What impact are rural placements having on student opinions about working rurally?

student placement survey review

Data from the 2018 & 2019 UDRH Student Placement Evaluation Survey

I’ll begin this blog with a disclaimer. This is not a complete, in depth analysis of long-term study data, nor is it a total survey review. I have only reviewed here data from particular questions of The University of Melbourne’s University Department of Rural Health ‘UDRH Student Placement Evaluation Survey’ from 2018 & 2019. The survey is completed by students who have been supported by the University of Melbourne/Going Rural Health to have completed a rural health placement. I will say though that there over two thousand data points included in this review, so is not limited in that respect.

Working closely with many students on placement in regional and rural areas, the Going Rural Health team are aware of case studies where regional and rural placements have had a huge impact on individual students – so much so that they are now working in regional and rural organisations, many for organisations where they actually completed their placements.

But in order to gather data on a larger scale to gauge how a regional or rural placement may affect students to consider a rural career, the following questions were included in the placement evaluation survey:

Prior to this placement I was considering living and working in a regional, rural or remote location following graduation.

and

This placement has encouraged me to consider living and working in a rural or remote location after I graduate.

The combined results from 2018 and 2019 are in the table below.

                                      

                                     Question

 

Response

Prior to this placement I was considering living and working in a regional, rural or remote location following graduation.

This placement has encouraged me to consider living and working in a rural or remote location after I graduate.

Strongly Disagree or Disagree

424 (190/234)

214 (100/114)              (-9.8%)

Neutral

491

474                                      (-0.8%)

Agree or Strongly Agree

1239 (693/546)

1466 (811/655)            (+10.5%)

TOTAL

2154

2154

 

One of the issues with data such as this is that statistical analyses such as the t-test and Chi-square are difficult to apply, especially since we used Likert scale responses not an either or proposition. Plus understanding of statistics is often limited (I include myself here), and, let’s face it, it is not the most interesting thing to talk about for a blog topic. So rather than discussing statistical significance of the above data in this blog, I’m going to talk about practical significance.

Results are practically significant when the difference is large enough to be meaningful in real life. So what practical significance can we take from this data?

Firstly and most obviously, the data shows a 50% reduction in the number of students in the strongly disagree/disagree group (i.e. those who would not consider a rural career) after a rural placement (a -9.8% change). While we can’t infer that the intent of all of these students is to work rural, we can understand the data to mean that more students are open to the possibility of working rurally after a rural placement, if the opportunity arises. And since we know that rural areas have issues with attracting and recruiting health professionals (e.g. Harvey et al 1995, Eley & Baker 2007), in terms being meaningful in real life, this is a win.

The results in the Agree/Strongly Agree group are a little more subtle. While it would be useful to analyse in more detail the responses where students opinions have shifted from one extreme to another, I’ll limit the discussion here to just the overall numbers and the effect this might have on rural workforce. A large proportion of participants were open to the idea of working rural from the beginning. Unsurprising considering a large number of students we work with are from regional universities, who will in all likelihood be of rural or regional origin, and many of whom will return to work in regional or rural areas. Overall, we saw more than a 10% increase in those who are considering working rurally, which should be good news for rural health.

But I have done one final quick analysis using some very rough data manipulation, just on the 2019 data, to look at these questions for select metro-based universities only (see data below). And the good news is that the effect discussed above is magnified for this group. If we are talking about workforce wins, and we have to be considering the workforce maldistribution between metro and rural (see Productivity Commission 2005, Zurn et al 2004), that’s the biggest win of all.

 

                                      

                                     Question

 

Response

Prior to this placement I was considering living and working in a regional, rural or remote location following graduation.

This placement has encouraged me to consider living and working in a rural or remote location after I graduate.

Strongly Disagree or Disagree

104 (51/53)

34 (18/16)                    (-24.6%)

Neutral

66

57                                       (-3.2%)

Agree or Strongly Agree

115 (69/46)

194 (118/76)                (+27.7%)

TOTAL (Melbourne based uni)

285

285

 

 

References:

Harvey, D., Sandhu, G. & Strasser, R. (1995). Unresolved healthcare issues in rural and remote Australia: Preliminary findings from a National Rural Health Unit Survey. Australian Journal of Rural Health 3, pp 34-36  https://doi.org/10.1111/j.1440-1584.1995.tb00143.x

Eley, R., and Baker, P.G. (2007). Rural and remote health research: Key issues for health providers in southern Queensland.  Australian Journal of Rural Health 15, pp 368-372 https://doi.org/10.1111/j.1440-1584.2007.00918.x

Productivity Commission (2005), Australia’s Health Workforce, Research Report, Canberra. https://www.pc.gov.au/inquiries/completed/health-workforce/report/healthworkforce.pdf

Zurn, P., Dal Poz, M.R., Stilwell, B. & Adams, O. (2004). Imbalance in the health workforce. Human Resoures for Health 2, 13. https://doi.org/10.1186/1478-4491-2-13

Trish Thorpe

Associate Lecturer, Rural Placement Co-ordinator Ballarat

Medical Scientist/Clinical Biochemist 

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