Access to this full-text is provided by Springer Nature.
Content available from BMC Medical Education
This content is subject to copyright. Terms and conditions apply.
RESEARCH Open Access
© The Author(s) 2024. Open Access 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 modied 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 h t t p : / / c r e a t i
v e c o m m o n s . o r g / l i c e n s e s / b y - n c - n d / 4 . 0 / .
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
https://doi.org/10.1186/s12909-024-06432-9 BMC Medical Education
*Correspondence:
Kate Odgers-Jewell
kodgersj@bond.edu.au
Full list of author information is available at the end of the article
Abstract
Background A culturally responsive health workforce is essential to ensure the delivery of culturally safe health
services that meet Aboriginal and Torres Strait Islander Peoples needs. In partnership with universities, placement
providers play an essential role in creating opportunities for immersive experiences that enable students to develop
their cultural responsiveness. This study evaluated students’ experiences of an innovative student placement model
embedded within an urban Aboriginal and Torres Strait Islander Community-Controlled Health Organisation.
Methods Students completed pre and post placement surveys administered using a web-based interface.
The surveys involved ve-point Likert and open-ended response items exploring students’ perceptions of their
knowledge, skills development, awareness and self-development,and overall placement experience. Frequencies
were calculated for the variables of interest and compared between pre and post surveys. The sign test for matched
pairs was used to calculate dierences between pre and post surveys, and a one-sided hypothesis test was utilised to
determine if the level of agreement increased from pre to post survey. Qualitative data obtained for seven questions
were thematically analysed using Groundwater Method, an Indigenous data analysis technique.
Results Between January 1, 2017, and June 30, 2019, 938 students from 32 disciplines were placed within the
organisation and its Member services. Survey responses were received from 338 participants pre-placement, and
158 participants post-placement. The matched pre-post group contained 81 students. The results indicate signicant
positive changes in cultural responsiveness, skills development, awareness, and self-development when comparing
pre- and post-placement responses. Students’ overall satisfaction with the quality of their placement was positively
associated with their intention to work in Aboriginal and Torres Strait Islander health contexts in the future. Key pre-
placement themes included competence, cultural skills, support and fear, and key post-placement themes included
expertise, cultural responsiveness, learning environment and challenges.
Conclusions Indigenous-led, regionally coordinated placements in urban Indigenous health contexts can support
transformative learning and the development of a culturally responsive workforce. Universities should aim to
develop reciprocal relationships with Indigenous-led organisations to support students to develop their cultural
Students’ experiences of placements in urban
Indigenous health contexts: developing
a culturally responsive workforce
KateOdgers-Jewell1* , AlisonNelson2,3 , ReneeBrown2,3,4 , NicoleHunter2, TianyAtkins1 and
KellyMenzel5,6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 2 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
Introduction
In Australia, signicant health inequities exist between
Aboriginal and Torres Strait Islander Peoples and non-
Indigenous peoples and are evident across all social
determinants of health [1]. Deeply embedded and struc-
tural inuences of racism are recognised as an inde-
pendent determinant of health [2]. One of the factors
contributing to the signicant discrepancy in health
outcomes between Aboriginal and Torres Strait Islander
Peoples and non-Indigenous peoples is the lack of cul-
tural safety experienced by many Aboriginal and Torres
Strait Islander Peoples in the health system [3]. Cultural
safety is dened as “ensuring that those individuals and
systems delivering healthcare are aware of the impact of
their own culture and cultural values on the delivery of
services, and that they have some knowledge of, respect
for and sensitivity towards the cultural needs of others”
(Page 8) [4]. Aboriginal and Torres Strait Islander Peoples
are more likely to access health services where providers
communicate respectfully, have some understanding of
culture, build good relationships with clients, deliver nur-
turing holistic care, and where Aboriginal and/or Torres
Strait Islander Health Workers are part of the health-
care team [5–7]. e Aboriginal Community Controlled
Health Sector (ACCHS) are an exemplar model for
health service delivery, providing culturally responsive
and comprehensive care, reducing experiences of racism
and barriers to accessing care, and embodying the right
to self-determination [8].
Cultural respect, dened as “the recognition, protec-
tion and continued advancement of the inherent rights,
cultures and traditions of Aboriginal and Torres Strait
Islander Peoples” (Page 7) [9], is essential in delivering
health services that are responsive to the health beliefs,
practices, and socio-cultural and linguistic needs of peo-
ple from all backgrounds [3]. is is particularly needed
in the context of the inequitable health outcomes expe-
rienced by Aboriginal and Torres Strait Islander Peoples
[3]. It is widely recognised that health providers attitudes
and behaviours towards Aboriginal and Torres Strait
Islander Peoples can either undermine or enable positive
health outcomes [3]. As such, the responsibility for qual-
ity healthcare should be shared across the health system,
not relegated to the Aboriginal and Torres Strait Islander
sector or workforce [10]. It is paramount that all univer-
sity graduates be equipped with the necessary knowledge,
skills, cultural capability (“demonstrated capacity to act
on cultural knowledge and awareness through a suite of
core attributes that are acquired through a lifelong-learn-
ing process” (Page 2–22)), and humility to enable them
to work across all Australian socio-cultural contexts [3].
is includes inuencing the enculturated values, atti-
tudes, behaviours and beliefs of those working within
health systems and professional cultures that result in
the delivery of culturally unsafe care and compound the
health inequities experienced by Aboriginal and Torres
Strait Islander Peoples [11].
e critical need to ensure culturally safe care for
Aboriginal and Torres Strait Islander Peoples has been
acknowledged by including cultural safety into curricu-
lum and updating accreditation requirements for health
professional training [12, 13]. In 2014, the Australian
Government released the national Aboriginal and Tor-
res Strait Islander Health Curriculum Framework (the
Framework) which was developed to address the vari-
ability among health professions and higher education
providers in terms of the nature and extent to which
Aboriginal and Torres Strait Islander curriculum and
Indigenous Knowledges are being implemented [3].
According to the Framework, higher education providers
play a pivotal role in ensuring graduates have the capac-
ity to work eectively and respectfully in Indigenous
health contexts [3]. is is particularly relevant to place-
ment providers as they play an important role in creating
opportunities for student learning and development, and
evaluating student performance [3, 14, 15].
e teaching of cultural competency in relation to
Indigenous health is a requirement of all Australian uni-
versities oering health programs to broaden student’s
knowledge and promote culturally responsive care [14].
Cultural competency is dened on page 6 of the Universi-
ties Australia Framework as “student and sta knowledge
responsiveness and improve the provision of culturally safe care for Aboriginal and Torres Strait Islander Peoples.
Future research should explore the longer-term impacts of student placements on cultural responsiveness, attitudes,
values, and behaviours, as well as the experiences of Aboriginal and Torres Strait Islander Peoples interfacing with
university students on placement in urban settings.
Note We will predominantly use the term ‘Aboriginal and Torres Strait Islander Peoples’, as opposed to ‘Indigenous’ or
‘First Nations’. When the term ‘Indigenous’ is used, it largely relates to government policy - except when referring to
Indigenisation of curriculum and Indigenous Knowledges - and where ‘First Nations’ is used, it is in a global context. In
addition, we use the term ‘Peoples’ to signify that Aboriginal and Torres Strait Islander Peoples are not one People or
Nation, but a collective of Peoples and Nations.
Keywords Student placement, Indigenous health, Aboriginal and Torres Strait Islander Peoples, Cultural capability
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 3 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
and understanding of Indigenous Australian cultures,
histories and contemporary realities, and awareness of
Indigenous protocols, combined with the prociency to
engage and work eectively in Indigenous contexts congru-
ent to the expectations of Indigenous Australian peoples”
[14]. Content is often taught in isolation from practical
experiences, frequently led by non-Indigenous sta, and
has the potential to be framed from a place of decit,
promoting only negative aspects of Indigenous health
and problematizing Aboriginal and Torres Strait Islander
Peoples and health as something to be xed [16, 17]. As
such, the potential to reduce health inequities by includ-
ing strength-based Aboriginal and Torres Strait Islander
health curricula to support a more culturally informed
health workforce is strongly recommended by the Frame-
work and recognised in the literature [10, 14, 15, 18–21].
e Framework identies ve interconnected gradu-
ate cultural capabilities including: respect, communica-
tion, safety and quality, reection, and advocacy [3]. e
development of these cultural capabilities in graduates
can enable the delivery of culturally safe and respon-
sive healthcare for Aboriginal and Torres Strait Islander
Peoples [3]. Cultural responsiveness diers from cultural
competence [22]. Being culturally responsive is to work
with Aboriginal and Torres Strait Islander Peoples in a
way that is collaborative, relational (develops relation-
ships), respectful, and inclusive of the local context and
inherent worldviews “in order to respond to the issues
and needs of communities in ways that promote social
justice and uphold human rights” (Page 21) [22]. Cultural
responsiveness is a constant state of learning in relation
to where one is and the local context, with each situation,
family and community requiring diering and diverse
responses [23].
