Preparing healthcare professional students for rural, regional and remote practice: demonstrating the effectiveness of an interprofessional simulation learning experience

ABSTRACT

Undertaking an authentic interprofessional simulation experience may be a useful and consistent strategy for healthcare professional students to build competencies required for a rural healthcare context. An observational comparative study design was adopted to evaluate a clinical simulation experience created to develop the interprofessional competencies of a sample of healthcare professional students at a regional university situated on multiple campuses in New South Wales (NSW), Australia. Over 200 students across three campuses of the university were involved in a simulation experience that included four interprofessional activities. Of these students, 189 (89%) agreed to participate in the study. The healthcare professional students who participated in the study were from second year occupational therapy, physiotherapy, and podiatry, and third year speech pathology programs. Retrospective pre and post self-assessed interprofessional collaborative competencies were compared for all students using the revised Interprofessional Collaborative Attainment Survey (ICCAS). Results demonstrated a statistically significant improvement in self-perceived scores using the validated revised ICCAS survey. The findings of this study suggest that carefully designed and authentic interprofessional simulation experiences can facilitate the development of competencies required for effective interprofessional practice, which are necessary for successful rural practice.

KEYWORDS:

• Healthcare professional students
• interprofessional education
• interprofessional practice
• rural health
• simulation
• simulation-based learning

Introduction

The known, global maldistribution of health professionals between urban and rural locations is reflected in the Australian allied health workforce, where professionals per 100,000 population significantly decrease with increasing remoteness (Battye et al., 2019). In Australia, the term “allied health” describes health professionals who are not medical, nursing, or dentistry trained, but who have university qualifications, a defined scope of practice, work autonomously, and provide direct health care to the public, for example, occupational therapists, physiotherapists, speech pathologists, or podiatrists (Allied Health Professions Australia, 2023). Allied health professionals (AHP) use evidence-based practices to provide preventative, diagnostic and intervention services to improve the health and wellbeing of clients and their communities (Allied Health Professions Australia, 2023). Rural allied health practice has been identified as a specialist area of practice, with organizations such as Services for Australian Rural and Remote Allied Health (SARRAH) supporting and promoting the Allied Health Rural Generalist Pathway (SARRAH, 2023). This pathway recognizes the unique knowledge, skills and attributes required to effectively manage the complexities and challenges encountered in rural practice (SARRAH & Remote Allied Health, 2023). Rural practice includes practice in regional, rural, and remote areas of Australia.

Rural practice differs from urban practice (Wakerman et al., 2017), and it is vital that students are appropriately prepared for rural contexts, as feeling well prepared to provide rural healthcare is a known predictor of both future recruitment and retention in these areas (Cosgrave et al., 2018). The undergraduate education of healthcare professionals has an important role to play in their preparation for rural practice, and the need to focus on this preparation has been acknowledged globally (World Health Organization [WHO], 2021), and in Australia at national (Battye et al., 2019) and state levels (New South Wales Parliament Legislative Council, 2022). Within Australian rural health practice contexts, the significant geographic distances, and workforce challenges necessitate the effective use of electronic information and communication, or eHealth strategies (Gray et al., 2014), including use of telephone, electronic health records, and telehealth (Cummings et al., 2019; World Health Organization [WHO], 2016). In rural areas, eHealth approaches to health are used to support coordination of discharge from urban hospitals (Street et al., 2019), source specialized allied health inputs from urban centers (Kingston et al., 2015), and to facilitate hub and spoke models of work (Elrod & Fortenberry, 2017). It is essential that healthcare professional students are provided with opportunities to develop skills in effectively using eHealth strategies in preparation for rural practice.

Another important contextual factor in rural practice is limited staffing and resources, which require adaptation to a complex, generalist caseload and necessitate shared care and interprofessional collaboration (Bourke et al., 2012; Wakerman, 2004; Wakerman et al., 2017) in a variety of clinical settings (SARRAH, 2023). Interprofessional collaboration requires integration of multiple health professional perspectives, in a spirit of respect and trust, to collectively address complex client needs (D’Amour et al., 2005). The ability to work effectively as a member of an interprofessional team also requires well developed communication skills and a commitment to a collaborative, interdependent approach (Carney et al., 2019) that aims to achieve mutually agreed goals (Hastie et al., 2016). As such, there is a need for undergraduate healthcare professional students to develop interprofessional collaboration capabilities, with multiple different professions, using a range of modalities that match their potential future experiences in rural practice.

