The aim of this study was to explore the features of high-quality rural health student placements from the perspective of university staff involved in designing, delivering and evaluating these programmes.

A sequential explanatory mixed methods design was employed, integrating quantitative survey data with qualitative interview findings to provide a comprehensive understanding of the research question.

The study was conducted online and sampled staff from universities across Australia, focusing on rural health student placements. The study involved 121 university staff members who participated in the survey, with 10 of these participants also taking part in follow-up qualitative interviews.

Quantitative data were collected using an online survey distributed to university staff involved in designing, delivering and evaluating rural health student placements. The survey included Likert scale, open-ended and demographic questions, and a preliminary analysis was used to write the interview questions. Qualitative data were gathered through semi-structured interviews, which were transcribed and analysed using the Framework approach. The quantitative and qualitative results were integrated to produce a narrative summary of findings.

Key features identified as essential for high-quality rural health placements included safe and affordable accommodation, financial support and personal safety. High-quality supervision, cultural awareness training and opportunities for interprofessional education were also highlighted. The qualitative findings provided depth to the quantitative data, emphasising the importance of structuring learning within a continuum of education and fostering connections through co-location and community engagement.

This study identifies fundamental features of high-quality rural health placements in Australia, including accommodation, student safety, supervision and cultural responsiveness training. These findings can inform the design, delivery and evaluation of rural health student placements, contributing to the quality of these programmes as an efficacious learning experience.

No data are available. Data generated by this research are not available due to ethics requirements and the small sample size.

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Rural health student placements are a critical component of health professional education, essential for meeting clinical training requirements in pre-qualifying health degrees in Australia. These placements, often conducted in rural settings, provide students with invaluable hands-on experience and a deeper understanding of health as a person-centred phenomenon within a social context. Despite the recognised importance of rural health student placements, there is a need for comprehensive insights into what constitutes high-quality rural placements, particularly from the perspective of university staff who play a pivotal role in designing, delivering and evaluating these programmes. This study aimed to explore the determinants of high-quality rural health student placements from the viewpoint of university staff involved in these processes. By focusing on the unique opportunities and challenges presented by rural settings, this research seeks to contribute to a holistic understanding of how to enhance the quality of these placements, thereby supporting the development of a capable and well-prepared health workforce.

Rural (the term referring to parts of Australia classified under the Modified Monash Model as MM2-7, see: https://www.health.gov.au/topics/rural-health-workforce/classifications/mmm) health student placements are a type of work-integrated learning (WIL) and a fundamental component of the education required to become a health professional. Reflecting this, pre-qualifying health degrees in Australia must include WIL in their curricula to meet clinical training requirements.1 2 Many WIL experiences in the health disciplines are undertaken as student placements, defined in Australia as a period of time in which a student is positioned in an industry organisation for the purpose of meeting learning outcomes relevant to their course.3 Student placements are pivotal for learning the complexity of health as a person-centred phenomenon situated in a social context.4–6 The significance of placements for student learning creates an imperative for stakeholders involved in the design and delivery of these programmes to have access to information to ensure their quality. Health student placements are generally cross-institutional and require collaborative stakeholder efforts and thus can be complex to deliver.7 In rural areas, this complexity can be heightened by the unique contextual features that influence placement programmes, such as being geographically distanced from university campuses, reduced resource availability and a reduced number of health professionals.8 This creates an impetus to generate knowledge that can guide the facilitation of health student placements in rural areas.

Considering the diversity of stakeholders involved in health student placements, it is important that understandings of quality represent multiple perspectives. An extensive amount of research on health student placements has focused on the perspectives of students (see9). Tthe student experience is important, but an exploration of the perspectives of university staff could help triangulate these findings and provide a more holistic understanding of quality. University staff have knowledge related to the processes and constraints related to creating health student placements that are important if we are to fully understand how to create high-quality health student placements within the context of tertiary organisations. This is particularly important for facilitating health student placements in rural areas where there are unique resourcing and environmental factors.

