Launching a new interprofessional education programme in a rural setting: a qualitative study of the first two years
Eileen McKinlay
1 * , Melanie Brown 2 , Louise Beckingsale 3 , Fiona Doolan-Noble 1 , Amanda Garnett 1 , Susan Pullon 1
1
2
3
Abstract
Delivery of interprofessional education (IPE) in rural settings can support pre-registration health sciences students to achieve interprofessional collaborative practice (teamwork) competencies. It can also grow the rural workforce with previous students recommending the programme to their peers and some choosing to work in a rural workplace as graduates. Launching and implementing a rural IPE programme in a new location is challenging, even when comparable IPE models exist in other settings.
We aimed to evaluate the implementation of a new rural IPE programme in Greymouth, New Zealand.
Qualitative evaluation data were collected through several rounds of interviews during the first 2 years of the programme. The interviews included students, stakeholders (Education Operations Group – the tertiary education providers who sent students, clinical placement providers, community stakeholders), and local programme staff. Focus group and interview data were explored using thematic analysis.
Three themes were identified, each with subthemes: (1) allow sufficient lead-in time, (2) ensure there is time to bed down, and (3) undertake location-specific quality improvement. These themes pointed to aspects that were important when implementing a new IPE programme, particularly to enable development of a local flavour.
Rural IPE programmes are complex, expensive to establish, and difficult to sustain, but such programmes may be key to increasing the rural workforce. It is critical to have local staff who can work effectively with all the stakeholder groups, all of whom are important to continuing the programme.
Keywords: evaluation, implementation, interprofessional education, rural, staff, students, sustainable, workforce.
| WHAT GAP THIS FILLS |
| What is already known: Rural interprofessional education programmes are challenging to establish yet provide rich learning for students about interprofessional collaborative practice. They are thought to be effective in encouraging students to work in rural practice as graduates. |
| What this study adds: Rural interprofessional education programmes take time to establish, tailor to the local community, and bed down. Conditions for success include being embraced by the local community and having local programme staff who are responsive and work well with local clinical staff, community stakeholders, and students. |
Introduction
Internationally, there is a shortage of health professionals in rural settings. Despite this, the need for health care is often greater in rural communities compared to urban communities1–3 with a higher prevalence of long-term conditions,4,5 more acute injuries relating to rural vocational work,6 and known rural health inequities,7–9 particularly for indigenous peoples.10–12 Yet rural dwellers are often extraordinarily resilient13–15 with a reliance on each other not seen in city areas.16 In rural health care, effective interprofessional teamwork is more evident.17–21 Being able to see resilient health professionals working collaboratively makes rural settings ideal locations for students to undertake interprofessional education (IPE) programmes.22–24 These programmes, often supported by urban universities,25 usually have multiple aims: to support students to learn about interprofessional collaborative practice, to develop knowledge of (and skills to engage with) local cultural and health contexts, and to encourage students to return as graduates.25–27 Despite the obvious benefits, rural IPE programmes are difficult and expensive to establish and often do not endure,28,29 with multifaceted reasons being proposed (socio-cultural, institutional, and organisational).29
The University of Otago Te Tai o Poutini IPE programme based in Greymouth, West Coast, South Island, a R1 classified rural area in Aotearoa New Zealand30 was established in 2021. We aimed to undertake a 2-year evaluation to assess the start-up and initial implementation of the programme and to discern conditions for success.
Background
The Te Tai o Poutini IPE programme was modelled on the long-established Tairāwhiti IPE programme31 (see Fig. 1 for an overview of both programmes and Table 1 for the shared features).
