Australian Universities Accord. Part 1: Rural health education.

The Australian Universities Accord, https://www.education.gov.au/australian-universities-accord, is seen as a once-in-a-generation review of every aspect of higher education in Australia. Submissions in response to a discussion paper have been lodged, and circulation of an interim report is imminent. By December, the full report is due with recommendations and performance targets, which will seek to improve the quality, accessibility, affordability and sustainability of higher education. Some rural and Indigenous health stakeholders have contributed to the review. However, most rural health academics, educators, researchers and community representatives have not been at the centre of this discourse, which may have profound implications for our common concerns. The goal of this editorial is to draw the attention of readers to the review. This is not an exhaustive analysis of the submissions, but a highlight of some key topics we have noted. We hope to encourage reflection and discussion within our Journal community. As the review unfolds, it will be incumbent on all of us to use the opportunities that arise to advocate for rural and remote health, education and research within Australian universities. To that end, being clear about our priorities and concerns will be vital. We are highlighting these implications in two parts. In this editorial, we will focus on rural health education, and in the October editorial, we will focus on rural health research. Universities are now billion-dollar enterprises. The extent and cost of university initiatives and the corporate nature of many processes reflect that reality. However, universities are about so much more than economic outcomes. As would be expected, respondents to the review have emphasised multiple outcomes, including social, educational, humanitarian and environmental. As the deliberations of the review unfold, it will be important to ask how we, the AJRH readership, should highlight the importance of the health, well-being and flourishing of our nation's rural, remote and Indigenous people and communities and how we might enable universities to meet the needs of these communities. We will all be acutely aware of issues affecting rural students and their academic journey. We know that rural and remote students are disadvantaged in university education and identified as an ‘equity cohort’. Rural-origin students face significant barriers gaining access to higher education with equity targets not being met. Participation and attainment rates of remote, rural and regional students remain considerably lower than those of metropolitan students. Beyond gaining access, for some students from the bush completing their studies is a further challenge. Given this foundational concern, how should the AJRH readership advocate that universities of the future improve access for, and retention of, rural students? Some respondents to the review have emphasised the need for greater regional equity in the form of broadening participation in tertiary education. They argued that rural communities need local support and facilities rather than requiring students to relocate to urban campuses. At one level, such an argument strengthens the case for nonmetropolitan universities, regional campuses and regional university centres. At a more granular level, it builds the case for place-based higher education support. This includes curriculum delivered via high-quality online learning environments, supplemented by intensive skill-based face-to-face on-campus teaching and clinical placements near home. It would require further investment in telecommunication services, online learning resources, tailored student support strategies for people learning in place and support for students to attend campus-based learning. It may extend to establishing local learning communities, face-to-face academic support, study spaces, exam support, well-being support and encouraging local cohorts of rural and remote students. Our readership shares a common concern about First Nations representation and participation in universities. That includes ensuring better support for rural-origin First Nations students and communities. So far in the review, we have noted some discussion around attention to culturally relevant student recruitment and culturally safe practices in education (including teaching), and peer-based learning. Increasing Aboriginal and Torres Strait Islander staff numbers in universities is crucial and includes ensuring that First Nations academics are given the time and opportunity to develop teaching and academic skills and expertise. In response to the above, some questions for the AJRH readership include ‘How should we emphasise system-wide approaches to increasing regional and First Nations access and equity?’ and ‘Can we deliver improved health-related curricula that will allow people to study in place?’ Rural and remote communities require graduates who are skilled, competent and confident clinicians, rather than technicians. For rural communities, we require a university education, which has been a transformative experience rather than a transactional service. As above, a question for the AJRH readership is ‘How might we best support transformative opportunities for skill development?’ The Australian Universities Accord review is concerned with how universities in coming decades might better support the skill development of students for the careers of the future. Australian universities are not producing enough graduates to address current and projected rural health workforce skill shortages. We cannot assume that prospective students will seek programs on the basis of areas of need. How might we incentivise career choices that address rural health skill shortages? A further dimension of skill development for health-related careers in rural and remote communities is lifelong learning. This pertains to ongoing professional skill development and training for transitions into health-related careers. How can we support lifelong learning across vocational and university sectors to continually foster health career transitions as well as enable professionals to work at their optimum scope of practice. In particular, ‘Can we strengthen or reform teaching and promote lifelong learning, so it is conducive to acquiring the skills required for rural and remote practice in coming decades?’ Health student placements are a vital strategy in skill development. However, in many instances across regional Australia, costs are prohibitive for students to relocate for study or for placements. One focus for our attention via the review might be to have greater equity of funding across different health professions. For some health professions in certain contexts, there is no funding, whereas for others, there are multiple financial incentives and a rich array of educational supports. Likewise, to promote greater equity across different localities, we may advocate for location-based scholarships to support place-based study and local student placements. These would support and incentivise students to complete placements in rural and especially remote locations (and ensure the required infrastructure). These are just a few of the issues relevant to our common concerns. The key issue is that since universities provide the training and foundational skill development of the majority of health professionals, the clarity and strength of our advocacy will influence rural and remote health, education and research within Australian universities for decades to come. We welcome comments and discussion on these matters and will draw attention to rural health research matters in Part 2. All authors contributed equally to writing this editorial. No ethics approval necessary.