In Australia, university staff involved in rural health placements typically fall into two groups. The first group are employees of tertiary-funded programmes that own the programmes of study in which students are enrolled. These university staff are primarily consumers of rural health placements. The second group are staff employed at University Departments of Rural Health (UDRH), who work under a health workforce-funded initiative.10 UDRH staff are based in rural areas and act as facilitators of rural health placements for students who are often enrolled at a university different to the UDRH university. Both groups of university staff are stakeholders in rural health placements and offer important and different perspectives about quality. Despite this, there has been a paucity of research exploring the perspectives of either group of Australian university staff on what constitutes a high-quality health student placement.9

Research that has explored university staff perspectives of placement quality has generally clustered university staff as part of broader stakeholder groups and not explored their perspectives as a standalone group. For example, Craig et al11 included university staff in their research focused on the outcomes of a service learning placement in rural Australia. Their sample included local facilitators, academic staff, health professionals and representatives of local health or community services. The interviews were analysed as one dataset, providing an overarching perspective of the quality of the programme under evaluation. Hosken et al12 similarly used a combined sample of social work students, field educators, social work university liaison staff and staff involved in the project team to evaluate a rotational social work field placement in regional Australia. Other research, such as that conducted by Jones et al13 14 has explored students and academic perceptions of a rural service learning placement on work readiness and employability of students14 and on the features that promote engaged health partnerships.13 This research grouped the results of the sample together and did not focus solely on quality during placements but used other outcomes as proxy indicators of quality (work readiness, employability, engaged partners).

One study conducted by Johnson and Blinkhorn15 focused specifically on the views of university staff and supervising clinicians on the feasibility and acceptability of a rural dentistry placement. This enabled the authors to elicit the opinions of these stakeholders about the aspects of the placement that contributed to a high-quality experience and the issues that affected the quality of the programme from a pedagogical and practical perspective. This study was the only one of its kind and had still grouped university staff with placement supervisors. Six interviews were conducted by Johnson and Blinkhorn,15 of which three participants were university staff.

It is evident that further work is required to explore features of quality in rural health student placements from the perspective of university staff. This study aimed to provide depth and breadth to the current evidence related to university staff perspectives of high-quality rural health placements. The study focused on exploring the features of high-quality rural health student placements from the perspective of non-UDRH university staff who have a role in designing, delivering and/or evaluating these placements for health students. Academic and professional staff perspectives were included from a range of institutions and health professions. Views of university staff from a diversity of geographical areas classified as rural locations were also included. By including a diverse sample of university staff from across Australia, this research contributes to holistic understandings of rural health student placement quality, including how to create and evaluate these programmes.

This study was positioned in the constructivist paradigm and ontologically emphasised the role of individuals in constructing their own reality and the role of the researchers in the co-construction of knowledge.16 This study is part of a larger research programme seeking to determine the features of high-quality rural health student placements. This article reports on Component A of the larger research programme17 and used an explanatory sequential mixed methods design (figure 1)18 with quantitative data collected from a cross-sectional survey and used to construct interview questions for further exploration of findings. Integration between the methods was undertaken at the stage of qualitative interview guide design (which drew on the preliminary findings of the quantitative data—see online supplemental file 3) and by viewing and interpreting both datasets together, although priority was given to the qualitative data. The research methods are reported in line with the COREQ and CROSS research checklists which are presented as online supplemental files 1 and 2.

The findings of this study suggest that, from the perspective of university staff, there are several identifiable features of high-quality rural health student placements. Affordable and safe accommodation, financial support and personal safety were considered fundamental to the quality of health student placements. High-quality supervision (incorporating training and engagement of supervisors), cultural awareness training before and during placements, interprofessional education and close liaison between the student, supervisor and university were considered very important for placement quality. Rurally focused learning opportunities, connecting students to each other and the community, transport and internet access were considered important for placement quality. The interviews suggested that to create high-quality rural health student placements, the continuum of an individual’ education should be considered, and co-location and connection are important facilitators of many of the features of high quality. These findings demonstrate there are specific features that can be incorporated in the design, delivery and evaluation of rural health student placements as a unique opportunity to contribute to tertiary education. The study results are congruent with the findings of the scoping review,9 which was used as a platform on which to build this research programme, and add nuance to understandings of high-quality rural placements, as well as further information on how they can be achieved. The features of high quality suggested in this study can be operationalised in the delivery of these programmes in a way that is contextually relevant to the host rural community.