| Feature | Description | |
|---|---|---|
| Funding | Funded by the NZ government, firstly the Ministry of Health and then Health NZ Te Whatu Ora. Funding covers student travel and accommodation, academic and administrative staff salaries, hire of teaching/learning space and cars, teaching and learning resources/activities, hospital clinical access, and payment to private clinical practice providers. | |
| Programme delivery | University of Otago deliver, accredit, and monitor the IPE programmes under the auspices of the Centre for Interprofessional Education. 32, 33 | |
| Learning outcomes | nterprofessional collaborative practice, rural health, Māori health, and long-term conditions. A | |
| Home discipline placements plus interprofessional (IP) placements and learning | Discipline specific clinical placements (3 days/week). B | |
| IP shadowing placements – where a student of one discipline shadows a student of another discipline (0.5 day/week) and other IP activities and learning (1 day/week). | ||
| Programme structure | 5-week blocks/5-times a year. Block dates maximise the opportunities for students from various disciplines to attend concurrently. | |
| IP student mix | Variable each block but always includes students from at least three and up to seven of the following health and social care professions: audiology, dentistry, dietetics, medical laboratory science, medicine, nursing, occupational therapy, paramedicine, pharmacy, physiotherapy, podiatry, social work. | |
| Locally employed university staff | Academic staff (part-time): programme leader and deputy leader. Administrative programme coordinator (full time). | |
| Centrally employed university staff | Administrative staff who liaise with tertiary institutions, establish contracts, manage travel, and make payments. | |
| Contributing tertiary education providers | Students come from multiple tertiary education organisations all over New Zealand. | |
| Learning space | Common, comfortable, and appropriate learning space/room(s), separate from clinical areas, and able to accommodate IPE staff and all students at the same time. | |
| Shared accommodation | Students live together (either in houses in close proximity or the whole group lives in one large house). | |
| Social accountability | Community stakeholders nominate and act as champions/sponsors for projects for the students to undertake relating to health and wellbeing (schools, factories, farms, health promotion, public health, Māori health providers). Projects are formally assessed and a mark/grade given. | |
| Quality improvement | Qualtrics surveys are routinely undertaken before and after block courses. These assess students’ knowledge and attitudes about IP collaborative practice, rural health, Hauora Māori, and long-term conditions. Focus groups are undertaken by the university’s Education Advisors twice a year. |
Preliminary scoping work started in 2019 including the remotely based university staff making site visits to Greymouth and having initial conversations with key stakeholder groups. From then on, and throughout 2020, details were firmed with local clinical and community groups and the tertiary education providers who would contribute students. Some work was done using Zoom, and there were regular 2–3 monthly on-site meetings in Greymouth attended by university staff to meet those who would be involved and enact the details and logistics of the new programme. Local programme staff were appointed in late 2020, 6 months before the programme started. The first block of students started in March 2021, and since then, bar one cancelled block during the COVID-19 pandemic, the programme has offered five blocks per year with 6–11 students attending each block (see Table 2 for the standard timetable that is tailored to each student).
| Sunday | Monday | Tuesday | Wednesday | Thursday | Friday | ||
|---|---|---|---|---|---|---|---|
| Week one | Noho marae | Orientation to IPE programme, clinical placements, meet community project champions/sponsors | Home discipline clinical placement | AM Pits and Peaks (highs and lows of the week) then interactive teaching session A | |||
| PM Community venture | |||||||
| Week two | Home discipline clinical placement | AM Shadowing | AM Pits and Peaks then interactive teaching session | ||||
| PM Time for IP learning including community project B | PM Community venture | ||||||
| Week three | Home discipline clinical placement | AM Shadowing | AM Pits and Peaks then interactive teaching session | ||||
| PM Time for IP learning including community project | PM Community venture | ||||||
| Week four | Home discipline clinical placement | AM Shadowing | AM Pits and Peaks then interactive teaching session | ||||
| PM Time for IP learning including community project | PM Community venture | ||||||
| Week five | Home discipline clinical placement | AM Shadowing | AM Pits and Peaks then interactive teaching session | ||||
| PM Time for IP learning including community project | PM Community venture | ||||||
Methods
A 2-year qualitative evaluation was undertaken, with data collected by experienced researchers not involved in the programme. Ethical approval was granted by the University of Otago Ethics Committee (D21/074).
Methods included
Focus groups with students.
Focus groups or individual interviews with the stakeholders:
Educations Operations Group (EOG): The governance network of clinical placement staff from contributing tertiary organisations. Some members have students in both Te Tai o Poutini and Tairāwhiti IPE programmes.
Clinical placement providers: The public and private health service organisations that will endorse and support the IPE programme by providing clinical, interprofessional, and Māori health placements.
Community stakeholders: The community members including the mayors, local councils, tourist development association, schools, and local iwi (Māori tribal groups) and non-governmental groups. They can also act as champions/sponsors for community projects undertaken by students.
Individual interviews with the locally employed programme staff.
