;=\u0026thinsp;3 (IQR\u0026thinsp;=\u0026thinsp;2 to 3)]. Participants reported that they did not agree First Peoples had the same level of access to health services as all other Australians [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;2 to 4)]. Participants agreed understanding First Peoples history [Mdn\u0026thinsp;=\u0026thinsp;4.50 (IQR\u0026thinsp;=\u0026thinsp;4 to 5)] and cultural values [Mdn\u0026thinsp;=\u0026thinsp;4.50 (IQR\u0026thinsp;=\u0026thinsp;4 to 5)] would inform their practice as a health professional.\u003c/p\u003e\u003cp\u003e\u003cem\u003eFactor 3 - Safety and Quality\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFactor 3 comprised of 2 items of the CCMT. Analysis of individual items revealed that participants disagreed that First Peoples were all the same [Mdn\u0026thinsp;=\u0026thinsp;2 (IQR\u0026thinsp;=\u0026thinsp;1 to 2.75)], acknowledging that history has an impact on First Peoples health [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;3.25 to 5)].\u003c/p\u003e\u003cp\u003e\u003cem\u003eFactor 4 - Advocacy\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFactor 4 comprised of 3 items of the CCMT. Analysis of individual items revealed that participants were neutral on any difficulty advocating for improvements in First Peoples health [Mdn\u0026thinsp;=\u0026thinsp;3 (IQR\u0026thinsp;=\u0026thinsp;2 to 4)], but did report some ability being cultural inclusive towards First Peoples [Mdn\u0026thinsp;=\u0026thinsp;4, (IQR\u0026thinsp;=\u0026thinsp;3 to 4)]. In addition, participants acknowledged their social responsibility to work for changes in First Peoples [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;4 to 4)].\u003c/p\u003e\u003cp\u003e\u003cem\u003eFactor 5 - Reflection\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFactor 5 comprised of 2 items of the CCMT. Analysis of individual items revealed that participants neither agreed nor disagreed on whether First Peoples are treated equally by health professionals [Mdn\u0026thinsp;=\u0026thinsp;3.00 (IQR\u0026thinsp;=\u0026thinsp;2 to 4)]. Participants agreed about their responsibility to challenge the way things are done in health practice [Mdn\u0026thinsp;=\u0026thinsp;4 (IQR\u0026thinsp;=\u0026thinsp;3 to 4.75)].\u003c/p\u003e\u003cp\u003eResponses to the CCMT are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCCMT Responses\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"23\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c21\" colnum=\"21\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c22\" colnum=\"22\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c23\" colnum=\"23\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22-item CCMT Questions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQ1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eQ3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQ4\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQ5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eQ6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eQ7\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eQ9\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eQ10\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eQ11\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eQ12\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eQ13\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eQ14\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003eQ15\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u003cp\u003eQ16\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c18\"\u003e\u003cp\u003eQ17\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c19\"\u003e\u003cp\u003eQ18\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c20\"\u003e\u003cp\u003eQ19\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c21\"\u003e\u003cp\u003eQ20\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c22\"\u003e\u003cp\u003eQ21\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c23\"\u003e\u003cp\u003eQ22\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e4.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e4.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStandard deviation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInter-quartile range\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.25 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.00 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.00 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.00 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.00 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.00 to 2.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.25 to 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.25 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4.00 to 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4.00 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e4.00 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e4.00 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e4.00 to 4.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e3.00 to 4.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e3.25 to 4.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e4.00 to 5.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e2.00 to 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e2.00 to 3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e2.00 to 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e2.00 to 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e3.00 to 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e4.00 to 4.