A consistent definition of cultural safety within Australian health professional education: a scoping review

Abstract

This scoping review aims to explore how cultural safety is defined in the Australian literature with health professional learners in clinical interactions. It maps how the components of the Australian Health Practitioner Regulation Agency definition of cultural safety align with this evidence. Databases were systematically searched for original, peer-reviewed research that included Australian Aboriginal and Torres Strait Islander peoples, health professional learners who were eligible for registration in Australia, teaching and assessment. Many elements of cultural safety lacked Indigenous input and had no patient involvement. General consultation and communications skills were key components of culturally safe interactions. The Australian Health Practitioner Regulation Agency consensus statement on cultural safety provides a consistent definition for teaching and learning cultural safety within health professions in Australia. The findings suggest that developing an approach for cultural safety requires incorporation of Indigenous voices, patient-centred care metrics, patient feedback, learner self-assessment and attitude measures.

Keywords

cultural competency cultural safety education health professional Indigenous

Background

Australia, like New Zealand, Canada and the United States, is a colonised country (Paradies, 2016). Aboriginal and Torres Strait Islander peoples are the sovereign owners of this land (Department of Prime Minister and Cabinet [DPMC], 2017). Colonisation has caused a “torment of powerlessness” with resultant negative impacts on the health and well-being of these peoples (DPMC, 2017, p. i). This includes a life expectancy gap of 8.6 years for males and 7.8 years for females (Productivity Commission, 2020). Life expectancy is influenced by many factors including behavioural risk factors, social and cultural determinants of health (Australian Institute of Health and Welfare [AIHW], 2020).

Addressing cultural determinants of health care is a core requirement for Australian health education providers. The Australian Medical Council (2012, 2015) standards for medical programmes currently require graduates to demonstrate effective and culturally competent communication and care for Australian Indigenous peoples, hereafter, respectively, referred to as Indigenous peoples. This is supported by the Aboriginal and Torres Strait Islander Health Curriculum Framework (The Framework) that describes graduate learning outcomes including culturally safe communication (Department of Health and Aged Care [DHAC], 2014).

Determining whether, or how, a student has sufficiently demonstrated this communication and care is a challenge for health academics to address. Validated student assessments are mostly limited to self-assessed measures of changes resulting from classroom-type teaching environments (Lin et al., 2017; West et al., 2017). For instance, West et al. (2017) reported development of a cultural capability assessment tool for Australian nursing students driven by the lack of validated tools to measure the development of cultural capabilities as described in The Framework (DHAC, 2014). Furthermore, there is a paucity of detail on how to assess cultural safety within clinical consultations (DHAC, 2014; Phillips, 2004; Universities Australia, 2011). For example, the Royal Australian College of General Practitioners (RACGP, 2016a) describes assessment of cultural safety through small-group projects, literature reviews, essays, observations, simulations, role-play, third-party reports, written and verbal questioning, reflective practice reports, participation in face-to-face and online assessment activities. However, there are no further details on criterion for demonstration of cultural safety, benchmarking of standards or examples of best practice for each activity (RACGP 2016a, 2016b). Moreover, the linkage between cultural training and subsequently improved patient outcomes is lacking (Francis-Cracknell et al., 2019; Horvat et al., 2014; Jongen et al., 2018a; Lie et al., 2011; Truong et al., 2014).

Contributing to this shortfall of evidence for the effectiveness of training and assessment of these cultural determinants is a lack of a consistent definition for this concept (Jongen et al., 2018a). The medical education literature contains many different terminologies and varying definitions for the concept of cultural determinants and health care (Grant et al., 2013): for example, cultural awareness, safety, competence, capability, responsiveness, security and respect (DHAC, 2014); cultural respect and sensitivity (National Aboriginal Community Controlled Organisation, 2011); culturally appropriate (Woolley et al., 2013); cultural humility (Chang et al., 2012); and cultural desire (Isaacs et al., 2016) are all overlapping terms. Some see awareness, sensitivity, and safety as a progression of skill (Ryder et al., 2019). The cultural providence and cultural voice in these definitions is frequently absent or unclear (Lock, 2019). As such, in December 2019, the Australian Health Practitioner Agency (AHPRA) released a consensus statement defining cultural safety to unify language in Australia. Significantly, this definition was arrived at through a consultative process led by Indigenous peoples, culminating in the definition:

Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practise is ongoing critical reflection of health practitioner knowledge, skills, attitude, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism. (AHPRA & National Boards, 2019, p. 1)

Adoption of this definition is variable. For example, the National Aboriginal and Torres Strait Islander Health Plan 2021–2031 embeds this definition (DHAC, 2021). However, the 2021 revision of The Framework uses an older definition (DHAC, 2014). Implementation of this consensus definition provides impetus and opportunity to review current curricula for alignment with this definition and its principles. Defining the input from Aboriginal and Torres Strait Islander peoples in previous work and ensuring cultural safety is defined by Aboriginal and Torres Strait Islander peoples are fundamental to this process (Atkinson et al., 2021).