Data collection
In 2021 and 2022 the following data were collected and the audio-recordings transcribed (see Table 3). Question schedules were tailored to the different stakeholder groups with the local clinical providers and community stakeholders asked about the set-up phase and ongoing interactions with local staff, the EOG members asked about the quality of the clinical placements and feedback from students, and students were asked about their satisfaction with the programme and the clinical and IPE placements.
| 2021 | 2022 | ||
|---|---|---|---|
| Students | Three recorded focus groups face-to-face or via Zoom A | Five focus groups recorded via Zoom B | |
| Transcript word counts: 5897; 6436; 6560 | Transcript word counts: 8847; 8880; 7289; 7148; 7508 | ||
| Education Operations Group (EOG) | Two focus groups recorded via Zoom | Two individual interviews recorded via Zoom | |
| Transcript word counts: 5372; 8014 | Transcript word counts: 10,026; 2553 | ||
| Clinical placement providers | One focus group recorded via Zoom | ||
| One individual interview recorded via Zoom | |||
| Transcript word counts: 7432; 4205 | |||
| Community stakeholders | One focus group recorded via Zoom | ||
| One individual interview recorded via Zoom | |||
| Transcript word counts: 5659; 2623 | |||
| Local IPE staff | Two individual interviews recorded via Zoom | Two individual interviews recorded via Zoom | |
| Transcript word counts: 4898; 6415 | Transcript word counts: 8246; 4406 |
Data analysis
The Braun and Clarke six-step method of qualitative analysis was undertaken to inductively analyse the interview transcripts: data familiarisation by re-reading, line-by-line coding supported by NVivo data management software, developing draft themes, reviewing draft themes, describing and naming final themes, and writing-up analysis.34 The goal of analysis was to develop broad themes and ideas for improving implementation success of the IPE programme, rather than an in-depth analysis of participants’ lived experiences. One researcher (MB) undertook the initial coding, which was then discussed with another researcher (EM) and then the full research team. In an iterative and reflexive process, earlier interview data were reanalysed as new information and codes emerged from later interviews, and after discussions between researchers about emerging themes, new codes were proposed, and coding frameworks revised.
Results
This data analysis generated three main themes: (1) allow sufficient lead-in time, (2) ensure there is time to bed down, and (3) undertake location-specific quality improvement.
Theme 1: allow sufficient lead-in time
Setting up any new education programme takes time, additionally so for a rural interprofessional programme where the University is remote and students come from many different tertiary institutions. It was not always immediately apparent who the various local stakeholders were or how similar the IPE programme might be to other rural IPE programmes, which are on the face of it comparable.
Community, clinical placement providers, EOG, and local staff stakeholders said they felt the lead-in time of around 12 months was about right. The effort required by the rural community to host an IPE programme, as well as the benefits, needed to be socialised well in advance.
I have had years of interaction with most of the (University) staff that are part of that programme, so I guess I had a bit of a heads up in that respect anyway, so I already had good relationships with them. The new (local) staff I was fortunate to be able to meet them last November and that was really awesome. (EOG 2021)
I think (the IPE Centre Director) approached our clinic. That’s how we kind of came on board. [Then] my bosses came in too. (Clinical placement provider stakeholder 2021)
Community and clinical stakeholders believed the employment of local staff was critical to the success of the programme, and the lead-in time enabled this to occur in a timely way. These staff were known in the community, and they leveraged off links and contacts established over many years.
I know (the local academic leader) … She had a role here at the PHO [primary health organisation] when we first started 14 years ago and just continued the relationship over the years. (Community stakeholder 2021)
I’d say the key successes are the (local) staff that are here. Because they have to think about other professions and other disciplines and how do they interact. And then the staff have to ask how are we going to teach into that (interprofessional) space, how are we going to support this learner with good experience, so they might actually want to come back? (Clinical placement provider stakeholder 2021)
The high-quality local pastoral care of students was acknowledged by students and EOG members.
I think having (the local staff) was like good, like a really good aspect of this whole programme because we could liaise with them if we had any issues at clinical or just like even personal reasons, and so they were like really open and friendly to everything that we had to say. They were really understanding about our issues as well. (Student, Block 3 2021)
So, my perspective of the overall organisation and the communication from the (local) IPE team has been wonderful. More than adequate, almost impressive … I even sort of got personal emails from the programme manager and the odd phone call and some really, … up-to-date feedback on my particular students. (EOG 2021)
Theme 2: ensure there is time to bed down
Community and clinical stakeholders advised us not to judge the outcomes of a rural IPE programme too soon. They felt it inevitable that there would be a settling period and initial teething problems, and these should be expected.