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLikert Scores\u003c/p\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"22\" nameend=\"c23\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(68.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e10\u003c/p\u003e\u003cp\u003e(62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(68.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e10\u003c/p\u003e\u003cp\u003e(62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e10\u003c/p\u003e\u003cp\u003e(62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e(18.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpact on Practice\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA small number of participants (n\u0026thinsp;=\u0026thinsp;3, 18.75%) reported the e-learning modules had no impact on their practice, whilst a quarter of participants (n\u0026thinsp;=\u0026thinsp;4, 25%) reported increased awareness of First Peoples \u0026lsquo;\u0026lsquo;\u003cem\u003eculture\u0026rsquo;\u0026rsquo;\u003c/em\u003e, \u0026lsquo;\u0026lsquo;\u003cem\u003ebehaviour\u0026rsquo;\u0026rsquo;\u003c/em\u003e and \u0026lsquo;\u0026lsquo;\u003cem\u003epotential customs\u003c/em\u003e\u0026rsquo;\u0026rsquo;. A larger proportion of OTDs (n\u0026thinsp;=\u0026thinsp;6, 37.5%) reported a change in practice following completion of the e-learning.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI am more aware of socio-economic inequalities and challenges related to access of healthcare, so try to provide a holistic approach and plan follow-up with the patient. (Participant 4, UK Graduate)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e Changes in practice included altered communication styles, in which two participants (n\u0026thinsp;=\u0026thinsp;2, 12.5%) commented specifically on avoiding eye contact.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eMore aware of asking if they would like a HLO (Health Liaison Officer) present, avoiding intense eye contact, respecting how they may like to be treated. (Participant 8, UK Graduate)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOther participants commented on a more holistic approach (n\u0026thinsp;=\u0026thinsp;2, 12.5%), increased family involvement (n\u0026thinsp;=\u0026thinsp;1, 6.25%) and involvement of a same sex clinician (n\u0026thinsp;=\u0026thinsp;1, 6.25%) as a result of the e-learning module.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eSometimes offering same sex clinician if performing sensitive examinations to those who identify as Aboriginal or Torres Strait Islander. (Participant 6, UK Graduate)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e2 participants (n\u0026thinsp;=\u0026thinsp;2, 12.5%) chose not to comment on the e-learning module\u0026rsquo;s impact on their practice. When asked explicitly, more than half of participants (n\u0026thinsp;=\u0026thinsp;9, 56.3%) reported asking First Nations People if they wanted a hospital liaison officer present.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEducational resource intervention preference\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOverall, participants were more interested in in-person teaching (n\u0026thinsp;=\u0026thinsp;7, 43.57%) than e-learning modules (n\u0026thinsp;=\u0026thinsp;5, 31.25%), with a few specifically preferencing teaching from First Peoples themselves.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eIn-person teaching, learning directly from First Peoples if able to learn about their experiences and learn from this. (Participant 4, UK Graduate)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOne participant mentioned \u0026lsquo;\u0026lsquo;\u003cem\u003esite visits and immersion into local groups/culture\u0026rsquo;\u0026rsquo;\u003c/em\u003e would be helpful, whilst a few OTDs (n\u0026thinsp;=\u0026thinsp;2, 12.5%) preferred education from the hospital\u0026rsquo;s liaison officers.\u003c/p\u003e\u003cp\u003eSome participants expressed preference on content based around First Peoples history (n\u0026thinsp;=\u0026thinsp;3. 18.75%) as well as information on \u0026lsquo;\u0026lsquo;\u003cem\u003ecultural differences\u0026rsquo;\u0026rsquo;\u003c/em\u003e and \u0026lsquo;\u0026lsquo;\u003cem\u003ecommon pitfalls while caring for this set of patients\u0026rsquo;\u0026rsquo;\u003c/em\u003e. 2 participants (n\u0026thinsp;=\u0026thinsp;2, 12.5%) chose not to comment on content or format of educational resources.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003eMain finding of this study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOTDs reported experience and a perceived understanding of people from different cultures, which extended into a shared sense of responsibility and desire to help improve First Peoples health. However, despite completion of the e-learning module, a lack of understanding of First Peoples' history and the implications for health outcomes limited OTDs in their ability to provide culturally safe healthcare. OTDs expressed preference for both in-person teaching and e-learning modules as means of enhancing their cultural capability skills.