Living and working with the people of ‘the bush’: A foundation for rural and remote clinical placements in undergraduate medical education

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Practice points

Medical students need to understand the rural/remote community context and its impact on the health of rural/remote populations. This can be taught by immersing medical students in rural/remote communities through ‘community’ as distinct from ‘clinical’ placements. Educators should consider engaging rural/remote communities as experts and equal partners in medical education.

Figure 1. Map of WA showing the Wheatbelt and Kimberley regions. The Perth metropolitan area (WA's capital) is the unlabelled region on the coast between the Wheatbelt and the South West.

Table 1  Student responses to the 2011 Wheatbelt and Kimberley placements

	Wheatbelt, n = 95				Kimberley, n = 85
Statement	Median score	SD/D (%)	Neutral (%)	A/SA (%)	Median score	SD/D (%)	Neutral (%)	A/SA (%)
I have a better understanding of the health issues of people living in rural/remote areas	4	3	11	86	4	8	18	74
The placement enhanced my interest in rural/remote area practice	4	17	19	63	4	21	26	52
The placement provided me with positive experiences of living in rural/remote areas	4	5	18	76	4	20	20	59
The remote area health placement prompted me to question some of my beliefs and opinions	4	19	24	57	4	17	20	63
The ‘Trapped … by space’/‘Living on medicine’ PBL problem focused my learning on the placement	4	25	19	56	3	49	29	23
I met most learning objectives using the resources provided before and during the placement	4	20	25	55	3	43	29	29
The placement provided me with opportunities to learn from rural/remote area residents about factors influencing their health	5	4	6	89	4	17	20	63
I have a better understanding of the diversity of cultures and languages in remote WA	N/A	N/A	N/A	N/A	4	11	7	82
The placement helped me to reflect on attitudes to health and values associated with treatment/management that I had/may have previously taken for granted	N/A	N/A	N/A	N/A	4	9	19	71
I have a better appreciation of ‘remoteness’, e.g. the magnitude of distances, the issues of communication, the isolation from others and from services	N/A	N/A	N/A	N/A	4	9	9	81
My host family made me feel welcome	5	1	3	96	N/A	N/A	N/A	N/A
My work placement host made me feel welcome	N/A	N/A	N/A	N/A	5	4	5	92
My accommodation/leisure placement host made me feel welcome^a	N/A	N/A	N/A	N/A	5	2	1	62
I felt safe (in a personal sense) during the placement	5	0	1	99	4	14	14	71
The length of the placement was appropriate	4	9	7	84	4	27	18	55
I recommend that the placement be retained in the MED100/MED200 curriculum	5	0	6	94	4	11	17	73

Notes: 1, strongly disagree (SD); 2, disagree (D); 3, neutral; 4, agree (A); and 5, strongly agree (SA) (Percentages may not add to 100% because of rounding.).

^a34% answered N/A because their work placement host was also their accommodation/leisure placement host.