Determining constructs of high-quality rural health student placements: a multiple case ECOUTER study

People living in regional, rural and remote communities experience inequitable access to health services compared with people living in metropolitan areas, in part due to the maldistribution of the health workforce. Health student placements in rural settings, a type of work-integrated learning, are a key approach to developing a sustainable rural health workforce in Australia and internationally. Proxies for quality in rural health student placements, including student satisfaction and intention to practice in rural settings, have been used to inform rural health placement development and facilitation. However, the determining constructs of high-quality rural health student placements in Australia are unknown.

A multiple case study design was adopted, drawing on the Employing COnceptUal schema for policy and Translation Engagement in Research (ECOUTER) methodology to iteratively collect and analyse data. Within each case, participants comprised Australian University Departments of Rural Health staff involved in designing, delivering, administrating and/or evaluating rural health student placements. In each case, participants identified features that contribute to high-quality rural health student placements and listed these on a virtual case mindmap. Case focus groups were conducted to refine top-level and sub features on each mindmap. Cross-case analysis identified overarching constructs and sub-constructs, which were refined by cross-case focus group participants.

Eighty-six people across ten cases participated in this study. Nine constructs determining high-quality rural health student placements were identified: placement planning, student selection, stakeholder communication and collaboration, placement orientation, student supervision, logistical resources, learning opportunities, connecting with the rural community, and student wellbeing and supports. The final cross-case focus group resulted in strong construct agreement from participants across diverse regional, rural, and remote Australian contexts.

Nine interconnected and contextually dependent constructs determine high-quality health student placements in regional, rural and remote communities, emphasising the complexity associated with providing a high-quality form of this work-integrated learning opportunity.