Method

This review explores Australian literature focusing on the cultural determinants of health, how cultural safety, or other similar terms—henceforth referred to simply as cultural safety—are defined and how the components of the AHPRA cultural safety consensus statement align with this body of evidence. We studied health professional learners in clinical interactions with patients. The review focusses upon demonstrating best practice in Indigenous research by calling attention to Indigenous voices and researchers (Australian Institute of Aboriginal and Torres Strait Islander Studies [AIATSIS], 2020).

A scoping review was chosen as we were seeking to clarify alignment of the AHPRA consensus statement with concepts, definitions and key characteristics in the literature (Munn et al., 2018). This review was unregistered.

In undertaking this literature review it is important to acknowledge the stance of the authors. K.B. is a general practitioner (GP) who both practises in Aboriginal health and medical education. K.B.’s cultural heritage is uncertain and is impacted by the complexities surrounding Aboriginal identity within Australia (Carlson, 2016). R.W. is an Aboriginal academic from Kunja Nations, R.E. a researcher and T.S.G. an academic GP.

Search strategy

The search was undertaken in October 2019 and then automated search findings reviewed as received. An initial search of MEDLINE OVID and CINAHL was undertaken in conjunction with a university librarian. This initial search was followed by analysis of the text words contained in the title and abstract, and of the key terms used to describe the article. This informed the development of a search strategy which was tailored for Scopus, EmCare, ERIC ProQuest, Informit and PsycInfo.

Search terms for the concept of cultural safety included competency, respect, safety, capability, humility, responsiveness, awareness, congruence and security. Trial searches with the terms appropriate, sensitivity and desire did not identify any additional papers. Databases were searched for health professional learners using terms that included undergraduate and post-graduate health and medical students, interns, registrars and health professionals participating in ongoing professional development. This strategy and search terms were applied for each database. No year limits were applied to the searching. Following this the reference lists of all papers selected for critical appraisal were screened for any additional studies that may also meet inclusion criteria. All papers found were written in English.

Inclusion and exclusion criteria

Titles and abstracts for peer-reviewed original research were screened against inclusion and exclusion criteria. To enable reporting of Indigenous contribution, only peer-reviewed journal articles, reporting primary research, where authorship and origin of data could be attributed to individuals were included. Other inclusion criteria were relating to Australian Aboriginal and Torres Strait Islander peoples, health professional learners who were eligible for registration in Australia with AHPRA and outcomes of interest such as the teaching and assessment of cultural impact and cultural safety within a patient–learner interaction in health professional education in Australia.

As this study was exploring the individual patient–clinician interaction, publications reporting student experience, cultural immersion, disease-specific interventions, curriculum development and delivery or systems related that examined parameters such as practice policy (Jongen et al., 2018a) were excluded. Studies that focussed only on learning within the classroom or online setting were excluded as Mills et al. (2018) had previously reported the key components of cultural competency training in this setting.

Identification and screening of publications

The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) diagram outlines the article screening process (Supplementary Figure 1). K.B. applied eligibility criteria to title and abstract for initial screen. Full texts were independently assessed for inclusion in the systematic review by K.B. and an experienced researcher, J.P., who was not part of the research team. Disagreements between individual judgements were resolved by R.E.

Data extraction and synthesis

Data were extracted using both Excel and NVivo for data management and included Indigenous authorship and research team, definition used for cultural safety and the origin of the definition, the person or people describing the characteristics of Aboriginal and Torres Strait Islander cultural safety, participant demographics, study population size, research setting and characteristics described as being related to cultural safety. A Critical Appraisal Skills Programme (CASP, 2019) checklist was also completed for each paper. Characteristics of cultural safety were, where possible, coded against components of the 2019 AHPRA consensus statement defining cultural safety. Indigenous researcher and involvement of Aboriginal and Torres Strait Islander communities and patients were highlighted.

