What works, why and how? A scoping review and logic model of rural clinical placements for allied health students

Abstract

Background Allied health services are core to the improvement in health outcomes for remote and rural residents. Substantial infrastructure has been put into place to facilitate rural work-ready allied health practitioners, yet it is difficult to understand or measure how successful this is and how it is facilitated. Methods A scoping review and thematic synthesis of the literature using program logic was undertaken to identify and describe the contexts, mechanisms and outcomes of successful models of rural clinical placements for allied health students. This involved all empirical literature examining models of regional, rural and remote clinical placements for allied health students between 1995 and 2019. Results A total of 292 articles were identified; however, after removal of duplicates and article screening, 18 were included in the final synthesis. Australian papers dominated the evidence base (n = 11). Drivers for rural allied health clinical placements include: attracting allied health students to the rural workforce; increasing the number of allied health clinical placements available; exposing students to and providing skills in rural and interprofessional practice; and improving access to allied health services in rural areas. Depending on the placement model, a number of key mechanisms were identified that facilitated realisation of these drivers and therefore the success of the model. These included: support for students; engagement, consultation and partnership with key stakeholders and organisations; and regional coordination, infrastructure and support. Placement success was measured in terms of student, rural, community and/or program outcomes. Although the strength and quality of the evidence was found to be low, there is a trend for placements to be more successful when the driver for the placement is specifically reflected in the structure of the placement model and outcomes measured. This was seen most effectively in placement models that were driven by the need to meet rural community needs and upskill students in interprofessional rural practice. Conclusion This study identifies the factors that can be manipulated to ensure more successful models of allied health rural clinical placements and provides an evidence based framework for improved planning and evaluation.

Co‐designing community‐focused rural placements for collaborative practice

“…Sustaining these models without a clear focus on outcomes and community partnerships remains a challenge. As noted in a recent scoping review, placement models can be more successful when the drivers for the placement are reflected in the design and implementation of the placement model itself 7 . In our situation, the main drivers were not only the maldistribution of workforce and subsequent community need and service priorities, but also the disconnect between curriculum and practice.…”

“…As noted in a recent scoping review, placement models can be more successful when the drivers for the placement are reflected in the design and implementation of the placement model itself. 7 In our situation, the main drivers were not only the maldistribution of workforce and subsequent community need and service priorities, but also the disconnect between curriculum and practice. This disconnect is evident in the lack of formal targeted student preparation for practice in rural and remote environments, and the lack of focus on interprofessional collaborative practice (IPCP) in particular.…”

“…5,6 Such placement models in rural areas facilitate both service provision and student education. 7 Sustaining these models without a clear focus on outcomes and community partnerships remains a challenge. As noted in a recent scoping review, placement models can be more successful when the drivers for the placement are reflected in the design and implementation of the placement model itself.…”

“…12 Our model was inspired by the need to increase the capacity for placements in rural and remote areas, contribute to rural workforce, develop supervisory models and respond to community needs. Whilst other UDRHs also have similar placement models 7 and use service learning to promote community and university partnerships and services, 5 our model is unique in the wrap-around placement support and preparation elements of the co-designed model, as well as the integration of theory to inform the transdisciplinary implementation and evaluation.…”

“…As a result, non‐traditional placements, such as community‐based service learning, project and role‐emerging placements, have been implemented not only to increase the social accountability focus of health courses, but also to assist with meeting these demands and identified areas of community need 5,6 . Such placement models in rural areas facilitate both service provision and student education 7 . Sustaining these models without a clear focus on outcomes and community partnerships remains a challenge.…”