Rural Placements Research Articles

A novel blended placement model improves dietitian students\u2019 work-readiness and wellbeing and has a positive impact on rural communities: a qualitative study

BackgroundClinical placement models that require students to relocate frequently can cause stress, which may impact the student experience and development of work-readiness skills. A blended placement, where placements are undertaken concurrently at one location has potential to address these issues by providing a positive placement experience. Blended long-stay placements undertaken in rural communities increase consistent service provision and may help encourage students to work rurally, with potential to reduce workforce shortages. The aim of this study was to pilot test the feasibility of blended placement models and explore the student experience and skills development. A secondary aim was to explore a fully blended long-stay rural placement and the benefits to the rural community.MethodsAn exploratory qualitative design was used. Focus groups were conducted with dietitian student who participated in usual placements (n = 14) or blended placements (n = 9). Individual semi-structured interviews were conducted with five student supervisors who participated in blended placements. Focus groups and interviews were recorded, transcribed verbatim and analysed together using inductive thematic analyses.ResultsThe overarching theme across all blended model placements was ‘enhanced work-readiness’, including increased flexibility, organisational skills and better preparedness for mixed roles. Enhanced work-readiness was influenced by three themes: stress and wellbeing impacts learning, working in two areas of practice concurrently allows for deeper learning, and blended placements meet supervisor needs. Fully blended long-stay rural placements revealed additional benefits. Firstly, in relation to the overarching theme ‘enhanced work-readiness’: students on these placements also developed extra skills in innovation, social accountability, interprofessional collaboration, conflict resolution and teamwork. Secondly, a new overarching theme emerged for fully blended long-stay rural placements: ‘increased community connections’ which included additional health services delivery, deeper personal experience and more rewarding student-supervisor relationships. Thirdly, two extra themes emerged that influenced work-readiness and community impact: ‘local organisational support and resources’ and ‘enhanced innovative and interprofessional learning opportunities’.ConclusionsBlended placements enhance work-readiness skills by providing an alternative model to that commonly applied, and providing flexibility in education programs. Additionally, fully blended long-stay rural placements positively influence the local community through impacting the student experience as well as providing more dietetics services and may therefore assist in reducing dietetics workforce shortages and health inequity.

The effect of rural placements on future rural general practice

Background: Providing health care to rural populations is a major issue in Australia. Disease burdenand health risk factorsincrease with remoteness, but the access to appropriate service decrease. The introduction of Rural Clinical Schools, rural locations for internship and residency, and decentralisation of the Australian General Practitioner Training Programaim to address this disparity. This systematic review aimed at determining if rural placements throughout medical training are associated with future rural general practice in Australia.Methods: Medline (Ovid), Pubmed, CINAHL and Science Direct were searched for the period January 2000 to July 2019. Included studies related specifically to rural general practitioners in Australia and studies were excluded if they reported only on intention to practice rurally. Evidence was assessed using the Standards for Quality Improvement Reporting Excellence Guidelines.Results: Eleven articles met the inclusion criteria. Three studies examined the effect of rural placements in medical school on future rural general practice. Three studies looked at placements as a junior doctor on future rural general practice. Four studies looked at the effect of rural general practitioner training on future rural general practice. One study reported on the effect of rural placements during both medical school and junior doctor years on future rural general practice. The studies supported an association between rural placements and future rural general practice, particularly for Australian born doctors, Australian graduates and individuals from rural backgrounds.Discussion: This review suggests that rural placements during medical training increase the likelihood of future rural general practice. The interplay of personal and professional life influence whether rural intention is sufficient to result in rural practice. Addressing human factors that influence rural practice will contribute to achieving equitable rural health care.

