Evaluation of the provision of fieldwork training through a rural student unit

The learning environment on a student ward: an observational study

INTRODUCTION

Worldwide, a growing number of healthcare students require clinical environments for learning. Some wards have become adapted 'student wards' to meet this demand. Benefits have been reported from the students', supervisors' and patients' perspectives. There is no definition of a student ward, and little research on what the term means. A deeper understanding of the characteristics of student wards is needed to support their use. The aim of this study is to describe what characterises the learning environment on one student ward.

METHODS

An ethnographic approach was used for an observational study on a student ward in a hospital in Sweden. Student nurses, supervisors and others on the ward were observed. Field notes were thematically analysed.

RESULTS

Four themes were identified: 'Student-led learning' described students learning by actively performing clinical tasks and taking responsibility for patients and for their own learning. 'Learning together' described peer learning and supervision. 'Staff's approach to learning' described personalised relationships between the students and staff and the build-up of trust, the unified inter-professional approach to teaching, and the supervisors' motivation for teaching and for their own learning. 'Student-dedicated space' described the effect of the student room on the learning environment.

DISCUSSION AND CONCLUSIONS

This study describes the characteristics of a student ward that centred around a community of practice that shared a view of learning as a priority, allowing staff to provide clinical care without compromising students' learning. This qualitative study at a single centre lays the groundwork for future research into other student wards.

Immersive placement experiences promote rural intent in allied health students of urban and rural origin

Introduction

Pre-vocational placement experiences are known to considerably influence the career preferences of health graduates and are a key factor in growing the rural allied health workforce. This paper explores the rural placement experiences and future work intentions of students who attended a placement with the University of Newcastle Department of Rural Health.

Methods

Part of a larger longitudinal mixed methods study of students’ placement experiences and subsequent career choices, this study explored students’ placement evaluations responses. Following each placement, students were invited to complete an online survey which asked about their placement experiences and future work intentions. Counts and proportion tests were performed for frequencies of quantitative variables. Wilcoxon signed rank tests were conducted on the paired pre- and post-rural intent scores to determine any perceived differences in intent before and after placement for students both with and without a rural background. Qualitative data from short answer questions were analyzed thematically guided by qualitative content analysis. Data were comparatively analyzed for students of a rural or urban background.

Results

Four hundred and forty end of placement surveys were completed by 275 students (response rate 69.8%). There was a positive shift in intention to work rurally for students of both rural and urban background post-placement, but this was only statistically significant in the group from an urban background (p≤0.001). From the qualitative analysis three themes emerged: immersed rural supported placement experience, immersed interaction in rural life with other students, and immersed interaction in the rural community. Students from both rural and urban backgrounds indicated similar benefits and challenges.

Conclusion

While the positive impact of rural placement experiences and rural background on future rural practice is well known, this study highlights the importance of positive supported placement experience for students from both rural and urban backgrounds.

Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study

QUESTION

What strategies can clinical partners and universities implement to enhance physiotherapy student engagement in non-metropolitan clinical placements?

DESIGN

Mixed-method research design combining focus groups and survey.

PARTICIPANTS

First-year physiotherapy students from one university at the commencement of their course (n=26); third-year and fourth-year students who had completed a non-metropolitan placement (n=39 survey, n=25 focus group); and clinical educators from three non-metropolitan clinical sites (n=15).

INTERVENTION

The cohort of first-year physiotherapy students was surveyed to establish their perceptions regarding non-metropolitan clinical education placements. A survey and four focus groups were conducted with third-year and fourth-year students after they had attended non-metropolitan clinical placements, to explore recent experiences. Two focus groups were conducted with clinical educators regarding student engagement at non-metropolitan placements. Quantitative data were summarised with descriptive statistics. Qualitative data were analysed using thematic analysis, synthesising the perspectives of students and clinical educators.

RESULTS

At the commencement of their physiotherapy course, interest in undertaking a non-metropolitan clinical placement was higher for students with a non-metropolitan upbringing. Concerns about attending non-metropolitan sites included finances, change in living situation, and perceived inferior quality of clinical education. After completing a non-metropolitan placement, four themes were identified in an analysis of student and educator perceptions: individual factors, clinical experience, logistical challenges and strategies for success.