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWhat is already known on this topic\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConcerns around recruitment of OTDs as a solution for medical workforce shortages have been reflected in reports stretching back to 2000, with issues around insufficient orientation to the Australian healthcare system and culture cited as common problems\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e. Whilst studies have demonstrated the utility of cultural education amongst healthcare professionals such as nursing, midwifery, and medical students\u003csup\u003e(\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e, there is relatively little known about the responses of OTDs to other health professional education programs. Given studies have shown treatment adherence\u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e, patient satisfaction\u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e and information seeking\u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e and sharing have been improved by culturally safe health care\u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e,\u003csup\u003e,\u003c/sup\u003e the importance of culturally safe OTDs in providing appropriate healthcare for First Peoples cannot be understated.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWhat this study adds\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBy structuring our discussion in relation to each of the five interconnected Framework factors, this study provides a clearer understanding of how OTDs\u0026rsquo; levels of cultural knowledge, awareness, and preparedness align with national cultural capability expectations. This approach helps identify where targeted educational interventions may be most beneficial for OTDs in the future.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRespect and communication\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAccording to the Framework, the factor of respect involves recognising First Peoples\u0026rsquo; ways of knowing, being and doing in the context of history, culture and diversity. This is complemented by the factor of communication, which focuses on culturally appropriate, safe and sensitive communication to facilitate impactful relationships\u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e. Our findings showed that OTDs reported an understanding and familiarity with people from different cultures, alongside a willingness to improve First Peoples health. Notably, previous studies among OTDs have not explored their willingness and sense of responsibility to improve First Peoples health. In this regard, our findings indicate that OTDs represent a promising cohort through which significant improvements in First People health can be made. On the other hand, OTDs understanding and awareness around First Peoples\u0026rsquo; culture was limited. Our findings showed that OTDs were unaware that First Peoples are less likely to access healthcare services than all other Australians. These findings are consistent among OTDs working in rural and remote Australia, who reported a similar lack of awareness of First People-related health and cultural challenges\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e. Existing research has explored the institutional and cultural barriers impeding progress in this area, all of which serves to emphasise the need for ongoing research in this field\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSafety and Quality\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe role of safety and quality involves applying evidence-based best practices in First People health care. Knowledge of First Peoples\u0026rsquo; demographic and health statistics, as well as policies and strategies regarding \u0026lsquo;Closing the Gap\u0026rsquo; are required for the provision of effective healthcare\u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e. Participants in our study confidently acknowledged the inherent differences in individual health needs among First People patients, in keeping with a general understanding that people from different cultures will require unique and tailored healthcare.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdvocacy\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs per the Framework, the role of advocacy is seen as paramount in helping recognise that the whole health system is responsible for improving First Peoples\u0026rsquo; health. This is directly supported by health practitioners in First People settings, who have recognised advocacy skills as part of an extended repertoire of attributes required by doctors\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e. Findings from this study indicated that OTDs acknowledged their social responsibility to work for change but did not feel strongly enough about actively advocating for improvements in First Peoples health. It could be that the insufficient orientation of OTDs to First Peoples' history and culture may result in a lack of understanding about the social injustices faced by this demographic, including the ongoing struggle for equitable outcomes. This lack of awareness may account for a diminished motivation among OTDs to actively advocate for improved healthcare for First Peoples. At present, there is no available data assessing the advocacy skills of OTDs in Australia, making these findings both novel and significant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eReflection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe factor of reflection is referred to as the ability to examine and reflect on one\u0026rsquo;s own cultural paradigms in the context of the healthcare challenges faced by First Peoples. Consistent with previous findings, our study indicated that OTDs shared a general awareness around health injustices, but lacked the contextual understanding needed to grasp the specific disadvantages faced by First Peoples.