Psychosomatic Factors Impinge on the Medical Students’ Choice of Rural Practice – A Systematic Review

There will be a great shortage of 4.3 million Doctors in 2030 in world level stated by WHO, their shortage in remote areas is an immense challenge. This review examines the evidence base of factors and preferences influencing medical students towards rural placements as they are the future workforce. The study adopted the PRISMA protocol. The factors reasoned for their aversion were formed into the framework of Alderfer’s ERG needs and classified based on positively and negatively perceived. Poor living conditions and social isolation is the major cause for the aversion of rural placements. But the proximity of the village and less competition were positively perceived in terms of existential needs. Family relationship, administrative hurdles and communication with rural people were perceived negatively perceived relationship needs, except availability of more support staff. The growth needs such as serving for poor, social status, Knowledge on rural diseases in an altruistic way, but only by rural background/rural upbringing students, Yet the urban origin students have a strong dislike for the reasons of professional stagnation, fewer career advancements, insufficient learning, and research opportunities in rural placements.

Training and retention in rural and remote Australia: Examining the association between GP vocational training placements and subsequent practice location in Western Australia

This paper aims to provide insights on the association between exposure to rural general practice vocational training placements and subsequent rural practice location in Western Australia. We further explore the possibility that the observed associations might depend on an individual's rural upbringing and or an individual's exposure to general practice during medical school. To this end, a cross-sectional analysis of practice location of 353 general practitioners who completed their vocational training through WA General Practice Education and Training between 2010 and 2017 was conducted. The empirical analysis uses a fully recursive conditional mixed process estimator to jointly estimate the probabilities that a general practitioner (GP) completes their vocational training placement at a rural location and subsequently practices at a rural location. The results show that GPs who chose rural locations for their first and last vocational training placements are more likely to practice at a rural location compared to their counterparts choosing metropolitan locations. Also, the probability of subsequent rural practice is further strengthened by having a rural background and having exposure to general practice during medical school even after controlling for potential confounders. The results also indicate that GPs stay in rural locations for reasons linked to their career, family and lifestyles. This evidence underscores the importance of vocational training organisations in WA and reinforces the need for ongoing rural opportunities in training to ameliorate location-based disparities in the distribution of the GP workforce in Western Australia.

Why do some medical graduates lose their intention to practise rurally?

Chronic medical workforce shortage and maldistribution continue to be a significant challenge in rural Australia. The Rural Clinical Schools (RCSs) program helps to alleviate this problem with evidence of increased rural location in graduates of rural training programs. However, rural work intent may change during the years after completing a rural placement. This qualitative study investigated the factors involved in the change of career intention from rural to urban work location among the Australian National University Medical School (ANUMS) Rural Stream (RS) alumni. A purposive sampling method was utilised to recruit ANUMS RS 2006-2016 graduates who expressed that their work plans had changed. Data collected with the use of in-depth, semi-structured interviews were transcribed verbatim. Transcripts were interpreted using thematic analysis and a modified version of I-poems, a component of Voice-Centred Relational Method or the Listening Guide. Thematic analysis produced three main themes. First, 'impacts of the working environment' highlighted some participants' views that career progression and sustenance, high-quality training and agreeable working conditions could not be achieved rurally. Second, 'ramifications of isolation' described the experienced or predicted feelings of social and professional isolation. Third, 'familial considerations' explained how the wishes and requirements of partners and families strongly influenced the participants' future work decisions. These findings were supplemented by the 'committed voice' and 'voice of uncertainty', heard through the use of I-poems. The 'committed voice' communicated the participants' dedication to their careers and partners. The 'voice of uncertainty' expressed confusion of intentions as participants attempted to balance the bidimensional needs of the 'committed voice'. The complex interaction between the availability of high-quality training positions, support issues and work-life balance is associated with the change of rural work intention of RCS graduates. Career and partner/family commitments are significant factors. Meanwhile, uncertainty towards future work location provides the opportunity for carefully developed and appropriate rural workforce strategies to intervene.

Supporting health students on rural placements: A scoping review.