CONCLUSION

Strategies that were perceived to enhance student engagement in non-metropolitan placements included: tailoring preparation for students, paired rather than individual placements, and near-peer presentations for physiotherapy students prior to undertaking non-metropolitan placements. Dedicated clinical coordinator positions at non-metropolitan sites and assistance in accessing affordable accommodation are likely to positively influence the student experience. [Francis-Cracknell A, Maver S, Kent F, Edwards E, Iles R (2017) Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study. Journal of Physiotherapy 63: 243-249].

Undergraduate physiotherapy students' expectations and perceptions of rural/regional clinical placements

OBJECTIVE

To explore undergraduate physiotherapy students' expectations and preconceptions of undertaking a rural/regional clinical placement and determine if these preconceptions differ between regional and metropolitan-based students.

DESIGN

Data was collected via focus groups and analysed via thematic analysis of emerging themes.

SETTING

All focus groups were undertaken in tutorial rooms at the participating universities between classes at a time convenient to participants.

PARTICIPANTS

Undergraduate physiotherapy students yet to complete a major clinical placement were invited to participate. Second year physiotherapy students from regional and metropolitan universities were recruited to form focus groups, allowing comparison between the two groups. Four metropolitan students and nine regional students made up the sample size.

RESULTS

Three major themes were identified via thematic analysis of transcripts; socio-cultural factors, education and professional factors. The significance of socio-cultural factors was far beyond what was expected to be found. Regional students did not generally have a more accurate perspective of rural/regional placement and voiced more concerns about missing out on educational opportunities.

CONCLUSIONS

Rural/regional clinical educators need to be mindful of creating quality experiences with caseloads appropriate for the specific placement's requirements. The impact of external socio-cultural factors must be acknowledged. Supervision strategies must be put in place to ensure students on rural/regional clinical placements are well supported to achieve a successful outcome for student and educator.

Addressing agricultural issues in health care education: an occupational therapy curriculum program description

CONTEXT

Medical and allied health professionals who work in agricultural states frequently address the needs of clients who live and work in rural and frontier environments. The primary occupations of those living in rural areas include farming, ranching, or other agriculture-related work. Farming is consistently ranked as one of the most high-risk occupations for work-related injuries and accidents; therefore, it is critical that health education programs include content to prepare future medical and health professionals to work with this population.

PURPOSE AND DESCRIPTION

This paper describes the rural issues component of the occupational therapy curriculum at The University of South Dakota. This rural issues module is designed to provide occupational therapists with training about the physical, temporal, and sociocultural aspects of production agriculture and the impact these have on the health and well-being of the agricultural population. It also addresses the occupational therapy implications for farmers and ranchers who have disabilities. Student assessments of the course content have been above average.

CONCLUSION

Training in agricultural health enables our occupational therapy students to be well prepared for work in the rural and frontier areas of South Dakota and other rural locations.

Going country: Rural student placement factors associated with future rural employment in nursing and allied health

OBJECTIVE

To measure the rate and predictors of health science graduates joining the rural health workforce following a rural placement.

DESIGN

Longitudinal survey including the years immediately prior to and post graduation.

SETTING

Western Australian health sciences graduates contacted by email and/or phone.

PARTICIPANTS

Allied health and nursing students from urban campuses of three Western Australian universities who had taken a rural placement in their final year of study between 2000 and 2003.

MAIN OUTCOME MEASURES

Location of employment six months or more after graduation.

RESULTS

Of 429 participating allied health and nursing graduates, 25% had entered the rural workforce. Factors with a positive bivariate association with rural employment were: rural background, health discipline, self-reported value of placement, non-compulsory rural placement, and placements of four weeks or less. After controlling for rural background, the value and duration of the placement were significantly associated with rural employment.

CONCLUSIONS

This study augments previous work showing that any prior rural background is a significant predictor of rural work. Rural practitioners of both urban and rural origin who undertake voluntary rural placements are more likely to enter rural practice and consequently mandatory placements may not be helpful to increasing the rural workforce. The quality of a placement is a highly significant factor associated with future workplace choice, the details of which need to be further investigated.

