· Fraser J, Simpkins B, Alexander C. From Research to Action; Working with Career Advisers to expand health career promotion in the New England Area. New England Area Rural Training Unit, Tamworth, 2001
1. INTRODUCTION
Long term recruitment strategies to address rural Australia’s health workforce shortage commence with the effective promotion of health careers to rural high school students. (1-8) Health Horizons, A Frame work for improving the health of rural, regional and remote Australia emphasizes the need for innovative collaboration and partnership between stakeholders and the need for planned research to plan programs.(11) This report describes a collaborative program between the Department of Education and Training and the New England Area Rural training Unit to improve resource and skills of rural career advisers in motivating students to pursue health careers. This project was based on a detailed needs assessment conducted in 1998, (10) which demonstrated the need for improved resourcing for rural high school career advisers.
In 2000 the Commonwealth Department of Health and Aged Care (Rural Undergraduate Steering Committee) and University of Newcastle, Discipline of General Practice funded the New England Area Rural Training Unit to implement a range of carefully selected, practical health careers promotional activities aimed at increasing high school careers advisers’ level of knowledge about health careers. A key aspect of fostering interest in pursuing a health career amongst high school students is raising motivation.(8) The needs assessment identified the need to provide opportunities for effective networking between schools and health professional willing to act as mentors for students or promote health careers at career days.
The project comprised three separate elements, namely, the holding of one workshop in each of three nominated regional centers to upskill career advisers knowledge about health careers and recent rural entry initiatives to Univeristies, the piloting and delivery of a ‘farm injury scenario’ as a means of convening this information to this group and the production of an area wide, locally relevant mentorship directory which would further enhance the careers advisers’ ability to effectively promote health careers to their high school students.
Initially, it was envisaged that the project’s funds would be fully utilised by employing a part-time project officer for six months, organising three workshops for high school careers advisers in the New England Health Service area, the ‘farm injury scenarios’ and publishing and distributing a mentorship directory. During the course of this project it was realised that these three activities were going to come in under the originally envisaged budget allocations.
With the approval of the funding Department it was agreed that three additional health career promotional activities, focusing on increasing local high school students’ awareness of health careers be included. This allowed some of the New England Area Rural Training Unit’s staff and the project officer to promote health careers as part of three Rotary Career Markets, the region’s major agricultural show (AGQUIP) and the September 2001 Croc Eisteddfod. Additionally, a number of rural health club visits and visits to schools to promote health careers were coordinated by this project.
More detailed information in respect of these activities is outlined in Appendix 1.
2. BACKGROUND
A. Relevant Literature
Rural high school students wishing to enter and to successfully complete a tertiary health course face a myriad of difficulties, including restricted school subject choices, lack of peer pressure for academic achievements, required high TER/UAI score, high financial costs and limited exposure to role models as well as lack of motivational coverage.8,9 Some of these disadvantages have been addressed by way of, for example, lowering the TER scores by 5 points for rural students wishing to enter the medical undergraduate program at the University of Newcastle, the establishment of a graduate medical program at the University of Sydney, the establishment of rural health clubs, the holding of residential health careers workshops in Sydney for rural NSW high school students and the Commonwealth Government’s allocation of $44million for undergraduate scholarships for rural students. Nevertheless, the issue of motivating rural high school students in their school environment to consider pursuing a health career remains ‘more difficult to address’ (Heaney, page 3)
A 1998 research project, carried out by the NSW Rural Doctors Network, entitled ‘Overcoming the 3Ms!’ explored the level of interest expressed by NSW rural high school students in pursuing a health career, the barriers these students perceive to exist and their suggestions as to how the impact of these barriers can be minimised.1 While the issues of achieving the required marks for entry into the relevant courses at universities and the financial implications of studying in a different environment have a large impact on these high school students’ actions, the third perceived barrier, namely motivation, is directly linked to effective promotional activities being carried out on a regular and systematic basis to Year 9 to Year 12 rural high school students. As the report states:
It remains, however, that rural and remote secondary schools and their students are disadvantaged in many ways. Not least of which is in access to careers promotional activities, exposure to positive role models in the variety of health care professionals and information and advice regarding health careers, the prerequisites and course requirements for these health careers. (Heaney, page 3)
As far as promotional activities are concerned, the Heaney report recommends, in part, that:
· rural/remote students with a genuine interest in health care professions be identified in Year 9 and be actively encouraged and supported to continue to prepare for such careers;
· parents and family be involved in the students’ career decision process; and
· careers promotion activities be introduced into Year 9.
Evidence from two other research projects also point out that:
· rural high school students who attended a presentation by medical students in respect of pursuing a health career were more likely to consider a health career as a result of structured talks and personal encouragement6; and
· In South Australia, 24 rural high school students who were sponsored by the Rural Practice Training Unit to attend special vacation revision and skill development courses did extremely well in respect of gaining entry into medicine, allied health course and science courses7.
B. Local Careers Advisers Health Promotion Needs Assessment
In mid 1998 the New England Area Rural Training (NEARTU) conducted a research project to assess how the area’s 47 high school careers advisers currently promote health careers to their rural high school students, the kind of health careers promotion strategies they use, how effective these interventions are and at what stage the careers advisers provide health careers information to their students.10
The high school careers advisers were also asked to rate their knowledge regarding health careers in medicine, nursing and allied health. Most careers advisers (66%) rated their knowledge of allied health careers advisers as being less than good. As far as medical careers are concerned most careers (63%) rated their knowledge as being less than good and, in respect of nursing careers about half (47%) rated their knowledge as less than good
The participating high school careers advisers use a variety of approaches in order to identify and foster appropriate students, relying on discussions with students (97%), inquiries from students (75%), referrals from other teachers (49%) and parents (46%).