The local programme staff and the university looked at the initial responses to the IPE programme. There were concerns from students regarding clinical placements to be addressed as quickly as possible.
I think it’s really important to really consider the placements that people are on. Where I was placed it was quite disorganised. I didn’t know where I was each day until I showed up … I felt like I’d only just got to know what I’m doing and we finished. (Student, Block 2 2021)
Despite these initial placement issues, students, EOG, and community stakeholders were positive about the IPE programme as a whole.
This (programme) has highlighted the importance of an interprofessional approach. So, I think going forward, like taking that (interprofessional approach) and trying to incorporate it wherever possible (in my practice). (Student, Block 5 2021)
The feedback from the students is amazing, like they love, love, love it. The positives out of it for the students were that confidence that they had around working with other students, ‘cause they didn’t realise what dietician students did, what pharmacy students did, what anyone else did apart from their own little world … (EOG 2021)
It appears to be me that (the IPE programme) is going okay. (There) seems to be a good lot of students all the time and (it) just seems very well run. (Community stakeholder 2021)
Some EOG stakeholders wanted all their students to take part.
My takeaway so far is it’s an amazing learning opportunity for my students. I really appreciate the opportunity to be involved and I really strongly want to continue our student’s involvement in any of the IPEs within New Zealand that occur. I think it’s a great learning opportunity for the students and the total immersion is amazing. (EOG 2021)
Stakeholders pointed out the need for the programme to bed down before judging success.
It’s probably hard to measure the true success after only 1 year. There’s a lot of the outcomes I think will show in the future. (Clinical placement provider 2021)
Some stakeholders felt success was largely associated with a willingness to move to Greymouth as graduates.
Getting some of them to come and spend some time in rural, yeah. That would be the bigger success. (Community stakeholder 2021)
Community, clinical, and local programme staff stakeholders thought it would take 2–3 years to determine the local placement capacity, balancing participation without overburdening the local community.
The main challenge is finding the placements. Given that we’ve got a small pool of health professionals here and health’s been pretty battered with the pandemic, a lot of people are feeling stressed and burnt out … that’s our biggest challenge. (Local programme staff 2022)
I think it’s probably just the logistics of starting a new programme (is challenging) and finding different placement providers (for students) starting those new relationships (with providers). I think it will come with time. (EOG 2021)
A particular issue was when education institutions also sent students for clinical placements (often for a full year) who were not part of the IPE programme, meaning there was inadvertent competition. Liaison between stakeholders became critical.
Sometimes we’re sending a student across to a placement that’s not in the IPE programme. Other times we’re sending one in IPE and one not an IPE. … But we have to pre-organise that with the DHB [district health board] manager. She needs to know because her staff can’t be stretched in all directions. So, yeah there’s a three way communication there between (IPE staff), myself and the DHB manager. And it does get a little bit clunky. (EOG 2022)
Some education institutions found the timing and/or length of the 5-week IPE block did not easily fit with their timetables, and they needed to find ways to make the programme fit with their structure.
The six weeks versus five weeks (block) is an issue for us … normally we would keep (students) over there for (an extra) week but it gets too complex, so we’ve just kept them within the programme but if it’s a longer placement, it is tricky … The transition students have a ten-week placement so a five week in IPE gets really tricky. (EOG 2021)
Theme 3: undertake location-specific quality improvement
Local programme staff, EOG members, and clinical stakeholders acknowledged the IPE programme would need to be modified to ensure it met the learning outcomes and was not burdensome for those taking part. They also endorsed the programme developing its own unique character.
