Purpose: Māori are significantly underrepresented within the surgical workforce in Aotearoa New Zealand, contributing to persistent inequities in access, experiences, and outcomes of surgical care. While barriers for minority groups in surgery have been described, little is known about Māori experiences across the full pathway from medical school to consultancy. This study aimed to explore Māori doctors’ experiences to identify barriers, enablers, and opportunities to strengthen pathways into surgery. Methods: A national qualitative study was undertaken using a Kaupapa Māori methodological approach. Māori medical students, junior doctors, and registrars completed an online survey exploring motivations, barriers, and access to support. Semi-structured interviews were conducted with Māori surgical consultants nationwide. Interviews were grounded in tikanga Māori, incorporating whakawhanaungatanga and karakia, and were transcribed verbatim. Data were analysed using thematic analysis Results Five key themes were identified: (1) early exposure and commitment to improving Māori health as motivators for pursuing surgery; (2) the central role of culturally grounded mentorship, particularly from Māori senior clinicians; (3) systemic and interpersonal racism influencing training experiences and career decisions; (4) cultural tension and imposter syndrome when navigating predominantly Pākehā surgical environments; and (5) the need for stronger, coordinated pipeline support from medical school through to consultancy. Māori-led initiatives, including interview preparation wānanga, were identified as effective enablers of progression. Conclusion Māori pursuing surgical careers face persistent systemic and cultural barriers across the training continuum. Strengthening culturally grounded mentorship, addressing racism within training structures, and implementing coordinated pipeline approaches are critical to improving Māori representation and equity within the surgical workforce.

Breast cancer is the most commonly diagnosed cancer among women in Australia. However, Aboriginal and Torres Strait Islander women experience significantly different outcomes compared to non-Indigenous women, with disparities evident in incidence, stage at diagnosis, treatment access, and survival rates. This literature and systematic review examines the current evidence on breast cancer rates among Aboriginal women in Australia, including patterns of incidence, mortality, and contributing social determinants of health. A systematic search of peer-reviewed literature was conducted using databases including PubMed, Scopus, and Informit, focusing on studies published between 2000 and 2024. Inclusion criteria were studies that reported quantitative data on breast cancer incidence or outcomes in Aboriginal and Torres Strait Islander populations. Grey literature and government health reports were also reviewed to capture recent epidemiological data and health policy context. A systematic review using an Aboriginal systems methodology was then completed on this literature The review found that while overall breast cancer incidence among Aboriginal women is slightly lower than in non-Indigenous women, mortality rates are significantly higher. Contributing factors include later-stage diagnosis, lower participation in breast screening programs, limited access to culturally safe healthcare, and higher prevalence of comorbidities. Studies also highlighted systemic barriers such as racism in healthcare and the underrepresentation of Aboriginal perspectives in cancer care planning. Breast cancer outcomes for Aboriginal women in Australia reflect ongoing health inequities rooted in broader social and structural determinants. Improving early detection, culturally appropriate care, and community-led health initiatives are critical for addressing these disparities. This literature and systematic review is informing a larger research project to increase breast cancer and breast surgery education in the Northern Adelaide Local Health Network.

Proposal There is a significant disparity in the detection, treatment and prognosis of breast cancer between Indigenous and non-Indigenous Australian women. Aboriginal and Torres Strait Islander women have a lower five-year overall survival from breast cancer compared to the general population (81% vs 90%) and a two-fold increased risk of death from breast cancer (1). This reflects the disparity in participation rates in breast cancer screening, with only 36.1% of Indigenous Australians participating in BreastScreen in 2022-2023, compared to 51.2% of non-Indigenous Australians (2). Given the unmet need to address these inequalities, we propose development of a culturally safe screening program specifically for Indigenous Australian women. This is in line with the RACS competency of ‘Cultural competence and cultural safety’ as well as the Indigenous Health Position Paper, advocating for a holistic understanding of Indigenous health in its inclusion of broader aspects of ‘family, community … and the connection to land…’. Through a Working Party including Indigenous community members, clinicians, BreastScreen Australia and the Australian Government, we aim to initiate a culturally safe subset of BreastScreen for Indigenous Australians and analyse data relating to breast cancer detection and treatment. Our proposed strategies include: 1.Provision of mobile mammography vans for remote communities 2.Empowerment of individuals with Aboriginal Liaison Officers throughout screening, delivery of results and treatment 3.Culturally safe education regarding the benefits of screening and treatment In doing so we aim to help bridge the gap in breast cancer outcomes between Indigenous and non-Indigenous Australian women. References 1.Roder D, Webster F, Zorbas H, Sinclair S. Breast screening and breast cancer survival in Aboriginal and Torres Strait Islander women of Australia. Asian Pac J Cancer Prev. 2012;13(1):147-55. 2.BreastScreen Australia Monitoring Report. Australian Institute of Health and Welfare. Updated Oct 1 2025. Accessed Jan 20 2026.

