Case studies exploring interprofessional education and learning in rural health services

Interprofessional collaboration is core to achieving optimal health outcomes for patients. This requires that health professionals learn how to work well together amidst the challenging dynamics of contemporary health care. However, the logistical constraints of managing overladen curricula and timetabling large interdisciplinary healthcare student cohorts to learn together have meant interprofessional education (IPE) is yet to be fully embedded into health professional curricula in Australia. Likewise, IPE is not yet a mandated competency. Despite these challenges, students are encouraged to experience IPE in the clinical setting where it is an integral part of everyday practice. The increasing impetus to facilitate opportunities for interprofessional learning (IPL) in the clinical setting has occurred with scant regard to its feasibility, the learning opportunities and resources available and the supervisory training and capacity of health services to support such learning. The situation is magnified in rural health services.
Though rural practice is known to be inherently collaborative, the services provided are somewhat limited. These organisations are often smaller than urban counterparts, have difficulty recruiting and retaining staff, especially medical and allied health professionals, and are therefore chronically short staffed, and operate with a lean skill mix. Considered in context, these factors highlight a) the potential that rural placements may afford students opportunities to experience interprofessional learning and practice; and b) that relatively little is known about the particular nature of rural clinical learning environments and the capacity of rural health services to provide interprofessional learning opportunities. This research used case studies and applied a convergent parallel mixed methods design to investigate these gaps.
The purpose of this study was to examine the readiness and potential of rural health services to provide IPE to undergraduate students undertaking placements Specifically, this study explored the opportunities available within six rural health services in Tasmania and Victoria to promote IPE, provide a culture conducive to interprofessional learning, and the conditions for successfully implementing IPE. It also assessed clinicians’ and students’ perceptions and readiness for interprofessional learning and developed case studies exemplifying how IPE operated in these health services. Purposive convenience sampling was utilised to recruit a total of 286 participants: 19 Managers, 46 Educators, 88 Clinicians, and 133 Students undertaking placement within the participating health services at the time of the study. Data were collected using the Organisational Readiness for Interprofessional Learning Scale, the student and graduate Readiness for Interprofessional Learning Scales, the Interdisciplinary Education Perception Scale; and semi-structured interviews and focus group discussions. Quantitative data were analysed using SPSS version 26 and qualitative data using NVIVO version 12 and manual content analysis underpinned by a narrative lens and reflexive thematic analysis
There were six primary findings. The first was that all categories of participants reported positive attitudes to IPE provision in rural health services. The second was that time constraints and competing priorities affected the ability of educators and clinicians to provide IPE opportunities and students to engage in IPE. The third was that organisational readiness either enabled or constrained IPE. Fourth, clinicians played a pivotal role in facilitating students’ IPE. Fifth, the readiness for and committed focus on IPE was greater within nursing and allied health than medicine. Finally, the lack of mandated interprofessional assessment devalued the perceived importance of IPE for all participant groups. There were two secondary findings: lost opportunities for interprofessional learning and continued siloing of professions, particularly medicine.
This study is the first in Australia to explore the provision of IPE in the rural context at the level of the organisation, that is, from a holistic, whole of system approach that includes multiple stakeholder perspectives. As such, this study contributes nuanced insight into the readiness and capacity of six rural health services to provide a range of IPE activities and provides valuable and practical insights into the needs of rural health services for facilitating IPE that could be useful to others. Providing this niche contribution addresses an important knowledge gap and adds a new dimension to understanding IPE in the rural context and the factors that enable or constrain its delivery and student engagement. Moreover, it draws attention to the latent capacity for harnessing interprofessional learning if resources are available and structured into planning. Additionally, the findings provide a basis for promoting organisational readiness, strategic planning, and developing guidelines for clinical educators to implement a suite of IPE activities for students undertaking rural placements. Accordingly, these findings have implications for policy, practice and future research and could be used to inform accreditation standards, curricula redesign, clinical placements, supervisory training, and potentially, the provision of IPE activities in other settings