Sustaining our rural allied health workforce: experiences and impacts of the allied health rural generalist pathway.

INTRODUCTION: Rural and remote communities face significant disadvantages accessing health services and have a high risk of poor health outcomes. Workforce challenges in these areas are multifaceted, with allied health professionals requiring broad skills and knowledge to provide vital services to local communities. To develop the expertise for rural and remote practice, the allied health rural generalist pathway (AHRGP) was introduced to develop and recognise specialist skills and knowledge required for rural and remote practice, however the experiences of professionals has not been explored. This study gained the experiences and perceptions of allied health professionals undertaking the pathway as well as their clinical supervisors, line managers, profession leads and consumer representatives. METHODS: A qualitative study was undertaken drawing on pragmatic approaches across four research phases. This study was one component of a larger mixed methods study investigating the experience, impact and outcomes of the AHRGP across six regional Local Health Networks in South Australia (SA). Interviews, surveys and focus groups were conducted to explore the perceptions and experiences of participants. Data was analysed thematically across participant groups and research phases. RESULTS: A total of 54 participants including 15 trainees, 13 line managers, nine clinical supervisors, six profession leads, four program managers and seven consumer representatives informed this study. Five themes were generated from the data; gaining broad skills and knowledge for rural practice, finding the time to manage the pathway, implementing learning into practice, the AHRGP impacts the whole team and confident, consistent, skilled allied health professionals positively impact consumers. CONCLUSION: The AHRGP is offering allied health professionals the opportunity to develop skills and knowledge for rural and remote practice. It is also having positive impacts on individuals' ability to manage complexity and solve problems. Findings indicated consumers and organisations benefited through the provision of more accessible, consistent, and high quality services provided by trainees. Trainees faced challenges finding the time to manage study and to implement learning into practice. Organisations would benefit from clearer support structures and resourcing to support the pathway into the future. Incentives and career advancement opportunities for graduates would strengthen the overall value of the AHRPG.

The allied health rural generalist pathway: a cost consequence analysis.

INTRODUCTION: Rural and remote health workforces face longstanding challenges in Australia. Little is known about the economic effectiveness of workforce initiatives to increase recruitment and retention. A two-level allied health rural generalist pathway was introduced as a workforce strategy in regional local health networks (LHNs) in South Australia in 2019. This research measured the resources and outcomes of the pathway following its introduction. METHODS: A multi-phase, mixed-methods study was conducted with a 3-year follow-up period (2019-2022). A cost-consequence analysis was conducted as part of this study. Resources measured included tuition, time for quarantined study, supervision and support, and program manager salary. Outcomes measured included length of tenure, turnover data, career progression, service development time, confidence and competence. RESULTS: Fifteen allied health professional trainees participated in the pathway between 2019 and 2022 and seven completed during this time. Trainees participated for between 3 and 42 months. The average total cost of supporting a level 1 trainee was $34,875 and level 2 was $70,469. The total return on investment within the evaluation period was $317,610 for the level 1 program and $58,680 for the level 2 program. All seven completing trainees continued to work in regional LHNs at the 6-month follow-up phase and confidence and competence to work as a rural generalist increased. CONCLUSION: This research found that the allied health rural generalist pathway has the potential to generate multiple positive outcomes for a relatively small investment and is therefore likely to be a cost-effective workforce initiative.

Experiences of working as early career allied health professionals and doctors in rural and remote environments: a qualitative systematic review.

BACKGROUND: Maintaining a health professional workforce in rural and remote areas poses a significant challenge internationally. A range of recruitment and retention strategies have had varying success and these are  generally developed from the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review explores, compares and synthesises the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience. METHODS: Qualitative studies that include early career allied health professionals' or doctors' experiences of working in rural or remote areas and the personal and professional factors that impact on this experience were considered. A systematic search was completed across five databases and three grey literature repositories to identify published and unpublished studies. Studies published since 2000 in English were considered. Studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach. RESULTS: Of the 1408 identified articles, 30 papers were eligible for inclusion, with one rated as low in quality and all others moderate or high quality. A total of 23 categories, 334 findings and illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, and personal and community influences make a difference. A rich dataset was obtained and findings illustrate similarities including the need to consider personal factors, and differences, including discipline specific supervision for allied health professionals and local supervision for doctors. CONCLUSIONS: Strategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community immersion. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021223187.

Experiences of working as early career allied health professionals and doctors in rural and remote environments: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to investigate the experiences of working as an early career allied health professional or doctor, and the factors that influence this experience in rural or remote environments. INTRODUCTION: Recruitment and retention of health professionals in rural and remote areas is challenging, with a range of strategies used to attract and retain them, which vary by profession and jurisdiction. Workforce recommendations are often based on the collective experience of all health professions. This review will explore the experiences of early career allied health professionals and doctors and compare and synthesize the evidence in order to better understand the individual and collective factors to generate relevant recommendations. INCLUSION CRITERIA: This review will consider qualitative studies that include early career allied health professionals' or doctors' experiences of working in rural or remote areas and the personal and professional factors that impact on this experience. METHODS: CINAHL, Embase, MEDLINE, Web of Science, Informit, ProQuest Dissertations and Theses, Google Scholar, and WorldWideScience.org will be searched to identify published and unpublished studies. Studies published since 2000 in English will be considered for the review. Identified studies will be screened for inclusion in the review by two independent reviewers. Studies for inclusion will be critically appraised by two independent reviewers. Data will be extracted using a standardized tool and reviewers will discuss any disagreements. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into synthesized findings that can be applied as evidence-based recommendations. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021223187.

Clinical supervisor training: using critical incidents to identify learning outcomes.

BACKGROUND: Student supervision training varies by design and mode and is typically evaluated via satisfaction and confidence rating surveys that consider participants' subjective perceptions and attitudes. This study investigated the effectiveness of a 2-day interprofessional student supervision training workshop by identifying participants' confidence and their learning outcomes, through their responses to a clinical supervision scenario. METHODS: Four workshops were held with 112 of 142 workshop participants who consented to respond to a pre- and post-training questionnaire investigating confidence ratings and to a critical clinical supervision scenario that identified key features, actions and subsequent intended outcomes. Critical incident theory was used in the study design and data analysis. RESULTS: Confidence in supervision knowledge and skills improved after the workshop. Participants identified similar key features of the scenario before and after the workshop; however, there were qualitative differences in their planned actions and intended outcomes. Pre-workshop, participants focused on feedback and communication strategies to identify and resolve challenges using a didactic approach. Comparatively, post-workshop, the participants' response to the scenario suggested that they would collaborate with the student to explore the situation and plan strategies in partnership and to mutually understand the issues. Participants' pre-workshop learning goals related to their post-workshop learning attainment, but findings suggested a deeper understanding and application of the learning after the workshop. DISCUSSION: Using a critical incident scenario in conjunction with confidence ratings in the evaluation of a student supervision workshop suggested that participants acquired an integrated understanding of students' learning in clinical placement and provided a framework to guide future training.