Results

Summary of articles

Included articles (n = 10) are summarised in Supplementary Table 1. All studies were published since 2013. Most of the included articles were written by two author research groups: four were authored by Abbott and Reath (Abbott et al., 2014a; Abbott et al., 2014b; Reath et al., 2018; Watt et al., 2015) and three were authored by Thackrah and Thompson (Thackrah et al., 2014, 2015; Thackrah & Thompson, 2018). With respect to the Thackrah articles, only the research relating to the cultural immersion or clinical placement was considered.

The only health students represented in the studies were medical and nursing professions with no allied health students included. Three articles applied to the same sample group of seven midwifery students (Thackrah et al., 2014, 2015; Thackrah & Thompson, 2018).

All study designs included a qualitative element to their methodology. Three mixed-methods papers incorporated surveys, observations, and interviews (Hart et al., 2015; Reath et al., 2018; Thackrah & Thompson, 2018) and other qualitative papers used semi-structured interviews (Abbott et al., 2014a; Askew et al., 2017; Thackrah et al.,2014, 2015; Watt et al., 2015), content analysis approach (Abbott et al., 2014b), and participatory action research (Woolley et al., 2013). The CASP checklist–suggested articles by Hart et al. (2015), Thackrah and Thompson (2018), and Thackrah et al. (2015) have lower value in this context (CASP, 2019).

No articles had an Indigenous lead researcher. Six articles attributed authorship to Aboriginal researchers (Abbott et al., 2014a; Abbott et al., 2014b; Askew et al., 2017; Hart et al., 2015; Reath et al., 2018; Woolley et al., 2013). However, two of these articles did not identify the authors as Indigenous (Hart et al., 2015; Woolley et al., 2013). This information was found by searching Google and contacting corresponding authors.

All projects had Indigenous people involved in the studies in various ways. For the Thackrah studies, this was limited to the development of the curriculum module that formed the foundation of the pre-placement cultural training rather than the conduct of the research (Thackrah & Thompson, 2018). Both Watt et al. (2015) and Reath et al. (2018) describe the importance of Aboriginal cultural mentors in their research. For Watt et al. (2015), this involved cultural mentoring sessions throughout data collection, and for Reath et al. (2018), the research team being supported by a national reference group of senior Aboriginal cultural educators and mentors.

Three studies did not include description of Indigenous community-led research processes (Thackrah et al., 2014, 2015; Thackrah & Thompson, 2018). They describe placement being arranged by an interested student, academics, and a midwife at the placement site. Watt et al. (2015) and Abbott et al. (2014a) imply collaboration with the Indigenous community through the engagement of cultural mentors (Watt et al., 2015) and a cultural mentor network (Abbott et al., 2014a). The other four studies demonstrated engagement with cultural educators, cultural mentors, Aboriginal Community Controlled Health Organisations (ACCHOs), National ACCHO (NACCHO)—the national peak representative body of ACCHOs and a partnership with the Mt Isa Aboriginal community (Abbott et al., 2014b; Hart et al., 2015; Reath et al., 2018; Woolley et al., 2013).

The cultural provenance and cultural voice (Lock, 2019) in defining cultural safety was frequently difficult to determine. There was no consistent definition used and definitions ranged from none (Askew et al., 2017; Reath et al., 2018) to a complex reference citing over 20 differing sources (Abbott et al., 2014a) (Supplementary Appendix 1).

Only three studies had the learner characteristics of cultural safety described by Australian Indigenous people (Abbott et al., 2014a; Reath et al., 2018; Woolley et al., 2013). In the other studies, the attributes were derived by students or other medical practitioners. Patients were not involved in defining cultural safety components in any of the studies under review.

Key attributes of student behaviours, gleaned from the articles, were coded to the components of cultural safety as detailed in the AHPRA definition including critical or self-reflection, knowledge, skills including general communication and consultation skills, attitudes and practising skills. These are summarised in Supplementary Table 2.

Discussion

This review described how cultural safety is defined in studies with health professional learners in clinical interactions and how the components of the AHPRA cultural safety consensus statement align with this body of evidence. It seems many of the elements of cultural safety in this review were derived from a paradigm of the dominant culture including the research lead, definitions used and research participants (Lock, 2019). The review found some alignment of existing evidence with the AHPRA consensus statement but also areas that require further research. It would be expected that future research will be improved by adherence to guidelines for the ethical conduct of research (National Health and Medical Research Council, 2018) and positioning with the AHPRA definition and its principles. The use of a tool such as the Aboriginal and Torres Strait Islander quality appraisal tool might assist in appraising the quality of research in this setting (Harfield et al., 2020). This further discussion is framed by the key elements of the AHPRA definition which are used to summarise the main findings from this study.

Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families, and communities—The priority for Indigenous voices in research has been highlighted (National Health and Medical Research Council, 2018). The role of the patient in development of a cultural safety clinical teaching and assessment process has not been well considered in the literature, with no patients directly involved in any of the studies. Caution needs to be taken to ensure the dominant culture does not determine the cultural safety of a consultation. In doing this, the role of the Aboriginal cultural mentor and cultural educator in contributing to the development of a culturally safe workforce as patient representatives is important to consider (Reath et al., 2018).

Involving patients in feedback is not new. Patient-reported experience measures (PREMs) are a routine component of the Australian health care system (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2012; Bull et al., 2019; RACGP, 2014) yet are not routinely used for assessment of cultural safety. A 2019 systematic review of PREMs (Bull et al., 2019) reported four articles from the Australian context including the practice accreditation and improvement survey (Greco et al., 2001). This survey and the dentistry equivalent (Narayanan & Greco, 2014) included items such as respect, warmth, ability to really listen and consideration of personal situation. An additional questionnaire by Oades et al. (2010) included items exploring stigma, power and powerless, relationship with community and family and staff, information and education and holistic care. Multi-source feedback assessment was the only measure of GP registrar cultural safety involving patient feedback found in the literature (Australian College of Rural and Remote Medicine [ACRRM], 2019). This is not unique to the medical profession with an integrative review of measures of cultural competence in nurses also finding no objective measures from a patient’s perspective (Loftin et al., 2013).

Cultural safety is ongoing critical reflection—Four of the 10 articles identified self-reflection as important. Validated assessment tools to encourage self-reflection are limited to self-assessments (West et al., 2018) without any external inputs to determine learner insight. The cultural capability measurement tool (CCMT) (West et al., 2017) measures five self-reported key factors—respect, communication, safety and quality, advocacy, reflection—and has been validated in Australian nursing students. While self-assessment is understood to be critical in professional identity formation and lifelong learning (Cruess et al., 2015; Jongen et al., 2018b), it needs to result in positive behaviour change and to measurabely reduce bias and racism.

Cultural safety is ongoing critical reflection of knowledge—Currently, curriculum frameworks for teaching cultural safety have a foundation of pre- and post-colonial history (DHAC, 2014; Phillips, 2004; RACGP, 2011). Many methods to assess cultural safety focus on historical knowledge as a direct indicator of cultural safety (Bainbridge et al., 2015). In only two papers (Abbott et al., 2014a, 2014b) was the importance of Aboriginal history a strong theme, and only one of these papers included Indigenous voices (Abbott et al., 2014a). The Aboriginal people of Mt Isa did not identify historical knowledge as a desired attribute for medical graduates (Woolley et al., 2013).

Cross et al. (1989) argue that without knowledge learners may develop “cultural blindness” (as cited in Abbott et al., 2014b, p. 6). Cross et al. describe cultural blindness as

where healthcare providers and services aim to provide the same care to all clients regardless of culture and ethnicity and, although often well intentioned, favours the clients most assimilated into the dominant culture and can lead to healthcare providers overlooking opportunities to reduce health disparities. (1989, as cited in Abbott et al., 2014b, p. 6)

Further arguments for not including Indigenous history and culture in the curriculum relate to the increased risk of stereotyping and assumptions (Abbott et al., 2014b), potential disempowerment by creating a knowledge gradient where the health practitioner may be the holder of greater historical and cultural knowledge (Ramsden, 2002) and lack of evidence that knowledge improves cultural safety and patient outcomes (Lie et al., 2011; Mills et al., 2018). It is asserted that if a patient-centred approach is adopted, the importance of ethnicity and culture will emerge over time (Abbott et al., 2014b). Hollinsworth (2013) argues that learners should “forget cultural competence and ask for an autobiography,” that is, rather than focusing on knowledge as a commodity to be “acquired and applied in ways to ensure maximum efficiency,” that health professionals should deeply listen to a patient’s narrative and what is important to the individual (p. 1048).

As the link between knowledge and culturally safe care is not established (Horvat et al., 2014; Mills et al., 2018), further research in this area is required.