This study has contributed to the literature by adding the perspectives of university staff to the extensive amount of work that has focused on the perspective of students, demonstrated in a recent systematic review by Eady et al.21 The work of Eady et al21 aligns with our current study as both found university staff and students felt that for placements to be high quality, they need to meet the learning needs of the student and contribute to the development of skills, knowledge and personal attributes. There was also agreement that student safety (physical, psychological and cultural) contributes to quality and that clear roles, expectations and organisation and coordination between stakeholders were important. Supportive relationships between supervisor and student were identified as important by Eady et al21 and our study, although students did not mention a requirement for supervisor training. Similarly, the university staff interviewed in our study discussed Aboriginal and Torres Strait Islander cultural training and interprofessional education and collaboration as important features of quality, which was not a finding in Eady et al’s21 systematic review.

Other notable differences when comparing the findings from Eady et al’s21 systematic review of student perspectives to that of university staff explored in our study are that students placed importance on the way they were assessed and the marks they received. This was not mentioned by university staff and perhaps indicates different roles and desired outcomes in the enterprise of student placements. Students also mentioned the effect that personal attributes of the student had on quality, indicating that they required initiative, positivity and agency. In both studies, there was recognition of the impact on the quality of student circumstances, including financial, social and cultural position. Students also mentioned the importance of feeling that they had made an impact during their time. Students wanted an authentic experience and wanted to be able to see themselves in a similar role in the future,21 whereas this was not an identified feature of quality in our study. These findings suggest that it is important to view quality from multiple viewpoints as there are key differences in the perspectives of key stakeholders, such as university staff and students.

Our study identified that safety during rural health student placements was considered fundamental to high quality, as demonstrated by ‘student personal safety’ and ‘safe and affordable accommodation’ being considered important or very important by 100% of participants. These factors encompass all aspects of safety, including physical safety and security, psychological safety and social well-being. The Australian Universities Accord Final Report has highlighted the importance of student welfare, safety and well-being to the overall student experience, stating that higher education institutions must ensure that all learning environments are safe, welcoming and inclusive.22 This study’s findings regarding the importance of meeting students’ needs so that they can engage with learning during their placement are supported by the literature. Students can only engage in learning through placements if their requirements for safety, security, belongingness, self-concept and learning are met.23 Therefore, suitable, secure, affordable and conveniently located accommodation must be available for students on rural clinical placements.24 25 Considering recent attention on placement poverty in Australia, the provision of free or subsidised accommodation has become particularly important, as it may alleviate stress and anxiety for students who experience a loss of income during their unpaid placement.26

In the last 15–20 years, the demographic profile of Australian students has evolved and now includes higher proportions of mature-aged students, Aboriginal and Torres Strait Islander peoples, students from low socio-economic backgrounds, students with a disability and people from regional, rural and remote areas. Further, health profession courses may have higher proportions of students from culturally and linguistically diverse backgrounds.22 27 Students with diverse backgrounds can face additional social and cultural barriers to participating in rural clinical placements, which may include caring for children or parents or religious practices. Students may be perceived to be ‘different’ by others or perceive themselves to be different, which can negatively impact student clinical placement experiences.28 As this study’s findings demonstrate, students with culturally diverse backgrounds may face additional challenges engaging in placements due to communication and language barriers, discrimination and racism.27 28 Considering these changes in tertiary students’ demographics and our findings that point to the importance of person-centred understandings of student needs, there is a need for future research to further explore this area and understandings of ensuring student safety during placement.

