{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T23:45:40Z","timestamp":1791762340106,"version":"4.3.4"},"reference-count":34,"publisher":"CSIRO Publishing","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"The New Zealand Medical Education Trust","award":["2024"],"award-info":[{"award-number":["2024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rural medicine is shaped by geographic distance from resources and specialist care, requiring broad generalist practice. International evidence supports rural-targeted postgraduate training, clinical\u2013academic integration, and a dedicated evidence base. Progress in Aotearoa New Zealand (NZ) has been constrained by underinvestment, workforce shortages, and persistent inequities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aimed to explore postgraduate rural medicine stakeholder perspectives on the current status of rural medicine as a speciality in NZ and what is needed to strengthen it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative study using semi-structured interviews. Thematic analysis was undertaken using a framework-guided rapid analysis approach. Interviews explored key patterns relating to clinical practice, postgraduate training, academic capacity, and system-level influences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Interviews with 31 participants (including trainees, clinicians, educators, academics, and institutional leaders) identified two themes. The first described postgraduate rural medicine development to date, including the importance of rural-targeted training, emerging career pathways, and ongoing invisibility. The second highlighted future priorities, including a rural-specific general practice pathway, stronger rural leadership, and greater collaboration and institutional investment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Strengthening rural-specific postgraduate pathways, together with stronger support for rural educators and researchers, is essential for improving visibility and fostering clinical\u2013academic career development. A coordinated, nationwide strategy is also needed to strengthen the academic standing of rural medicine, ensure its long-term sustainability, and advance rural health equity in NZ.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/hc26151","type":"journal-article","created":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T23:26:43Z","timestamp":1791761203000},"source":"Crossref","is-referenced-by-count":0,"title":["Current state and future directions of the discipline of rural medicine in Aotearoa New Zealand: a qualitative study"],"prefix":"10.1071","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4041-3390","authenticated-orcid":true,"given":"Katharina","family":"Blattner","sequence":"first","affiliation":[{"name":"Centre for Rural Health, Faculty of Medicine A , , , , .","place":["Omapere, Far North, New Zealand"]},{"name":"University of Otago A , , , , .","place":["Omapere, Far North, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2181-1120","authenticated-orcid":true,"given":"Lynne","family":"Clay","sequence":"additional","affiliation":[{"name":"Centre for Rural Health, Faculty of Medicine B , , , , .","place":["Oxford, Canterbury, New Zealand"]},{"name":"University of Otago B , , , , .","place":["Oxford, Canterbury, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4221-6892","authenticated-orcid":true,"given":"Rory","family":"Miller","sequence":"additional","affiliation":[{"name":"Centre for Rural Health, Faculty of Medicine C , , , , .","place":["Whangamata, Waikato, New Zealand"]},{"name":"University of Otago C , , , , .","place":["Whangamata, Waikato, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8192-1412","authenticated-orcid":true,"given":"Garry","family":"Nixon","sequence":"additional","affiliation":[{"name":"Centre for Rural Health, Faculty of Medicine D , , , , .","place":["Clyde, Central Otago, New Zealand"]},{"name":"University of Otago D , , , , .","place":["Clyde, Central Otago, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1127-1952","authenticated-orcid":true,"given":"Tim","family":"Stokes","sequence":"additional","affiliation":[{"name":"Department of Primary Health Care, Dunedin, Faculty of Medicine E , , , .","place":["Dunedin, New Zealand"]},{"name":"University of Otago E , , , .","place":["Dunedin, New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"3","key":"2026101119263531700_R1","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.healthplace.2012.02.009","article-title":"Understanding rural and remote health: a framework for analysis in Australia.","volume":"18","author":"Bourke","year":"2012","journal-title":"Health Place"},{"issue":"1","key":"2026101119263531700_R2","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-023-00819-3","article-title":"Rural medical workforce pathways: exploring the importance of postgraduation rural training time.","volume":"21","author":"McGrail","year":"2023","journal-title":"Hum Resour Health"},{"key":"2026101119263531700_R3","unstructured":"World Health Organization. WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. World Health Organization; 2021."