Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
BMC Med Educ. 2019 Sep 4;19(1):331. doi: 10.1186/s12909-019-1751-3.
The maldistribution of the Australian health workforce contributes to restricted accessibility and poorer health outcomes for rural and remote populations, especially Aboriginal and Torres Strait Islander Australians. Student exposure to rural and remote settings is a long-term strategy that aims to reduce workforce shortages by encouraging rural career uptake, with well-supervised, positive placement experiences associated with rural practice intentions. Furthermore, placements can build students' cultural capabilities and foster interest in working with disadvantaged and underserved Aboriginal communities. However, little is known about the translation of rural practice intentions to career paths, and the factors influencing employment decision-making and application of clinical and cultural content to professional practice. This in-depth study reports on the second stage of an investigation into the longer-term impact of remote placements. Stage One identified factors that contributed to students' learning experiences and highlighted challenges encountered; Stage Two explored the impact on professional practice and employment decision-making amongst a subset of the original cohort.
Of 12 interviews with participants who completed a remote placement in 2013/4 (Stage One), eight graduates were located four years later and seven were re-interviewed. Telephone interviews used a semi-structured schedule; each interview was recorded, transcribed and analysed for recurring themes and meanings.
At the time of interview, all participants were employed as health professionals and worked in Australia. The follow-up highlighted the enduring legacy of the student placement in terms of participants' personal and professional growth. The majority were employed in rural settings; some were attracted by a rural lifestyle and employment opportunities while others were drawn by a desire to reduce rural health disparities. Regardless of setting, all actively applied clinical and cultural learnings acquired on placement to their professional practice. Rural job security, professional support and opportunities for professional development were all influences on continuing rural practice.
Despite the challenges of qualitative longitudinal follow-up, the findings of this study provide valuable information, which can inform scaled-up investigations into the role of placements in developing an expanded, more stable and culturally respectful rural workforce.
澳大利亚卫生劳动力分布不均，导致农村和偏远地区人口（尤其是澳大利亚原住民和托雷斯海峡岛民）的可及性受限，健康状况较差。让学生接触农村和偏远地区是一项长期战略，旨在通过鼓励农村职业选择来减少劳动力短缺，良好的监督和积极的实习经历与农村实践意向相关。此外，实习可以培养学生的文化能力，并激发他们对与贫困和服务不足的原住民社区合作的兴趣。然而，对于农村实践意向转化为职业道路的情况，以及影响就业决策和将临床和文化内容应用于专业实践的因素，我们知之甚少。本深入研究报告了对远程实习的更长期影响的第二阶段调查结果。第一阶段确定了促成学生学习经验的因素，并强调了所遇到的挑战；第二阶段探讨了这些因素对职业实践和就业决策的影响，对象是原始队列中的一部分。
在对 2013/4 年完成远程实习的 12 名参与者进行了第一阶段访谈（共 12 名）之后，四年后找到了其中的 8 名毕业生，并对他们进行了重新访谈。电话访谈采用半结构化的时间表；对每次访谈进行记录、转录和分析，以确定反复出现的主题和含义。
在接受采访时，所有参与者都作为卫生专业人员就业，并在澳大利亚工作。后续结果突显了学生实习在个人和专业成长方面的持久影响。大多数参与者受雇于农村地区；有些人被农村生活方式和就业机会所吸引，而另一些人则希望减少农村卫生差异。无论工作地点如何，他们都积极将实习期间获得的临床和文化知识应用于专业实践。农村工作的稳定性、专业支持和职业发展机会都是继续从事农村工作的影响因素。
尽管对定性纵向随访存在挑战，但本研究的结果提供了有价值的信息，可用于深入调查实习在培养更多、更稳定和更尊重文化的农村劳动力方面的作用。
