title: Overseas-trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains.
abstract: OBJECTIVE
  To examine how OTDs and staff in rural and remote Indigenous health contexts communicate and negotiate identity and relationships, and consider how this may influence OTDs' transition, integration and retention.
  
  
  METHODS
  Ten case studies were conducted in rural and remote settings across Australia, each of an OTD providing primary care in a substantially Indigenous practice population, his/her partner, co-workers and Indigenous board members associated with the health service. Cases were purposefully sampled to ensure diversity in gender, location and country of origin.
  
  
  RESULTS
  Identity as 'fluid' emerged as a key theme in effective communication and building good relationships between OTDs and Indigenous staff. OTDs enter a social space where their own cultural and professional beliefs and practices intersect with the expectations of culturally safe practice shaped by the Australian Indigenous context. These are negotiated through differences in language, role expectation, practice, status and identification with locus with uncertain outcomes. Limited professional and cultural support often impeded this process.
  
  
  CONCLUSIONS
  The reconstruction of OTDs' identities and mediating beyond predictable barriers to cultural engagement contributes significantly not only to OTDs' integration and, to a lesser extent, their retention, but also to maximising effective communication across cultural domains.
  
  
  CONCLUSIONS
  Retention of OTDs working in Indigenous health contexts rests on a combination of OTDs' capacity to adapt culturally and professionally to this complex environment, and of effective strategies to support them.
authors.affiliation: Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, WA 6531, Australia. angelad@cucrh.uwa.edu.au
authors.forename: Angela
authors.initials: A
authors.lastname: Durey
authors.forename: Peter
authors.initials: P
authors.lastname: Hill
authors.forename: Rachelle
authors.initials: R
authors.lastname: Arkles
authors.forename: Marisa
authors.initials: M
authors.lastname: Gilles
authors.forename: Katia
authors.initials: K
authors.lastname: Peterson
authors.forename: Susan
authors.initials: S
authors.lastname: Wearne
authors.forename: Condy
authors.initials: C
authors.lastname: Canuto
authors.forename: Lisa Jackson
authors.initials: LJ
authors.lastname: Pulver
mesh_terms: D001315:Australia; D003469:Culture; D004501:Education, Medical / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D007391:International Cooperation; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D010820:Physicians / Q000523:psychology* / Q000600:supply & distribution; D010865:Pilot Projects; D044382:Population Groups / Q000706:statistics & numerical data*; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration / Q000600:supply & distribution*; D000095283:Australian Aboriginal and Torres Strait Islander Peoples