The participating careers advisers have currently good access to information health courses offered by the relevant universities and TAFE colleges. A majority of careers advisers lack access to a rural high school careers kit (71%) and a directory of local health professional (82%) or undergraduate students enrolled in a health related tertiary course willing to act as role models for high school students (63%).
Less than half the participating careers advisers consider that they are currently able to access effective health career promotion activities. There was a demand for greater access to many effective motivational activities by the region’s careers advisers, including visits by undergraduate students and locally practising health professionals, health careers site visits, health careers days, information evenings and residential workshops (see Table 1).
Table 1: Health Career Promotion Activities
Current Activities:
Visits by undergraduate students: 34%Visits by local health professionals: 29%
Health careers site visits: 18%
Health careers days: 13%
Information evenings: 11%
Residential workshop: 8%
Activities Considered to be Effective
Visits by undergraduate students: 76%Visits by local health professionals: 76%
Health careers site visits: 76%
Health careers days: 68%
Information evenings: 50%
Residential workshop: 47%
Career advisers’ were asked, ‘What strategy do you suggest should be employed to motivate students to consider pursuing a health career?’. Of the 38 career advisers who responded,
· 34 nominated the arranging of visits of locally practising health professionals;
· 33 referred to arranging visits of undergraduate students enrolled in tertiary health courses;
· 26 indicated that offering a mentor to interested students would be useful;
· 24 listed involving parents of interested students; and
· 9 nominated involving teachers of interested students.
Most careers advisers lack lists of locally practising health professionals and undergraduate students enrolled in tertiary health courses willing to visit their local schools, yet 31 careers advisers consider a list of such local health professionals useful and 24 careers advisers consider a list of relevant undergraduate students useful in their efforts to effectively promote health careers. There is the potential for undergraduate students to visits schools when they are placed in rural towns under existing schemes such as the John Flynn scholarship scheme where students return to the same town each year.
This survey demonstrates a lack of access to effective health career promotional resources and access to health professionals and enrolled undergraduate health students available to assist in the promotion of health careers to high school students within the New England region. This is a significant barrier to long term recruitment strategies to obtain local health professionals in our region. Careers advisers rate access to health professionals and undergraduate health students as the most effective motivator to assist students in their decision to pursue a health career.
While all careers advisers have access to health course information from the relevant university and most (33) have access to TAFE health courses, only 11 have currently access to a rural high school careers kit, yet 27 careers advisers believe that having such a promotional kit available would be very useful.
On the basis of knowing what is happening in the New England Health Service area in relation to health career promotions to high school students and knowing what kind of further initiatives could be undertaken in order to further improve the effectiveness of such promotional activities, it appeared that a focus on improving the careers advisers’ knowledge concerning health careers may be warranted. In addition, a project which could combine conveying this type of information with opportunities to network effectively, including networking with locally practising health professionals and other careers advisers, would further enhance the effectiveness of careers advisers identifying and fostering high school students with an interest and academic ability to pursue a health career.
A multi-disciplinary approach promoting health careers in schools was used as it demonstrated the team approach of health care delivery in rural areas, broadened the potential number of students who could be assisted by this project. Additionally, there is a shortage of all types of health professional in NW NSW and continued health service delivery is dependent on recruitment of medical, nursing and allied health staff. A related fact to justify this rationale is that entry into a related health course can be an entry into medical studies and a number of local medical students from this region have followed this career path.
3. METHODOLOGY
A project officer was appointed to facilitate 3 workshops focusing on the promotion of health careers and to pilot a ‘farm injury scenario’ to the region’s high school careers advisers as a means of conveying this information in an interactive format which demonstrated the networking and collaboration which occurs between health professionals in rural areas. In addition to inviting high school careers advisers, it was also decided to extend an invitation to the region’s Aboriginal Education Assistants due to the region’s high Aboriginal and Torres Strait Islander population. The New England Health area has the third highest proportion (5.83%) of Aboriginal and Torres Strait Islanders of any statistical division within New South Wales. In absolute numbers, the New England Health area has, compared to any other NSW Health area, the largest number of Indigenous people (10,218).
All these workshops are to be held in the New England Health Service area. In addition, the project funds also allowed for a mentorship directory, listing local health professionals and addresses of Australian tertiary institutions, to be produced and distributed to all the region’s careers advisers.
A. Workshops
In September, 2000 a teleconference, involving staff of the University of Newcastle, New England Area Rural Training Unit and the NSW Education Department, was held in order discuss various aspects of this project, including the locations of workshops to be conducted and ways for the project officer to be able to participate in a relevant workshop organized by the University of Newcastle in early 2001.
Subsequent to these events, and discussions involving a number of key stakeholders, it was decided to convene three one day workshops in the region’s main rural centres, namely Armidale, Moree and Tamworth. (see Map) The reasons for choosing these locations included the fact that these centres are spread throughout the region and that, by choosing these regional centres, the opportunities for high school careers advisers to attend these workshops are maximized, as travel time is minimized.
Following approval received by region’s vocational education consultants for high school careers advisers to participate in these workshops, letters, explaining the purpose, format, venue and date of relevant workshops were sent to the region’s 40 careers advisers and 26 Aboriginal Education Assistants. The letter also explicitly referred to the fact that the project’s funds allowed for the provision of monies to be reimbursed as per the Education Department Award. In essence, this allowed for a casual teacher to be employed for the duration of the careers’ advisers one day attendance at a workshop.