Contrary to common assumptions, most Aboriginal
and Torres Strait Islander Peoples live in urban areas and
access mainstream health services, therefore, cultural
capabilities are necessary for all health providers, not
only for those wanting to work in Indigenous health or
in rural and remote contexts [3]. e traditional focus on
rural placements driven by government funding has not
yet adapted and/or recognised the signicant population
shift to regional and urban areas, resulting in the miscon-
ception that working in Indigenous health equates to liv-
ing in rural Australia [24]. Additionally, there is limited
research on the impacts of student placements in urban
Indigenous contexts, with previous research stating that
students exposed to community-engaged rural place-
ments have unique learning opportunities to develop
their cultural understanding that are not necessarily
available to their urban counterparts [25, 26].
e Institute for Urban Indigenous Health (IUIH) is a
not-for-prot, Community Controlled Health Organisa-
tion (CCHO) which leads the planning, development and
delivery of comprehensive primary healthcare to Aborig-
inal and Torres Strait Islander Peoples in the South East
Queensland (SEQ) region [27]. e IUIH and its four
Founding Member ACCHSs: the Aboriginal and Torres
Strait Islander Community Health Service (ATSICHS)
Brisbane Limited, Kalwun Development Corporation
Limited (Kalwun Health Service), Kambu Aboriginal and
Torres Strait Islander Corporation for Health, and Yulu-
Burri-Ba Aboriginal Corporation for Community Health
serve Australia’s second largest, but fastest growing
Aboriginal and Torres Strait Islander population [27]. As
well as providing a coordination, integration, and leader-
ship role across the region, IUIH directly delivers health,
wellbeing, and social support services to the Moreton
Bay region through Moreton ATSICHS [27]. e IUIH’s
vision is “healthy and strong Aboriginal and Torres Strait
Islander children, families and communities”, and its pur-
pose is to provide “leadership in health system reform and
provision of a high quality, integrated system of health
and social support services” [27].
e IUIH collaborated with a local university (Uni-
versity of Queensland [UQ]) in 2010 to develop an
innovative, Indigenous-led model of student placement
coordination, establishing a student placement agree-
ment across the entire university. e model aimed to
support service and workforce development in CCHOs
as well as provide practical experiences that develop stu-
dents’ cultural responsiveness prior to graduation [28].
is innovative model includes regional coordination
of student placements through a university-resourced
Student Placement Coordinator based within the IUIH;
contextualized clinical education training for super-
visors; mutually benecial placement opportunities;
community-led placement projects; and non-traditional
placement opportunities such as placements in policy,
community legal services and local kindergartens or
schools. Opportunities for university student place-
ments were extended to other universities when addi-
tional placement opportunities and resourcing became
available.
A previous cross-sectional analysis of post-placement
survey data from students undertaking placement at the
IUIH evaluated students’ perceptions of these place-
ments in developing their capacity to provide culturally
responsive care, examining themes around knowledge,
skills and intention to work in Indigenous health contexts
at the end of their placement [24]. is new study aims
to extend the evaluation of students’ perceptions of their
placement and development of cultural responsiveness
by exploring the impact of the placement through com-
paring pre- and post-placement survey data across sev-
eral larger placement cohorts across more disciplines and
utilising a longer post-placement survey to enable a more
detailed evaluation of students’ placement experiences.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 4 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
is study provides an evaluation of students’ expe-
riences of placement in an urban Indigenous health
context, including the development of cultural respon-
siveness and intention to work in the sector.
Methods
e IUIH student placement model incorporates regional
coordination of Indigenous-led, sector driven place-
ments across the IUIH, its four Member ACCHSs, More-
ton ATSICHS and a local Aboriginal and Torres Strait
Islander Independent Community School (the Murri
School), which provides preparatory to Year 12 educa-
tion. Placement durations for each type of placement
varied from one to three days for community events or
conferences, to periods longer than two months for clini-
cal service provision or project placements. Placement
duration was specied by the university in most circum-
stances to align with accreditation requirements. e
duration of placement for community events or confer-
ences was set by the IUIH based on the duration of the
event, and students from any discipline had the oppor-
tunity to support community events or conferences. Stu-
dent’s responsibilities varied from participating in clinical
service provision, planning, facilitating, or observing pre-
ventative health or chronic disease management pro-
grams, involvement in specic sector-led projects or
research opportunities, or supporting community events
or conferences. Most health students hosted by the IUIH
were engaged in interprofessional placements, further
enabling the development of their clinical knowledge and
skills, professional identity, and cultural responsiveness.
For example, speech pathology and occupational ther-
apy students usually delivered clinical service provision
together at kindergartens or the Murri school; nursing
and medical students worked together at primary health
clinics to consult with clients; and allied health students
(exercise physiology, psychology, nutrition and dietetics,
occupational therapy, pharmacy, podiatry, optometry,
and physiotherapy) worked together to facilitate chronic
disease prevention or management programs.
e student placement model is underpinned by the
IUIH’s cultural integrity investment framework, ‘e
Ways Statement’ and guided by the student placement
policy which enables mutually benecial, sector driven
placements, and encompasses various processes and
supporting activities (Fig. 1). e Ways Statement is a
stance or positioning statement that frames the IUIH’s
approach, providing a framework for aligning all organ-
isational systems and processes with the cultural and
philosophical worldview or Aboriginal Ways of seeing,
knowing, being, doing and belonging [27]. Most stu-
dents engaging in placement with the IUIH, its Mem-
ber ACCHSs, Moreton ATSICHS and the school were
centrally coordinated by two sta members at the IUIH
(AN and KOJ). is reduced the administrative burden
on placement sites, provided centralized support and
Fig. 1 The IUIH student placement model
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 5 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
mentoring to supervisors and students, and enabled con-
textualised opportunities for workforce development
through sta developing their clinical education and
supervision skills.
Students attended a two-hour orientation session in
which they were provided with an overview of the his-
tory of the IUIH and its Member ACCHSs, cultural
training underpinned by the IUIH’s ‘Making Connec-
tions’ framework [29], as well as general information
on the logistics of the placement. e ‘Making Connec-
tions’ framework was initially developed to help guide
occupational therapists in the art of connecting with
Aboriginal and Torres Strait Islander clients and fami-
lies [29]. Making connections is broader and deeper than
typical approaches to building rapport or relationships
with clients. e framework is now used across all dis-
ciplines to guide relational ways of working with clients
and sta within the IUIH [29]. Following the orientation
session, students were provided with readings, videos,
and reective learning activities which sought to foster
culturally respectful approaches such as understanding
your own values and how these impact on practice, build-
ing connections with clients, utilising clinical yarning in
practice, understanding community-controlled health
service delivery, and client autonomy. is aspect of the
student orientation process was formalised in 2018 as a
ve-week student cultural skills program, ‘Propa Ways’
(developed by RB and KOJ) which aimed to help students
understand, align, and embed the IUIH’s ‘Ways’ into their
practice, and as an opportunity to reect on and under-
stand their personal lens and journey including how their
privilege, social positioning, and potential power imbal-
ances aect practice. Additionally, Aboriginal and Torres
Strait Islander and non-Indigenous sta from the IUIH
regularly worked in partnership to design, develop and
deliver curriculum for local universities on topics such
as Aboriginal and Torres Strait Islander community-con-
trolled health, culturally responsive healthcare, and the
systems transformation work of the IUIH and its member
services.
A total of 938 students from 32 disciplines and 13 Aus-
tralian universities engaged in placement at the IUIH
and its Member ACCHSs between January 1, 2017, and
June 30, 2019. Of these, 91% (n = 855) were enrolled at
either the UQ or the Queensland University of Technol-
ogy (QUT), with most students (784 of 855; 92%) study-
ing at the UQ, due to the collaboration agreement. e
UQ were oered rst right of refusal for all appropriate
placement opportunities, and placement opportunities
which were not utilised by the UQ were oered to other
local universities. Additionally, placement students were
sourced from other local universities for programs not
oered by the UQ, such as optometry and podiatry. Stu-
dents enrolled at any university who identied as Aborig-
inal and/or Torres Strait Islander were generally oered
placements at the IUIH and its Member ACCHSs to sup-
port the development of the Aboriginal and Torres Strait
Islander workforce. e 855 students engaging in place-
ment at the IUIH from the UQ and the QUT were from
28 disciplines, extending beyond the health disciplines in
the collaboration agreement (Fig.2).
Most students were enrolled in Occupational erapy
(n = 304, 36%), Medicine (n = 117, 14%), Architecture
(n = 99, 12%), Speech Pathology (n = 34, 4%) or Nutri-
tion and Dietetics (n = 34, 4%). e number of students
placed from each discipline was inuenced by the type
and mode of placement and is not reective of the length
nor scope of the placements. Students enrolled in Archi-
tecture, Business, Engineering, Health Science, Human
Services, Mental Health, Pharmacy, Political Sciences,
Fig. 2 Professional background and number of students per discipline placed within urban Indigenous ACCHSs (n = 855)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 6 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
Public Health and Social Science generally completed
project placements. Students studying Medicine, Nurs-
ing & Midwifery, Dentistry and Allied Health disciplines
(Audiology, Counselling, Exercise Physiology, Health,
Sport and Physical Activity, Nutrition & Dietetics, Occu-
pational erapy, Optometry, Pharmacy, Physiotherapy,
Podiatry, Psychology, Social Work, Speech Pathology,
and Sports Coaching) typically completed clinical place-
ments in which they planned, facilitated or observed
clinical service provision to individual clients or groups
of clients. Occupational erapy, Nutrition and Dietetics,
Sports Coaching, Social Work and Psychology students
also sometimes engaged in project placements. Only
Occupational erapy and Speech Pathology students
were placed within the Murri School or Kindergartens. In
these settings students provided developmental screen-
ings, play-based therapy and whole-class activities tai-
lored to teacher priorities, such as support with reading,
physical activity and/or writing.
