A qualitative exploration of health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic.

OBJECTIVE: To explore health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic. SETTING: Australia. PARTICIPANTS: Allied health, nursing and medical students with a planned rural or remote placement between February and October 2020. DESIGN: Semi-structured interviews (n = 29) with data thematically analysed. RESULTS: Five main themes emerged from student experiences: (1) 'Do we go? Don't we go? Like how much risk is involved?' related to student concerns regarding acquiring and transmitting COVID-19 on placement; (2) 'We are sort of just standing at the door trying to watch' encompassed student perceptions of missed clinical learning opportunities in response to health and safety measures related to COVID-19; (3) 'I, as a student, sort of fell under the radar' related to student perceptions of suboptimal supervision; (4) 'It was a bit more difficult to engage with that wider community' recognised student feelings of social disconnection and their lack of opportunity for community immersion; and (5) 'We felt like we got something that is more than we expected' emerged from student reflections on training during the pandemic and alternative placements (virtual, simulated and non-clinical) that exceeded expectations for learning. CONCLUSIONS: Although most students were willing and able to undertake their rural or remote placement in some form during the early stages of the pandemic and identified unanticipated learning benefits, students recognised lost opportunities to build clinical skills, become culturally aware and connect with rural communities. It remains unknown how these rural and remote placement experiences will impact rural intention and in turn, rural workforce development.

A call to action for more disability-inclusive health policy and systems research.

To date, the exclusion of people with disability participating in research has limited the evidence base informing health system strengthening policy and practice more generally, and addressing disability-related inequalities in access to health services and better health outcomes more particularly. Given that more than 1 billion people, or 16% of the world's population, have a disability, we may fail to respond to the needs of a large proportion of the population unless we are purposeful with inclusion. Our research in this area indicates that online qualitative methods can be effective in engaging under-represented groups and are essential to ensure their input into health policy and systems research. This has important implications for researchers whose responsibility it is to make all health research disability inclusive, for ethical and methodological reasons, so they do not perpetuate the under-representation of people with disability in health policy and systems research. Our paper puts forward several recommendations to facilitate more people with disability participating in health policy and systems research. By critically reflecting on a health system strengthening research project, in which we purposefully aimed to support the participation of people with disability, we identify lessons learnt and issues to consider when planning and conducting accessible research. We also propose a set of actions for moving the agenda forward.