Editorial Special Issue

Education in and for the rural and remote workforce is critical to ensuring that people living in those regions have equitable access to sustainable high-quality health care.1 The accumulating evidence for rural and remote workforce retention emphasises the importance of locally available educational options for initial training and ongoing career pathway opportunities.2-4 Much of this evidence relates to the rural medical workforce, with an emerging body of research from the nursing and allied health professions.3, 5 There continues to be inequitable access to health services for rural and remote communities, particularly in allied health and specialist medical services. This need to deliver services closer to, and appropriate for, the rural and remote communities was a major consideration in the conception of this special issue. As guest editors, our experiences working in rural and remote practice and being academics in non-metropolitan universities fuelled out shared passion to initiate and edit this special issue focusing on education. The call for papers resulted in an astounding number of submissions and resulted in the largest-ever issue of the AJRH. The issue brings together research articles, policy analysis, commentary papers and short reports reflecting the current status on rural and remote health professional education in Australia and New Zealand. The authors contributing to the special issue are from every state and territory in Australia, as well as New Zealand and Canada. The fact that four commentary papers and one policy analysis have been included demonstrates the interest and importance many people place on educating for rural and remote health practice. This desire to reflect deeply on how education can frame rural and remote practice is important in building appropriate health services for these communities. Aligning with the broad nature of educating health professionals for rural and remote practice, the topics covered in this special edition are wide-ranging. Papers cover discipline-specific education, the use of simulation to enhance the rural clinical experience,6 and numerous papers investigating interprofessional entry-level clinical education. Postgraduate training is also included with articles on medicine and allied health postgraduate training and educational pathways, as well as commentary on the need for research training to be situated in and for rural communities. Given the serious health workforce maldistribution and shortages faced, it is imperative that initiatives that educate health professionals for regional, rural and remote practice continue to be developed and are supported to flourish. Roberts et al7 argue that education programs must move away from metro-normative models and be held accountable for ‘place-consciousness’ to properly prepare professionals for rural practice. This is also reported in papers by Fuller et al8 and Hays et al9 where they discuss the outcomes seen by having university health professional programs based in non-metropolitan areas. Sutton et al10 and Thomas et al11 also highlight that students who undertake rural clinical placements are more likely to practise rurally once they have graduated. While education can help in building an appropriate workforce, there is also a need to fund these experiences. Without adequate funding, it is hard for students to undertake rural placements due to the costs involved in travel and accommodation. As highlighted by three articles,12-14 undertaking quality rural interprofessional educational experiences is important for the development of understanding health care models, the full scope of generalist practice and the rewards of working in rural communities. Pullon et al15 provide evidence to show that five weeks of rural interprofessional clinical placement enabled graduates to see the issues faced by residents in rural areas and can be sufficient to attract graduates to work rurally. The benefits of a rural interprofessional experience were also reported by Waller et al16 where benefits were reported not only by the students but by the service and patients accessing the service. These wider benefits are important in framing clinical placements to enable sustainable service delivery and maximise educational opportunities. The theme of improved services for people living rurally through the use of interprofessional placements was echoed in the study undertaken by Mangiameli et al17 exploring the perspective of the rural disability workforce. There has been minimal research investigating the rural disability workforce so this paper is a welcome step in highlighting the issues in this area. The study by Hyde et al18 used a community-focused approach to the development and delivery of placements, which enabled an interprofessional student-led service using flexibility in supervision of students by other health professionals. This need to understand the perspective of supervisors is further explored in the article by Moore et al19 to ensure that students receive a quality learning experience. Without skilled clinical supervisors, rural and remote clinical education will have limited impact. These articles help to not only provide a deeper understanding of the complexities associated with rural and remote clinical placements but also highlight the benefits gained by students, services and communities when the needs of all stakeholders are taken into account. Further research is needed to assess the benefits to all stakeholders, the range and quality of services for communities and the cost associated with rural and remote placements. Not only is there the need for entry-level health professional education programs to support rural and remote practice development, but also postgraduate training opportunities are needed to develop competent rural and remote practitioners and provide the services required for people living in these communities. A number of authors in this issue have addressed specific aspects in postgraduate education. The evaluation outcomes from the emerging initiative of allied health rural generalist practice as a career pathway, which supports and educates early-career allied health professionals, are presented by Barker et al20 This pathway was developed to support both new graduates and early-career allied health professionals to develop the range of skills needed to work outside metropolitan areas, as well as to develop an understanding of their community and the service delivery strategies that can be used to enable access to health care closer to home. Three papers examine postgraduate medical training options that address the pathways and opportunities in rural and remote practice for junior doctors.21-23 Varela et al24 present the literature on supervision of rural and remotely located clinical psychologists, and Campbell and Kumar25 argue for increased research education and capacity building via better higher degree support. These initiatives are a start in building the evidence around support and retention for rural and remote health professionals. They also highlight the need to have research training that enables the rural and remote health workforce to undertake essential research into appropriately contextualised practice and service delivery. Aboriginal and Torres Strait Islander peoples comprise a significant proportion of the population in regional, rural and remote Australia. Thus, any discussion about educational initiatives to support health workforce must also address cultural safety and educating health professionals to practise in cross-cultural environments. Three papers in this issue focus particularly on assessing,26 preparedness for27 and valuing28 cultural safety in the context of Aboriginal and Torres Strait Islander health. Further exploration of cultural security in rural clinical practice and education is needed to ensure that educational experiences and service provision meet the needs of Aboriginal and Torres Strait Islanders and their communities. Despite the importance and quality of the submissions to this special issue, some gaps remain. The journal would welcome further submissions particularly of original research, policy analysis and literature reviews that add to the body of evidence addressing educational initiatives in Aboriginal workforce development, higher education research degrees as capacity building, and international developments focused on health workforce education. Addressing these gaps will further the collective knowledge about the global provision of sufficient health workforce that is well prepared for the rural and remote context. In addition, while many papers addressed the importance of selecting students from rural or remote backgrounds, there was a dearth of submissions regarding the collective responsibility to guide rural and remote high school students towards health careers. Finally, the AJRH would welcome the submission of commentary-style manuscripts that address issues raised by authors in this issue. As usual, the journal implemented its double-blind peer review process and would like to thank all those individuals who contributed to the quality of the papers within the issue. Consistent with the ethical standards of the AJRH,29 the guest editors had no part in curating any submitted papers on which they were authors or had a potential conflict of interest. In conclusion, we thank you for your commitment to furthering the health of residents in rural and remote Australia. By advocating for importance of locally available health education in all its forms, we can all contribute to a legacy of better health for rural and remote residents.

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