Background

There are core skills healthcare practitioners require to engage in interprofessional practice. For example, the Canadian Interprofessional Health Collaborative (CIHC, 2023) identified role clarification, team functioning, interprofessional conflict resolution, and collaborative leadership as four key skills necessary for effective interprofessional practice. A similar skill set is necessary to successfully work in rural settings. P. Martin et al. (2022) found that rural healthcare workers need to possess skills in teamwork, relationship building, collaborative practice, and role clarification. Adams (2023) conducted a scoping review of education to prepare health professionals for rural practice and identified core skills required by students to successfully transition to and remain in rural practice. These skills include the ability to work autonomously, to develop relationships, to lead, and to communicate. Adams (2023) advocated that education experiences should “enable students to develop self-confidence and proficiency to work with greater autonomy in challenging environments” (p. 33) and that rural placements should include a focus on interprofessional education to appropriately prepare students for rural practice. Given the challenges of rural healthcare, including poorer overall health, fewer health professionals, geographical distances, and the complexity of client presentations, it is highly desirable that a deliberate focus on preparing healthcare professional students for practice in rural contexts includes the development of interprofessional skills.

Workplace learning placements are an integral component for preparing students for practice, including practice in rural contexts (Boshoff et al., 2020). However, due to placement availability and differences in workplace learning settings, it is difficult to guarantee every student has consistent and adequate exposure to the development of interprofessional collaboration skills required for effective rural practice (Mills et al., 2019). Additionally, Adams (2023) suggested there may be on over reliance on these placements to provide students with important rural content to prepare them for practice. Use of simulation provides opportunities for students to participate in deliberately designed authentic practice experiences that provide consistency of experience, a safe place to make errors, and scope for the development of skills that are highly transferable to practice (Gough et al., 2012). Simulation is a guided teaching and learning strategy that replicates, augments, or replaces all or part of a real practice experience (Gaba, 2004). Simulation in health degrees has commonly been implemented for single disciplines, in a single location, where face-to-face communication is both possible and relatively straightforward (Spaulding et al., 2019). There have also been examples of simulation being used to expose healthcare professional students to the realities of rural practice (Johnston & Wakely, 2021). The use of interprofessional simulation has become more common particularly with medical and nursing students and the occasional addition of one allied health discipline (Olson & Bialocerkowski, 2014). This type of co-located, one-to-one professional collaboration model reflects only one component of the work of healthcare professionals in rural areas. Other researchers have found that simulation can be used to assist students to make connections between interprofessional approaches to healthcare and healthcare provision in rural contexts (Stilp & Reynolds, 2019; Woodroffe et al., 2012).

Therefore, an alternative approach to simulation was required to adequately prepare healthcare professional students for effective and authentic rural practice, including the development of skills in interprofessional collaboration. This concept is supported by a study undertaken by Hayes et al. (2022) who evaluated five healthcare disciplines and found that involving students in interprofessional simulation experiences facilitates their understanding of roles and development of collaborative decision-making skills and communication skills.

The allied health faculty at a regional university identified an opportunity to leverage the diversity of the multiple discipline groups and geographically diverse campuses to develop a synchronous, cross-campus, interprofessional simulation experience. The interprofessional simulation aimed to provide students with the opportunity to “learn with, from and about each other” (Centre for the Advancement of Interprofessional Education [CAIPE], 2016, p. 1) and to collaborate about simulated clients within and between campuses using multiple modes of communication including eHealth strategies. The aim of the research presented in this paper was to determine if a multi-campus, interprofessional simulation, authentic to rural practice contexts, facilitated the development of healthcare professional students’ interprofessional collaboration competencies, across different professions. This paper presents the findings of the impact of the simulation experience on the development of interprofessional collaboration skills as self-reported by students using the validated and revised Interprofessional Collaborative Attainment Survey (ICCAS) self-assessment tool (Schmitz et al., 2017). The qualitative experience of staff and students involved in this simulation has been reported elsewhere (Robson et al., 2023).

