Johnston C.1, Newstead C.1, Sanderson M.1, Wakely L.2, Osmotherly P.1
1University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Newcastle, Australia, 2University of Newcastle Department of Rural Health, Discipline of Physiotherapy, Tamworth, Australia
Background: Clinical placements are an essential component of physiotherapy training programs and many entry-level physiotherapy programs mandate the completion of at least one rural/remote clinical placement. Physiotherapy practice often differs between geographical settings, and clinical placements in rural/remote areas offer students opportunities to experience a diverse caseload, develop independent thinking, work with limited resources and learn multiprofessional teamwork skills. As the number of physiotherapy programs, and therefore students, in Australia has increased over recent years, there may be a greater reliance on rural/remote physiotherapists to provide clinical education experiences. It is, however, unknown as to whether a shift in placement distribution away from a historically metropolitan dominated pattern has occurred given that the geographical distribution of physiotherapy student clinical placements has not been recently comprehensively examined. It is also unknown as to whether placements in rural/remote areas offer equivalent outcomes for students to those situated in inner regional and metropolitan settings.
Purpose: To describe the geographical distribution of physiotherapy clinical placements, and to investigate the relationship between geographical setting and placement assessment outcomes.
Methods: A retrospective cohort design was used. Data from all Bachelor of Physiotherapy clinical placements at The University of Newcastle, Australia between 2003 and 2014 were collected, including: student grade, year of study and geographical location. Placement geographical locations were classified using the Modified Monash Model (MMM), which contains categories from one (most metropolitan) to seven (most remote). Categorical data were analysed by frequency and percentage, and the median assessment marks for each geographical setting were compared using Kruskel-Wallis and Wilcoxon Rank Sum tests.
Results: Data from 3964 placements (616 students) were included. From 2003 to 2014 the proportion of clinical placements undertaken in metropolitan areas (MMM1) decreased from 78% to 59% and increased in rural areas (MMM3-6) from 22% to 40%. There were significant differences in grades between placements classified as MMM1 and all other categories, with lower median marks in MMM1.
Conclusion(s): The majority of clinical placements were undertaken in metropolitan areas however this proportion decreased gradually across the years included in the study. This changing distribution of physiotherapy clinical placements may reflect increasing student numbers, more regional programs of study and greater efforts to support students to undertake rural/remote placements. The reasons for the differences between grades in the various geographical settings are unknown but may reflect student and/or educator factors including access to clinical supervisor training.
Implications: Efforts to increase numbers of students undertaking placements in rural/remote settings appear to be successful and the resultant shift in geographical distribution of placements may have a positive effect on the rural/remote physiotherapy workforce. Further research is required to determine the specific training and support needs of students and clinical educators in rural and remote settings.
Funding acknowledgements: Nil
Topic: Education
Ethics approval: Ethics approval granted by the Human Research Ethics Committee of the University of Newcastle prior to commencement (approval number H-2012-0430)
All authors, affiliations and abstracts have been published as submitted.