Local programme staff recognised the importance of feedback from a variety of sources to highlight issues that could then be worked on (see Table 4).
| Issues | Examples | |
|---|---|---|
| Communicate | Maybe starting communications a bit earlier … I’m not sure if everyone else feels the same, but we sort of started getting stuff maybe a few weeks before the programme, which might have been a bit too late for some. (Student, Block 1 2022) | |
| I’ve got some ideas on (improving the) information that we’re sending out (to students). We send them an orientation manual, and it’s abundantly clear that they don’t read it. …I can see (we need to develop some better) communication that’s a little bit, sort of one page key points and just keep it a little bit snappier’. (Local programme staff 2022) | ||
| We had a bit of confusion as to who to go to with any questions. And I wonder whether some sort of document, as to you know who the key contacts are, might be quite useful … (EOG 2022) | ||
| Timely preparation | We had never had a student before, so we didn’t even know what our responsibility was. Thankfully, … the Uni (staff member was able) to travel to the Coast but we were already a week or so into the placement … It would’ve been nice to have happened 2 weeks before the student arrived. (Clinical placement provider 2021) | |
| I’d say the key successes are the (shadowing placements) … But staff have to think (in advance) about other professions and other disciplines and how do they interact … (Clinical placement provider 2021) | ||
| COVID-19 pandemic impact | I got COVID for the first week of the placement, so I was stuck in Dunedin for a week, and they were really good about communicating, seeing how I was doing, when I was gonna be able to come and join everybody. (Student, Block 1 2022) | |
| We had to cancel our two students who were going on block four before the COVID episode because of the insecurity of knowing if the placement could take the students, and we couldn’t leave it till the last minute to cancel. (EOG 2021) | ||
| Respond to issues and requests | We had a student who can’t drive and that was going to be quite a bit of a roadblock until we kind of worked around that. (EOG 2022) | |
| I would like there to be a little bit more shadowing. I got (to) shadow two persons but … I would have liked to have gone to dental clinics. (Student, Block 3 2021) | ||
| I personally found the community project quite demanding in terms of time. And the project was quite broad and quite big. And we had very limited time to actually work on it. (Student, Block 4 2022) | ||
| Make adjustments | The issues aren’t so much with the IPE side of it, it’s more with some of our faculties’ internal assessment side that I need to change. (EOG 2021) | |
| That has probably taken a little bit more work because the IPE learning objectives don’t directly align with our learning objectives. So, we have had to make some adjustments. (EOG 2021) | ||
| People from the schools (EOG) can help iron those things out (aligning student assessments with IPE assessments), …, that would make it a lot better for those students here. (Local programme staff 2022) | ||
| It’s the first time IPE has been linked (in my programme) so I’m still not 100% sure how much cross crediting there’s gonna be between the projects. (Student, Block 3 2021) |
Programme staff worked hard to develop the programme that had its own local character with an emphasis on rural health.
(the IPE programme) gives the opportunity for people to see the West Coast, get the experience of what rural is like, and most importantly I think too, to understand the breadth of people’s roles and where they overlap … And I think that’s where the appreciation of the interprofessional comes in. (Local programme staff 2022)
I think it’s always assumed that urban is better and rural is worse and so there’s a lot of mythology that needs to be broken and if you stay in the cities, you stay in the cities. I think the way the (IPE) programme’s been structured to allow for people to meet other professionals, to realise the strength of other professionals and that I think expands people’s knowledge of the rest of the team. (Clinical provider 2021)
Students appreciated visiting rural and cultural settings.
I think the visit to the farm like really highlighted the rural aspect so getting to talk with those workers just really gave us the perspective of how like living so far away from health care and the access, and the way health people like the health professionals to treat them as well and things like that. (Student, Block 3 2021)
The experience of opening this entire placement with the trip to the local marae and hearing from local iwi just about the region itself and the story that’s led to this, well about this area … I found it a really great way to set the scene and I think is a really important part of being on the West Coast. (Student, Block 5 2021)
And being embraced by the local community.
We have felt we have been accepted really well by the community here and I think that’s probably a good reflection on just the community in general but also the staff that we have been interacting with, and also (the clinical placement) supervisors. (Student, Block 2 2021)
In turn, students were able to contribute back to the West Coast community by their community projects.
The community projects that the (students) have been doing are really sensible projects for that environment and you know I really think the team on the ground on the Coast in conjunction with the community are the best to advise about that. (EOG 2021)
One of the students said to me … ‘In my university work I’d write these assignments up, I send them in, I get a mark back, but this (community project) was actually really, really meaningful because I could see that I was making a difference.’ Suddenly the penny dropped that that was actually very real and meaningful compared to an academic assignment. (Local programme staff 2022)
Discussion
Rolling out a new rural IPE programme during the COVD-19 pandemic was not for the fainthearted, but 2 years after the programme began there were strong indications that it was accepted in the community and of the conditions for its success.
