Effect of Rural Clinical Placements on Intention to Practice and Employment in Rural Australia: A Systematic Review

Abstract

Background: Supporting the provision of clinical placement (CP) experiences in rural areas is a strategy used worldwide to promote the rural health workforce. While there is international evidence for this intervention in medicine, there is limited understanding of the influence of rural CP for nursing, midwifery, allied health, and dentistry health professions in Australia, which have received substantial federal investment. This review examined the relationship between rural CP and non-medicine health students’ future rural practice intentions and workforce outcomes. Methods: Four databases were systematically searched; papers were screened using defined criteria and appraised using the mixed-methods appraisal tool (MMAT). Findings were synthesized using a critical narrative approach. Results: The methodological quality of the 29 eligible studies (13 quantitative non-randomized, 10 mixed method, 4 qualitative, 2 quantitative description) was appraised. Ten high-quality studies were identified. The review found that positive CP experiences may influence intention to practice rurally amongst undecided students and serve as a reinforcing experience for those students already interested in rural practice. There were mixed findings regarding the influence of CP length. The review also found that there is currently only evidence for the short-term effects of CP on students’ future practice outcomes in rural areas with focus thus far on early practice outcomes. Conclusions: Those looking to use rural CP to promote the rural health workforce should focus on supporting the quality of a large number of CP experiences that are undertaken in rural areas, as there are currently differing findings on the role of rural CP length. Future studies of rural CP should consider greater use of social and educational theories to guide them.

Rural origin student representation in health courses at the University of Tasmania: 2011–2020

“…The RHMT program aims to improve the size and composition of the rural health workforce through a variety of mechanisms that include: targeted rural health research; initiatives that increase the participation of rural origin students in health courses and student exposure to quality rural (MM2‐7) placement experiences as part of their training 2 . These approaches have been shown to have a positive impact on rural workforce development over time, 3 and are supported by the growing body of literature which demonstrates that lived rural experience and quality rural placements are both precursors to rural health workforce participation 4,5 …”

“…2 These approaches have been shown to have a positive impact on rural workforce development over time, 3 and are supported by the growing body of literature which demonstrates that lived rural experience and quality rural placements are both precursors to rural health workforce participation. 4,5 The RHMT program prescribes participating universities with minimum expectations for rural origin student enrolments in health courses. 2 Within rural medical training, participating medical programs are required to ensure at least 25% of the commonwealthsupported placements are for students of rural origin.…”

Positive change in intent to practice rurally is strongly associated with nursing and allied health students of metropolitan origin after rural clinical placement

“…8 Research has found that students of rural-origin and students who undertook longer clinical training in a rural or remote setting were more likely to practice in rural or remote regions, particularly in medicine. 9,10 Further, having an interest in rural practice 8 and experiencing a positive student placement have also been found to influence intention to practice rurally. 6,8 However, the evidence relating to how clinical placements may contribute to rural and remote nursing and allied health practice in future remains limited.…”

“…6,8 However, the evidence relating to how clinical placements may contribute to rural and remote nursing and allied health practice in future remains limited. In addition, although it is well-recognised that rural origin is a determinant for both intention for rural practice and actualised rural practice, 3,8,11,12 limited high-quality evidence exists for other determinants.…”

“…Rural university centres facilitate these placements and an independent evaluation described this as relatively successful 5 . Other evidence also suggests that rural clinical placements encourage health professionals to practice in rural and remote areas in the short to medium term, 6–8 particularly in the medical field 8 …”