Introduction

General practitioners (GPs) serve as the frontline of healthcare, offering continuous and comprehensive care that spans acute, chronic, and preventive services. Their training must therefore encompass a wide array of competencies tailored to the specific healthcare landscapes of their respective countries [1, 2]. While the overarching goal of GP training programs is to cultivate proficient, patient-centred physicians, the structure and administration of these programs vary significantly across nations [3-4]. This study provides an in-depth comparison of GP training in Australia, New Zealand, the UK, and the USA, aiming to elucidate differences, shared practices, and exemplary models that could inform future advancements in GP education [2, 5].

Methods

This research employs a qualitative comparative analysis of publicly accessible academic and industry sources, including peer-reviewed

journal articles, institutional reports, and government publications. The comparison focuses on seven metrics: (1) training duration, (2) governance and administration, (3) number of trainees, (4) assessment methods, (5) educational resources, (6) placements, and (7) unique features. Data were meticulously extracted and synthesised into a comparative framework to facilitate a comprehensive analysis.

Results

1. Duration of Training

• Australia: The Australian General Practice Training (AGPT) program typically spans three years, with an optional fourth year dedicated to advanced rural skills training. This structure is designed to address the diverse healthcare needs across urban and rural settings [1, 2].
• New Zealand: GP training in New Zealand comprises a three-year program, beginning with a one-year general practice placement followed by two years of advanced professional development. This progression ensures a solid foundation in general practice, augmented by opportunities for specialisation [2].
• United Kingdom: The UK’s GP training program has undergone restructuring to include two years of general practice placements within a three-year framework. This adjustment aims to provide trainees with more extensive hands-on experience in primary care settings [5].
• United States: Family medicine residency programs in the USA, which serve as the equivalent of GP training, last three years. There is ongoing debate about extending the duration to better prepare physicians for the complexities of modern healthcare [3].

2. Governance and Administration

• Australia: The AGPT program is overseen by the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). These bodies are responsible for setting educational standards, accrediting training posts, and conducting assessments [1, 2].
• New Zealand: The Royal New Zealand College of General Practitioners (RNZCGP) manages GP training, with partial funding from the government. The RNZCGP sets the curriculum, accredits training practices, and administers assessments to ensure the quality of training [2].
• United Kingdom: The Royal College of General Practitioners (RCGP) governs GP training, which is organised through regional deaneries. These deaneries coordinate training placements, provide educational resources, and support trainees throughout their training [5].
• United States: Family medicine residency programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME). Governance is shared among local health authorities and universities, ensuring adherence to national standards while accommodating regional healthcare needs [4].

3. Number of Trainees

• Australia: In recent years, there has been an increase in the number of junior doctors entering GP training programs. In 2025, more than 1,750 offers were expected, reflecting a concerted effort to address GP shortages [2].
• New Zealand: The formal GP training pathway offers a limited number of funded positions, supplemented by independent training pathways. This structure aims to balance the supply of GPs with the country’s healthcare demands [2].
• United Kingdom: While exact numbers fluctuate, the UK has been actively increasing GP training positions to meet rising healthcare needs. Initiatives have been implemented to attract more medical graduates into general practice [5].
• United States: Over 13,000 family medicine residents are in training annually, reflecting efforts to bolster the primary care workforce amid growing healthcare demands [3].

4. Assessment Methods

• Australia: Trainees undergo a comprehensive assessment process, including written exams, clinical evaluations, and supervisor reports. This multifaceted approach ensures that trainees meet the competencies required for independent practice [1, 2].
• New Zealand: Assessments are conducted throughout training, combining formative and summative methods to provide continuous feedback and ensure competency development [2].
• United Kingdom: Trainees undertake objective structured clinical examinations (OSCEs) and workplace-based assessments, culminating in membership of the RCGP (MRCGP). This rigorous assessment framework evaluates both clinical skills and professional behaviours [5].
• United States: Evaluation centres on competency-based milestones, with certification exams administered by the American Board of Family Medicine (ABFM). This system emphasises the attainment of specific competencies essential for family medicine practice [3, 4].

