Emergency departments across Australia and Aotearoa New Zealand provide care to nearly 11 million patients annually, yet only a small proportion of care is supported by high-quality evidence. Identifying unanswered research questions that matter most to patients, consumers, whanau, carers and clinicians is essential to reducing research waste and duplication and improving emergency care. The Australasian College for Emergency Medicine, through its Clinical Trials Network, is undertaking a Priority Setting Partnership with the James Lind Alliance and supported by the College of Emergency Nursing Australasia and College of Emergency Nurses New Zealand to establish a prioritised research agenda for emergency care over the next five to 10 years. Using a transparent, evidence-informed process, the partnership aims to ensure research reflects the diverse needs of communities across both countries, including groups historically under-represented in research. Meaningful participation of consumers and clinicians will be essential to translate these priorities into research, funding and improvements in emergency care.

Regional, rural and remote (RRR) healthcare is frequently compared to metropolitan models despite fundamental differences in geography, service provision, patient preferences and local cultures. Metropolitan bias is reinforced through educational and professional language and by literature that can perpetuate narratives of deprivation, rather than recognising the expertise required to manage uncertainty and resource limitations. The ACEM Emergency Medicine Education and Training (EMET) programme provides on-site FACEM supervision and multidisciplinary education. This is valuable in strengthening trainee confidence, supporting clinical governance and maintaining high training standards in resource-limited settings. However, challenging metropolitan bias also requires strengthening the status of RRR medicine. With research infrastructure concentrated in metropolitan centres, rural hospitals remain under-represented, highlighting the importance of grassroots research initiatives that generate locally relevant data. Challenging metropolitan bias therefore requires a shift in how RRR emergency medicine is represented, taught, researched and governed. EMET offers an important step towards reframing RRR placements as rigorous, supported, and professionally valuable, with potential implications for workforce recruitment and retention.

The new blended supervision placement (BSP) presents an expanded array of training opportunities for TS2/3 ACEM registrars in regional, rural and remote locations. These newly accredited sites, previously not eligible for recognised training time, offer varied learning opportunities in both clinical and non-clinical domains. The development of this placement is aligned with the 2027 curriculum alteration in rural and remote training requirements for ACEM trainees, and reflects real workforce evolution around Australia and Aotearoa New Zealand. This opinion piece is a reflection on one TS2 trainee's recent experience at the newly BSP-accredited Macksville District Hospital on the NSW mid north coast. It reflects the value of continuity in clinical supervision across a parent and peripheral site, as well as the professional and personal rewards of practising emergency medicine in a smaller and more connected community.

From 2027, new ACEM trainees must complete 6 months of emergency medicine training at an eligible regional, rural or remote site. The requirement aligns training more closely with where emergency physicians work and offers valuable experience in generalism and decision making with limited resources. Its success will depend on authentic placements, supportive training networks and employment arrangements that recognise the burden of relocation.