Data collection
Student placement experiences were evaluated using
pre- and post-placement surveys administered using
a web-based interface (SurveyMonkey Inc., Palo Alto,
California, USA). e pre-placement survey included
demographic questions, 18 ve-point Likert items relat-
ing to students’ perceptions of the learning environment,
skills development, awareness, and self-development,
and three open-ended response items exploring the
aspects students were most looking forward to regarding
the placement, how they would like to receive support,
and any concerns they had about engaging in the place-
ment (Supplemental File 1). e post-placement survey
included demographic questions, 25 ve-point Likert
items relating to students’ perceptions of the learning
environment, skills development, awareness and self-
development, supervision and feedback, and overall sat-
isfaction of the placement, and two open-ended response
items exploring the positive and negative aspects of the
placement and how they impacted on learning (Supple-
mental File 2). Fifteen ve-point Likert items included
in the pre-placement survey were repeated in the post-
placement survey.
e post-placement survey was initially designed based
on best practice standards to explore clinical education
outcomes beyond cultural responsiveness in isolation by
the UQ’s teaching and learning evaluation unit [24]. e
pre-placement survey was designed by the student place-
ment team at the IUIH (RB,AN and KOJ)and was based
on the post-placement survey. e student placement
team requested feedback from Aboriginal and Torres
Strait Islander sta in 2018 on both surveys. rough a
consultation process, several changes were made includ-
ing the addition of a demographic question regarding
how the university prepared students for placement in an
urban Indigenous setting in both surveys, the additional
of a ve-point Likert item exploring students’ intentions
to work in the setting in both surveys, a change in the
wording of two Likert items from negative to positive
phrasing (“I am afraid of doing/saying something wrong”
to “I am not afraid of doing/saying something wrong”) in
the post-placement survey, and two open-ended response
questions providing students with an opportunity to
share a really ‘deadly’ (awesome or great) story from their
placement experience, and suggestions or ideas on how
to improve the student placement experience.
Recruitment
Ethics approval was obtained from the UQ’s Human
Research Ethics Committee (approval number
2011001115), and written approval was obtained from
the Executive Dean, Faculty of Health from the QUT to
recruit students on placement with the IUIH. Survey data
collected from students enrolled at other universities
were summarized for internal use only as ethics approval
was not sought from all universities.
University students placed with the IUIH were invited
via email by the Student Placement Coordinator (KOJ)
to complete the pre-placement survey one or two weeks
prior to commencing their placement, and the post-
placement survey at the end of their placement, usually
on their nal day of placement or within two weeks of
completing placement. No reminder emails were sent.
Occasionally, students involved in a specic program, for
example, completing a placement at the Murri School or
an observational day at a chronic disease management
program, were invited to complete the pre- or post-
placement survey by an academic at their host university
through the learning management system. Upon access-
ing the survey/s, students were invited to read a preamble
and provide voluntary informed consent to participate
by ticking ‘agree’ on a consent question and complet-
ing the survey/s. Participation was voluntary, not com-
pensated, and anonymous. Only the rst author (KOJ)
could reidentify participants if needed to match pre and
post surveys by accessing hard copies of their placement
paperwork stored in a locked cabinet at the IUIH.
e pre-placement survey was sent to 62% (n = 529)
of the placement cohort, and the post-placement survey
was sent to 66% (n = 568) of the placement cohort from 22
disciplines (Supplemental File 3). e percentage of stu-
dents from each of the 22 disciplines sent the pre-survey
ranged from 10 to 100%, and for the post-survey ranged
from 32 to 100%. ere were several reasons for sur-
veys not being sent out including: students engaging in a
one-day observational placement or community activity
which often did not warrant them completing the sur-
veys; and administrative errors such as not sending the
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 7 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
pre-placement survey before placements commenced or
academics not disseminating the surveys via the learning
management system within an appropriate timeframe.
Data analysis
Data were extracted from the data collection system,
aggregated, and cleaned for missing data and any dier-
ences in coding between pre and post survey’s. Questions
were reworded if the Likert scale did not match between
pre and post surveys. Likert Scales were aggregated when
cross tabs had multiple empty or small cells. A link-
age key for survey participants was created using the
rst three letters of the student’s surname, day of birth,
gender, and response year. is key was used to identify
matched pre and post survey response for individual
participants.
Descriptive statistics were generated to report the fre-
quency and type of demographic (age, gender, Aboriginal
and/or Torres Strait Islander status, qualication enrolled
in, year level) and placement characteristic (engagement
length, hours completed, placement location, prepara-
tion). ese were calculated for the pre, post and linked
participant matched survey groups separately. Frequen-
cies were calculated for the variables of interest and com-
pared between pre- and post-placement surveys.
For the linked participant matched survey’s, the dier-
ences between pre and post survey for the 15 duplicate
ve-point Likert items were calculated using the sign test
for matched pairs in Stata version 17.0/SE (StataCorp,
2021). e sign test measures the equality of matched
pairs of observations between the pre and post tests. We
used the “signtest” command that tests if the median of
the dierences between the pre and post tests are equal
to zero (null hypothesis). Firstly, we converted the ve-
point Likert scale to an interval scale so each possible
response received a value from 1 to 5 (1 for strongly
agree, 2 for agree, 3 for both not applicable and uncer-
tain, 4 for disagree and 5 for strongly disagree). We used a
one-sided test where the alternative hypothesis is that the
median of the dierences between the pre and the post is
greater than zero (changes to a higher level of agreement
from pre to post) which is testing if the paired post sur-
vey responses became more positive in nature compared
to the pre survey responses. We rejected the null hypoth-
esis at a signicance level of 0.05.
e open-ended responses were checked, corrected,
and collated. An Indigenous, qualitative data analy-
sis technique known as the Groundwater Method [30,
31] was used. is technique is dened by Menzel and
Yunkaporta (2022) as “mirroring the thinking and rela-
tional processes of walking through a landscape and look-
ing for things that are both seen and unseen”. e method
of inquiry is rigorous, requiring ‘polyangulation’, a pro-
cess of relating multiple sources of data to verify their
trustworthiness, accuracy, and consistency [30–32]. e
Groundwater Method was performed by Indigenous
researcher (KM) and non-Indigenous researcher (KOJ)
who discussed the collective data from the pre- and
post-placement surveys and polyangulated the informa-
tion. is method allowed both researchers to develop
potential themes by reecting holistically, mindfully and
engaging authentically with the data sets to draw upon
more complex explanations. From this deep analysis,
key themes and subthemes emerged, and representa-
tive quotes were identied to illustrate and exemplify the
themes and subthemes. Data analysis occurred in Lennox
Heads, New South Wales, on the traditional land of the
Arakwal Peoples of Bunjalung Nation.
Reexivity
In the spirit of self-reexivity and embracing the impor-
tance of relationality, this paper has been co-authored by
KM, an Aboriginal researcher, pedagogical expert and
educator, and the Director of the Aboriginal and Torres
Strait Islander Initiative at the Burnet Institute; KOJ, a
non-Indigenous researcher and educator, who worked for
the IUIH as Student Placement Coordinator from 2017 to
2019; AN, a non-Indigenous researcher and Director of
Organisational Development at the IUIH; RB, an Aborig-
inal researcher and the Cultural Integrity Team Lead at
the IUIH; NH, a non-Indigenous researcher and the
Manager of Student Placements at the IUIH; and TA, a
non-Indigenous researcher and biostatistician from Bond
University. e interpretation of ndings was informed
by authors’ expertise, experiences, cultural lens, and
familiarity with the study site. e authors recognise the
importance of stating our positionality in an eort to
identify our social and cultural positioning, describe rela-
tionalities, and explain our place, belonging and identity,
including the associated power relations [33, 34].
Results
Pre-placement survey responses were received from 338
participants (64% response rate), and post-placement
survey responses were received from 158 participants
(28% response rate). Fewer participants (n = 81) com-
pleted both the pre- and post-placement surveys, most
of which were students from the UQ (n = 59, 73%) and
all students were from health disciplines. Most survey
respondents were female, aged 18 to 25 years, did not
identify as Aboriginal and/or Torres Strait Islander, were
enrolled in an undergraduate qualication, and were in
their fourth year or higher of their program (Table1).
Placements took place across the IUIH head oce,
the IUIH’s network of 19 primary healthcare clinics,
local kindergartens, and the Murri school, with stu-
dents often delivering services across multiple sites. e
pre-placement survey data revealed that most students
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 8 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
were engaged in placements primarily based at the
IUIH (56.2%) or the Murri school or local kindergartens
(26.6%). e post-placement survey data indicated that
most students completed up to four weeks (32.9%), ve
to eight weeks (21.5%) or more than two months (26%)
of placement within the IUIH and its Member ACCHSs,
with most engaging in placement for more than 40hours
(56.3%).
For the matched pre-post group (n = 81), there was a
statistically signicant improvement (p < 0.001 or p < 0.01)
in all 15 ve-point Likert items evaluating measures of
students’ perceptions of the learning environment, their
skills development, and their awareness (Fig.3; Table2).
e 11 Likert scale items exclusive to the post-place-
ment survey which evaluated students’ perceptions of the
learning environment, their awareness and self-develop-
ment, the supervision and feedback provided, and their
overall satisfaction with the placement, received largely
positive feedback (Table 3). Students who completed
both the pre- and post-placement surveys (n = 81) evalu-
ated the learning environment, their awareness and self-
development, the supervision and feedback provided,
and their overall satisfaction with the placement, slightly
more favourably (1.9–5.3% more students selected agree
or strongly disagree) than those who only completed the
post-placement survey (Table3).
ere was a signicant correlation (p < 0.001) b etween
students’ overall satisfaction with the quality of their
placement, and their intention to work in Aboriginal and
Torres Strait Islander health contexts in the future, with
students who positively rated their satisfaction with the
quality of the placement more likely to want to work in
Aboriginal and Torres Strait Islander health contexts in
the future.
