Cultural safety as clinical practice: an evidence-informed model for general practice training

BACKGROUND: Cultural safety is a core expectation of contemporary general practice and a critical component of high-quality care for Aboriginal and Torres Strait Islander peoples. It is defined by the Australian Health Practitioner Regulation Agency (Ahpra) as an ongoing, reflective practice that recognises power imbalances, addresses systemic racism, and is determined by the patient. Cultural safety remains difficult to operationalise within general practice education and assessment. Traditional training and assessment tools privilege observable behaviours and technical competence, offering limited capacity to evaluate reflexivity, power awareness, and relational trust. This study aimed to develop a community-informed framework and recommendations to guide the teaching, supervision, and assessment of cultural safety in general practice training. METHODS: A multi-phase qualitative and consensus-development study was undertaken in Australian general practice settings. Data were drawn from interviews with general practitioners (GPs), GP registrars, and Aboriginal and Torres Strait Islander participants; a modified nominal group technique incorporating yarning with Aboriginal and Torres Strait Islander participants; and a modified eDelphi process involving experts in Aboriginal and Torres Strait Islander health, education, and community leadership. Findings from all phases were synthesised and aligned with the Ahpra definition of cultural safety to develop a consolidated framework. RESULTS: The resulting framework articulates key knowledge domains, skills, and practising behaviours relevant to culturally safe general practice, while emphasising reflexivity, power awareness, and relational accountability. It identifies elements that may be meaningfully supported and assessed within training, highlights the central role of patient perspectives, and cautions against checklist-based approaches that risk undermining the relational nature of cultural safety. CONCLUSION: This study presents a practical, evidence-informed framework and recommendations to support general practice training organisations, supervisors, and registrars in embedding cultural safety within clinical education and assessment. Grounded in Aboriginal and Torres Strait Islander perspectives and expert consensus, the framework offers guidance for moving beyond procedural approaches towards culturally safe practice as a relational, patient-determined process.