5. Educational Resources

• Australia: The training program includes in-practice teaching, workshops, and online resources, with a strong focus on rural and Indigenous health. This comprehensive approach ensures exposure to diverse patient populations and health issues [1, 2].
• New Zealand: The RNZCGP provides a range of resources, including in-practice teaching, peer review groups, and online learning modules. Trainees benefit from a mentoring system that fosters professional development and provides guidance throughout their training [2].
• United Kingdom: GP trainees have access to a variety of educational materials, including e-learning modules, simulation training, and workshops provided by the RCGP and local deaneries. Trainees also participate in protected teaching sessions to enhance their learning experience [5].
• United States: Family medicine residency programs emphasise hands-on learning complemented by didactic sessions, journal clubs, and online educational platforms. Programs often provide resources tailored to specific areas of interest, such as rural health or global health [3, 4].

6. Placements

• Australia: Placements are divided between hospital rotations and general practice clinics, with significant time allocated to rural and remote areas. This exposure prepares trainees to manage the unique challenges of providing care in underserved regions [1, 2].
• New Zealand: Trainees rotate through general practices, hospitals, and community settings, ensuring a broad range of clinical experiences. The program includes a mandatory rural placement to address healthcare disparities in remote areas [2].
• United Kingdom: Placements are structured to include time in both hospital settings and general practices, with a focus on developing comprehensive primary care skills. Trainees spend at least 18 months in general practice placements to gain handson experience in community healthcare [5].
• United States: Residency programs provide diverse placements, including inpatient, outpatient, and emergency care settings. Rural tracks are available in many programs to encourage trainees to work in underserved areas [3, 4].

7. Unique Features

• Australia: The AGPT program places a strong emphasis on rural and Indigenous health, with specific pathways for rural generalists. The integration of advanced skills training enables GPs to specialise in areas such as obstetrics, anaesthesia, or mental health [1, 2].
• New Zealand: The New Zealand GP training program incorporates a unique mentoring system that fosters close relationships between trainees and experienced GPs. The program’s focus on cultural competence, including Māori and Pacific Islander health, is a standout feature [2].
• United Kingdom: The UK’s program includes the comprehensive Workplace Based Assessment (WPBA) framework, which integrates feedback from various stakeholders, including patients. Additionally, the RCGP offers a “Training Hubs” initiative to enhance collaboration between primary care providers and educational institutions [5].
• United States: Family medicine residency programs often allow trainees to pursue specialised tracks, such as global health, women’s health, or academic medicine. Some programs also include an optional fourth year for advanced training in leadership or specific medical disciplines [3, 4].

Discussion

The comparative analysis of GP training programs across Australia, New Zealand, the UK, and the USA highlights notable similarities and differences that reflect the healthcare priorities, systemic structures, and population health needs of each country. These findings allow for an in-depth discussion of the effectiveness of current training methods, opportunities for improvement, and potential cross-national learnings.

Training Duration
The duration of GP training across the countries aligns broadly, with programs spanning approximately three years in Australia, New Zealand, and the UK, with the USA adhering to a similar timeframe for family medicine residencies [1, 2]. However, the optional fourth year in Australia for advanced rural skills training underscores the country’s emphasis on addressing rural healthcare disparities [1]. This extra training year allows Australian GPs to develop critical competencies in areas such as obstetrics, anaesthesia, or mental health, tailored to the unique challenges of rural practice.

The USA’s ongoing debate about extending family medicine residency beyond three years is noteworthy. Proponents argue that additional time could better prepare physicians for the complexities of modern primary care, including managing multimorbidity, advanced procedural skills, and interprofessional collaboration [3]. However, critics caution that longer training may deter medical graduates already burdened by extended education timelines and student debt.

Governance and Administration
All four countries have centralised governing bodies ensuring uniformity and quality across training programs. The RACGP and ACRRM in Australia, the RNZCGP in New Zealand, the RCGP in the UK, and the ACGME in the USA all set training standards, accredit programs, and conduct assessments [1, 4]. However, differences in governance structures reflect distinct national healthcare priorities:

• Australia and New Zealand emphasise rural and remote training pathways to address geographical healthcare inequities [2].
• The UK and the USA focus on incorporating primary care into broader systemic reforms, such as the NHS’s patient-centred care agenda and the USA’s move towards integrated care models [4, 5].