Methods

Setting

Three campuses of a single, regional university were the settings for the simulated learning activities, which were scheduled synchronously and conducted both in-person and virtually across campuses. Location One had occupational therapy, physiotherapy, podiatry, and speech pathology students participating, Location Two had only physiotherapy, and Location Three had both physiotherapy and occupational therapy students participating. Students were allocated to interprofessional teams, with each team having members from a minimum of three health professions to ensure there were opportunities for interprofessional collaboration. Virtual cross-campus collaboration occurred between the locations throughout the experience. Students engaged in in-person interprofessional communication between the disciplines on campus as well as with students on other campuses through eHealth communication strategies such as electronic report writing.

Outline of the interprofessional simulation experience

Students from four healthcare professional disciplines across three regional campuses, were involved in a range of interprofessional simulated learning activities including handovers, referrals, and case conferences that were reflective of what students would encounter in workplace learning placements, with guidance of academics and clinicians. As outlined in a previous article (Robson et al., 2023), the interprofessional activities took place synchronously on three campuses for students from four healthcare professions. Clinical case studies and simulation activities were developed collaboratively by staff with experience in rural healthcare delivery from the four disciplines and included profession specific activities as well as interprofessional interaction activities. The case studies were deliberately designed to reflect the complexities of rural practice and enabled students to participate in a range of simulated activities and reflective practice to build skills and competencies in an interprofessional approach to rural healthcare delivery. There were four interprofessional, simulated activities embedded within a rural context: orientation to the simulated rural healthcare organization, handover and referral of a simulated patient, interprofessional case conference synchronously conducted in-person and online, and team reflection on and evaluation of the simulated placement. Technologies including Skype and videoconferencing were used to enable cross-campus collaboration and replicated an eHealth approach to healthcare (World Health Organization [WHO], 2011). The interprofessional academic and clinical faculty teams provided online and in-person support to students to facilitate development of the knowledge and competencies to work in an interprofessional team.

All students from each discipline were involved in the orientation session. This session was facilitated by academics from the four disciplines; videoconferencing was used to link the three campuses. Students were purposefully paired with a student from a different discipline for the clinical handover session; during this session students discussed relevant information either in-person or online, depending on geographic location of their partner. Students used the World Health Organization (2016) endorsed introduction, situation, background, assessment, recommendation (ISBAR) structure to verbally handover relevant details of the simulated client they had worked with during discipline-specific activities. Students were required to document the handover interaction and prepare a letter of referral to another health professional who would be involved in the client’s healthcare. Supervisors were available for students to consult with, and opportunity was provided for students to critique their partner’s handover. The case conference activity involved groups of six to eight students with a combination of in-person and online participants depending on the geographic location of group members. Each group included at least three of the four disciplines, and students on at least two of the three campuses. The number of students from each discipline varied due to different cohort sizes for each discipline. At the case conference, students presented information relevant to the simulated clients they had worked with during discipline-specific simulation activities. Supervisors monitored two to three groups each and were available to provide feedback and ask prompting questions to facilitate an appropriate plan of action. In the final interprofessional activity students reflected on, discussed, and evaluated their performance and learning from the experience.

Participants

Enrolled students in second year occupational therapy, physiotherapy, and podiatry, and third year speech pathology, undertook the interprofessional simulation experience. It was compulsory that all students participate in the simulation as preparation for future workplace learning experience. All students participating in the interprofessional simulation were invited to participate in the study; research involvement was voluntary. Informed consent was gained from students who agreed to participate in the research.

Study design

An observational comparative study design was used to evaluate the development of interprofessional competencies of a convenience sample of healthcare professional students who participated in the interprofessional clinical simulation experience. All students self-assessed their competency using a retrospective pre and posttest questionnaire, the revised ICCAS self-assessment tool (Schmitz et al., 2017), just after the interprofessional simulated learning experience had been completed.