Qualitative results
Responses to the open-ended pre-placement ques-
tions were received from 321 students, and responses
to the open-ended post-placement questions received
137 responses. e two questions added to the post-
placement survey in 2018 received 51 responses. e
key themes from the pre-placement survey and post-
placement survey, including subthemes and representa-
tive quotes are provided in Table4. During the analysis,
the researchers perceived these themes and subthemes to
often be linked and inter-related.
e pre-placement survey responses indicated a mix-
ture of excitement, trepidation, and fear, with four key
themes identied: competence, cultural skills, sup-
port, and fear. Competence was organised into two
subthemes: (1) skills development and (2) broadening
experiences. Within this theme, participants spoke of
looking forward to the opportunity to gain or consoli-
date their clinical, research and/or communication skills,
Table 1 Demographic information from student survey groups
Pre-
survey
(n = 338)
Post-
survey
(n = 158)
Matched
(n = 81)
n (%) n (%) n (%)
Age
< 18 1 (0.3) 0 (0) 0 (0)
18–25 271 (80.2) 111 (70.3) 54 (66.7)
26–33 49 (14.5) 29 (18.4) 16 (19.8)
33–40 10 (3.0) 9 (5.7) 6 (7.4)
40+ 7 (2.1) 9 (5.7) 5 (6.2)
Gender
Female 285 (84.3) 132 (83.5) 69 (85.2)
Male 53 (15.7) 26 (16.5) 12 (14.8)
Do you identify as Aboriginal or
Torres Strait Islander?
Aboriginal 9 (2.7) 6 (3.8) 2 (2.5)
Torres Strait Islander 1 (0.3) 1 (0.6) 0 (0)
Not Aboriginal or Torres Strait
Islander
328 (97.0) 151 (95.6) 79 (97.5)
What type of qualication are
you currently enrolled in?
Doctorate 3 (0.9) 0 (0) 2 (2.5)
Graduate / Postgraduate 83 (24.6) 62 (39.2) 25 (30.9)
Undergraduate 245 (72.5) 95 (60.1) 49 (60.5)
Masters 2 (0.6) 0 (0) 2 (2.5)
Unknown/Missing 5 (1.5) 1 (0.6) 3 (3.7)
Which year level best describes
your current progress in this
program?
1st year 21 (6.2) 13 (8.2) 8 (9.9)
2nd year 45 (13.3) 32 (20.3) 13 (16.1)
3rd year 51 (15.1) 30 (19.0) 17 (21.0)
4th year or higher 221(65.4) 83 (52.5) 43 (53.1)
Please indicate where you com-
pleted your placement:
Aboriginal and Torres Strait Islander
health service
47 (13.9) 47 (29.7) 22 (27.2)
Murri Carnival / Community Day 11 (3.3) 5 (3.2) 2 (2.5)
Murri School / Kindergarten 90 (26.6) 24 (15.2) 9 (11.1)
IUIH 190 (56.2) 82 (51.9) 48 (59.3)
How many hours of placement
have you completed in this ser-
vice in total?
<= 40h 155 (45.9) 69 (43.7) 27 (33.3)
> 40h 171 (50.6) 89 (56.3) 54 (66.7)
Missing 12 (3.6) 0(0) 0(0)
How long did you engage in
placement with the service?
1day - 18 (11.4) 3 (3.7)
<= 1 week - 13 (8.2) 6 (7.4)
Up to 4 weeks - 52 (32.9) 29 (35.8)
5–8 weeks - 34 (21.5) 21 (25.9)
More than 2 months - 41 (26.0) 22 (27.2)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 9 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
and their excitement about the prospect of new experi-
ences and broadening their level of competence. Cultural
skills contained three subthemes: (1) developing cultural
capability, (2) helping others, and (3) building connec-
tions. Within this theme participants described looking
forward to working with the Aboriginal and Torres Strait
Islander community, learning more about culture and
Indigenous health, helping others, and building connec-
tions with clients, peers, supervisors, and the community.
Support was arranged into two subthemes: (1) guidance
to develop cultural responsiveness and (2) needing clear
expectations, regular feedback, and open communica-
tion. Participants expressed various needs including
wanting support to develop their cultural capability and
clinical skills, a desire for regular, constructive feedback,
open communication, opportunities to ask questions,
clear expectations, opportunities to observe others, and
guidance from their supervisors. e theme of fear con-
tained two subthemes: (1) saying or doing something
wrong, and (2) not feeling concerned. Within this theme,
most participants described feeling nervous about say-
ing or doing something wrong or culturally inappropri-
ate during the placement or lacking condence in their
knowledge or clinical skills. Some participants shared
that they did not feel concerned about the placement, felt
condent that they would be supported during the place-
ment, or expressed feeling expected nervousness about
the placement.
e post-placement survey responses were pre-
dominantly positive, with four key themes identied
including expertise, cultural responsiveness, learning
environment and challenges. Expertise was organised
into two subthemes: (1) opportunities for learning and (2)
working in an interdisciplinary team. Within this theme,
participants described various opportunities to develop
their clinical skills, knowledge, and condence includ-
ing being empowered to attend programs, events, and
visit multiple clinics, and to further extend their expertise
through working in an interdisciplinary team. Cultural
responsiveness contained two subthemes: (1) develop-
ing cultural capability and (2) making connections. Par-
ticipants described the development of their cultural
capability, including opportunities to develop a deeper
understanding of Aboriginal and Torres Strait Islander
culture, and to make connections with Aboriginal and
Torres Strait Islander sta and clients in a safe, support-
ive learning environment. Some participants commented
on the value of the orientation session and materials such
as the Propa Ways cultural skills program, in supporting
the development of their cultural responsiveness. is
theme was closely connected to the succeeding theme,
learning environment, which was organised into two
subthemes: (1) supportive environment and (2) sense of
belonging. Participants described a positive, supportive
environment conducive to learning, approachable and
knowledgeable supervisors, feeling welcomed and val-
ued by sta, peers, clients, and the community, a sense of
belonging, and opportunities to integrate into the team.
A few challenges were shared, including negative expe-
riences of the learning environment, learning opportuni-
ties and logistics, however, most students mentioned that
these experiences did not overshadow their positive over-
all experience. e challenges regarding learning envi-
ronment included experiencing professional hierarchies,
Fig. 3 Pre/Post-Placement Survey: Comparison of Results
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 10 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
workplace conicts, feeling unwelcomed or isolated, not
having enough time with, or support from, supervisors,
unclear expectations, and reduced learning opportuni-
ties due to low attendance rates, observing others, or a
narrow caseload. Some participants expressed a desire
for a longer placement or more clinical hours, whilst
others shared logistical challenges including a lack of
continuity with clients, limited resources, and the hassle
Table 2 Results of sign-test for matched pre-post survey results
Survey Item NMean Median SD Positives Negatives Zeros P-value
Learning Environment
I feel well prepared by the university for this placement
Pre 81 2.51 2.0 0.76 35 8 38 < 0.0001
Post 81 2.12 2.0 0.91
Skills Development
I feel condent about communicating eectively in an urban Indigenous context
Pre 81 2.42 2.0 0.80 42 4 35 < 0.0001
Post 81 1.79 2.0 0.59
I am condent I have the clinical knowledge to work eectively in an urban Indigenous context
Pre 81 2.52 2.0 0.84 41 5 35 < 0.0001
Post 81 1.94 2.0 0.70
I am condent I have the clinical skills to work eectively in an urban Indigenous context
Pre 81 2.49 2.0 0.85 40 6 35 < 0.0001
Post 81 1.96 2.0 0.71
I am aware of evidence-based practice principles for working eectively in an urban Indigenous context
Pre 81 2.69 3.0 0.86 54 2 25 < 0.0001
Post 81 1.69 2.0 0.63
I feel condent about working about working in an urban Indigenous context
Pre 81 2.53 2.0 0.82 42 15 24 0.0002
Post 81 2.16 2.0 1.13
I am not afraid of doing something if I was working in an urban Indigenous context
Pre 81 3.19 3.0 1.06 42 13 26 0.0001
Post 81 2.44 4.0 1.02
I am not afraid of saying something if I was working in an urban Indigenous context
Pre 81 3.17 3.0 1.07 41 9 31 < 0.0001
Post 81 2.48 4.0 1.10
I know where to access resources and tools to support my work in an urban Indigenous context
Pre 81 2.81 3.0 0.85 43 7 31 < 0.0001
Post 81 2.21 2.0 0.83
I have a network of peers and colleagues I can refer to for support and assistance in my work
Pre 80 2.47 2.0 0.87 35 9 36 0.0001
Post 80 1.91 2.0 0.73
Awareness
I am skilled at being adaptable and exible
Pre 81 2.22 2.0 0.71 31 6 44 < 0.0001
Post 81 1.88 2.0 0.64
I have an understanding and appreciation for Aboriginal and Torres Strait Islander cultures and knowledges
Pre 80 2.41 2.0 0.81 34 2 44 < 0.0001
Post 80 1.90 2.0 0.66
I am aware of health issues faced by Aboriginal and Torres Strait Islander people
Pre 80 1.95 2.0 0.63 32 2 46 < 0.0001
Post 80 1.54 2.0 0.50
I intend to work in Aboriginal and Torres Strait Islander contexts in the future
Pre 81 2.44 3.0 0.81 34 11 36 0.0004
Post 81 2.12 2.0 0.80
I have built good relationships with Aboriginal and Torres Strait Islander people
Pre 81 2.11 2.0 0.96 31 15 35 0.0129
Post 81 1.85 2.0 0.73
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 11 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