Our findings highlight the importance of partnerships between universities, students and supervisors to achieve high-quality placements. University staff described two important roles in these relationships. The first was to communicate clearly to the students the value of rural placements to current student learning and for future career options, which aligns with previous work by Ross et al.29 The second role was to develop relationships with placement supervisors and to communicate the expectations of the rural placement in the context of curricula and the students’ learning journey. Further expectations of universities were to provide student supervision training to supervisors and to offer ongoing support to supervisors during the placement. Developing relationships involves regular communication to clarify objectives and roles30 31 and, although challenging across geographically dispersed rural areas, can be assisted by modern communication technology.30 While the importance of these partnerships has been highlighted in previous research,32–35 there is a need for further work to explore processes and resources required for the creation of strong, collaborative partnerships between multiple stakeholders. The role of rural communities as a stakeholder in placements has yet to be fully explored and presents an opportunity for future work.

This national multidisciplinary study is one of the first to explore determinants of high-quality rural health student placements from the perspective of university staff, a largely missing stakeholder in existing research.9 It provides a wider perspective in comparison with previous research, which has been largely focused on perspectives of students or supervisors, specific placements or specific geographical areas.11 36 Views of participants from 31 Australian universities across 22 health disciplines increase the applicability to a wider audience. The explanatory sequential mixed methods design used the preliminary analysis of quantitative findings to inform the interview guide for the qualitative analysis. This allowed for deeper exploration and responsiveness, including further interpretation and integration of all data following the qualitative analysis.

The study does have limitations. While the snowballing recruitment method allowed distribution of the survey to a wide audience, it is not possible to determine how many university staff received the survey and to calculate a response rate. Publicly available details for university staff obtained through university websites may have been out of date. In addition, the choice to forward the survey remained with the university staff initially contacted, and therefore, key personnel may not have received the survey. The snowballing recruitment method may have introduced sampling bias as respondents were likely to forward the survey to those who had similar priorities or work functions. Participants for the interviews were drawn from the survey respondents, meaning participants needed to have completed the survey to be eligible for an interview. This may have limited the sample size and selection. Selection bias may be present in the study, with participants who volunteered for interviews being more likely to have strong or positive views about rural placements. The interviews were conducted by researchers who identify as females, and all interviewees also identified as females. This may have impacted the results of the study. While limitations may impact generalisability, the research informs future directions for research about high-quality rural health student placements.

This study has several implications for policymakers and education institutions. Policymakers should consider the importance of ensuring affordable and safe accommodation for students during their placements. They should also promote policies that support co-location of students and facilitate connections between students and the local community to enhance the quality of placements. Adequate resourcing should be considered so that students have access to reliable transportation and internet services during their placements. This may involve partnerships with local transport providers and investment in digital infrastructure. Universities should establish clear guidelines for regular communication and liaison between students, supervisors and university staff to ensure cohesive and supportive placement experiences. They should prioritise initiatives to help students integrate into the rural community, fostering a sense of belonging and engagement. Universities should also consider how they empower high-quality supervision through the provision of ongoing professional development and engagement strategies.

This study highlights several key features that contribute to high-quality rural health student placements from the perspective of university staff. Fundamental features such as safe and affordable accommodation, financial support and personal safety are crucial for ensuring that students can fully engage with their learning experiences. High-quality supervision, cultural awareness training and opportunities for interprofessional education and collaboration are also essential components that enhance the overall quality of placements. The findings underscore the importance of considering the continuum of education and the role of co-location and connection in fostering meaningful learning experiences. By integrating these features into the design, delivery and evaluation of rural health student placements, universities can better support students and contribute to the development of a skilled and resilient rural health workforce. Future research should continue to explore the perspectives of various stakeholders to further refine and improve the quality of health student placements in rural settings.

No data are available. Data generated by this research are not available due to ethics requirements and the small sample size.

The authors would like to thank Rebecca Barker for her continuous administrative support with the research. We would also like to acknowledge the contributions of Dr James Debenham and Dr Jodie Bailie.