},{"issue":"9","key":"2026101119263531700_R4","doi-asserted-by":"publisher","first-page":"635","DOI":"10.31128\/AJGP-05-24-7272","article-title":"Integrated general practitioner training pathways: components, barriers and enablers.","volume":"54","author":"Penney","year":"2025","journal-title":"Aust J Gen Pract"},{"issue":"2","key":"2026101119263531700_R5","doi-asserted-by":"publisher","DOI":"10.22605\/RRH7118","article-title":"Evaluation of postgraduate rural medical training programs and implications for rural workforce development: a systematic review.","volume":"22","author":"Saito","year":"2022","journal-title":"Rural Remote Health"},{"issue":"5","key":"2026101119263531700_R6","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1111\/ajr.12473","article-title":"Learning from history: how research evidence can inform policies to improve rural and remote medical workforce distribution.","volume":"26","author":"Humphreys","year":"2018","journal-title":"Aust J Rural Health"},{"issue":"9","key":"2026101119263531700_R7","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1136\/jech-2023-220337","article-title":"Comparison of urban and rural mortality rates across the lifespan in Aotearoa\/New Zealand: a population-level study.","volume":"77","author":"Nixon","year":"2023","journal-title":"J Epidemiol Community Health"},{"key":"2026101119263531700_R8","unstructured":"Minister of Health. Rural Health Strategy. Wellington, New Zealand. Ministry of Health; 2023."},{"key":"2026101119263531700_R9"},{"issue":"1","key":"2026101119263531700_R10","doi-asserted-by":"publisher","DOI":"10.22605\/RRH8364","article-title":"Development of a rural strategy for an urban-based medical program: a pragmatic reality.","volume":"24","author":"Eggleton","year":"2024","journal-title":"Rural Remote Health"},{"issue":"1","key":"2026101119263531700_R11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1071\/HCv11n1_ED2","article-title":"Guest editorial: failing to thrive: academic rural health in New Zealand.","volume":"11","author":"Nixon","year":"2019","journal-title":"J Prim Health Care"},{"key":"2026101119263531700_R12","unstructured":"Waatea News. Medical schools agree on rural training. Available at https:\/\/waateanews.com\/2023\/09\/27\/med-schools-agree-on-rural-training [accessed July 2026]"},{"issue":"1","key":"2026101119263531700_R13","doi-asserted-by":"publisher","DOI":"10.22605\/RRH9583","article-title":"Distributed learning as a means of delivering socially accountable medical training.","volume":"26","author":"Lillis","year":"2026","journal-title":"Rural Remote Health"},{"issue":"3","key":"2026101119263531700_R14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2025-114478","article-title":"Predictors of rural medical practice in Aotearoa New Zealand: a national outcomes prospective cohort study.","volume":"16","author":"Costello","year":"2026","journal-title":"BMJ Open"},{"issue":"1529","key":"2026101119263531700_R15","first-page":"57","article-title":"New Zealand\u2019s vocational rural hospital medicine training Programme: the first ten years.","volume":"134","author":"Blattner","year":"2021","journal-title":"The New Zealand Medical Journal (Online)"},{"issue":"6","key":"2026101119263531700_R16","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1080\/14739879.2017.1319253","article-title":"A targeted rural postgraduate education programme - linking rural doctors across New Zealand and into the Pacific.","volume":"28","author":"Blattner","year":"2017","journal-title":"Educ Prim Care"},{"issue":"1","key":"2026101119263531700_R17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.22605\/rrh4047","article-title":"Training generalist doctors for rural practice in New Zealand.","volume":"17","author":"Nixon","year":"2017","journal-title":"Rural Remote Health"},{"issue":"1143","key":"2026101119263531700_R18","first-page":"492","article-title":"New Zealand rural general practitioners 1999 survey--part 1: an overview of the rural doctor workforce and their concerns.","volume":"114","author":"Janes","year":"2001","journal-title":"N Z Med J"},{"issue":"1191","key":"2026101119263531700_R19","first-page":"pU812","article-title":"The future of rural general practice in New Zealand.","volume":"117","author":"London","year":"2004","journal-title":"The New Zealand Medical Journal (Online)"},{"key":"2026101119263531700_R20","doi-asserted-by":"publisher","first-page":"141","DOI":"10.26635\/6965.7546","article-title":"Rural medicine in