The stakeholders signalled that the success of the initial implementation was due to strong local relationships and support from the community. Having more than a year to set up and involving multiple stakeholder groups at the start were critical to engaging the community. This long lead-in time was particularly helpful because when the COVID-19 pandemic caused disruption in the community and other priorities overtook them, the programme continued because it was known and trusted.
Employing local staff was critical to the success of the programme; however, researchers who have also noted this caution that employment can take many months, as staff skill and availability is limited in rural areas.22,31,35 Our study showed that having a match of skills is essential, with a mix of part-time academic (health professional) and full-time administrative staff needed, each with well-established community and cultural connections. Administrative staff have a key role in approaching local health providers for clinical placements, arranging student placement dates, organising programme and student logistics, and providing student pastoral support.
As other studies have found,26,36 it was hard to accurately judge in advance how many clinical placements a rural health care community could sustainably offer, as well as the ideal number of students to accommodate per block and how many blocks to offer each year. Flexibility and sensitivity to local community and clinical provider stress are important, and the programme has had to sometimes quite suddenly temporarily change student intakes (due to the COVID-19 pandemic or extreme weather events) to achieve sustainability.
Robust quality improvement measures in rural IPE programmes are recognised as critical in order to balance students’ attainment of IP and clinical learning outcomes, enjoyment in the programme, and desire to work in rural settings as graduates35,37,38 yet without over burdening the clinical placement providers and the wider community.39 This balance is known to require responsive and nimble governance40 which the EOG was able to provide with the support of the experienced central university management team. Stakeholders noted areas where the programme could improve, but they were also sympathetic that the programme was establishing itself as well as managing the impact of the COVID-19 pandemic.
The distinct rural flavour of the Te Tai o Poutini IPE programme was increasingly evident as it developed, and this process of localisation should be encouraged in other new and developed IPE programmes. The local staff used their contacts and drew on the suggestions of community and clinical stakeholders to offer students placements and experiences that highlighted the unique Greymouth rural area.
In this present study, stakeholders realised that the success of the IPE programme could not be measured immediately. Some were uncertain about what success would look like and how it should be assessed, but recognised it was not solely about local recruitment. Local recruitment numbers themselves may not tell everything41 as, although new graduates might have been keen to come to the West Coast, no suitable new jobs may be available, or IPE programme graduates may have gone to other rural settings and not be able to be tracked. This mirrors other studies in which, although acknowledging the rich learning opportunities in rural IPE, researchers note variability between programmes, including the impact of length of placement, differences between disciplines, and inability to track students as graduates.38,40,41
This study supports the importance of programme teams in developing a strong local community focus, even when the IPE is based on another comparable programme (Tairāwhiti IPE). The structural elements are the same in both programmes, but the focus in Greymouth is strongly on rurality. This has meant that the IPE students felt included in the community, met the rural and interprofessional learning outcomes, and contributed practical outcomes that were meaningful to the local community. A steady flow of students have returned to Greymouth as graduates (9 from 100 students between 2021 and 2023).
There are limitations to this study. It is specific to the Greymouth location; however, the results are similar to studies about the implementation of the Tairāwhiti IPE programme.31,37 The COVID-19 pandemic meant fewer interviews than planned (particularly focus groups) were able to be undertaken; however, this was countered by having a 2-year evaluation with this longer length better showing the changes in the programme over time.
Conclusion
Rural IPE programmes strongly support students to learn about interprofessional collaborative rural health care, with a number returning to rural settings to work as graduates. The programmes are, however, inherently challenging to establish and sustain, and securing long-term funding is essential.
Conflicts of interest
The Te Tai Poutini Interprofessional Education Programme is funded by Health NZ Te Whatu Ora. The funder did not play any part in the writing of this paper. The authors declare no other conflicts of interest.
Declaration of funding
The University of Otago Centre for Interprofessional Education funded the research.
Acknowledgements
We thank the students and the current and former local staff team in the Te Tai Poutini IPE Programme (Wendy Stratford, Alice Cochrane, Diana Panapa, Juliette Sexton, Sue Donaldson, Kerri Miedema, and Megan Tahapeehi), the Greymouth community, and clinical placement providers.