Learning environment
Q: I received an adequate orientation when I started the placement
Strongly Agree 78 (49.4) 46 (56.8)
Agree 71 (44.9) 34 (42.0)
N/A 0 (0) 0 (0)
Disagree 0 (0) 0 (0)
Strongly Disagree 0 (0) 0 (0)
Uncertain 7 (4.4) 1 (1.2)
Missing 2 (1.3) 0 (0)
Q: I had access to appropriate resources during the placement
Strongly Agree 71 (44.9) 43 (53.1)
Agree 70 (44.3) 31 (38.3)
N/A 2 (1.3) 2 (2.5)
Disagree 5 (3.2) 1 (1.2)
Strongly Disagree 0 (0) 0 (0)
Uncertain 7 (4.4) 3 (3.7)
Missing 3 (1.9) 1 (1.2)
Q: My contribution was valued during this placement
Strongly Agree 73 (46.2) 44 (54.3)
Agree 65 (41.1) 30 (37.0)
N/A 1 (0.6) 1 (1.2)
Disagree 3 (1.9) 1 (1.2)
Strongly Disagree 1 (0.6) 0 (0)
Uncertain 13 (8.2) 5 (6.2)
Missing 2 (1.3) 0 (0)
Q: Overall, the environment was conducive to learning
Strongly Agree 83 (52.5) 46 (56.8)
Agree 62 (39.2) 30 (37.0)
N/A 2 (1.3) 2 (2.5)
Disagree 3 (1.9) 1 (1.2)
Strongly Disagree 0 (0) 0 (0)
Uncertain 6 (3.8) 2 (2.5)
Missing 2 (1.3) 0 (0)
Awareness and self-development
Q: I would recommend that other student’s complete placement in an urban Indigenous health context
Strongly Agree 88 (55.7) 49 (60.5)
Agree 63 (39.9) 30 (37.0)
N/A 0 (0) 0 (0)
Disagree 1 (0.6) 1 (1.2)
Strongly Disagree 0 (0) 0 (0)
Uncertain 4 (2.5) 1(1.2)
Missing 2 (1.3) 0 (0)
Supervision and feedback
Q: I received sucient supervision during this placement
Strongly Agree 74 (46.8) 39 (48.2)
Agree 65 (41.1) 35 (43.2)
N/A 3 (1.9) 1 (1.2)
Disagree 7 (4.4) 3 (3.7)
Strongly Disagree 1 (0.6) 1 (1.2)
Uncertain 6 (3.8) 2 (2.5)
Missing 2 (1.3) 0 (0)
Q: There were sucient opportunities to receive feedback and discuss my progress
Strongly Agree 76 (48.1) 43 (53.1)
Agree 58 (36.7) 30 (37.0)
Table 3 Post-placement survey results vs. matched post-survey results
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 12 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
of travelling to multiple clinics. Finally, suggestions for
improvement of placements included improved com-
munication, logistics and planning, clearer expectations,
improved supervision and mentoring, providing more
opportunities for learning and skills development, and
encouragement to continue the placement program for
future students.
Discussion
is study evaluated students’ experiences of Indige-
nous-led, regionally coordinated placements within a
network of urban ACCHSs, and their perceptions of the
development of their cultural responsiveness. e results
of this study indicate that students’ perceptions of the
learning environment, their skills development, their
awareness, and their cultural responsiveness signicantly
improved because of their placement. Additionally, stu-
dents’ perceptions of their awareness and self-develop-
ment, the supervision and feedback provided, and their
overall satisfaction with the placement were generally
positive. Finally, students’ overall satisfaction with the
quality of their placement was positively associated with
their intention to work in Aboriginal and Torres Strait
Islander health contexts in the future.
Learning environment
N/A 6 (3.8) 2 (2.5)
Disagree 5 (3.2) 2 (2.5)
Strongly Disagree 1 (0.6) 0 (0)
Uncertain 10 (6.3) 4 (4.9)
Missing 2 (1.3) 0 (0)
Q: My educator was a good facilitator of my learning
Strongly Agree 85 (53.8) 48 (59.3)
Agree 57 (36.1) 28 (34.6)
N/A 7 (4.4) 4 (4.9)
Disagree 4 (2.5) 0 (0)
Strongly Disagree 0 (0) 0 (0)
Uncertain 3 (1.9) 1 (1.2)
Missing 2 (1.3) 0 (0)
Q: I received sucient support during this placement
Strongly Agree 86 (54.4) 50 (61.7)
Agree 54 (34.2) 24 (29.6)
N/A 2 (1.3) 1 (1.2)
Disagree 6 (3.8) 3 (3.7)
Strongly Disagree 2 (1.3) 1 (1.2)
Uncertain 6 (3.8) 2 (2.5)
Missing 2 (1.3) 0 (0)
Q: If a suitable position were to be advertised at my placement site, I would apply*
Post-survey (n = 61) Matched Post-Survey (n = 28)
Strongly Agree 36 (59) 16 (57.1)
Agree 17 (27.9) 9 (32.1)
N/A 0 (0) 0 (0)
Disagree 1 (1.6) 0 (0)
Strongly Disagree 1 (1.6) 1 (3.6)
Uncertain 2 (3.3) 1 (3.6)
Missing 4 (6.6) 1 (3.6)
Overall satisfaction
Q: Overall, I was satised with the quality of this placement
Strongly Agree 79 (50.0) 43 (53.1)
Agree 69 (43.7) 35 (43.2)
N/A 0 (0) 0 (0)
Disagree 5 (3.2) 1 (1.2)
Strongly Disagree 0 (0) 0 (0)
Uncertain 3 (1.9) 2 (2.5)
Missing 2 (1.3) 0 (0)
*This ques tion was added to the pos t-placem ent survey in 2018
Table 3 (continued)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 13 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
Pre-placement
Theme Subtheme Example quotes (student discipline and year)
Competence Skills
development
“I’m looking forward to learning new skills from being in a new placement situation.” (Occupational Therapy 1,
2017)
“I’m excited to see how I handle myself and use my clinical skills working [with clients from] a diverse background.”
(Nursing and Midwifery 1, 2019)
“I am looking forward to learning how to communicate well with Aboriginal and Torres Strait Islander People.”
(Speech Pathology 1, 2018)
Broadening
experiences
“A dierent experience that will broaden my knowledge and skill set.” (Dentistry 1, 2018)
“New experiences and unique learning opportunities.” (Occupational Therapy 2, 2017)
Cultural skills Developing cul-
tural capability
“I am most looking forward to understanding the intricacies of working in an Indigenous health clinic, learning how
to and expanding my cultural competency, feeling comfortable in providing eective and sensitive healthcare and
support, and meeting people that challenge my worldview and push me to reconsider myself.” (Medicine 1, 2017)
Helping others “I’m most looking forward to making a positive contribution to the organisation and the people it serves.” (Nutrition
& Dietetics 1, 2017)
Building
connections
“Learning about Aboriginal and Torres Strait Islander culture and making lasting connections.“ (Occupational
Therapy 3, 2018)
Support Guidance to
develop cultural
responsiveness
“Guidance as to how we should adapt our consultations to respect any dierences in culture.” (Optometry 1, 2017)
“Support through reading resources, reection opportunities and being able to ask questions freely.” (Occupational
Therapy 4, 2017)
Needing clear
expectations,
regular feedback,
and open
communication
“I would like to feel comfortable approaching my colleagues and supervisors with any questions, queries and to
receive feedback on my practice.” (Psychology 1, 2017)
“I would like to be told very clearly and specically what is expected of me every step of the way.” (Political Science
1, 2017)
“Lots of observation opportunities and supervised practice with constructive feedback.” (Occupational Therapy 5,
2017)
Fear Saying or doing
something wrong
“I am concerned about my own subconscious biases. I have only learned about Indigenous Peoples from non-
Indigenous teachers, and I am not condent that this has prepared me for the reality of working with them.” (Nurs-
ing and Midwifery 2, 2017)
“I have some concerns about saying the wrong thing or not showing respect in the appropriate way to the people I
am working with.” (Occupational Therapy 6, 2017)
Not feeling
concerned
“No concerns as such, just a little bit nervous as I have never worked in a setting like this before.” (Pharmacy 1, 2017)
“No concerns. I feel condent that I will receive a level of support to assist me during this placement.” (Psychology 2,
2017)
Post-placement
Theme Subtheme Example quotes
Expertise Opportunities for
learning
“Varied caseload (paediatrics, adults and project placement) allowed me to develop skills across dierent Aboriginal
and Torres Strait Islander settings.” (Occupational Therapy 7, 2017)
“I gained a lot of experience and knowledge from my time at IUIH because of the hands-on work I did.” (Health Sci-
ence/Public Health 1, 2017)
Working in a mul-
tidisciplinary or
interprofessional
team
“Having a strong multi-disciplinary approach to therapy meant I learnt so many new skills from other allied health
areas.” (Occupational Therapy 8, 2018)
Cultural
responsiveness
Developing cul-
tural capability
“The university learning about cross-cultural communication can make you feel a bit anxious about working with
Indigenous people, so actually working with people and learning from them directly was immensely helpful in
terms of learning skills and developing condence.” (Social Work 1, 2017)
“I really enjoyed the exposure to Aboriginal and Torres Strait Islander people within the oce. It was a non-threat-
ening environment, and people would have been very understanding had I said or done something they deemed
oensive.” (Speech Pathology 2, 2018)
“The orientation package that outlined the Making Connections and Ways Frameworks gave me condence in how
to approach working Indigenous people, as I was apprehensive about this when entering my placement.” (Nutrition
& Dietetics 2, 2017)
Making
connections
“It also provided an opportunity to develop relationships with Indigenous community members in a non-formal
setting. This was benecial as it broke down common stereotypes and helped to enhance my own cultural compe-
tence.” (Nutrition & Dietetics 3, 2017)
“Working with the Work It Out [group-based chronic disease management program]clients was amazing. I felt
such a connection and it denitely ignited my passion for working with Aboriginal and Torres Strait Islander clients.”
