# The Anabranch Framework for the Ruralization of Health Professional Education

## TL;DR

This paper introduces a framework to improve health education for rural and First Nations communities by addressing urban-centric biases and promoting equity in healthcare.

## Contribution

The Anabranch Framework is a novel high-level strategy for ruralizing health professional education to address systemic inequities and workforce shortages.

## Key findings

- Urban-centric education biases deter rural and First Nations healthcare practice uptake.
- The Anabranch Framework includes four rural domains and constructs to guide rural health education reform.

## Abstract

What are the main findings?
Health professional education is routinely dominated by urban-centric and colonizing worldviews that act to deter practice uptake in rural, remote, and First Nations communities.The lack of rural, remote, and First Nations theory, pedagogy, practice, and connectivity in health professional education further marginalizes and stigmatizes these populations, places, and healthcare provision, undermining health equity attainment.

Health professional education is routinely dominated by urban-centric and colonizing worldviews that act to deter practice uptake in rural, remote, and First Nations communities.

The lack of rural, remote, and First Nations theory, pedagogy, practice, and connectivity in health professional education further marginalizes and stigmatizes these populations, places, and healthcare provision, undermining health equity attainment.

What are the implications of the main findings?
Insight into the challenges confronted by the Australian University Departments of Rural Health in the ruralization of health professional education and practice in achieving substantive health and health workforce outcomes.High-level strategic guidance to inform the ruralization of health professional education towards equity-orientated healthcare and the development of a rural-literate, competent, and committed health workforce.

Insight into the challenges confronted by the Australian University Departments of Rural Health in the ruralization of health professional education and practice in achieving substantive health and health workforce outcomes.

High-level strategic guidance to inform the ruralization of health professional education towards equity-orientated healthcare and the development of a rural-literate, competent, and committed health workforce.

Background/Objective: The quality of care afforded to rural, remote, and First Nations Peoples is dependent on access to a health workforce with the capacity to contextualize healthcare and practice to the needs and expectations of these populations. In Australia, the lack of representation of rural health in undergraduate and post graduate health professional education undermines this preparedness and consideration of rural practice uptake and longevity, compounding the inequities confronted by 7 million Australians residing in these locations. Urgent educational reforms are required to address this omission, the deficit discourses used to characterize rural healthcare, and the persistent health workforce shortages experienced. This paper presents the Anabranch Framework for the Ruralization of Health Professional Education, a high-level strategy to transform rural healthcare provision, professional practice, and health workforce outcomes. Methods: The framework was developed through an iterative process involving a series of systematic steps. The process included the following: individual and group critical dialogues with internal academic educators, external health service leaders, metropolitan academic allies, and leaders of other rural health academic departments; an internal review of empirical studies of relevance to the ruralization of health professional education and practice; the visualization of a place-based framework; the academic conceptualization of the framework; and further critical dialogues to test the framework’s face validity. Results: The Anabranch Framework comprises four inter-related rural domains: theories, pedagogies, practices, and connectivity; four constructs: knowledge acquisition and generation, immersion in rural curriculum, knowledge translation and sharing, and relational practice; and two structural elements: spiraled and scaffolded curriculum and duration and the quality of rural placement and practice. Conclusions: The Anabranch Framework is a high-level strategy to ruralize health professional worldviews, advance rural person-centered practice, enable a deeper understanding of rural places and the development of an equity-orientated, sustainable and rural-literate health workforce.