Lessons learned from adapting a remote area health placement from physical to virtual: a COVID-19-driven innovation

Abstract

Objectives: To investigate the acceptability and the effectiveness of a virtual adaptation of a well-established, mandatory, community-based pre-clinical remote area health placement in which medical students learn about the social and environmental determinants of health in remote Australia; and make recommendations to guide the delivery of future learning experiences. Methods: A mixed-methods convergent design was used. All 99 students, 36 placement hosts and 10 staff were invited to complete an online survey and 27(27%), 12(33%) and 10(100%), respectively, contributed data. Qualitative data were collected via semi-structured interviews from four students, four hosts and six staff. Survey data were analysed using descriptive statistics (frequency and percentage) and open-ended responses summarised to provide supporting contextual evidence. Interview transcripts were analysed and coded independently, then corroborated to identify and summarise common themes using thematic analysis.Results: Survey and interview data indicated that the virtual placement was acceptable to students and hosts and enabled students to achieve intended learning objectives. Virtual activities enabled students and hosts to develop authentic, genuine interpersonal relationships, which in turn were facilitated when hosts and students had practiced videoconferencing beforehand with good high-speed internet connections via mobile devices. Pastoral care and access to IT support were essential. Conclusions: Virtual placements can be used in combination with and are an option for students and hosts who cannot attend/courses that cannot fund physical placements. Careful design and further research is required to ensure that virtual placements enable "head, heart and hands" learning and do not create/reinforce inequities.

A qualitative exploration of health student perspectives of rural and remote placements during the early stages of the COVID‐19 pandemic

“…Importantly, this sense of disconnection between rural and remote communities was amplified for students who undertook a virtual rural or remote placement experience, where they remained at home and delivered services remotely via telehealth. This finding is similar to Mak et al 11 who found that virtual placement experiences allow students to achieve clinical learning outcomes, but were not as effective in facilitating their affective and physical learning about the rural location. This reinforces that the physical and relational experiences on rural and remote placements are valued by students and important for their learning and enjoyment of their rural or remote placement 29 .…”

“… 10 , 11 , 12 , 13 In particular, studies have focused on examining virtual placements and telehealth service delivery 11 , 13 , 14 , with students largely achieving learning outcomes. 11 Medical student perspectives about changes to placements during the pandemic have been sought via survey with most students reporting negative impacts on the quality of their learning. 15 This included supervision and missed opportunities for clinical procedures and increased mental health challenges including isolation and reduced social support.…”

“…Although other research has examined rural placement changes during the pandemic, these studies have largely described strategies aimed at minimising disruption to student learning and the provision of services to rural and remote communities 10–13 . In particular, studies have focused on examining virtual placements and telehealth service delivery 11,13,14 , with students largely achieving learning outcomes 11 .…”

“…9 Although other research has examined rural placement changes during the pandemic, these studies have largely described strategies aimed at minimising disruption to student learning and the provision of services to rural and remote communities. [10][11][12][13] In particular, studies have focused on examining virtual placements and telehealth service delivery 11,13,14 , with students largely achieving learning outcomes. 11 Medical student perspectives about changes to placements during the pandemic have been sought via survey with most students reporting negative impacts on the quality of their learning.…”

Te Paatu o Te Ao Hurihuri – pandemic-related virtual adaptation of an established marae-based workshop for rural doctors: a qualitative study

“…An Australian study of medical undergraduates undertaking ruralcommunity virtual placements during the pandemic found the virtual format more accessible but less effective than in-person at delivering 'heart and hands' learning. 4 New Zealand postgraduate rural vocational trainees have expressed concerns about pandemic-related loss of opportunities for cross-cultural learning through place-based immersion, particularly important in view of the known health disparities for Māori. 5,6 The University of Otago's (UoO) mainly distance taught postgraduate GENA725 academic module, Communication in Rural Hospital Medicine (hereafter G725), is a component of the Royal New Zealand College of General Practitioners national Rural Hospital Medicine (RHM) training programme.…”