Table 4 Mechanisms for delivery of different placement models

1

Support for students

Multiple papers [33, 35,36,37, 39,40,41,42,43,44, 46, 47, 49] identified student support as: Information booklets and maps for the locality; travel and/or accommodation costs paid for; daily student allowance provided; induction provided at the beginning of placement; orientation session and tutorials; discussion of learning objectives; discussion of key concepts of rural health practice; accurate communication about what clinical experience in rural practice will offer to students; duration; pre placement reflection of personal strengths/weaknesses; post placement debrief opportunity; 1:1 supervision at the end of every clinical session; clusters of students being placed together; for IP placements, understanding of professional identity prior to placement; internet access; phone coverage; access to a library; provision of social opportunities;

2

Support and recognition for supervisors

Provision of supervisor courses for local clinicians; providing support to supervisors during clinical placements; and provision of tutorial programs for students run by the UDRH/Rural Clinical Schools or universities. One paper identifies ongoing difficulties with health staff recruitment and retention impacting on capacity to provide consistent support for student supervision, particularly in rural areas where departments are relatively small [37]. Wolfgang et al. [37] describe how the UDRH provides support and education to clinical supervisors.

3

External funding or sponsor

Guion et al. [46] for example describe receipt of funding from an ‘interdisciplinary grant’ to set up the placement model. Frakes et al. describe the effect of receiving intermittent pockets of state and federal government funding on the ability to maintain their placement model. Kirby et al. (2018) reiterate the importance of ongoing funding for placements designed to address community needs and the need to embed placements into government health and education policy to ensure sustainability

4

Sustained funding

Frakes et al. [41] identify that capacity to implement and evaluate the impact of sustainable RCPs that require collaboration between multiple stakeholders is keenly affected by whether or not funding sources are sustained [41, 42].

5

Regional coordination / infrastructure and support

For example the Australian University Departments of Rural Health (UDRH) function as a single coordination point for the whole region and all the health organisations – ‘a one-stop shop for student placements’ that involves streamlining administrative procedures, maintaining links with service partners, clinical supervisors, feeder universities and students [36, 37, 40, 41].

6

Coordination role between university and placement site

Several papers [36, 37, 41, 47] emphasized the importance of a central broker, advocate or ‘go-between’ in the success of implementing ‘collaborative fieldwork’ models that can increase the capacity of a clinical educator to take multiple students at one time. For example Wolfgang et al. [37] describe how a unit coordinator was responsible for meeting regularly with students or telephoned those in remote locations, coordinated the placement with the university and field work site, provided support and training to supervisors and organised accommodation and transport .

7

Stakeholder engagement, consultation and partnership

The importance of ‘building meaningful partnerships’ and ‘monitoring that all roles and visions are clear and understood’ were essential components of engagement with stakeholders when devising and delivering rural IP clinical placements. Kirby et al. [43] describe trust as a key factor for success: whereby high levels of trust was facilitated by close relationships between stakeholders which in turn was facilitated by social connection in the local community. Kirby states that the combination of work and social connection enriched levels of interaction and facilitated partnerships. The enabled a commitment to be investing and sharing resources. A Memorandum of Understanding to meet unmet need underpinned the partnership.

8

Needs / demand analysis

As identified by Allan’s study [38] describing university clinics, where needs analyses are not conducted there is a risk that the clinic may not provide a sufficient amount or range of clients due to poor geographic positioning of clinic within the campus, sporadic and ineffective marketing and/or lack of range of clients/problem types.

9

Support for university placement staff

Two studies [38, 41] describe the need to adequately support academic staff who run university clinics as their role is often stretched to cover both clinic operations as well as an academic load. Key to successful running of university clinics is also year-round running of the clinic, making support for academic staff even more pertinent to their success.

10

Selection criteria / student traits

Moosa and Shurr [44] describe a placement opportunity for students to develop speech pathology resources in extremely remote and under resourced communities in Canada. They iterated the importance of a selection process to ensure the students had the aptitude and character to cope with the demands of the placement and the ‘hands-off’ supervision model utilised. The authors stated the following requirements for students to undertake the placement: “Interest in rural issues/working rurally, strong academic record, clinical placement evaluations that identified strong professional and ethical conduct, exceptional interpersonal communication skills, rapid integration of feedback, independent problem solving, critical thinking skills” (p.162). Interest in rural practice was also cited as a selection criterion [44].

11

Resourcing

Adequate resourcing for RCPs refers to the infrastructure, time, resources and staffing required to plan, develop, coordinate and deliver the placement such as: providing the placement venue (e.g. school/health service), keeping track of and coordinating all student placements within the health service/community setting and organising and delivering structured education and supervision opportunities (e.g. integrated clinical debrief sessions; group interprofessional sessions; case studies; online activities; and journal clubs). Ongoing resourcing was linked closely to ongoing external funding, which was particularly important for placements designed to address community needs [34].

12

Support from registration bodies and/or professional associations

One author cites that Interprofessional competencies need to be part of placement requirement/university requirement as expressed by one participant “clinical training requirements are set by the universities who set requirements for placements—they don’t require cross discipline work, so the hospital won’t provide it” [43].

13

Evidence based approach to placement model

Frakes et al. [41, 42] describe using reviews of evidence and inviting international experts to present evidence and collaborate in research evaluating placement effectiveness in an effort to maintain quality placements.

14

Regular program planning, evaluation and feedback

Regular evaluation against needs assessment is key to sustainability and success of placement, in particular for placements designed to meet unmet community need. Drawing from implementation science literature, Frakes et al. for example describe the need for a focus on evaluating all aspects of a new model (context, processes and interactions and capacity to sustain). The Capricornica model therefore uses of multi-level evaluation and feedback loops as mechanisms to monitor sustainability and success by collecting impact data around student, staff, patient, referrer and health service outcomes [41, 42]

15

Student autonomy

Student autonomy over determining community needs (conducting needs analyses) or developing the services and resources requested by the communities was key to student learning outcomes, particularly for placements designed to meet community need [40, 44].