To review Australian literature on initiatives used to provide support for pre-registration health students undertaking a rural placement. A scoping literature review. Rural, regional and remote areas of Australia. Publications were sourced from scientific databases including Ebscohost and CINAHL. Grey literature and journal citations were searched to identify other relevant articles. Identification of the various initiatives used to support students, evaluation of the success of these initiatives, and the feasibility and sustainability of implementing these initiatives. There were 36 articles included in the final analysis. The findings identified support initiatives specific to individual professions, not on supporting health students as a whole cohort. The key findings were grouped into identification of support initiatives and the alignment of these to students feeling a sense satisfaction, belonging and connectedness. Constraints to support health students undertaking rural placements identified disparity and inequity of support initiatives available for health students with medical students provided more support than other health students. This review highlights the importance of students developing a sense of belonging and building connections to community, which are strongly aligned with rural placements and student satisfaction. The need for socio-cultural, organisational and institutional support is linked to higher student satisfaction and intention to practice rurally. A centralised collation of support initiatives would benefit students, higher education institutions and stakeholders in their efforts to attract students to undertake rural placements and be immersed in these unique learning experiences.

The use of clinical practice to facilitate community engagement in the Faculty of Health Science

AimThis article seeks to describe how clinical practice can be used to facilitate community engagement in the Faculty of Health Science. DesignThe study followed a qualitative exploratory, descriptive and contextual design. MethodsThe study was conducted in the Faculty of Health Science at a public university in Namibia, Southern Africa. A total of 19 academic staff were purposively selected to participate in the focus group interviews. Thereafter, Giorgi’s method of phenomenological data analysis was used to analyse data. Lincoln and Guba’s strategies were used to establish trustworthiness. The ethical considerations followed Dhai and McQuoid-Mason’s four principles. ResultsThe three themes that emerged as findings were: facilitation of community engagement through home visits as part of clinical practice; facilitation of community engagement through clinical rural placements; and facilitation of community engagement through interprofessional education and practice. ConclusionsIt is concluded that health science students and academic staff should conduct home visits, students’ placement should also include rural based facilities and allow inter-professional education and practice in clinical practice. However, there remains an overall need to explore for community engagement projects that may be conducted in rural settings. Additionally, a generic service-learning course for all undergraduate health science students may help facilitate community engagement through interprofessional education and practice.

Objective Simulated Bush Engagement Experience (OSBEE): A novel approach to promote rural clinical workforce.

The mal-distributed Australian medical workforce continues to result in rural medical workforce shortages. In an attempt to increase rural medical workforce, the Australian Government has invested in the Rural Health Multidisciplinary Training (RHMT) program, involving 21 medical schools (RHMT program, 2020). This funding requires participating universities to ensure at least 25% of domestic students attend a year-long rural placement during their clinical years and 50% of domestic students experience a short-term rural clinical placement for at least four weeks.

Interventions for improving attraction and retention of health workers in rural and underserved areas: a systematic review of systematic reviews.

Global health workforce shortages exist with disparities in the skill mix and distribution of health workers. Rural and underserved populations are often disadvantaged in terms of access to health care. This systematic review summarized all systematic reviews that assessed interventions for improving attraction and retention of health workers in rural and underserved areas. We systematically searched selected electronic databases up to 31 March 2020. The authors independently screened the reviews, extracted data and assessed the certainty of evidence using GRADE. Review quality was assessed using the ROBIS tool. There was a paucity of evidence for the effectiveness of the various interventions. Regulatory measures were able to attract health workers to rural and underserved areas, particularly when obligations were attached to incentives. However, health workers were likely to relocate from these areas once their obligations were completed. Recruiting rural students and rural placements improved attraction and retention although most studies were without control groups, which made conclusions on effectiveness difficult. Cost-effective utilization of limited resources and the adoption and implementation of evidence-based health workforce policies and interventions that are tailored to meet national health system contexts and needs are essential.