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEducational resource intervention preference\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRegarding content and format of appropriate cultural education, participants reported preference for in-person teaching, followed by e-learning modules. Despite the flexibility of e-learning, four OTDs who completed the survey did not finish the mandatory e-learning modules. This raises the question of whether in-person teaching may be more effective in ensuring engagement compared to e-learning. Existing research has demonstrated that appropriate training interventions can effectively enhance the delivery of culturally safe healthcare among OTDs. A comprehensive literature review of OTDs in the United Kingdom revealed effective cultural interventions should form part of a rigorous and mandatory induction, last between 3 to 5 days in length, and involve ongoing evaluation of OTDs\u0026rsquo; adjustment\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e. Interestingly, despite the importance of programme content and delivery, an organisational culture that creates a social support network and a feeling of being welcomed was considered more important for an OTDs transition into a new healthcare system\u003csup\u003e(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/sup\u003e. For incoming OTDs in Australia, Sullivan and colleagues developed a 4-week programme consisting of core-group teaching and hospital attachments centred around communication, culture and workplace skills\u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/sup\u003e. Encouragingly, OTDs reported a greater understanding of staff and communication issues following this intervention, highlighting the benefit of a more comprehensive, in-person approach to cultural education. Based on the literature and our findings, future interventions should aim to be more comprehensive, including a detailed orientation to First Peoples\u0026rsquo; history and culture.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe nature of the study predisposes responses to selection bias, in which OTDs with previous cultural experience may be more inclined to participate within the study. To account for this, participants were asked about any previous cultural competency training prior to completing the survey. Only two participants indicated they had undertaken previous cultural competency training.\u003c/p\u003e\u003cp\u003eSimilar to the previous validation study by West and colleagues\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e, there was a predominance of a single demographic in this study - specifically, the majority of OTDs had obtained their licensing in the UK. OTDs educated in other countries may have responded differently to the CCMT and helped minimise sampling bias. However, given the CCMT had previously been piloted with midwives and later with a larger sample of health professional students, the results from this survey with OTDs addresses a potential gap and helps ensure the tools applicability across varying health professions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights gaps in OTD awareness of First Nations health needs, informing the development of culturally appropriate education for incoming OTDs in Australia. Comprehensive orientation and stronger engagement with First Peoples represent promising areas for targeted future intervention, with further research needed to evaluate the impact of such programmes on improving health outcomes for First Peoples.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOTD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Overseas Trained Doctor\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMSH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Metro South Health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAHPRA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Australian Health Practitioner Regulation Agency\u003c/p\u003e\n\u003cp\u003eCCMT Cultural Capability Measurement Tool\u003c/p\u003e\n\u003cp\u003eSPSS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Statistical Package for the Social Sciences\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki for research involving human participants and received ethics approval from the Metro South Human Research Ethics Committee, reference number -\u0026nbsp;HREC/2024/QMS/108020.\u0026nbsp;All participants read a \u0026lsquo;participant information sheet\u0026rsquo; prior to taking part, and informed consent was implied through completion of the survey. Participants were informed of the aims of the study and that submission of the survey would mean they could no longer withdraw their data. No identifying information was collected from the participants to assure confidentiality. This process was clearly outlined for all participants in both the email advert and the \u0026lsquo;participant information sheet\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical trial number\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due ethical and institutional data protection policies but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research project was conducted without any external funding or financial contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRDJ and AP designed the survey and collected subsequent data. AP analysed and interpreted the data and wrote the main manuscript text. RB contributed to the final version of the manuscript and supervised the project. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany thanks are given to Dr Rachel Brimelow (Main Supervisor) and Dr Kirsten Strudwick (Research Assistance). This project would not have been possible without their assistance in study design, data collection, analysis and interpretation, project progression and write-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026rsquo; information\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAkshay Pabary is first author\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOCCRID ID:\u0026nbsp;\u003c/strong\u003ehttps://orcid.org/0009-0004-0285-2183\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWelfare AIOHa. Health Workforce. Australian Institute Of Health and Welfare. 