Surgical care is often delivered in time-pressured environments where efficiency, technical precision and task-oriented workflow is prioritised. These contraints can often unintentionally limit opportunities for meaningful communication and culturally safe care for Indigenous patients. However, surgical experiences are shaped by more than clinical outcomes alone and must incorporate trust, communication and inclusive care across the peri-operative continuum. This presentation explores how the entire pathway can either strengthen or undermine trust in surgical care, from pre-operative discussions, intra-operative dynamics and post-operative recovery. Key themes include understanding consent as an ongoing relational process rather than a single signed document, recognising communication barriers and implicit assumptions, as well as considering the role of family members, Elders and cultural practices in surgical decision-making. By examining common points of misalignment between surgical systems and the needs of individual Indigenous patients, this presentation aims to highlight practical reflections focused on improving operative experiences. Overall, it delineates that cultural safety should be presented, not as an added task, but as an integral component of high-quality surgical care.

Purpose: There are ethnic inequities in the provision of publicly funded hip and knee arthroplasty in New Zealand. Although Pacific peoples have the highest age standardised rates of total knee arthroplasty, their disproportionate exposure to osteoarthritis risk factors and inequitable access to health services make this difficult to interpret. Pacific peoples have the lowest age standardised rates of hip replacements, unlikely explained by a lack of need. This study aims to explore the experiences of Pacific peoples in New Zealand in accessing publicly funded hip and knee arthroplasty. The analysis of these perspectives will provide a deeper understanding on the ethnic inequities in arthroplasty provision and the impact on Pacific peoples. Methodology: This is a qualitative study, using talanoa, which is a Pacific research methodology of narrative inquiry. These decolonizing research methodologies are grounded in Pacific values and uplift Pacific voices regarding the inequities they experience. Results: There were 15 interviews which revealed personal experiences of fear and mistrust were leading factors limiting Pacific peoples willingness for arthroplasty surgery. Systemic barriers including prolonged waitlists, difficulty optimizing comorbidities and challenging interactions with health professionals which impeded their journey to surgery. Pacific values including family, love, reciprocity and connectedness enabled the participants to overcome these barriers and acquire surgery. Conclusion: An holistic approach is required to address inequities in accessing publicly funded surgery for Pacific peoples in New Zealand. International literature suggests the barriers faced by ethnic minorities are predicated by institutional racism which infiltrates multiple parts of the health system. Culturally grounded interventions centering Pacific values are proven to mitigate these barriers and improve access for Pacific peoples to this life changing surgery

Purpose: Otoscopic evaluation is critical for diagnosing ear pathologies, yet traditional methods used in primary care settings suffer from diagnostic inaccuracy. Artificial intelligence (AI) offers a promising solution for enhancing diagnostic accuracy. Our convolutional neural network (CNN) classifier was originally trained on a dataset of 10,000 otoscopic images from Aboriginal and Torres Strait Islander children, demonstrating good performance characteristics (AUC of 0.963 to 0.997 on test images). This study aimed to assess the CNN’s cross-population generalisability by evaluating its diagnostic accuracy using adult otoscopic test images not used in its original training. Methodology: This retrospective, cross-sectional study utilised publicly available open-source otoscopic image data from three international databases: Turkey (54 images), Chile (40 images), United States (40 images), each with clinician-derived ground truth classifications. Images were processed sequentially by the CNN, with predictions and confidence levels recorded. Performance was quantitatively evaluated using accuracy, sensitivity and specificity. Results: Across test images, diagnostic accuracy as high as 90% (95% CI 75-100%) was achieved (normal ear in Chile dataset). The model demonstrated overall accuracy of 65.6% (95% CI 57.4-72.7%), sensitivity of 57.1% (95% CI 48.4-65.7%), and specificity of 87.1% (95% CI 83.9-89.8%), indicating good overall discriminative performance. Performance metrics showed greatest accuracy in the identification of normal ear and chronic otitis media across the three geographic cohorts. Conclusion: The convolutional neural network demonstrated good cross-population generalisability for the diagnosis of otoscopic pathology in a heterogeneous adult cohort, despite its original training on a paediatric Indigenous population. Further studies should focus on multi-site, diverse external validation to improve consistent generalisability.