Destinations of nursing and allied health graduates from two Australian universities: A data linkage study to inform rural placement models.

Combined, nursing and allied health constitute most of the Australian health workforce; yet, little is known about graduate practice destinations. University Departments of Rural Health have collaborated on the Nursing and Allied Health Graduate Outcomes Tracking to investigate graduate entry into rural practice. Data linkage cohort study. Monash University and the University of Newcastle. Graduates who completed their degree in 2017 across seven disciplines. The outcome variable was Australian Health Practitioner Regulation Agency principal place of practice data. Explanatory variables included discipline, age, gender, location of origin, and number and duration of rural placements. Of 1130 graduates, 51% were nurses, 81% females, 62% under 21years at enrolment, 23% of rural origin, 62% had at least one rural student placement, and 23% had over 40 cumulative rural placement days. At the time of their second Australian Health Practitioner Regulation Agency registration, 18% worked in a 'Rural principal place of practice.' Compared to urban, rural origin graduates had 4.45 times higher odds ratio of 'Rural principal place of practice.' For graduates who had <20 cumulative rural placement days, compared to zero the odds ratio of 'Rural principal place of practice' was the same (odds ratio=1.10). For those who had 20-40 rural placement days, the odds ratio was 1.93, and for >40 rural placement days, the odds ratio was 4.54). Rural origin and more rural placement days positively influenced graduate rural practice destinations. Outcomes of cumulative placements days may compare to immersive placements.

Co-designing community-focused rural placements for collaborative practice.

As a University Department of Rural Health, we have identified recurrent areas of service need among vulnerable rural populations, specifically the need for allied health. Concurrently, we have also identified missed opportunities for deliberate collaborative practice in rural clinical placements. This paper provides a commentary on our work in progress as we work to leverage available opportunities to provide both service from and education for health profession students on rural clinical placements. We developed a transdisciplinary placement model, informed by practice theory, which encompasses pre-placement preparation, student support, host sites and clinicians, and a structured evaluation strategy. This model aims to facilitate service provision alongside of student learning about community and collaborative practice. In particular, the co-design of the model is expected to facilitate student's sense of social accountability and reduce stigma in working with vulnerable population groups. This paper highlights the need for greater alignment between rural health education and practice, describes a placement model that is working towards this and showcases how this has been enacted in a remote community in New South Wales. More cross-sector discussion and evaluation is needed to determine the implications of adopting this model more widely if service and learning opportunities are to be equally achieved, and to determine the ways in which training and service provision can be aligned with community need, as recommended in the recent Rural Health Commissioner Report.

Rural placements during undergraduate training promote future rural work by nurses, midwives and allied health professionals.

Rural placements during undergraduate training promote future rural work by nurses, midwives and allied health professionals.

Understanding the elements of a quality rural/remote interprofessional education activity: A rough guide.

To offer a rough guide to a quality rural/remote interprofessional educational activity. Australian remote and rural interprofessional undergraduate placements offered in Modified Monash Model 3-6 locations. Biggs' triple P framework from the interprofessional educational literature and Allport's contact hypothesis are used to describe map, and explore the educational dimensions and positive elements, of a quality rural/remote interprofessional educational activity. Delivery of a quality interprofessional educational activity requires attention to all dimensions of the activity with acknowledgement of the value of the remote or rural contexts. Interprofessional learning requires constructive alignment and positive contact conditions to ensure a quality and sustained experience.

Delivering introductory physiotherapy clinical placements incorporating simulated learning experiences in rural settings.