(Human Services 1, 2018)
Table 4 Summary of developed key themes, and subthemes with representative quotes from participants
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 14 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
Aspects of the student placement model that likely
inuenced the positive placement outcomes from its
commencement in 2010 include the regional coordina-
tion of student placements and support available to sta
from a dedicated resource funded by the university and
based within the CCHO, opportunities for students to
engage with and learn from Aboriginal and Torres Strait
Islander clients and sta, and to engage with sta and
peers from various professions, and curriculum develop-
ment and delivery into local universities to support the
preparation of students for placement in an urban Indig-
enous health context. e regional coordination model
through a university-resourced Student Placement Coor-
dinator based within the organisation is as an innovative
approach to placements which enables the identication
of mutually benecial placement opportunities, enables
placement projects to be community-led, reduces the
administrative and supervisory pressures on organisa-
tions and clinicians, and ensures students are better pre-
pared and supported throughout their placements [3,
35]. Traditionally, placement coordinators are employed
by, and based within, universities [3]. Embedding the
placement coordinator within the organisation facilitates
the development of strong relationships resulting in the
eective coordination and support of a large number of
placements based on a deep understanding of the needs
of the ACCHSs [3]. Supervising students in health set-
tings can be complex and stressful for clinical educators,
particularly when supervising students in need of addi-
tional support [36]. is innovative student placement
model may reduce stress on supervisors through support
provided by the Student Placement Coordinator, contex-
tualised training and skills development, and a positive
workplace culture regarding student placements [36].
e results of this study indicated that students appre-
ciated the opportunity to develop a deeper understand-
ing of Aboriginal and Torres Strait Islander culture, and
to make connections with Aboriginal and Torres Strait
Islander sta and clients in a safe, supportive learning
environment. Previous research indicates that situated
learning through student placements enables students to
learn directly from Aboriginal and Torres Strait Islander
Peoples, and can increase graduates’ empathy, compas-
sion for, and personal connection with Aboriginal and
Torres Strait Islander Peoples and communities [37, 38].
Service-learning experiences in urban Indigenous con-
texts are shown to equip the emerging workforce with
supportive networks, experience in culturally respon-
sive service provision, and supported opportunities to
develop ways of thinking, doing, and partnering with
Aboriginal and Torres Strait Islander Peoples towards
optimising health and well-being [24]. Appropriate cul-
tural awareness training provided within the university
environment with complementary, localised, and authen-
tic learning experiences in the placement environment
can support students to feel more condent and engaged,
Pre-placement
Theme Subtheme Example quotes (student discipline and year)
Learning
environment
Supportive
environment
“The supportive and friendly environment which was vastly dierent to any clinic experience before.” (Nursing and
Midwifery 3, 2017)
“I thoroughly enjoyed becoming a part of the team and feeling like a valued member of the organisation. It
increased my condence in my role as a practitioner.” (Psychology 3, 2018)
Sense of
belonging
“I loved how ‘uni friends’ are received throughout the [Murri]school community especially by the children, so I felt
needed and wanted.” (Speech Pathology 3, 2017)
“All the patients were very supportive of me being involved in their health and were very positive in wanting me to
learn from my peers.” (Pharmacy 2, 2018)
Challenges Learning
environment
“Some conict in the workplace, was uncomfortable at times.” (Medicine 2, 2018)
“Communication was quite poor between our group and our mentor. She was not very responsive to emails.”
(Speech Pathology 4, 2017)
Learning
opportunities
“High patient failure to attend rates on some days. Less opportunity to learn hands on, but more time to discuss
cases with supervisors.” (Dentistry 2, 2018)
“I observed a lot which can become quite monotonous. It would have been nice to have had a go at doing the skills
a little more.” (Optometry 2, 2017)
Logistics “Only downside was the number of desks available on certain days as there would be little to no room.” (Pharmacy
3, 2017)
“At times it felt slightly disorganised and we had to rearrange our schedules last minute, however I understand that
is just part of working within a community and being a exible clinician so it wasn’t necessarily a negative.“ (Speech
Pathology 5, 2017)
“The travel time to each site was the only small negative I had,but there is not much that can be done about that!
The overall experience of going to dierent sites made the travel time less of an impact.” (Exercise Physiology 1,
2017)
“The only negative would be the limited time frame of four weeks - a longer placement block would have allowed
for more experiences.” (Nutrition & Dietetics 4, 2019)
Table 4 (continued)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 15 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
can enable the consolidation of their knowledge, and
support them to challenge their assumptions [21, 39].
Student placements situated within Indigenous health
contexts oer a unique opportunity for transformative
learning in which students encounter new experiences
and through a reiterative process of reection, explora-
tion and support, the way they see the world or make
meaning in the world is changed, initiating greater and
longer lasting changes than university-based learning
experiences alone [40–42].
In the qualitative post-placement survey responses,
participants described being supported by approach-
able and knowledgeable supervisors, feeling welcomed
and valued by sta, peers, clients, and the community, a
sense of belonging, and opportunities to integrate into
the team. Placements within ACCHSs provide unique
opportunities for students to experience cultural super-
vision and culturally responsive supervision [3]. Accord-
ing to Bessarab (2012), cultural supervision is “embedded
in an Aboriginal/ Indigenous space that is supportive and
culturally safe for Aboriginal and non-Aboriginal (sta
and students) to engage in and reect on cultural issues
emerging in their practice/ research” (Page76) and can
be provided by Aboriginal and Torres Strait Islander sta
[43]. Culturally responsive supervision reects respect-
ful collaborative relationships with Aboriginal and Tor-
res Strait Islander Peoples and recognises the centrality
of Indigenous knowledges in understanding clients’ situ-
ation [43]. Cultural supervision is important in ensuring
that students are supported to understand and reect
on their practice from Aboriginal and Torres Strait
Islander and non-Indigenous perspectives, assisting
them to develop cultural responsiveness [22, 44]. Place-
ments within ACCHSs enable students to identify their
own assumptions, self-reect, debrief, and examine their
prior assumptions in a supportive learning environment,
enabling transformative learning [41].
Often students’ rst interaction with the IUIH was
through the delivery of curriculum on Aboriginal and
Torres Strait Islander health within their university
courses. is approach is supported by the Aboriginal
and Torres Strait Islander Health Curriculum Framework
which encourages universities to engage Aboriginal and
Torres Strait Islander community members to partici-
pate in curriculum development and delivery, enabling
students to be exposed to Aboriginal and Torres Strait
Islander contexts regularly throughout their studies [3].
Providing curriculum that supports student learning
to enable them to work with people from dierent cul-
tural backgrounds is essential to improve patient health
outcomes [45]. Health professionals report experiencing
anxiety or inadequacy when working in Indigenous health
[46]. Previous research has identied characteristics to
support non-Indigenous health professionals to practice
in Indigenous health contexts, including an awareness of
cultural identity, reection on one’s own position, and an
awareness of Aboriginal and Torres Strait Islander his-
tory [46]. ese concepts should be incorporated into
university training for future health professionals [46].
However, providing opportunities to learn about Indig-
enous health, history and the invasion and colonisation
of Australia without a framework of follow-up support
or discussion about ways to deal with new and emerging
awareness of these issues can result in increased fragility,
guilt, anxiety and fear, and may discourage future health
professionals from working in Indigenous health [46–49].
e ndings from this study indicate that placement in
a positive environment which enabled supported oppor-
tunities to discuss and make sense of new learnings and
uncomfortable feelings, assisted in reducing anxiety and
fear, and increased intention to work in Aboriginal and
Torres Strait Islander health settings.
ere was a substantial decrease in the number of
students who reported feeling afraid of doing or saying
something wrong when working in an urban Indigenous
context from the pre- to post-placement surveys. A pre-
vious qualitative study exploring dietetic student experi-
ences of a rural Indigenous health placement supported
these ndings, indicating that students felt more con-
dent working with Aboriginal and Torres Strait Islander
Peoples as a result of the placement [37]. Building per-
sonal connections with sta, clients and the community
in a safe, supportive learning environment seemed to
enable students to develop empathy, understanding, and
cultural competence. Furthermore, the engagement of
students from 32 disciplines enabled interprofessional
engagement opportunities throughout the placement,
including with students from non-health backgrounds.
