Up close and real: living and learning in a remote community builds students\u2019 cultural capabilities and understanding of health disparities

Rosalie D Thackrah,Sandra C Thompson,Maeva Hall,Kathryn Fitzgerald

doi:10.1186/s12939-017-0615-x

Rosalie D Thackrah, Sandra C Thompson + Show 2 more

Open Access

https://doi.org/10.1186/s12939-017-0615-x

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Abstract

BackgroundRural and remote communities in Australia fare worse than their urban counterparts across major health indicators, with geographic isolation, restricted accessibility to health services, socioeconomic disadvantage, lifestyle and behavioural factors all implicated in poorer health outcomes. Health disparities, which are especially stark in Australian Aboriginal and Torres Strait Islander populations, underscore the urgent need to build a culturally responsive and respectful rural health workforce.Allied health student placements in settings with high Aboriginal populations provide opportunities for the development of cultural capabilities and observation of the causes and impact of health disparities. A service learning pedagogy underpinned by strong campus-community partnerships can contribute to effective situated learning. Positive placement experiences can also encourage future rural practice alleviating workforce shortages. This article reports on the first stage of a proposed longitudinal investigation into the impact of remote placements on clinical practice and employment choices.MethodsIn-depth interviews were undertaken with health science students and recent graduates from Australian universities who spent up to 4 weeks at the remote community of Mt. Magnet (Badimaya country) in Western Australia. Interviews, which occurred between two and 12 months following the placement were recorded, transcribed and thematically analysed for patterns of meaning.ResultsFactors which contributed to positive professional, personal and socially responsive learning experiences were identified. These included pre-placement cultural training to build understanding of the local Aboriginal community, peer support, community engagement, cultural exchanges and interprofessional collaboration. Highlights were associated with relationship-building in the community and opportunities to apply insights into Aboriginal cultural ways to clinical and community practice. The role of the Aboriginal mentor was integral to students’ understanding of the social and cultural dynamics in the practice setting. Challenges related to the logistics of supervision in remote locations and workloads.ConclusionsThe interprofessional placement offered students a unique opportunity to experience how isolation, socioeconomic disadvantage and cultural factors conspire to produce health inequities in remote Australian settings and to observe how communities respond to their circumstances. Despite difficulties encountered, learnings derived from the application of clinical, social and interprofessional skills, and rural employment opportunities that arose following graduation, were all highly valued.

Highlights

Rural and remote communities in Australia fare worse than their urban counterparts across major health indicators, with geographic isolation, restricted accessibility to health services, socioeconomic disadvantage, lifestyle and behavioural factors all implicated in poorer health outcomes
Recent rural classifications differentiate “outer regional” areas using population size and distance from nearest major towns as a measure of “rurality” or “remoteness”. This is important as classification of rurality is tied to workforce incentives, which have not always reflected the challenges associated with attracting health professionals to small rural towns [5]
Australian rural and remote communities fare worse than their urban counterparts across all major health indicators

Summary

Introduction

Rural and remote communities in Australia fare worse than their urban counterparts across major health indicators, with geographic isolation, restricted accessibility to health services, socioeconomic disadvantage, lifestyle and behavioural factors all implicated in poorer health outcomes. Recent rural classifications differentiate “outer regional” areas using population size and distance from nearest major towns as a measure of “rurality” or “remoteness” This is important as classification of rurality is tied to workforce incentives, which have not always reflected the challenges associated with attracting health professionals to small rural towns [5]. Poorer health outcomes are associated with geographic isolation, restricted accessibility to health services, socioeconomic disadvantage, and lifestyle and behavioural factors [2, 4, 6]. As noted by Greenhill and colleagues, with reference to medical practitioners and specialists, “the more remote the community, the more likely it is to be underserved” [3]

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