To investigate the delivery, in rural settings, of introductory physiotherapy clinical placements incorporating simulation and describe the impact of these placements on the uptake of longer-term rural immersion opportunities. Retrospective cohort design. The University of Newcastle and the University of Newcastle Department of Rural Health (UONDRH), New South Wales, Australia. Data from undergraduate physiotherapy students were included. Second-year University of Newcastle physiotherapy students undertake an introductory placement which includes one week of simulated learning followed by a two-week traditional health care placement. Supervisor training and active promotion of placements were undertaken to increase the capacity of rural sites to deliver these placements, including both simulation and immersion components. Data relating to numbers of students undertaking introductory placements and final-year rural immersion experiences in the UONDRH between 2012 and 2020 were described. A simple review of the placement strategy was also undertaken. Introductory placements incorporating simulation were successfully implemented in the UONDRH settings and have continued annually. Physiotherapy staff in the UONDRH have been upskilled and have supported local clinicians to increase their supervisory capacity. The proportion of students undertaking introductory placements supported by the UONDRH has increased considerably as has the number of students completing full-year rural immersion experiences in the UONDRH. Delivering introductory physiotherapy placements incorporating simulation in rural settings was feasible and this strategy leads to increased placement capacity. Early rural clinical placement opportunities can increase students' uptake of longer-term rural immersion experiences which, in turn, can positively influence rural practice intentions.

Examining Clinical Teaching Observation Scores as a Measure of Preservice Teacher Quality

We draw on rich longitudinal data from one of the largest teacher education programs in Texas to examine the properties of rubric-based observational evaluations of preservice teachers (PSTs) during clinical teaching. Using a variance decomposition approach, we find that little of the variation in observation scores is attributable to actual differences between PSTs. Instead, differences in scores largely reflect differences in the rating standards of field supervisors. Men and PSTs of color receive systematically lower scores, as do PSTs in lower-income and rural placement schools. Finally, higher-scoring PSTs are slightly more likely to become employed as K–12 public school teachers and substantially more likely to be hired at the same school as their clinical teaching placement.

Profile and rural exposure for nursing and allied health students at two Australian Universities: A retrospective cohort study.

ObjectiveLinking enrolment and professional placement data for students' from 2 universities, this study compares characteristics across universities and health disciplines. The study explores associations between students' location of origin and frequency, duration and type of placements.DesignRetrospective cohort data linkage.SettingTwo Australian universities, Monash University and the University of Newcastle.ParticipantsStudents who completed medical radiation science, nursing, occupational therapy, pharmacy or physiotherapy at either university between 2 February 2017 and 28 February 2018.InterventionsLocation of origin, university and discipline of enrolment.Main outcome measure(s)Main measures were whether graduates had multiple rural placements, number of rural placements and cumulative rural placement days. Location of origin, discipline and university of enrolment were the main explanatory variables. Secondary dependent variables were age, sex, socio‐economic indices for location of origin, and available placements.ResultsA total of 1,315 students were included, of which 22.1% were of rural origin. The odds of rural origin students undertaking a rural placement was more than 4.5 times greater than for urban origin students. A higher proportion of rural origin students had multiple rural placement (56.0% vs 14.9%), with a higher mean number of rural placement days. Public hospitals were the most common placement type, with fewer in primary care, mental health or aged care.ConclusionsThere is a positive association between rural origin and rural placements in nursing and allied health. To help strengthen recruitment and retention of graduates this association could be further exploited, while being inclusive of non‐rural students

Exploring the preparation and the effectiveness of meeting perceived learning needs of undergraduate nursing students who undertake clinical placements in rural facilities from the perspectives of students

Universities are seeking alternative Work Integrated Learning (WIL) placements for nursing students due to increasing demand. Whilst significant research exists relating to rural and remote placements (particularly in their utility for recruitment upon graduation), there is a lack of research relating to student preparation for these placements. Third year nursing students participated in a qualitative exploratory study to provide their perceptions of preparation for WIL placements in a Queensland rural health service. While participants in this study valued their experience highly, concerns relating to their preparation were identified. These included inadequate university and facility communication, accommodation issues, and a lack of advance rostering. Negative impacts on participants included outdated facility policies and nursing practices, and a lack of acceptance from some nursing staff. Some also experienced loneliness, isolation and financial problems. Conversely, participants were unprepared for positive aspects of the placement including enjoying the rural lifestyle and sense of belonging. Students experienced greater autonomy, and more support for individual learning needs than in metropolitan placements. This resulted in higher levels of teamwork, interprofessional practice and immersion in wide-ranging experiences. Improved pre-placement information from the university and facility would enhance students’ experience of rural and remote WIL placements.