Cultural safety is ongoing critical reflection of skills and practising behaviours—Skills and practising behaviours identified in the review include a variety of factors such as patient-centred care, clinical skills and general communication and consultation skills including active listening, appropriate language, establishing rapport, respect and trust. However, the voice of Indigenous patients was not well privileged or prioritised and as such questions the validity of these data.

Trust and respect were the most frequently identified characteristics of culturally safe care. Trust is integral and foundational to a GP consultation and is known to be facilitated, in general, by a range of factors including improved communication, shared decision-making, adequate time, continuity of care and congruence of doctor and patient beliefs (Croker et al., 2013). These factors overlap with the features of patient-centred care. Patient-centred care is a pivotal approach to GP consultations within Australia (ACSQHC, 2011; Delaney, 2018) and promotes flexibility to accommodate patient preferences and values (Brouwers et al., 2017). Brouwers et al. (2017) have described 14 different instruments for the objective assessment of patient-centred care. None of these instruments are in common use in Australia, or appear to have been validated in the Australian population. Similarly, there are over 20 measures for physician–patient communication but none that are specific to the Australian Indigenous population (Zill et al., 2014). Furthermore, there are no quality indicators for measuring cultural safety within patient-centred care (Ahmed et al., 2018).

The emergent work of McKivett et al. (2019) on a framework for improved communication with Aboriginal patients may shape assessment models in Australia. Huria et al. (2014) have adapted the Calgary-Cambridge guide—a commonly used structure for a patient-centred consultation (Kurtz et al., 2003)—a culturally specific, and ultimately increasingly culturally safe, model of consultation for Māori patients. Unique to this Meihana model is conceptualisation of how factors such as marginalisation, colonisation, migration, racism, connection to country, family and cultural protocols impact upon health care (Pitama et al., 2017).

Any new measure of cultural safety must explore this complexity of interplay between patient-centred care and cultural safety.

Cultural safety is ongoing critical reflection of attitude—Respect was the strongest theme across the articles with only three articles not highlighting this attribute. Numerous self-assessment tools exist to measure learners’ behaviour and attitude, including the previously mentioned CCMT designed for nurses (West et al., 2017). Ryder et al. (2019) developed and validated a questionnaire for use by health professionals and medical students to measure attitude change following completion of a cultural safety training programme. Both questionnaires by West et al. (2017) and Ryder et al. (2019) occur outside of the context of patient interaction and are self-assessed measures of attitude. A learner’s response in these questionnaires and surveys may not accurately reflect their behaviour, or the opinion and experience of the patient (Carr et al., 2011).

Within the patient-centred care frameworks, attitude is not explicitly included (Delaney, 2018). In delineating the difference between culturally competent care and patient-centred care, Abbott et al. (2014b) highlight the centrality of attitude:

Culturally competent care is aligned to patient-centred care in terms of a respectful approach and a shared commitment to healthcare which is effective and acceptable to individuals in their context. However, it goes beyond this to explicit recognition of the power differential that exists between the dominant culture and other peoples and an active commitment to equity of care. (p. 6)

An assessment of cultural safety is likely to need incorporation of patient-centred care and attitude measures.

Cultural safety is ongoing critical reflection of power differentials—Power differentials was not a strong theme in the included articles. Power differentials frequently exist in general practice due to sociocultural differences such as a diversity of world views (Jongen et al., 2018a), and a disparity in social determinants of health care including income, education, employment, racism and colonisation (AIHW, 2020; Paradies et al., 2015; Reath et al., 2018). The Pitama et al. (2017) Meihana model provides a useful guide to incorporation of these in consultations but questions remain on how to assess this in a consultation.

Cultural safety is responsive health care free of racism—two of 10 articles in this review identified recognition of unconsious racism (Abbott et al., 2014a) and knowing racism exists (Woolley et al., 2013) as important. A 2013 meta-analysis by Paradies et al. (2015) demonstrated a clear link between racism and poorer health outcomes. The incidence of racism in a medical setting has been reported at 32.4% among Indigenous patients (Cunningham & Paradies, 2013), and 54% of Indigenous health professionals, compared to 37% for other health professionals (Australian Indigenous Doctors’ Association [AIDA], 2016). A patient-driven assessment of cultural safety may introduce the patient’s own bias, including potential racial bias. The development of a process where the influence of both patient and learner biases may be identified and qualified is likely to be central to assessing a culturally safe consultation.