2022. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aihw.gov.au/reports/workforce/health-workforce\u003c/span\u003e\u003cspan address=\"https://www.aihw.gov.au/reports/workforce/health-workforce\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 10 Dec 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHawthorne L. International medical migration: what is the future for Australia? Med J Aust. 2013;199(Suppl 5):18\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOECD. Health Workforce. Health workforce migration. 2023. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.oecd-ilibrary.org/content/data/3ed4148b-en\u003c/span\u003e\u003cspan address=\"https://www.oecd-ilibrary.org/content/data/3ed4148b-en\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 10 Dec 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMurray RB, Craig H. A sufficient pipeline of doctors for rural communities is vital for Australia's overall medical workforce. Med J Aust. 2023;219(Suppl 3):5\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGatwiri K, Rotumah D, Rix E. BlackLivesMatter in Healthcare: Racism and Implications for Health Inequity among Aboriginal and Torres Strait Islander Peoples in Australia. Int J Environ Res Public Health. 2021;18:4399.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAIHW, The Health, and Welfare of Australia\u0026rsquo;s Aboriginal and Torres Strait Islander Peoples. 2015. 2015. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aihw.gov.au/getmedia/584073f7-041e-4818-9419-39f5a060b1aa/18175.pdf?v=20230605181240\u0026amp;inline=true\u003c/span\u003e\u003cspan address=\"https://www.aihw.gov.au/getmedia/584073f7-041e-4818-9419-39f5a060b1aa/18175.pdf?v=20230605181240\u0026amp;inline=true\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 15 Dec 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGardiner FW, Rallah-Baker K, Dos Santos A, Sharma P, Churilov L, Donnan GA, et al. Indigenous Australians have a greater prevalence of heart, stroke, and vascular disease, are younger at death, with higher hospitalisation and more aeromedical retrievals from remote regions. EClinicalMedicine. 2021;42:101181.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAspin C, Brown N, Jowsey T, Yen L, Leeder S. Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC Health Serv Res. 2012;12:143.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDepartment of Health. Aboriginal and Torres Strait Islander health curriculum framework. Canberra: Australian Government. 2014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.health.gov.au/sites/default/files/documents/2020/12/aboriginal-and-torres-strait-islander-health-curriculum-framework.pdf\u003c/span\u003e\u003cspan address=\"https://www.health.gov.au/sites/default/files/documents/2020/12/aboriginal-and-torres-strait-islander-health-curriculum-framework.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 10 Jan 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWest R, Wrigley S, Mills K, Taylor K, Rowland D, Creedy DK. Development of a First Peoples-led cultural capability measurement tool: A pilot study with midwifery students. Women Birth. 2017;30:236\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWest R, Mills K, Rowland D, Creedy DK. Validation of the first peoples cultural capability measurement tool with undergraduate health students: A descriptive cohort study. Nurse Educ Today. 2018;64:166\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePostgraduate Medical Council of Victoria. AMC candidates in the Victorian public hospital system. Melbourne: PMCV. 2002. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://catalogue.nla.gov.au/catalog/2225683\u003c/span\u003e\u003cspan address=\"https://catalogue.nla.gov.au/catalog/2225683\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 10 Jan 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThackrah RD, Thompson SC, Durey A. Exploring undergraduate midwifery students' readiness to deliver culturally secure care for pregnant and birthing Aboriginal women. BMC Med Educ. 2015;15:77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaul D, Carr S, Milroy H. Making a difference: the early impact of an Aboriginal health undergraduate medical curriculum. Med J Aust. 2006;184:522\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGradellini C, G\u0026oacute;mez-Cantarino S, Dominguez-Isabel P, Molina-Gallego B, Mecugni D, Ugarte-Gurrutxaga MI. Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. Scoping Rev Front Psychol. 2021;12:682920.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWall W, Tucker CM, Roncoroni J, Allan BA, Nguyen P. Patients' perceived cultural sensitivity of health care office staff and its association with patients' health care satisfaction and treatment adherence. J Health Care Poor Underserved. 2013;24:1586\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaez KA, Allen JK, Beach MC, Carson KA, Cooper LA. Physician cultural competence and patient ratings of the patient-physician relationship. J Gen Intern Med. 2009;24:495\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCastro A, Ruiz E. The effects of nurse practitioner cultural competence on Latina patient satisfaction. J Am Acad Nurse Pract. 2009;21:278\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJongen C, McCalman J, Bainbridge R. Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res. 2018;18:232.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArkles R, Hill P, Jackson Pulver L. Overseas-trained doctors in Aboriginal and Torres Strait Islander Health Services: many unanswered questions. Med J Aust. 2007;186:528\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarcus K, Purwaningrum F, Short S. Towards more effective health workforce governance: The case of overseas-trained doctors. Aust J Rural Health. 2021;29:52\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDurey A, Hill P, Arkles R, Gilles M, Peterson K, Wearne S, et al. Overseas-trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains. Aust N Z J Public Health. 2008;32:512\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgency NIA, CTG Annual Report and Implementation Plan. 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.niaa.gov.au/sites/default/files/documents/2024-02/ctg-annual-report-and-implementation-plan.pdf\u003c/span\u003e\u003cspan address=\"https://www.niaa.gov.au/sites/default/files/documents/2024-02/ctg-annual-report-and-implementation-plan.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 11 Dec 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGruen RL, Yee TF. Dreamtime and awakenings: facing realities of remote area Aboriginal health. Med J Aust. 2005;182:538\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKehoe A, McLachlan J, Metcalf J, Forrest S, Carter M, Illing J. Supporting international medical graduates' transition to their host-country: realist synthesis. Med Educ. 2016;50:1015\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalliath T, O'Driscoll M, Gillespie D, Bluedorn A. A test of the Maslach Burnout Inventory in three samples of health professionals. Work Stress. 2000;14:35\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSullivan EA, Willcock S, Ardzejewska K, Slaytor EK. A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997-99. Med Educ. 2002;36:614\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cultural safety, medical education, foreign medical graduates, Indigenous","lastPublishedDoi":"10.21203/rs.3.rs-7023410/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7023410/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003e32% of the medical workforce are overseas-trained doctors (OTDs), with Australia\u0026rsquo;s reliance on OTDs expected to continue. Providing culturally safe healthcare for First Peoples is crucial, highlighting the need for effective learning and delivery of culturally safe healthcare amongst OTDs. The primary aim is to explore the perceived capability of OTDs following completion of the Metro South Health \u0026lsquo;Aboriginal and Torres Strait Islander Capability Module\u0026rsquo;. The secondary aim is to understand OTDs\u0026rsquo; preference on the best content and format of cultural education.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA pilot study consisting of surveys sent to OTDs practicing within Bayside Health Service, Queensland, Australia. Eligible participants were overseas-trained doctors employed within the Regional Health Service between 01-07-23 to 01-07-24, who had provisional registration with Australian Health Practitioner Regulation Agency (AHPRA). The survey utilised a validated 22-item Cultural Capability Measurement Tool (CCMT) to measure cultural capabilities, as well as free-text responses to elicit views on format and content of future cultural education. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS)\u0026rsquo;s statistical functions, with results presented as median, the inter-quartile range, frequencies, and percentages for each Likert score within the CCMT. Qualitative data were analysed using descriptive thematic analysis and integrated with frequency counts to highlight key patterns.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA sample of 16 OTDs (response rate of 45.7%) were recruited. OTDs reported an understanding of people from different cultures, which extended into a shared sense of responsibility to help improve First People\u0026rsquo;s health. A lack of understanding of First People\u0026rsquo;s history has limited OTDs in their ability to provide culturally safe healthcare. OTDs expressed preference for both in-person teaching and e-learning modules to enhance their cultural capability skills.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe current \u0026lsquo;Aboriginal and Torres Strait Islander Capability Module\u0026rsquo; is an effective starting tool to aid OTDs' delivery of culturally safe healthcare. Comprehensive orientation programmes represent a promising area for future development in cultural education, with potential to build on existing foundations and better equip OTDs to meet the cultural needs of First Peoples. This research contributes to broader efforts to improve health outcomes and narrow disparities between First Peoples and other Australians.\u003c/p\u003e","manuscriptTitle":"Aboriginal and Torres Strait Islander Cultural capability of overseas-trained doctors within a regional hospital health service","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:00:26","doi":"10.21203/rs.3.rs-7023410/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e234f642-66cb-48d8-98c2-ed34671a4757","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T07:08:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:00:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7023410","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7023410","identity":"rs-7023410","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}