E-Peer Coaching: A Model to Support Rural Special Education Field Placements

Providing adequate supervision for pre-service teachers enrolled in special education field placements is a challenge. Rural placements often exacerbate this challenge due to the large geographical areas in which these placements are located. The purpose of this article is to describe one approach to early field supervision in rural settings that may provide solutions to this dilemma. E-peer coaching utilizes video-facilitated peer coaching to provide novice pre-service teachers (NPTs) with accurate feedback that is both frequent and timely. This study investigated the use of a Google App that allowed NPTs to record instructional sessions and provide feedback to one another under the supervision of a course instructor. Recommendations for implementation are discussed.

Health Professional Student Placements and Workforce Location Outcomes: Protocol of an Observational Cohort Study.

BackgroundThe successful recruitment and retention of health professionals to rural and remote areas of Australia is a health policy priority. Nursing or allied health professional students’ learning placements in the Northern Territory (NT) of Australia, most of which is considered remote, may influence rural or remote work location decisions.ObjectiveThe aim of this study is to determine where allied health professionals and nurses who have had a student placement in the NT of Australia end up practicing.MethodsThis research is an observational cohort study, with data collection occurring at baseline and then repeated annually over 10 years (ie, 2017-2018 to 2029). The baseline data collection includes a demographic profile of allied health and nursing students and their evaluations of their NT placements using a nationally consistent questionnaire (ie, the Student Satisfaction Survey). The Work Location Survey, which will be administered annually, will track work location and the influences on work location decisions.ResultsThis study will generate unique data on the remote and rural work locations of nursing and allied health professional students who had a placement in the NT of Australia. It will be able to determine what are the most important characteristics of those who take up remote and rural employment, even if outside of the NT, and to identify barriers to remote employment.ConclusionsThis study will add knowledge to the literature regarding rates of allied health and nursing professionals working in remote or rural settings following remote or rural learning placements. The results will be of interest to government and remote health workforce planners.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000797976; https://www.anzctr.org.au/ACTRN12620000797976.aspxInternational Registered Report Identifier (IRRID)PRR1-10.2196/21832

It sounds like a good handover but can I trust it: the correlation between perceived quality and accuracy?

This article was migrated. The article was marked as recommended. Background Safe handover is crucial in healthcare and is taught in undergraduate and pre-vocational training curricula. It is now considered an Entrustable Professional Activity (EPA). Handover assessment tools have been developed but the correlation between the perceived quality of a handover and its accuracy has not been studied. Aims This paper aims to determine the correlation between the perceived quality and the accuracy and safety of handover. Methods This descriptive, quantitative study looked at medical students on long-term rural clinical placements who gave clinical handovers to supervisors. The supervisors scored the handovers using the Clinical Handover Assessment Tool (CHAT) and assessed the accuracy and safety of the handover, after seeing the patient. The correlation between handover scores, accuracy and safety was calculated using Cramer's V coefficient. Results 114 handovers from 25 students were assessed. The correlation coefficient for a global assessment of quality and accuracy was 0.585 and for safety was 0.583, considered large effects (>0.35). This also held using a checklist quality assessment but less strongly: 0.419, 0.363 respectively. Conclusion These findings suggest that handovers that sound 'good' are likely to be accurate: clinicians can 'trust their gut-feeling'. A high quality handover reflects more than the trainee'. clinical reasoning, communication and organisational skills: it suggests that they can provide accurate and safe handover. This supports the use of global assessments of handover as an important part of the multi-source feedback required for summative entrustment decision-making.