The impact of COVID-19 on student placements facilitated by university departments of rural health
Bourke, L and Hellwege, B and Jessup, BL and Heaney, S and Sheepway, L and Hoang, Ha and Podubinski, T and Farthing, A and Rasiah, R and Fitzroy, R and Obamiro, KO and Jatrana, S and Argus, G and Knight, S, The impact of COVID-19 on student placements facilitated by university departments of rural health, Australian Rural Health Education Network (ARHEN), Australia, pp. 1-25. (2021) [Report Other]
University Departments of Rural Health (UDRHs) facilitate clinical placements in rural and remote settings throughout Australia for students enrolled in tertiary health courses. The focus is largely nursing, midwifery and allied health placements but medical and other placements are also included. UDRHs support students to travel to rural and remote regions, provide accommodation, ensure clinical learning needs are met, enable work integrated learning, ensure quality supervision, supplement student education and training, and intervene when problems arise. Placements must be at least two weeks, and are often longer, and undertaken full-time.2-9 In 2019, the 16 UDRHs across Australia supported over 16,500 placements in 28 different disciplines of study with students from most universities around Australia.1
The impact of the COVID-19 virus began to be felt in Australia early in 2020. By February, the virus was detected among international travellers in quarantine and in March, Australia recorded the first cases of community transmission. Governments then began to restrict the movements of residents and introduced widespread social distancing rules. By the end of March, all non-essential businesses and activities were ‘shutdown’ and work and study from home was enforced for most university staff and students. Health services remained open and a surge workforce was recruited. Tasmania closed its borders on March 20, closely followed by the Northern Territory, Western Australia, South Australia and Queensland. These measures were put in place initially to slow the spread of the virus while the health system and hospital intensive care units prepared for an expected rapid increase in the numbers of COVID-19 patients.10
The restriction on travel, reluctance to move around and a focus on essential services dramatically changed the ability of students to travel to rural and remote areas and across state and territory borders. Further, universities were concerned about the safety of their students undertaking placements in healthcare settings during this time while, simultaneously, rural and remote health services were concerned about the safety of their community if allowing outsiders (students) to come from other areas with known COVID-19 cases. The number of COVID-19 cases was higher in metropolitan regions, and rural and remote communities feared a local outbreak because of limited healthcare capacity to treat infected residents and higher proportions of at risk populations, including Aboriginal and Torres Strait Islander people, older residents, and people with chronic conditions.11 The movement of students into rural and remote regions to undertake a clinical placement became very difficult and, in declared biosecurity zones, impossible.
As placements had been planned and some placements were underway, UDRHs had to quickly respond to the needs of students, local health services, their local communities, universities and government guidelines.2,3 In a short amount of time, placements were cancelled, postponed, adapted, moved to online or condensed to enable students to get home, remain safe and to continue their university course if possible. This required changes to placement settings, use of Personal Protective Equipment (PPE), training students in infection control or telehealth, changes to student accommodation to meet social distancing requirements and changes to travel arrangements that had been made, including trying to re-coup costs of cancelled travel. The response was swift, focused on safety and the changes were many. UDRH staff across Australia worked hard to enable
students to undertake placements where it was safe, however many rural and remote placements were cancelled.2,3
As COVID-19 cases eased in Australia, in June placements were re/organised and students began travelling to some rural and remote regions. Placements in Aboriginal and Torres Strait Islander communities were generally halted and a second wave of COVID-19 cases in Victoria restricted travel from July to November into and around the state. As a result, some students were able to undertake a rural or remote placement while others were unable, depending on where the student lived, where the placement had been organised, the setting of the placement and response to students coming in by the rural/remote region. Over time, it became apparent that some students, some disciplines and some regions were more impacted than others, and some students had experienced the cancellation of multiple placements. Anecdotally, some students expressed concern about progression through their university course. Others articulated concerns about a lack of clinical learning and some expressed fear for their safety during placements. Responses from students, universities and rural/remote health services responses were diverse and not well understood.
Because of these many changes and responses to COVID-19 as well as the resulting restrictions, UDRHs were interested in student experiences of their organised placements during COVID-19. To this end, all 16 UDRHs agreed to participate in a study of students who had a placement organised by a UDRH from February to October, 2020. The aims of the study were to:
1) identify student perspectives of impacts to UDRH-facilitated placements due to COVID-19;
2) identify student perspectives of UDRH-facilitated placements during COVID-19;
3) understand student experiences of UDRH-facilitated placements during COVID-19.