Assessment instrument

The team were unable to locate a tool that assessed both rural practice competencies and interprofessional competencies. Given the identified overlap between the skills required for rural practice and interprofessional practice, a validated assessment instrument, the revised ICCAS (Schmitz et al., 2017), was employed to quantify and evaluate individual and team performance in interprofessional collaboration following completion of the experience. This tool allows users to reflect upon and rate their interprofessional competencies following an interprofessional learning activity. The ICCAS is a 20-item five-point Likert-type scale (poor, fair, good, very good, excellent) proficiency assessment instrument (Schmitz et al., 2017) based on a retrospective pre and post learning intervention design. The six domains evaluated through the 20-item questions are communication, collaboration, roles and responsibilities, collaborative patient-family centered approach, conflict resolution, and teamwork (Archibald et al., 2014; Schmitz et al., 2017). The original tool was revised to include an additional question, number 21, which asks students to provide an overall rating of improvement in interprofessional competency after completion of the learning activity compared to prior to the activity using a five-point Likert-type scale (much better now, somewhat better now, about the same, somewhat worse now, much worse now; Schmitz et al., 2017). The revised ICCAS is regarded as a reliable tool to assess self-reported interprofessional collaborative competency in the healthcare sector (Archibald et al., 2014; Schmitz et al., 2017).

Using the ICCAS, students evaluated their own interprofessional competence in six domains. Due to the practical limitations of evaluating human performance or behavior, continuous measures are deemed impracticable or risk recording falsely accurate results in comparison to an ordinal measurement framework where responses can be rated or ranked, but there is no assumption that the difference between the responses is equal. Therefore, a multi-item questionnaire, Likert-type scale assessment tool, such as the ICCAS, is a commonly accepted method to validly assess human behavior and performance. Retrospective pre and posttest questionnaires, such as the ICCAS, aim to minimize response shift bias and improve the accuracy of self-reported measures (Andrich & Marais, 2019; Pratt et al., 2000; Schwarz & Oyserman, 2001). They are deemed to be a feasible and effective way to measure human performance and behavior thus further reinforcing the suitability of the ICCAS as an appropriate measure for this study.

Data collection

Data collection occurred at all three campus locations where the interprofessional simulation experience occurred. Data were collected using the revised ICCAS following completion of the interprofessional simulation experience as part of a student reflection activity. Informed consent was gained from all study participants.

Data analysis

Statistical data analyses for this observational study were conducted using R (R Core Team, 2021), and the results are available in the form of tables of frequencies, and median and interquartile ranges for each item of the ICCAS. The statistical significance of difference pre and post simulation activity for all students was assessed using the Wilcoxon Signed Ranks Test as the sample was paired (each student self-assessed their competency twice), the variable was ordinal, and no specific probability distribution was assumed (Upton & Cook, 2006). The threshold level for determining statistical significance was set at .05.

As the data collected using the ICCAS were ordinal, ordinal statistics were employed for analysis (Sheskin, 2011; Upton & Cook, 2006). As such, the median rather than the mean was used to measure the central tendency of these data, and the interquartile range rather than standard deviation for measuring the dispersion. The median was used to compare the difference in performance between occupational therapy and physiotherapy students. The interquartile ranges for the two cohorts were calculated to compare the distribution of the two groups of data points; Interquartile Range (IQR) included 50% of data points that were around the median value (25% below and 25% above).

Question 21 of the revised ICCAS, which is a global measure of change pre and post an interprofessional activity, had a lower response rate than other items of the ICCAS. The Wilcoxon test was used to compare the median scores of occupational therapy and physiotherapy students who responded to this question. As only one speech pathology and no podiatry students completed this question they were not included in this analysis.

Ethics approval

Ethics approval was granted by the Charles Sturt University Human Research Ethics Committee, approval number H19233.

Results

A total of 189 students out of 217 students volunteered to participate in this study (Table 1). Participants included 50 occupational therapy students (26.46%), 111 physiotherapy students (58.73%), 16 podiatry students (8.47%), and 12 speech pathology students (6.35%). More than half the participants (54.50%) were based at the Location 1, 30.16% were at Location 2, and 15.34% were from Location 3.

Table 1. A cross tabulation summary of the number of participants by discipline and campus.