References
1 Green D, Minchin L. Living on climate-changed country: Indigenous health, well-being and climate change in remote Australian communities. EcoHealth 2014; 11: 263-72.
| Crossref | Google Scholar | PubMed |
2 Fearnley D, Kerse N, Nixon G. The price of ‘free’. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals. J Prim Health Care 2016; 8: 204-9.
| Crossref | Google Scholar | PubMed |
3 Reid S. The rural determinants of health: using critical realism as a theoretical framework. Rural Remote Health 2019; 19: 5184.
| Crossref | Google Scholar | PubMed |
4 Walker RC, Tong A, Howard K, et al. Patient expectations and experiences of remote monitoring for chronic diseases: systematic review and thematic synthesis of qualitative studies. Int J Med Inform 2019; 124: 78-85.
| Crossref | Google Scholar | PubMed |
5 Golembiewski EH, Gravholt DL, Torres Roldan VD, et al. Rural patient experiences of accessing care for chronic conditions: a systematic review and thematic synthesis of qualitative studies. Ann Fam Med 2022; 20: 266-72.
| Crossref | Google Scholar | PubMed |
6 Nixon G, Davie G, Whitehead J, et al. Comparison of urban and rural mortality rates across the lifespan in Aotearoa/New Zealand: a population-level study. J Epidemiol Community Health 2023; 77: 571-7.
| Crossref | Google Scholar | PubMed |
7 Whitehead J, Davie G, de Graaf B, et al. Unmasking hidden disparities: a comparative observational study examining the impact of different rurality classifications for health research in Aotearoa New Zealand. BMJ Open 2023; 13: e067927.
| Crossref | Google Scholar |
9 MacKinnon NJ, Emery V, Waller J, et al. Mapping health disparities in 11 high-income nations. JAMA Netw Open 2023; 6: e2322310.
| Crossref | Google Scholar |
10 Disler R, Glenister K, Wright J. Rural chronic disease research patterns in the United Kingdom, United States, Canada, Australia and New Zealand: a systematic integrative review. BMC Public Health 2020; 20: 770.
| Crossref | Google Scholar | PubMed |
11 Australian Government, Australian Institute of Health and Wellness, Rural and Remote Health; 2023. Available at https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health [accessed 7 November 2023].
12 Crengle S, Davie G, Whitehead J, et al. Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand. Lancet Reg Health West Pac 2022; 28: 100570.
| Crossref | Google Scholar | PubMed |
15 Spector S, Cradock-Henry NA, Beaven S, et al. Characterising rural resilience in Aotearoa-New Zealand: a systematic review. Reg Environ Change 2019; 19: 543-57.
| Crossref | Google Scholar |
16 Jaye C, McHugh J, Doolan-Noble F, et al. Wellbeing and health in a small New Zealand rural community: assets, capabilities and being rural-fit. J Rural Stud 2022; 92: 284-93.
| Crossref | Google Scholar |
17 Walker SM, Kennedy E, Nixon G, et al. The allied health workforce of rural Aotearoa New Zealand: a scoping review. J Prim Health Care 2022; 14: 259-67.
| Crossref | Google Scholar | PubMed |
18 Gum LF, Sweet L, Greenhill J, et al. Exploring interprofessional education and collaborative practice in Australian rural health services. J Interprof Care 2020; 34: 173-83.
| Crossref | Google Scholar | PubMed |
19 Franklin CM, Bernhardt JM, Lopez RP, et al. Interprofessional teamwork and collaboration between community health workers and healthcare teams: an integrative review. Health Serv Res Manag Epidemiol 2015; 2: 2333392815573312.
| Crossref | Google Scholar | PubMed |
20 Perron D, Parent K, Gaboury I, et al. Characteristics, barriers and facilitators of initiatives to develop interprofessional collaboration in rural and remote primary healthcare facilities: a scoping review. Rural Remote Health 2022; 22: 7566.
| Crossref | Google Scholar | PubMed |
21 Stockton DA, Fowler C, Debono D, et al. World Health Organization building blocks in rural community health services: an integrative review. Health Sci Rep 2021; 4: e254.
| Crossref | Google Scholar | PubMed |
22 Wros PL, Tilden VP, Osborne M. Community-based interprofessional education in rural primary care. J Interprof Educ Pract 2023; 31: 100629.
