Smith Tony, Cross Merylin, Waller Susan, Chambers Helen, Farthing Annie, Barraclough Frances, Pit Sabrina W, Sutton Keith, Muyambi Kuda, King Stephanie, Anderson Jessie
Department of Rural Health, University of Newcastle, Taree, NSW.
Centre for Rural Health, University of Tasmania, Launceston, TAS.
J Multidiscip Healthc. 2018 Jan 31;11:85-97. doi: 10.2147/JMDH.S150623. eCollection 2018.
Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students' future rural practice intentions.
Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software.
The core concept identified from the thematic analysis was "ruralization of students' horizons," a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, "preparation and support," "rural or remote health experience," and "rural lifestyle and socialization," each of which includes multiple subthemes. From the content analysis, factors that promoted students' rural practice intentions were having a "positive" practice experience, interactions with "supportive staff," and interactions with the "community" in general. It was apparent that "difficulties," eg, with "accommodation," "Internet" access, "transport," and "financial" support, negatively impacted students' placement experience and rural practice intentions.
The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.
卫生人力短缺促使澳大利亚和其他西方政府投资，让更多卫生专业学生参与农村和偏远地区的实习。这项定性研究的目的是了解在澳大利亚各地不同非都市地区进行实习的学生的生活经历。除了提供改善农村实习的建议外，该研究还深入探讨了影响学生未来农村执业意愿的积极和消极经历的促成因素。
使用两种独立且同时应用的方法，对来自多个卫生专业和大学的3204名学生对开放式调查问题的回答进行分析：人工主题分析和使用Leximancer软件的计算机化内容分析。
主题分析确定的核心概念是“学生视野的乡村化”，这一构想体现了让卫生专业学生为在非都市地区执业做好准备的重要性。乡村化体现了三个相互关联的主题，即“准备与支持”、“农村或偏远地区的卫生经历”以及“农村生活方式与社交”，每个主题都包含多个子主题。从内容分析来看，促进学生农村执业意愿的因素包括有“积极的”实习经历、与“支持性员工”的互动以及与“社区”的总体互动。显然，“困难”，如“住宿”、“网络”接入、“交通”和“经济”支持方面的困难，对学生的实习经历和农村执业意愿产生了负面影响。
研究结果对继续支持进行地区、农村和偏远地区实习的学生，并让他们为未来在非都市地区执业做好准备具有政策和实践意义。因此，本研究可能会进一步为改善农村实习经历以及加强农村卫生人力招聘、留用和能力建设的现行策略提供信息。