Campus/Profession	Occupational therapy	Physiotherapy	Podiatry	Speech pathology	Row Total
Location 1	29	46	16	12	103
Location 2	0	29	0	0	29
Location 3	21	36	0	0	57
Column Total	50	111	16	12	Grand total:189

Prior to the simulation activity, median scores for the first 20 items of the ICCAS (Schmitz et al., 2017) indicated that most students rated their interprofessional competencies as “Good,” with only one item (“Actively listen to IP members’ ideas and concerns”) as “Very good.” After the simulation activity, most students rated their interprofessional competencies as “Very good” for the first 20 items of the ICCAS (Schmitz et al., 2017), which included the domains of communication, collaboration, roles and responsibilities, collaborative patient/family-centered approach, conflict management/resolution and team functioning. The difference pre and post simulation was statistically significant for the first 20 items of the ICCAS (Schmitz et al., 2017; p < .001).

The final question of the ICCAS (Schmitz et al., 2017), which asked students to provide a global rating of improvement in interprofessional competency, was completed by around one quarter of participants. Following completion of the interprofessional simulation activity, just over half the occupational therapy students rated their interprofessional competency as “Somewhat better” and a similar proportion of physiotherapy students rated themselves as “Much better now,” (Table 2). A statistical difference between the median scores of the occupational therapy and physiotherapy students was noted for this question following completion of the simulation.

Table 2. ICCAS results of question 21 by student discipline.

	Occupational therapy (n = 16) (%)	Physiotherapy (n = 33) (%)
1. Much better now	4 (25)	17 (51.52)
2. Somewhat better now	9 (56.25)	16 (48.48)
3. About the same	3 (18.75)	0
Median (Q1, Q3)^a	2(1.75, 2)	1(1, 2)
p-value^b	0.025

^a(Q1, Q3) represents the inter-quartile range; ^bAs per Wilcoxon Signed Ranks Test, two independent samples.

Discussion

Well-developed interprofessional collaboration skills have been identified as essential to successful and sustained rural healthcare professional practice (Perron et al., 2022). In our observational comparative study we evaluated the development of interprofessional competencies of a sample of healthcare professional students who participated in an interprofessional clinical simulation experience that occurred across three campuses of a regional Australian university. The findings suggest that the experience facilitated the development of students’ interprofessional collaborative competencies and confidence as self-assessed by students using the revised ICCAS (Schmitz et al., 2017).

Recruitment and retention of healthcare professionals are a challenge in rural Australian areas, and demand for allied health services in these areas continues to grow (Foley et al., 2021). A lack of health professionals in these regions contributes to health inequalities and poorer health outcomes for rural Australian communities (King et al., 2022). Education providers therefore have a responsibility to ensure graduates have the necessary skills and level of competence to succeed in a range of contexts, and to prepare future health professionals for all areas of practice, including rural practice. In a scoping review of interprofessional collaboration in rural and remote practice, Perron et al. (2022) found that approaches to improve interprofessional collaboration require both academic and practice-based leadership to be successful. They also found that few strategies to improve interprofessional collaboration in rural and remote settings have been published in recent years. Our results contribute to filling this existing gap in knowledge. Through collaborative and careful design of authentic rural interprofessional experiences embedded in simulation activities, students were able to demonstrate development of interprofessional competence as measured by the revised ICCAS (Schmitz et al., 2017). Given the important role that effective interprofessional practice plays in rural contexts (Perron et al., 2022), the authors suggest that participation in carefully and collaboratively designed simulation activities that have been designed to reflect rural practice, such as that evaluated in this paper, may facilitate the development of skills and the appropriate level of competence required for rural practice.

The simulation experience students engaged in deliberately included opportunities for students to develop their skills in communication, including eHealth communication, and teamwork as these are known to be important skills for interprofessional practice in rural contexts. The handover, case conference, and referral experiences provided students with opportunities to develop their skills and confidence in in-person, online and written communication, as well as facilitating their understanding of their own and other professions. The opportunity to work with a team of students, including students from their own and other professions, assisted in the development of competence in collaborative teamwork and conflict resolution. Other researchers have found that educational opportunities that promote teamwork are essential to develop healthcare practitioners who can work successfully in rural contexts (Stilp & Reynolds, 2019).

