Quilliam, Claire, Ferns, Jane, Green, Elyce, Ridd, Melissa, Moore, Leigh, Sheepway, Lyndal, Seaton, Catherine, Taylor, Christine, Rasiah, Rohan L, Bailie, Jodie, Fitzgerald, Kathryn, and Debenham, James (2026) Determining constructs of high-quality rural health student placements: a multiple case ECOUTER study. BMC Health Services Research. (In Press)

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Abstract

Background People living in regional, rural and remote communities experience inequitable access to health services compared with people living in metropolitan areas, in part due to the maldistribution of the health workforce. Health student placements in rural settings, a type of work-integrated learning, are a key approach to developing a sustainable rural health workforce in Australia and internationally. Proxies for quality in rural health student placements, including student satisfaction and intention to practice in rural settings, have been used to inform rural health placement development and facilitation. However, the determining constructs of high-quality rural health student placements in Australia are unknown.

Methods A multiple case study design was adopted, drawing on the Employing COnceptUal schema for policy and Translation Engagement in Research (ECOUTER) methodology to iteratively collect and analyse data. Within each case, participants comprised Australian University Departments of Rural Health staff involved in designing, delivering, administrating and/or evaluating rural health student placements. In each case, participants identified features that contribute to high-quality rural health student placements and listed these on a virtual case mindmap. Case focus groups were conducted to refine top-level and sub features on each mindmap. Cross-case analysis identified overarching constructs and sub-constructs, which were refined by cross-case focus group participants.

Results Eighty-six people across ten cases participated in this study. Nine constructs determining high-quality rural health student placements were identified: placement planning, student selection, stakeholder communication and collaboration, placement orientation, student supervision, logistical resources, learning opportunities, connecting with the rural community, and student wellbeing and supports. The final cross-case focus group resulted in strong construct agreement from participants across diverse regional, rural, and remote Australian contexts.

Conclusions Nine interconnected and contextually dependent constructs determine high-quality health student placements in regional, rural and remote communities, emphasising the complexity associated with providing a high-quality form of this work-integrated learning opportunity.

Item ID:	92692
Item Type:	Article (Research - C1)
ISSN:	1472-6963
Copyright Information:	© The Author(s) 2026. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Funders:	Australian Rural Health Education Network
Date Deposited:	31 Aug 2026 02:01
FoR Codes:	39 EDUCATION > 3901 Curriculum and pedagogy > 390115 Work integrated learning (incl. internships) @ 50% 39 EDUCATION > 3901 Curriculum and pedagogy > 390110 Medicine, nursing and health curriculum and pedagogy @ 50%
SEO Codes:	16 EDUCATION AND TRAINING > 1601 Learner and learning > 160102 Higher education @ 50% 20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200508 Rural and remote area health @ 50%
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