Students appeared to value these opportunities and the
benets of understanding their role within a broader
health system. Interprofessional practice is a valuable
approach to addressing complex health challenges such
as the disparities that exist due to the ongoing eect of
colonialisation [50, 51].
e signicant increases in students’ skills develop-
ment, awareness and self-development, indicate that
regionally coordinated placements within urban ACCHSs
support the development of cultural responsiveness. is
is further supported by the signicant increases in under-
standing and appreciation of Aboriginal and Torres Strait
Islander cultures and knowledge, awareness of the health
issues faced by Aboriginal and Torres Strait Islander Peo-
ples, and building good relationships with Aboriginal and
Torres Strait Islander Peoples. A culturally responsive
health professional is reexive about their own identity
and positioning, their biases, history, and the theories
and skills that they bring to their practice [23]. e Propa
Ways cultural skills program appeared to support this
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 16 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
kind of reection by encouraging university students
on placement in an urban Indigenous health setting to
develop their cultural responsiveness through critically
reecting on whether their own values, beliefs and prac-
tices promote or compromise the health of Aboriginal
and Torres Strait Islander Peoples [52].
When asked if students intend to work in Indigenous
health contexts in the future, 69% agreed or strongly
agreed, a substantial increase from the 40% who agreed
or strongly agreed in the previous study. Importantly,
almost all students (96%) in the current study reported
that they would recommend other students’ complete
placement in an urban Indigenous health context, and
when asked if they would apply if a suitable position were
to be advertised at their placement site, most agreed or
strongly agreed (87%). Previous research has indicated
that providing positive placement experiences in rural
and remote Indigenous health contexts inuences gradu-
ates’ intentions to work in this setting and may contrib-
ute to workforce supply over time [53–55]. A systematic
review published in 2017 which narratively synthesized
14 studies, found that placements in rural Indigenous
health increased understanding and awareness of Aborig-
inal culture, promoted deeper understanding of the
complex determinants of health for Aboriginal Peoples,
increased awareness of the racism towards Aboriginal
Australians, and enhanced desire to work in Aboriginal
health [56]. Furthermore, a qualitative study published in
2019 found that placements in rural settings can support
students to build their cultural capabilities and foster
their interest in working with Aboriginal communities
[57]. ere is limited research on the impacts of student
placements in urban Indigenous contexts, however this
study indicates that urban Indigenous health placements
increase students desire to work with Aboriginal and
Torres Strait Islander Peoples. As such, these placements
support the development of a culturally responsive work-
force in urban settings where most Aboriginal and Torres
Strait Islander Peoples reside, which may provide value to
ACCHSs and mainstream health services.
e results of this study indicate further improvements
to the student placement program when compared to
the previous cross-sectional analysis of post-placement
survey data from 241 students undertaking placement
at the IUIH between January 2011 and December 2016
[24]. In the previous study, 77–87% of students reported
that they received adequate orientation, believed that
the environment was conducive to learning, received
adequate supervision and sucient opportunities to
receive feedback, and felt that their clinical educator was
a good facilitator of their learning [24]. Whilst in the cur-
rent study, 85–94% of students agreed or strongly agreed
with these statements. In the previous study, most stu-
dents were satised with the quality of their placement
(83%) [24], whilst in the current study almost all students
reported that they were satised with the overall quality
of their placement (94%). When compared with the pre-
vious study, more students in the current study felt con-
dent that they had the clinical skills to work in an urban
Indigenous context (79% vs. 70%) and had a good under-
standing and appreciation of Aboriginal and Torres Strait
Islander cultures and knowledges (88% vs. 80%) [24]. In
both studies, the same proportion of students reported
feeling that their contribution was valued (87%), and
100% of the students reported that they were aware of the
disproportionate health disadvantage faced by Aboriginal
and Torres Strait Islander Peoples [24].
e improved perceptions of students regarding the
learning environment, supervision and their overall
experience between the previous and current studies are
likely due to several factors, including quality improve-
ments in the coordination and facilitation of student
placements such as preferencing placing students nearing
the end of their studies to enable a focus on developing
their cultural skills, contextualised clinical education and
supervision training for sta, and informal mentoring
from the Student Placement Coordinator to build sta
capacity to supervise students well, improvements to the
student orientation process including guidance on prac-
tising in a culturally responsive way, and the development
of the Propa Ways cultural skills program, and expansion
of curriculum development and delivery into additional
disciplines and local universities.
e responsibility for developing culturally respon-
sive health professionals should be shared by universi-
ties and placement providers and should not overburden
ACCHSs. It is essential that non-Indigenous health pro-
fessional students are adequately prepared for place-
ments to enable them to work safely within Indigenous
health contexts [58]. Students who are not adequately
prepared by their university for placement in an Indig-
enous health setting may lack condence and cultural
capability, requiring more time, guidance, support, cul-
tural supervision, or culturally responsive supervision
from placement supervisors. e broad implementa-
tion of the Framework within universities will ensure
that students are better prepared for their placements in
ACCHSs with a greater understanding of the Indigenous
health context, and the impacts of the health system and
health service delivery on Aboriginal and Torres Strait
Islander Peoples [3]. Universities should prioritise build-
ing mutually benecial, reciprocal relationships with
ACCHSs to develop placement opportunities, and ensure
that curriculum is reective and responsive to the real-
world context of Indigenous health service delivery [3].
Utilising an Indigenous-led placement model in which
universities resource ACCHSs, enabling them to estab-
lish and implement student placements aligned with
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 17 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
community needs and values can improve outcomes and
cultural responsiveness.
Limitations
ere are several limitations to the study. e change in
wording of survey questions between years from nega-
tive phrasing to positive phrasing may have inuenced
the way in which students responded to the questions.
Some students who completed placements before the
end of the study period may have only received the post-
placement surveys after data collection for this study
ended. ere were limited matched responses in the sur-
vey data, and we did not collect data on whether students
were involved in direct clinical patient care or not. No
reminders were sent to students to complete the surveys,
and some surveys were not sent to all students as email
addresses for the students were not always provided to
the organisation by the university. e post-placement
survey response rate was 28%, whilst in the previous
study, the response rate was 20% [24]. As with any sur-
vey, there is a potential for sampling bias or participant
bias based on the characteristics of those who chose to
respond, versus those who did not. Additionally, there
may have been issues with the survey questions. Finally,
no validated measures of cultural responsiveness were
used as a validated measure suitable for use in Australian
First Nations contexts was only developed and validated
with health professional students in 2018 [59].
Conclusion
Regionally coordinated, Indigenous-led placements in
urban Indigenous health contexts can support trans-
formative learning and the development of a culturally
responsive workforce. Universities and ACCHSs should
aim to develop reciprocal relationships to support stu-
dents to develop their cultural responsiveness and
improve the provision of culturally safe care for Aborigi-
nal and Torres Strait Islander Peoples. Future research
should utilise validated measures of cultural responsive-
ness and should explore the longer-term impacts of stu-
dent placements on cultural responsiveness, attitudes,
behaviours, and practice. Additionally, future research
should explore the experiences of Aboriginal and Torres
Strait Islander Peoples interfacing with university stu-
dents on placement in urban settings.
Abbreviations
ACCHS Aboriginal and Torres Strait Islander Community Controlled Health
Service
CCHO Community-Controlled Health Organisation
IUIH Institute for Urban Indigenous Health
UQ University of Queensland
QUT Queensland University of Technology
SEQ South East Queensland
Supplementary Information
The online version contains supplementary material available at h t t p s : / / d o i . o r
g / 1 0 . 1 1 8 6 / s 1 2 9 0 9 - 0 2 4 - 0 6 4 3 2 - 9 .
Supplementary Material 1
Acknowledgements
The authors would like to acknowledge this manuscript has been written
on the unceded sovereign lands of the Yuggera and Turrbal Peoples, the
Kombumerri People, and the Wijabul Wiabul Peoples of the Bundjalung
Nations of Australia. We pay genuine respect to their Elders past and present,
and to the First Nations Peoples of all Countries whose lands are signicant.
We express our gratitude to the communities and clients of the Institute for
Urban Indigenous Health and its Member services for their support of the
student placement program. We honour the legacy and the vision of those
who have paved the way and those who continue to guide us. We thank
the study participants who kindly completed the placement surveys and
openly shared their experiences. We also thank Lyle Turner from the Institute
for Urban Indigenous Health for his contributions to data preparation and
analysis.
Author contributions
KOJ contributed to the design of the work, the acquisition, analysis, and
interpretation of the data and drafted the manuscript. AN contributed to
the design of the work, the acquisition and interpretation of the data, and
revision of the manuscript. RB contributed to the design of the work, the
acquisition and interpretation of the data, and revision of the manuscript. NH
contributed to the interpretation of the data, and revision of the manuscript.
TA contributed to the analysis and interpretation of the data, and revision
of the manuscript. KM contributed to the analysis and interpretation of the
data, and revision of the manuscript. All authors read and approved the nal
manuscript.
Funding
The authors received no nancial support for the research or authorship of
this article. Researcher time was provided ‘in kind’ by Bond University, the
Burnet Institute,and the Institute for Urban Indigenous Health (IUIH).
Data availability
The datasets used and/or analysed during the current study are available from
the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Ethics approval was obtained from the University of Queensland’s Human
Research Ethics Committee (approval number 2011001115). Written approval
was obtained from the Executive Dean, Faculty of Health from the Queensland
University of Technology (QUT) to recruit students on placement with the
Institute for Urban Indigenous Health (IUIH). Upon accessing the survey/s,
students were invited to read a preamble and provide voluntary informed
consent to participate by ticking ‘agree’ on a consent question and completing
the survey/s. Participation was voluntary, not compensated, and anonymous.