Limitations

The review found limited papers on cultural safety among health learner groups in Australia. The validity and merit of our review is limited by minimal Indigenous input (AIATSIS, 2020). We only reviewed Australian, peer-reviewed literature. Grey literature may further inform this topic. A comparison of similar Indigenous health contexts such as New Zealand and Canada may add to this work, but risks limited generalisability due to cultural diversity.

Conclusion

The AHPRA consensus statement on cultural safety provides a consistent definition for teaching, assessment and research within health professions in Australia. The review found that there was some literature that aligned with the AHPRA consensus statement but also several areas that require further research. Indigenous voices, determining the cultural safety of consultations, have not been amplified in the past. Moving forward, developing an approach that incorporates Indigenous voices, patient-centred care metrics, patient feedback, learner self-assessment and attitude measures may start to encapsulate the complexity of teaching and assessing cultural safety in Australia. Designing a culturally respectful approach to the assessment of cultural safety for health professionals must ensure that cultural safety is determined by Australian Indigenous peoples and deserves further research.

Supplemental Material

sj-docx-1-aln-10.1177_11771801221118950 – Supplemental material for A consistent definition of cultural safety within Australian health professional education: a scoping review

Supplemental material, sj-docx-1-aln-10.1177_11771801221118950 for A consistent definition of cultural safety within Australian health professional education: a scoping review by Kay Brumpton, Rebecca Evans, Raelene Ward and Tarun Sen Gupta in AlterNative: An International Journal of Indigenous Peoples

Supplemental Material

sj-docx-2-aln-10.1177_11771801221118950 – Supplemental material for A consistent definition of cultural safety within Australian health professional education: a scoping review

Supplemental material, sj-docx-2-aln-10.1177_11771801221118950 for A consistent definition of cultural safety within Australian health professional education: a scoping review by Kay Brumpton, Rebecca Evans, Raelene Ward and Tarun Sen Gupta in AlterNative: An International Journal of Indigenous Peoples

Supplemental Material

sj-docx-3-aln-10.1177_11771801221118950 – Supplemental material for A consistent definition of cultural safety within Australian health professional education: a scoping review

Supplemental material, sj-docx-3-aln-10.1177_11771801221118950 for A consistent definition of cultural safety within Australian health professional education: a scoping review by Kay Brumpton, Rebecca Evans, Raelene Ward and Tarun Sen Gupta in AlterNative: An International Journal of Indigenous Peoples

Supplemental Material

sj-docx-4-aln-10.1177_11771801221118950 – Supplemental material for A consistent definition of cultural safety within Australian health professional education: a scoping review

Supplemental material, sj-docx-4-aln-10.1177_11771801221118950 for A consistent definition of cultural safety within Australian health professional education: a scoping review by Kay Brumpton, Rebecca Evans, Raelene Ward and Tarun Sen Gupta in AlterNative: An International Journal of Indigenous Peoples

Footnotes

Acknowledgements

Dr Janani Pinidiyapathirage, Rural Medical Education Australia—Screening articles for inclusion and exclusion.

Authors’ note

Kay Brumpton, Associate Professor, is a GP with over 25 years’ experience in Aboriginal health and over 15 years’ experience in medical education and general practice training. She is Subdean Rural of the Griffith Medical Program and Director of Education and Training at Rural Medical Education Australia (RMEA). Associate Professor Brumpton with Professor Sen Gupta, Dr Evans and Associate Professor Ward have recently published a paper exploring cultural safety assessment in general practice in the Australian Journal of General Practice.

Rebecca Evans is a researcher with experience in qualitative, quantitative and mixed-methods designs. Dr Evans has a track record of research student supervision from Honours through PhD levels.

Raelene Ward, Associate Professor, is an Aboriginal Kunja woman, originating from Cunnamulla. She has been a practising nurse for 30 years and is an early-career researcher. She has worked extensively across several sectors: universities; rural, remote and regional communities; government organisations; and the Aboriginal Community Controlled Health sector. Associate Professor Ward works in the Nursing programme at the University of Southern Queensland undertaking research, teaching and community engagement.

Tarun Sen Gupta, Professor, is an experienced GP, academic and researcher. He is Professor of Health Professional Education and Head of the Townsville University Hospital Clinical School at James Cook University. He is experienced in assessment of GP registrars and medical students and has experience in qualitative, quantitative and mixed-methods research designs.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

ORCID iD

Kay Brumpton

Supplemental Material

Supplemental material for this article is available online.

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