tutions (universities and regional training providers) are present. As with the consolidated practices, resources (patient population, physical infrastructure, supervision and educational administration) are sufficient to host multiple learners at varying stages of their training. Also, processes for curriculum development, orientation and teaching are well established. Supervisors are likely to hold formal educational qualifications. There is administrative support for both the educational and the research activities. These practices conduct research either independently or in close partnership with academics from outside institutions. Personnel within the practice are familiar with research paradigms and processes, ethics approval and scholarly writing. Research grants together with education payments and grants are significant funding streams for the practice.
This model has two particular strengths. First, this is a holistic model that places service, education and research together as integrated activities for the mature academic rural general practice. In this way, each activity supports the other activities. Second, this is a bottom-up model putting the individual general practice at the centre rather than on the periphery. Putting the individual general practice at the centre gives a capacity for genuine ownership of academic activity by general practices. This focus is likely to engender research agenda setting and ownership by general practices14 and integration of research into clinical services31 and educational activity in the community setting.
It is acknowledged that the model suggests that engagement in education precedes engagement in research. This is consistent with the historical reality of the recent steep increase in the engagement of general practices in education while engagement in research has remained low5. The present study's sample of general practices and subsequent model was based on engagement in education. It would be valuable to test the framework on a sample based on engagement in research.
Strengths and limitations
The study strengths include the sampling of the diverse types of practices and the interviews with multiple stakeholders. The method of analysis was robust, with several rounds of data interrogation. The case study method enabled interpretation of results at the level of the practice, reflecting a realistic unit of analysis for propelling significant change.
The study was set in rural Victoria, which may not reflect the broader landscape of general practices, training providers and higher education in other locations. The multidisciplinary research team (general practitioner, allied health academic/practitioner, organisational behaviour academic and education academic) enabled several perspectives to be offered during each phase of the study. This strengthens the study, reducing biases associated with a singular perspective. However, it may also mean that nuances were overlooked in data that are evident to those immersed in practice. Throughout the project, the research team met regularly and shared their perspectives and analyses. As in all interview-based studies, the quality of data may have been influenced by the context of the interview itself. Although the interviewer is experienced, it is possible that interviewees offered views that they thought socially desirable. However, early interview transcripts were reviewed by at least one other research member and interview technique examined. The interviewer approach was considered 'neutral' and 'encouraging'. The interviewer made notes on each interview and although some interviewees were noted as more forthcoming than others, with rapport established the flow of conversation in all interviews became easy.
Future research may investigate the transferability of the findings, especially using negative case analysis. It would be valuable to test the framework in other settings.
There is already sturdy evidence that learners are essential to addressing long-term workforce issues in Australian rural general practices. An establ