The collaborative efforts between government health departments and these governing bodies play a critical role in ensuring that training aligns with workforce demands and healthcare policy goals. For example, Australia’s recent transition to integrate GP training entirely under the RACGP and ACRRM reflects a shift towards unified governance, potentially reducing administrative fragmentation [1, 2].

Trainee Numbers and Workforce Planning
Australia’s proactive measures to increase GP trainee numbers stand out as a strategic response to its ageing GP workforce and rural GP shortages. The 2025 forecast of over 1,750 training offers represents a significant investment in strengthening the primary care sector. Similarly, the UK’s initiatives to incentivise general practice as a career pathway, such as financial support schemes and marketing campaigns, aim to address workforce gaps in underserved areas [5].

In contrast, the USA faces challenges with its reliance on foreign-trained physicians to fill family medicine positions, raising questions about the sustainability of its primary care workforce. While New Zealand maintains a balanced approach to workforce planning, its limited training positions highlight the need for careful alignment with healthcare system capacity and demand [3, 4].

Assessment Methods
The assessment methods employed across countries reflect a commitment to rigorous evaluation of clinical and professional competencies. Australia’s multifaceted assessment, combining exams, clinical evaluations, and supervisor reports, aligns closely with the UK’s OSCEs and workplace-based assessments [1, 5]. Both systems ensure comprehensive evaluation of trainees in real-world settings, enabling the identification of strengths and areas for improvement.

The USA’s competency-based milestone system, although effective, may lack the breadth of real-world situational assessments seen in the UK and Australia. New Zealand’s continuous feedback approach during training is a strength, fostering a culture of ongoing improvement rather than a singular focus on high-stakes examinations [2].

Placements and Educational Resources
Australia and New Zealand’s strong focus on rural and Indigenous health placements provides critical exposure to underserved populations. These placements are complemented by targeted educational resources, such as cultural competency training and telemedicine skills [1, 2]. The UK also incorporates diverse placements into its training, with an increasing emphasis on community-based care in alignment with NHS priorities [5].

The USA’s family medicine residencies, although comprehensive, could benefit from greater emphasis on underserved and rural placements. Expanding exposure to these populations may help address disparities in access to care, particularly in so-called medical deserts [3, 4].

Unique Features and Cross-National Learnings
Australia’s optional advanced rural skills training and its integration of Indigenous health education into GP training represent best-practice models that other countries could adopt. Similarly, New Zealand’s strong mentorship and smaller-scale training environment foster personalised development for trainees [1, 2].

The UK’s structured program for GP trainees, including its well-defined MRCGP qualification pathway, offers a model of clarity and consistency that could inform the USA’s competency-based training evolution [5]. The USA, with its focus on comprehensive family medicine, provides lessons in breadth of training that other nations could incorporate, particularly regarding multimorbidity management [3].

Limitations
Despite the comprehensive nature of this comparative analysis, several limitations must be acknowledged. First, the data included in this research is based on publicly available sources, which may not capture the full spectrum of each country’s GP training programs. Specifically, the lack of access to confidential or unpublished internal reports and the variability in how each country collects and reports data on GP training complicates cross-country comparisons.

Additionally, differences in the healthcare systems, societal needs, and funding mechanisms across the four countries mean that what works well in one context may not be directly transferable to others. Furthermore, this study primarily relies on secondary data, which may introduce biases based on the perspectives of the organisations and authors producing the reports and articles. As such, the absence of firsthand accounts from trainees or faculty members involved in these programs may limit the accuracy and depth of the findings.

Finally, the research focuses on general training programs and does not consider sub-specialised tracks or the experiences of those entering specific areas of practice, which could offer important insights into how these programs cater to niche healthcare needs.

Implications
The findings from this comparative analysis carry several significant implications for general practice training and the broader healthcare systems in these countries. One of the most important takeaways is the critical role of rural and underserved area training. Australia and New Zealand in particular have demonstrated the value of integrating rural placements into training programs, which not only enrich trainee experiences but also contribute to alleviating the healthcare workforce shortages in remote regions. These approaches may serve as models for countries like the USA and the UK, where rural healthcare continues to face substantial challenges.