Many health professional accreditation standards mandate that students undertake a broad range of clinical experiences during their training; given the nature of practice in Australia and the ongoing shortage of health professionals in rural areas, exposure to rural practice is important. Ensuring all students have the opportunity to participate in a rural placement that includes interprofessional collaboration prior to completing their studies can be difficult due to lack of placement opportunities and variability in approaches. Additionally, student reluctance to participate in rural placements due to cost, lack of familiarity with the environment, and distance from their usual supports may impact the uptake of these placements (Johnston & Wakely, 2021). Carefully designed simulated placement experiences provide opportunities for education providers to ensure each student is exposed to the nuances and complexities of rural practice and that these experiences provide opportunities to simultaneously develop skills in interprofessional practice. A single simulation experience is unlikely to be adequate to fully prepare students for effective interprofessional practice in rural areas and as recommended by Adams (2023); it is important the experience is scaffolded with curriculum content that educates students about both rural and interprofessional practice.

The incorporation of eHealth activities within the evaluated simulation experience, was to provide students with opportunities to build confidence in engaging with these technologies and communicating with colleagues in different geographic locations. This inclusion was seen as both important and necessary to authentically replicate contemporary rural healthcare practice. The use of eHealth approaches by healthcare practitioners gained significant momentum during the global pandemic (Fisk et al., 2020), and it has been proposed that it is important for eHealth services, including telehealth, to remain an integral component of health care into the future (Fisk et al., 2020). To utilize eHealth effectively and efficiently, healthcare practitioners must be provided with opportunities to develop and apply the required knowledge and skills (Fisk et al., 2020). The simulation experience evaluated in our research enabled students to engage in interprofessional collaboration, using eHealth options, and to facilitate informed health outcomes for the simulated clients.

Evidence suggests that participation in rurally based workplace learning or clinical placement experiences provides important opportunities for interprofessional education and practice (Janes et al., 2022) and exposes students to the diversity of rural practice (Seaman et al., 2022). These placements have also been found to influence students’ future decisions about employment in rural areas of practice (Seaman et al., 2022). Simulation has been demonstrated to be an effective education strategy to begin acquisition of new skills (Nandon & Scott, 2014) and using simulation, educators are able to intentionally design learning experiences that include opportunities to develop knowledge and skills to foster a more collaborative healthcare culture (Banks et al., 2019). In rural practice, well-designed simulation experiences have been shown to improve students’ understanding of rural healthcare and rural empathy (R. Martin et al., 2023). Through intentional design, simulation experiences can focus on the development of attributes essential to rural practice such as interprofessional collaboration, and ensure all students are provided with equitable opportunities to achieve a required level of competence.

Limitations

As shown in Table 1, there was an uneven distribution of participants between different campuses and professions. This uneven distribution poses limitations on what data analysis was appropriate to conduct and the interpretation of this analysis. For example, while one of the three campuses had students from all four disciplines, students on the other two campuses were from only one and two disciplines. This unbalanced distribution pattern made comparative analysis between campuses inappropriate. Despite the uneven distribution between disciplines and campuses, all students were required to work in cross campus teams as part of the interprofessional simulation. Uneven distributions between disciplines are not uncommon in healthcare practice and thus the experience replicated many rural healthcare practice settings.

This observational study employed a convenience sampling approach and thus the results have limited generalizability based on statistical sampling distribution grounds. Additionally, the data collected were based on a single suite of simulation activities, conducted at single regional Australian university, at one point in time. However, the findings demonstrate the potential effectiveness of well-designed simulation experiences in facilitating the development of interprofessional clinical competencies relevant to rural practice. The consistent pattern of improvement provides quantitative evidence to confirm the effectiveness of the simulated learning experiences.

There are some limitations of the tool used to measure the students’ interprofessional collaborative competencies. The layout of the form and positioning of the final question (question 21) in the revised ICCAS (Schmitz et al., 2017) may have contributed to the small number of students completing this question; more responses to this question would have enabled a better understanding of students overall rating of their interprofessional competence. The ICCAS (Schmitz et al., 2017) does not include questions about the use of eHealth strategies, and thus we do not know how students perceived their skills in this area. Given the increasing use of eHealth strategies in rural health practice, incorporating questions regarding eHealth competencies in future studies would provide valuable insights. Additionally, the ICCAS (Schmitz et al., 2017) does not focus on rural practice skills, however in the absence of a specifically rural interprofessional practice tool and given the similarities in the skills required for rural practice and interprofessional practice, the ICCAS was deemed to be a suitable tool to use.

