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Equal opportunities needed for all health students

24 Mar 2022

Two thirds of nursing students never had the opportunity to complete a rural or remote placement, recent National Rural Health Student Network (NRHSN) research has shown. NRHSN Chair Jean-Baptiste Philibert MD IV WSU explores how our institutions can empower a greater number of students to go remote, for longer.

The Aus­tralian health care sys­tem expos­es its stu­dents to var­i­ous set­tings and loca­tions to best pre­pare them for the diver­si­ty of their future prac­tice. This includes cru­cial expo­sure to rur­al and remote practice. 

Unfor­tu­nate­ly, despite the best efforts of all involved, the COVID-19 pan­dem­ic has and con­tin­ues to dis­pro­por­tion­ate­ly affect the more remote place­ments of health stu­dents due to a vari­ety of fac­tors such as pro­tect­ing vul­ner­a­ble com­mu­ni­ties and bor­der closures. 

The North­ern Ter­ri­to­ry had some of the most dis­rupt­ed place­ments over that peri­od, yet pro­vides life-chang­ing expe­ri­ences, as I was lucky enough to expe­ri­ence in Ten­nant Creek in 2019 and Yuen­du­mu in 2020.

These place­ments are cru­cial for the future work­force of the Ter­ri­to­ry and all remote loca­tions in Aus­tralia. The lit­er­a­ture has shown that the longer the place­ment, to a dura­tion of up to three months in rur­al and remote Aus­tralia, the greater the like­li­hood the stu­dent will prac­tice rurally. 

Med­ical stu­dents, such as myself, are well sup­port­ed to expe­ri­ence long term place­ments in rur­al and remote areas via fund­ing pro­vid­ed to the Rur­al Clin­i­cal Schools (RCS) by the Rur­al Health Mul­ti­dis­ci­pli­nary Train­ing (RHMT) program.

These oppor­tu­ni­ties are, how­ev­er, spars­er to stu­dents study­ing non-med­ical cours­es, yet these pro­fes­sions are cru­cial to the future of rur­al and remote Aus­tralia and con­stant­ly fac­ing short­ages. Dis­ci­plines such as Nurs­ing, Phar­ma­cy and Audi­ol­o­gy only have place­ments in rur­al and remote set­tings of less than four weeks and none of the non-med­ical degrees have the oppor­tu­ni­ty for a long-term place­ment in rur­al and remote Aus­tralia (greater than six months). Fur­ther­more, the lit­er­a­ture demon­strates that often these stu­dents had to source and fund the place­ments themselves.

This is reflect­ed in a 2021 sur­vey from the NRHSN to its mem­bers on short-term rur­al place­ment oppor­tu­ni­ties. The NRHSN received over 500 respons­es, of which over 50% were by non-med­ical stu­dents. 87% of the sur­vey respon­dents were inter­est­ed in short-term place­ments in rur­al and remote set­tings. 33% of the sur­vey respon­dents had not had any expo­sure to rur­al health through their degree, increas­ing to 53% for nurs­ing stu­dents. Two-thirds of nurs­ing stu­dents nev­er had the oppor­tu­ni­ty to com­plete a rur­al and remote placement.

Sim­i­lar fig­ures were seen in Allied Health stu­dents. Of the stu­dents who had been on a short-term place­ment pro­gram, 85% intend­ed to work or train rural­ly, and the main fac­tor in influ­enc­ing them was their past place­ment in such settings.

These fig­ures demon­strate that rur­al intent is not nec­es­sar­i­ly fol­lowed through in non-med­ical stu­dents due to the lack of oppor­tu­ni­ties pro­vid­ed to them. This was con­firmed by the two main bar­ri­ers iden­ti­fied by these stu­dents, which were con­tacts to facil­i­tate place­ments (31%) and finan­cial bar­ri­ers (22%).

These are essen­tial­ly removed for med­ical stu­dents who take part in the extend­ed place­ments in rur­al and remote Aus­tralia through their RCS.

The sur­vey respon­dents saw an ide­al place­ment being between two to five weeks in length and regard­ed accom­mo­da­tion and finan­cial sup­port as a key com­po­nent of a suc­cess­ful place­ment. There is there­fore sig­nif­i­cant scope to remove the exist­ing bar­ri­ers that Nurs­ing, Mid­wifery and Allied Health stu­dents face for them expe­ri­ence all that rur­al and remote Aus­tralia has to offer.

The exist­ing oppor­tu­ni­ties such as the CRANAplus under­grad­u­ate schol­ar­ship are fan­tas­tic sup­port for these stu­dents but more can be done to remove the issues with sourc­ing place­ments, par­tic­u­lar­ly in the uncer­tain times we live in.

There­fore, the NRHSN is advo­cat­ing for the estab­lish­ment of a mul­ti­dis­ci­pli­nary pro­gram with repeat­ed lon­gi­tu­di­nal expo­sure for Nurs­ing, Mid­wifery and Allied Health stu­dents to expe­ri­ence life in rur­al and remote Aus­tralia beyond the con­straints of their degrees.

The 2022 NRHSN Exec­u­tive Group.

Why stu­dents applied or would apply for a pro­gram out­side of their university:

  • The great­est bar­ri­er as a first-gen­er­a­tion work­ing-class stu­dent was finan­cial, as not only are stu­dents sup­port­ing them­selves in the rur­al com­mu­ni­ty, but they are sac­ri­fic­ing time at work while away. The ide­al pro­gram would sup­port stu­dents financially.”
  • I applied as I craved rur­al expe­ri­ence, due to COVID-19 pre­vent­ing all pre-planned rur­al activ­i­ties through my uni­ver­si­ty… [I] want­ed an indi­vid­ual expe­ri­ence that would enable me to repli­cate the envi­ron­ment in which I could work in the future… sep­a­rate from the safe­ty of my uni­ver­si­ty friends, where it was just myself, the men­tor and the community.”
  • To get expe­ri­ence rural­ly, as I haven’t been offered rur­al expe­ri­ence through my rur­al clin­i­cal school despite mul­ti­ple applications.”
  • As I live in an out­er met­ro­pol­i­tan sub­urb of Ade­laide it was the only way to get an expe­ri­ence of more remote health.”

The Nation­al Rur­al Health Stu­dent Net­work (NRHSN) is the peak rep­re­sen­ta­tive body for med­ical, nurs­ing and allied health stu­dents who are pas­sion­ate about pur­su­ing careers in rur­al health. With over 11,000 mem­bers from 29 Rur­al Health Clubs (RHCs) across the coun­try, the NRHSN is one of Australia’s largest stu­dent organ­i­sa­tions in the health sec­tor. The NRHSN is an ini­tia­tive of the Aus­tralian Gov­ern­ment Depart­ment of Health, admin­is­tered by the Con­sor­tium of Rur­al Work­force Agen­cies (RWAs). The NSW Rur­al Doc­tors Net­work is the RWA man­ag­ing the NRHSN on behalf of the consortium.