Aotearoa New Zealand: a narrative synthesis of the literature with a postgraduate focus.","volume":"139","author":"Blattner","year":"2026","journal-title":"NZMJ"},{"issue":"1592","key":"2026101119263531700_R21","doi-asserted-by":"publisher","first-page":"9","DOI":"10.26635\/6965.6553","article-title":"The Aotearoa New Zealand doctor shortage: current context and strategies for retention.","volume":"137","author":"Hitchon","year":"2024","journal-title":"N Z Med J"},{"key":"2026101119263531700_R22","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research.","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"issue":"10","key":"2026101119263531700_R23","doi-asserted-by":"publisher","first-page":"1596","DOI":"10.1177\/1049732320921835","article-title":"Rapid techniques in qualitative research: a critical review of the literature.","volume":"30","author":"Vindrola-Padros","year":"2020","journal-title":"Qual Health Res"},{"issue":"1493","key":"2026101119263531700_R24","first-page":"12","article-title":"Building collaborative research networks across rural and provincial Aotearoa.","volume":"132","author":"Gutenstein","year":"2019","journal-title":"N Z Med J"},{"issue":"2","key":"2026101119263531700_R25","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1111\/ajr.12725","article-title":"How might access to postgraduate medical education in regional and rural locations be best improved? A scoping review.","volume":"29","author":"Kiuru","year":"2021","journal-title":"Australian J Rural Health"},{"key":"2026101119263531700_R26","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1584501","article-title":"Retention of doctors in remote, rural and First Nations communities using distributed general practice education: a scalable solution.","volume":"12","author":"Giddings","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"2026101119263531700_R27","unstructured":"ACRRM. Australian College of Rural and Remote Medicine. Brisbane. Available at https:\/\/www.acrrm.org.au\/about-us [accessed 2 May 2026]"},{"key":"2026101119263531700_R28","unstructured":"Department of Health Disability and Ageing. National Rural Generalist Pathway: Australian Government; 2025. Available at https:\/\/www.health.gov.au\/our-work\/national-rural-generalist-pathway [accessed 15 July 2026]"},{"issue":"Suppl 3","key":"2026101119263531700_R29","doi-asserted-by":"publisher","first-page":"S27","DOI":"10.5694\/mja2.52027","article-title":"Creating a sustainable and supportive health research environment across rural and remote Australia: a call to action.","volume":"219","author":"Alston","year":"2023","journal-title":"Med J Aust"},{"issue":"5","key":"2026101119263531700_R30","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1111\/ajr.12470","article-title":"Two decades of building capacity in rural health education, training and research in Australia: University Departments of Rural Health and Rural Clinical Schools.","volume":"26","author":"Lyle","year":"2018","journal-title":"Aust J Rural Health"},{"issue":"4","key":"2026101119263531700_R31","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1111\/ajr.12746","article-title":"Consensus-based framework for the growth and sustainability of rural health research.","volume":"29","author":"O\u2019Sullivan","year":"2021","journal-title":"Aust J Rural Health"},{"key":"2026101119263531700_R32","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1600660","article-title":"Research in place: the critical role of rural health research in Canada.","volume":"12","author":"Welton","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"2026101119263531700_R33","unstructured":"Hauora Taiwhenua. Aotearoa New Zealand Declaration on Rural Health 2026. Available at https:\/\/htrhn.org.nz\/wp-content\/uploads\/2026\/05\/Aotearoa-NZ-Declaration-on-Rural-Health-2026.pdf"},{"issue":"3","key":"2026101119263531700_R34","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1071\/HC24133","article-title":"Taken out of context: academic rural health in Aotearoa New Zealand.","volume":"16","author":"Nixon","year":"2024","journal-title":"J Prim Health Care"}],"container-title":["Journal of Primary Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/hc\/article-pdf\/doi\/10.1071\/HC26151\/1973172\/hc26151.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/hc\/article-pdf\/doi\/10.1071\/HC26151\/1973172\/hc26151.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T23:26:45Z","timestamp":1791761205000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/hc\/article\/doi\/10.1071\/HC26151\/276102\/Current-state-and-future-directions-of-the"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":34,"URL":"https:\/\/doi.org\/10.1071\/hc26151","relation":{},"ISSN":["1172-6156"],"issn-type":[{"value":"1172-6156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]}}}