The impact of clinical placement location on nursing students' competence and preparedness for practice

The challenges confronting nurses in today's health care environments have highlighted the necessity for graduating students to feel both competent and prepared for practice. The aim of the aspect of the study reported in this article was to determine the relationship between the location of clinical placements and competence and preparedness for practice from the perspective of the nursing students. A quasi-experimental design using a pre-test post-test survey was used. The population consisted of all final year Bachelor of Nursing students at Queensland University of Technology, who undertook their clinical placement in either a rural or metropolitan location. The response rate was 65% in the pretest (n = 137) and 57% in the posttest (n =121). The results of the study highlight the importance of both rural and metropolitan clinical environments in developing not only student competency but also students' satisfaction with their clinical experience. The results suggest that the selection of a rural placement is more likely to occur when students feel competent, confident and organised about their clinical experience. Strategies to increase students' perceptions of competence and confidence to undertake a rural placement are likely to increase students' selection to 'go rural'.

Removing the roadblocks to medical and health student training in rural hospitals in Victoria

OBJECTIVE

To assess the extent of undergraduate health student placements in regional hospitals in northern Victoria in 1999, prior to substantial changes in rural undergraduate medical education in Australia.

METHOD

Cross sectional postal survey with telephone follow-up in north-east Victoria. Subjects were all 17 regional and rural hospitals involved in health student teaching in North-east Victoria. Main outcome measures were the numbers, duration and discipline of health students placements and reported barriers to such placements.

RESULTS

Large regional hospitals accounted for two-thirds of all undergraduate health student placements. Smaller sites placed few allied health students. Barriers to a larger, more sustainable system of rural placements and rotations included accommodation shortages and funding constraints, particularly in smaller rural hospitals.

CONCLUSIONS

Adequate resourcing of placements of a meaningful duration, stronger institutional support, and improved resourcing of regional accommodation is required to facilitate a larger, more systematic and sustainable system of medical and health student placements in rural areas.

The impact of rural clinical placement on student nurses' employment intentions

Commonwealth Government health policy and professional organisations have indicated that successful recruitment and retention strategies are crucial to address the shortage of health professionals in rural and remote areas. This research study aimed to evaluate the effectiveness of a Clinical Placement Support Scheme for nursing students as a recruitment strategy for rural and remote health care services, and to develop an increased awareness of the employment opportunities available in these areas. The population consisted of final year Bachelor of Nursing students enrolled in either a rural or metropolitan clinical placement in 2000. A pre-post test survey design was used. Analysis of pre- and post-test data found a 12% increase (to 89%) in the number of students intending to seek employment in a rural setting, compared to a 5% increase (to 46%) in students who undertook a metropolitan placement. One-third of the students who chose a rural placement had no previous experience of a rural lifestyle and over half of these students indicated their intention to work in a rural setting following their clinical placement. These results support the theory that undergraduate rural clinical experience can have a positive influence on the recruitment of health professionals to rural areas.

Rural training and the state of rural health services: effect of rural background on the perception and attitude of first-year medical students at the university of melbourne

The aim of this project is to investigate the relationship between medical students' background and their perception of the state of rural health services; willingness to undertake internship training or work as a doctor in a rural hospital; expected benefits and disadvantages of training or working as a doctor in a rural hospital; and factors interfering with acceptance of a job as a doctor in rural areas. A questionnaire-based survey was distributed to 100 first-year medical students attending the Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne at the end of semester 1. The response rate was 97%, including 44 males and 53 females. A strong relationship was found between rural background and an intention to undertake internship training in a rural hospital (86% of students from a rural background expressed this desire vs 30% of students from an urban background). Furthermore, all students from a rural background expressed a desire to work as a doctor in a rural hospital after completing postgraduate training. Compared to urban students, students from a rural background showed a more positive attitude towards health services in rural areas including public hospitals ( P = 0.02), private general practice ( P = 0.004), ambulance service ( P = 0.0002) and baby health centres ( P = 0.005). Citizenship or gender was not significantly related to the perception of any of these services. The ranking of factors interfering with acceptance of a job as a doctor in rural areas were different for rural and urban students. Students from rural backgrounds reported spouse/partner needs (76% vs 49%, P = 0.038) and school availability for children (59% vs 30%, P = 0.023) as barriers more frequently than urban students, respectively). On the other hand, urban students rated the following factors higher: personal factors (76% vs 53%, respectively), education opportunities (56% vs 24%), social/cultural facilities (50% vs 41%) and the need for frequent travel (29% vs 12%). None of these interfering factors were significantly different. Urban students were more likely than rural students to report that their views were a result of adverse media reports. In conclusion, students from a rural background were more willing to be trained or to work as doctors in rural areas. This was associated with a greater adverse influence by the media upon students.