Finally, students self-assessed their interprofessional collaborative competencies using the ICCAS following completion of the experience. Self-assessment can result in subjective responses where students may over-estimate their own competence and confidence (León et al., 2023). However, given students in this study undertook pre and post self-ratings, even if they initially over-estimated their competencies, the results still indicated improvement after undertaking the simulation experience. It can also be argued that retrospective ratings of interprofessional collaboration competency may be more valid in this instance, as it is likely that students increased their understanding of interprofessional collaboration during the simulation. Reflection and self-evaluations were undertaken immediately after the simulation; future research is recommended to monitor retention of competence and confidence over time, and with transition to clinical placement and future clinical practice.

Conclusion

The authentic simulation experience evaluated in this study provided multiple opportunities for students from four healthcare disciplines, across three campuses to practice and develop interprofessional skills relevant to rural practice in a safe education environment with the support of an interprofessional team of academics and clinicians. As a staff of a regionally based university, the authors are committed to the development of graduates who have the necessary competencies to actively contribute to the health and wellbeing of rural individuals and communities. A deliberate focus on ensuring appropriate competencies and knowledge for contemporary rural practice was a key driver for the implementation of this simulated interprofessional experience for healthcare professional students. Our results suggest that providing healthcare professional students with the opportunity to participate in simulated interprofessional learning experiences can contribute to the development of interprofessional competencies relevant to rural practice.

Ethics approval

Ethics approval was granted by Charles Sturt University Human Research Ethics Committee, approval number H19233.

Acknowledgments

The authors would like to acknowledge the support of our academic colleagues and the external clinicians for their role in designing and delivering this experience and extend our appreciation to the students who consented to participating in this research and completed the ICCAS. We would also like to acknowledge the in-kind contribution of the Charles Sturt University Quantitative Consulting Unit and the Three Rivers Department of Rural Health, which is supported by the Australian Government Department of Health, Rural Health Multidisciplinary Training Programme, in the preparation of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data and materials related to this study can be requested by contacting Dr Tracey Parnell (http://[email protected]). All of the material is owned by the authors and/or no permissions are required.

Additional information

Funding

This work was supported by a Charles Sturt University Learning and Teaching Internal Grant.

Notes on contributors

Tracey Parnell

Dr. Tracey Parnell is Associate Head of School and senior lecturer in occupational therapy at Charles Sturt University. Her research is largely focused on exploring lived experience, understanding the value of occupational participation to health and wellbeing, and facilitating regional health equity.

Kristy Robson

Dr. Kristy Robson is a senior research fellow with Three Rivers Department of Rural Health at Charles Sturt University. Her research focuses on allied health workforce, interprofessional practice, and effective models of care, particularly for rural communities.

Stephanie Nelson

Stephanie Nelson is a Research Fellow in the Three Rivers Department of Rural Health, Charles Sturt University, with a background in physiotherapy and public health. Her research interests include rural health education, the provision of allied health care in aged care and improving access to health services for rural communities.

Gang Xie

Dr. Gang Xie is an accredited statistician (admitted by Statistical Society of Australia since 2019). He works as a Statistics Support Officer at Office of Research Services and Graduate Studies, Charles Sturt University, to provide statistical support to research graduate students and staff across the university.

Karen Hayes

Karen Hayes (M. HthSci (Ed), SFHEA) Karen Hayes is an occupational therapy lecturer at Charles Sturt University in Port Macquarie Australia. Her research centres on development of rural-ready health workforce for underserved communities.

Laura Hoffman

Dr. Laura Hoffman is an academic integrity officer, lecturer and researcher in speech pathology. Her research interests include interprofessional practice in allied health and rural health education.

Cherie Wells

Dr. Cherie Wells (B App Sci Physio, M Manip Ther, PhD) Dr Cherie Wells was a senior lecturer in physiotherapy at Charles Sturt University at the time of this study. She is now an Associate Professor and Head of Discipline of Physiotherapy at the University of the Sunshine Coast. Cherie has led the design and delivery of several new entry-level physiotherapy programs in Australia and is dedicated to ensuring health professional graduates are optimally prepared for future employment. Cherie is a passionate advocate for interprofessional collaboration in clinical practice and ongoing improvement of learning and teaching experience and outcomes for health professional students.