Additionally, the emphasis on cultural competence, particularly in New Zealand, highlights the growing need for training programs to incorporate strategies addressing healthcare disparities faced by minority and Indigenous populations. The emphasis on mentoring and peer support systems, as seen in the UK and New Zealand, suggests that fostering strong relationships between trainees and experienced practitioners could enhance learning outcomes and professional development. The unique ability of these countries to incorporate advanced procedural skills and specialised training tracks within GP training also provides insight into how to improve the depth of training while maintaining comprehensive primary care skills.

Future Considerations
Looking ahead, there are several promising avenues for enhancing the effectiveness and global competitiveness of GP training programs. One area that warrants further exploration is the potential for international collaboration and standardisation in training outcomes. The establishment of international frameworks for GP education could lead to the development of common competencies and best practices that would facilitate greater mobility of healthcare professionals across borders.

Additionally, the integration of technology into GP training presents an exciting opportunity. As seen in several countries, including the United States and the United Kingdom, the use of e-learning platforms, simulation labs, and digital resources is becoming increasingly common. These innovations can supplement traditional methods and provide more flexible, accessible, and scalable training opportunities for future GPs, particularly those in rural or remote areas.

Future research could also investigate the impact of extended training durations, particularly in the United States, where discussions about whether to extend the length of family medicine residency programs are ongoing. Longitudinal studies could help assess whether such extensions lead to better patient outcomes or enhanced GP retention rates.

Finally, given the shifting globl healthcare challenges, such as aging populations and the rise of chronic diseases, the inclusion of more specialised training in areas such as geriatric care, palliative care, and mental health could become increasingly important. These specialised competencies would equip future GPs with the skills needed to manage the evolving demands of patient care in an ever-changing healthcare landscape.

Summary
This comparative study highlights that while GP training programs across Australia, New Zealand, the UK, and the USA share commonalities in duration, governance, and assessment, each system has distinct features shaped by its healthcare priorities and population needs.

Australia’s integration of rural skills and Indigenous health education positions it as a leader in addressing healthcare inequities, a model that could inspire other nations. New Zealand’s mentorship-focused approach ensures personalised trainee development, while the UK’s structured training pathway provides clarity and standardisation. The USA’s breadth of training in family medicine, although effective, could be enhanced by expanding rural placements and adopting more real-world clinical assessments.

Cross-national collaboration and knowledge-sharing could drive improvements in GP training globally. By adopting best practices from each system, countries can better equip their GPs to navigate the complexities of modern healthcare. Future research should focus on longitudinal studies assessing the impact of training reforms on patient outcomes, workforce retention, and trainee satisfaction, providing further evidence to refine these programs.

Conclusions

With primary care at the forefront of healthcare reform worldwide, investment in robust, adaptable, and context-specific GP training is essential. These programs must continue to evolve to meet the challenges of ageing populations, rising chronic disease burdens, and technological advancements in medicine. The lessons drawn from this analysis provide a foundation for such advancements, ensuring the next generation of GPs is well prepared to lead the way in delivering high-quality, patient-centred care.

Learning Points

• Rural and Underserved Training – Australia and New Zealand demonstrate the benefits of integrating rural placements into GP training, which helps address workforce shortages in remote areas. Other countries, such as the UK and USA, could adopt similar models to improve access to care in underserved regions.

• Governance and Workforce Planning – Centralised governing bodies ensure uniformity in GP training across all four countries, but Australia and the UK are particularly proactive in expanding trainee numbers to address workforce shortages, whereas the USA relies heavily on foreign-trained physicians.

• Assessment and Training Structure – The UK and Australia employ rigorous real-world assessments, while New Zealand focuses on continuous feedback. The USA’s competency-based model could be enhanced by incorporating more situational evaluations and structured GP training pathways.

• Conflicts of Interest The authors have no conflicts of interest to declare.

• Funding No funding.

Author Contributions

• Ji Woo Kim - Literature review, visualisation of findings, and final manuscript editing.

• Shabnam Mohamad Shafiq - Conceptualisation, methodology, data collection, and manuscript drafting.

• Amlan Chowdhury - Data analysis, comparative framework development, and critical revision of the manuscript.

• Ethics Approval - No ethics approval was needed as this project was a compilation of existing literature.