Aspire2Health and COVID-19: the impact of the pandemic on outcomes from an outreach program to increase high school student interest in rural health careers

INTRODUCTION

Rural health career outreach programs promote health careers to secondary school students and aim to address rural health workforce shortages. This study analyses student feedback data from Aspire2Health, a multidisciplinary rural health career outreach program conducted in Queensland Australia before COVID in 2019, and during COVID lockdown and isolation periods during 2020-2021. The study aims were to assess the suitability of the program and its elements, the program's short-term impact on students' interest in health careers and whether COVID restrictions on program delivery affected students' program experience and outcomes.

METHODS

We conducted statistical and semantic analysis of data collected pre- and peri-COVID from participating secondary school students living in regional, rural and remote Australian communities. Data validity was established by triangulating quantitative results from items using a five-point Likert scales, qualitative themes from short-response items and frequency analysis of themes. Data were collected pre-COVID (2019, n=125) and peri-COVID (2020-21, n=248).

RESULTS

Student responses to the program remained extremely positive despite COVID-imposed restrictions. Feedback scores indicated quite strong agreement in pre- and peri-COVID periods that the program motivated students to pursue a career in health (mean (M)=4.6 pre-COVID v M=4.5 peri-COVID) and that students would recommend the program to a friend (M=4.8 pre-COVID v M=4.7 peri-COVID). Overall ratings of the event were high, although a drop occurred during the peri-COVID period (M=4.8 pre-COVID v M=4.7 peri-COVID; p=0.043). Activity interest rankings indicated that, irrespective of the pandemic, clinical skills sessions, meeting health professionals and watching the emergency scenario were more interesting to students than ambulance and hospital tours (p<0.001). Four themes were generated from analysing qualitative data. In response to the item 'What did you enjoy the most?' the themes were 'clinical skills' (n=203, 55% of respondents) and 'interacting with professionals' (n=146, 39% of respondents). Responses to 'Is there anything we could do differently?' produced the themes 'no changes required' (n=158, 58% of respondents) and 'variety and duration' (n=40, 11% of respondents). 'Variety and duration' described students' desire for more variety, more professionals and more time to engage in activities. The themes and their frequency among student responses indicate strong support for the validity of the results.

CONCLUSION

This study found that the Aspire2Heath program continued to motivate rural students to pursue health careers during the COVID-19 pandemic and that student interest is greatest during activities with hands-on clinical skills and student-professional interactions. These results suggests that rural health career outreach programs can be run under challenging social circumstances with confidence that students can be successfully encouraged to pursue health careers. Furthermore, program design should emphasise hands-on clinical skills and interactions with professions. These findings have practical implications for rural health career outreach programs, particularly those faced with restricted financing or external circumstances that limit their access to external healthcare resources.

Evaluation of postgraduate rural medical training programs and implications for rural workforce development: a systematic review

INTRODUCTION

Providing postgraduate rural training programs has been recognised as central for successful recruitment and retention of medical workforce. While there have been many documented cases of rural training program development, documented program outcome evaluations are few. This review investigated how postgraduate training and educational programs for rural and remote medicine are evaluated worldwide. Through the use of a systematic review, the study explored three questions: 'What are the outcomes of postgraduate rural and remote training programs worldwide?', 'How are the program evaluations conducted?' and 'What evaluation models and approaches are used in evaluating the effectiveness of these training programs?'

METHODS

A qualitative synthesis was undertaken of evaluations of postgraduate rural training programs published in the English language in medical education journals. The study involved pooling quantitative and mixed-methods research data and findings from qualitative studies, which were aggregated, integrated and interpreted. PubMed, PsycINFO, ERIC and Web of Science databases were searched to identify studies that satisfy the search criteria.

RESULTS

Of the 1297 articles identified through the database search, 26 studies were included in the analysis. Most of the evidence from the studies consists of descriptive studies with some longitudinal tracking programs and cohort studies. Nine themes were identified: practice location after training completion; training location and decentralised model; educational aspects; incentives, political contexts and regulations; personal, social and cultural issues; professional development; rural orientation and community engagement; support system; and gender and racial issues. Key outcomes were analysed and cross-validated against the 2020 WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. These studies' most frequent evaluation methods were surveys, followed by interviews, questionnaires and secondary data from existing databases. Methodological characteristics, the relationship between rural background and program outcomes, and implications for decentralised training, telehealth and tele-assessment during the COVID-19 pandemic are discussed. Analysis from the key outcomes suggests evaluation as a strategy to uncover outcomes in postgraduate rural and remote training and medical education.

CONCLUSION

Regardless of the similar outcomes, the program evaluations implemented and the robustness of evidence vary across programs and medical schools. The absence of solid evaluation designs and their alignment to the program objectives will lessen the strengths of evidence. Better quality research and evaluation design, objective settings, qualitative inquiry to uncover the contexts, and developing appropriate indicators and benchmarks for monitoring and evaluating strategies must be considered during program development and implementation.