An Indigenist review of the development of the Aboriginal and Torres Strait Islander Emergency Medicine workforce in Australia. Recommendations for future proofing success, not just parity.
Australasian College for Emergency Medicine
Who funded the project
The Australasian College for Emergency Medicine (ACEM) commissioned this Indigenist review to deepen understanding of the experiences of Aboriginal doctors within Emergency Medicine (EM) training and practice. Initiated by an Aboriginal ACEM Fellow in response to sustained cultural and colonial load, and supported by ACEM through its Indigenous Health Strategy, Reconciliation Action Plan, and Specialist Training Program Support Project, the review provides an evidence base for strengthening Aboriginal participation, retention, and leadership within the EM Fellowship pathway.
The review was delivered by Karabena Consulting, using an Indigenist evaluation methodology grounded in Indigenous ways of knowing, being, and doing. The approach prioritised relational accountability, self-determination, and Indigenous cultural governance, ensuring Aboriginal voices retained authority throughout all stages of the work.
The purpose of this project was to document lived experience, analyse the structural and institutional conditions shaping those experiences, and identify reforms required to create a culturally safe, sustainable, and high-performing Emergency Medicine workforce. The review moves beyond parity-based approaches, positioning cultural safety, Indigenous governance, and institutional accountability as core requirements for workforce excellence.
Summary
The project sought to:
Document the lived experiences of Aboriginal Emergency Medicine trainees, Fellows, and doctors who have paused or exited training.
Analyse structural and cultural factors affecting recruitment, retention, progression, and wellbeing within ACEM training pathways.
Identify enablers of success, including mentorship, peer support, and culturally safe learning environments.
Provide ACEM with actionable, Indigenist-informed recommendations to support sustainable Aboriginal participation and leadership in Emergency Medicine.
Project Aims
The methodology adopted an Indigenist framework in conjunction with Western methodologies. Key elements included:
An Indigenous-led, Indigenist methodological approach grounded in self-determination, relational accountability, culturally grounded yarning, and Indigenous data governance.
Recruitment through Indigenous professional networks using invitation-based protocols that prioritised trust, informed choice, and participant control.
Qualitative yarning interviews with Aboriginal doctors, including audio-recording, transcription, and participant verification of transcripts and findings.
Quantitative review of ACEM’s Indigenous Trainee and Fellow Survey to provide institutional context without displacing lived experience.
Iterative, Indigenous-led thematic analysis incorporating investigator workshops, reflexivity, and shared interpretive control.
Ethical and cultural governance embedded across recruitment, data collection, analysis, reporting, and data management.
Methodologies
Outputs
The project delivered two comprehensive reports as its primary outputs.
An Indigenist Review of the Development of the Aboriginal and Torres Strait Islander Emergency Medicine Workforce in Australia
Appendices to the Indigenist Review of the Development of the Aboriginal and Torres Strait Islander Emergency Medicine Workforce in Australia
Emergency Medicine strongly appeals to Aboriginal doctors motivated by service, community responsibility, and fairness in care. However, participation and progression are shaped more by individual effort than by structured, culturally safe systems.
Some of the key project findings included:
Recruitment into Emergency Medicine is rarely planned and occurs mainly through clinical exposure rather than targeted or structured outreach.
Early visibility of Emergency Medicine within Indigenous medical pathways is limited, with unclear training information and few visible Aboriginal role models.
Aboriginal trainees demonstrate high resilience and commitment but face structural barriers including cultural taxation, racism, inflexible training, and limited culturally safe mentorship.
Mentorship and peer support are critical to retention, confidence, and wellbeing, with absence of support increasing isolation and burnout.
Gendered and intersectional pressures, particularly caring responsibilities, compound training and examination demands.
Aboriginal Fellows remain highly engaged as mentors, educators, and advocates, often through unpaid cultural and leadership labour, contributing to fatigue and attrition risk.
Project Outcomes
#ACEM
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