| Crossref | Google Scholar |
23 Reed K, Reed B, Bailey J, et al. Interprofessional education in the rural environment to enhance multidisciplinary care in future practice: breaking down silos in tertiary health education. Aust J Rural Health 2021; 29: 127-36.
| Crossref | Google Scholar | PubMed |
24 Adams M. Education to prepare health professionals for rural practice: a scoping review. Aust J Rural Health 2023; 33: 17-40.
| Crossref | Google Scholar |
25 Fraher EP, Lombardi B, Brandt B, et al. Improving the health of rural communities through academic–community partnerships and interprofessional health care and training models. Acad Med 2022; 97: 1272-6.
| Crossref | Google Scholar | PubMed |
26 Martin P, Argus G, Ford M, et al. The rural and interprofessional education and collaborative practice interface: findings from a qualitative study. J Interprof Care 2024; 38: 182-5.
| Crossref | Google Scholar | PubMed |
27 Dymmott A, George S, Campbell N, et al. Experiences of working as early career allied health professionals and doctors in rural and remote environments: a qualitative systematic review. BMC Health Serv Res 2022; 22: 951.
| Crossref | Google Scholar | PubMed |
28 Rogers C. Supporting health students on rural placements: a scoping review. Aust J Rural Health 2021; 29: 319-31.
| Crossref | Google Scholar | PubMed |
29 Janes TL, Rees J-L, Zupan B. Is interprofessional education a valued contributor to interprofessional practice and collaboration within allied health in Australia and New Zealand: a scoping review. J Interprof Care 2022; 36: 750-60.
| Crossref | Google Scholar | PubMed |
30 University of Otago, Geographical classification for health; 2025. Available at https://www.otago.ac.nz/dsm-gprh/centre-for-rural-health/research/geographic-classification-for-health [accessed 20 April 2025].
31 Pullon S, McKinlay E, Gallagher P, et al. Interprofessional education in a rural clinical setting: a quick-start innovation for final-year health professional students In: Abdulrahman K, Mennin S, Harden R, et al., editors. Routledge International Handbook of Medical Education. New York: Routledge; 2015.
32 University of Otago, Division of Health Sciences, Centre for Interprofessional Education; 2016. Available at https://www.otago.ac.nz/healthsciences/staff/ipe/otago087119.html [accessed May 2025].
33 Symes A, Pullon SR, McKinlay E. Programmatic evaluation of interprofessional education: a quality improvement tool. J Interprof Care 2024; 38: 768-71.
| Crossref | Google Scholar | PubMed |
34 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101.
| Crossref | Google Scholar |
35 Croker A, Hudson JN. Interprofessional education: does recent literature from rural settings offer insights into what really matters? Med Educ 2015; 49: 880-7.
| Crossref | Google Scholar | PubMed |
36 Stewart RA. Building a rural and remote health workforce: an overview of effective interventions. Med J Aust 2023; 219: S3-4.
| Crossref | Google Scholar |
37 Pullon S, Darlow B, McKinlay E Building Evaluation into the Development of Interprofessional Education Initiatives. In: Forman D, Jones M, Thistlethwaite J, editors. Leading Research and Evaluation in Interprofessional Education and Collaborative Practice. London: Palgrave Macmillan UK; 2016. pp. 145–66.
38 Gum LF, Richards JN, Walters L, et al. Immersing undergraduates into an interprofessional longitudinal rural placement. Rural Remote Health 2013; 13: 2271.
| Google Scholar | PubMed |
39 Martin P, Hill A, Ford M, et al. A novel interprofessional education and supervision student placement model: student and clinical educator perspectives and experiences. Int J Environ Res Public Health 2022; 19: 10734.
| Crossref | Google Scholar | PubMed |
40 Walker L, Cross M, Barnett T. Mapping the interprofessional education landscape for students on rural clinical placements: an integrative literature review. Rural Remote Health 2018; 18: 4336.
| Crossref | Google Scholar |
41 Webster CS, McKillop A, Bennett W, et al. A qualitative and semiquantitative exploration of the experience of a rural and regional clinical placement programme. Med Sci Educ 2020; 30: 783-9.
| Crossref | Google Scholar | PubMed |