Only the rst author could reidentify participants if needed to match pre and
post surveys by accessing hard copies of their placement paperwork stored in
a locked cabinet at the IUIH.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Author details
1Faculty of Health Sciences and Medicine, Bond University, Gold Coast,
Australia
2The Institute for Urban Indigenous Health, Brisbane, Australia
3The University of Queensland, Brisbane, Australia
4Nunuccal Woman of Minjerribah, Queensland, Australia
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 18 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
5The Burnet Institute, Melbourne, Australia
6Ngadjuri Woman, South Australia, Australia
Received: 8 March 2024 / Accepted: 29 November 2024
References
1. West R, Mills K, Rowland D, Creedy D. Impact of a discrete First Peoples health
course on students’ experience and development of cultural capabilities.
High Educ Res Dev. 2019;38(5):1090–104.
2. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a
determinant of health: a systematic review and meta-analysis. PLoS ONE.
2015;10(9):e0138511.
3. Australian Government. Aboriginal and Torres Strait Islander Health Curricu-
lum Framework. In: Department of Health, editor. Canberra, Australia 2014.
4. Phillips G. CDAMS indigenous health curriculum framework. VicHealth Koori
Health Research and Community Development Unit Melbourne; 2004.
5. Davy C, Cass A, Brady J, DeVries J, Fewquandie B, Ingram S, et al. Facilitating
engagement through strong relationships between primary healthcare
and Aboriginal and Torres Strait Islander peoples. Aust N Z J Public Health.
2016;40(6):535–41.
6. Harrington Z, Thomas DP, Currie BJ, Bulkanhawuy J. Challenging perceptions
of non-compliance with rheumatic fever prophylaxis in a remote Aboriginal
community. Med J Aust. 2006;184(10):514–7.
7. Aspin C, Brown N, Jowsey T, Yen L, Leeder S. Strategic approaches to
enhanced health service delivery for Aboriginal and Torres Strait Islander
people with chronic illness: a qualitative study. BMC Health Serv Res.
2012;12:1–9.
8. Mazel O. Self-determination and the right to health: Australian
aboriginal community controlled health services. Hum Rights Law Rev.
2016;16(2):323–55.
9. Aboriginal AHMACSCf, Party TSIHW. Cultural respect Framework for Aborigi-
nal and Torres Strait Islander Health, 2004–2009. Department of Health, S.
Aust.; 2004.
10. Commonwealth of Australia. National Strategic Framework for Aboriginal
and Torres Strait Islander Peoples’ Mental Health and Social and Emotional
Wellbeing. Department of the Prime Minister and Cabinet. editor. Canberra:
Australian Government; 2017.
11. Garond L. The meaningful dierence of ‘Aboriginal dysfunction’and the
neoliberal ‘mainstream’. eTropic: Electron J Stud Tropics. 2014;13(2).
12. Ryder C, Mackean T, Ullah S, Burton H, Halls H, McDermott D, et al. Develop-
ment and validation of a questionnaire to measure attitude change in health
professionals after completion of an Aboriginal health and cultural safety
training Programme. Australian J Indigenous Educ. 2019;48(1):24–38.
13. Jones S. Implementing an Aboriginal and Torres Strait Islander Health Cur-
riculum Framework: ndings from environmental scans of entry level health
curricula, accreditatition and professional competency standards. Adelaide:
Health Workforce Australia; 2014.
14. Universities Australia. National Best Practice Framework for Indigenous
Cultural Competency in Australian Universities. In: Department of Education:
Employment and Workplace Relations, editor. Canberra, Australia, 2011.
15. Grote E. Principles and practices of cultural competency: a review of the
literature. Citeseer; 2008.
16. Warren JM, Irish GL, Purbrick B, Li JJ, Li X, Fitzpatrick DJ, et al. Developing the
future indigenous health workforce: the feasibility and impact of a student-
led placement programme in remote indigenous communities. Aust J Rural
Health. 2016;24(5):306–11.
17. Menzel K, Cameron L. A meeting of Freshwater and Saltwater: opening the
dialogue of Aboriginal concepts of Culture within an academic space. Indig-
enous Knowledges: Brill; 2021. pp. 117–46.
18. Thackrah RD, Thompson SC. Confronting uncomfortable truths: receptiv-
ity and resistance to Aboriginal content in midwifery education. Contemp
Nurse. 2013;46(1):113–22.
19. Flavell H, Thackrah R, Homan J. Developing indigenous Australian cultural
competence: a model for implementing indigenous content into curricula. J
Teach Learn Graduate Employab. 2013;4(1):39–57.
20. Behrendt L, Larkin S, Griew R, Kelly P. Review of higher education access and
outcomes for Aboriginal and Torres Strait Islander people. Department of
Industry, Innovation, Science, Research and Tertiary Education; 2012.
21. Nash R, Meiklejohn B, Sacre S. The Yapunyah project: embedding Aboriginal
and Torres Strait Islander perspectives in the nursing curriculum. Contemp
Nurse. 2006;22(2):296–316.
22. Zubrzycki J, Green S, Jones V, Stratton K, Young S, Bessarab D. Getting it right:
Creating partnerships for change. Integrating Aboriginal and Torres Strait
Islander knowledges in social work education and practice. 2014.
23. Bessarab D. Changing how and what we do: the signicance of embedding
Aboriginal and Torres Strait Islander ways of knowing, being, and doing in
social work education and practice. Taylor & Francis; 2015. pp. 1–4.
24. White R, Nelson A. Development of a culturally responsive workforce in
Urban Aboriginal and Torres Strait Islander Health. Australian J Clin Educ.
2019;5(1):1–20.
25. Mak DB, Miin B. Living and working with the people of ‘the bush’: a founda-
tion for rural and remote clinical placements in undergraduate medical
education. Med Teach. 2012;34(9):e603–10.
26. Purea P, Brumpton K, Kumar K, Pinidiyapathirage J. Exploring the learn-
ing environment aorded by an Aboriginal Community Controlled
Health service in a rural longitudinal integrated clerkship. Educ Prim Care.
2022;33(4):214–20.
27. The Institute for Urban Indigenous Health (IUIH). About IUIH 2024 [ h t t p s : / / w
w w . i u i h . o r g . a u / a b o u t - i u i h /
28. Shannon C, Carson A, Nelson A. Teaching and learning: developing health
student placements in partnerships with urban Aboriginal and Torres Strait
Islander Community Controlled Health Services. LIME good practice Case
studies volume 2. Onemda VicHealth Koori Health Unit, The University of
Melbourne Parkville, VIC; 2013. pp. 29–34.
29. Nelson A, Iwama M. Cultural inuences and occupation-centred practice
with children and families. Occupation centred practice with children: A
practical guide for occupational therapists. 2010:75–93.
30. Menzel K, Yunkaporta T. Settler-on-Settler violence: ritual protocols in You-
Tube street ght videos-paper 1. J Indigenous Res. 2022;10(2022):5.
31. Menzel K, Yunkaporta T. Settler-on-Settler violence: Ritual protocols in You-
Tube Street ght videos-part two. J Indigenous Res. 2022;10(2022):6.
32. Mertler CA. Introduction to educational research. Sage; 2021.
33. Coburn E, Moreton-Robinson A, Sefa Dei G, Stewart-Harawira M. Unspeakable
things: Indigenous research and social science. Socio La nouvelle revue des
sciences sociales. 2013(2):331 – 48.
34. Kennedy M, Maddox R, Booth K, Maidment S, Chamberlain C, Bessarab D.
Decolonising qualitative research with respectful, reciprocal, and responsible
research practice: a narrative review of the application of yarning method in
qualitative Aboriginal and Torres Strait Islander health research. Int J Equity
Health. 2022;21(1):134.
35. Taylor K, Durey A, Bullen J, Mulcock J, Kickett M, Jones S. February. Case
studies: innovations in Aboriginal and Torres Strait Islander curriculum imple-
mentation. HWA, Adelaide Retrieved 2014;3:2017.
36. Bourne E, Short K, Kenny B, McAllister L. Clinical educators can supervise
students without increased stress: a study of interacting factors using insights
from complexity theory. Adv Health Sci Educ. 2022:1–21.
37. Svarc R, Davis C, McDonald H, Perruzza J, Browne J, Delbridge R, et al. Explor-
ing the impact of Aboriginal health placement experiences on the prepara-
tion of dietetic graduates for practice with Aboriginal communities. Nutr
Dietetics. 2018;75(5):448–56.
38. Benson J, Ryder C, Gill M, Balabanski A. A brief experience for medi-
cal students in a remote Aboriginal community. Aus Fam Physician.
2015;44(10):752–9.
39. Birks M, Bagley T, Park T, Burkot C, Mills J. The impact of clinical placement
model on learning in nursing: a descriptive exploratory study. Australian J
Adv Nurs the. 2017;34(3):16–23.
40. McAllister L, McEwen E, Williams V, Frost N. Rural attachments for stu-
dents in the health professions: are they worthwhile? Aust J Rural Health.
1998;6(4):194–201.
41. Prout S, Lin I, Nattabi B, Green C. I could never have learned this in a lecture’:
transformative learning in rural health education. Adv Health Sci Educ.
2014;19:147–59.
42. Archer-Kuhn B, Samson P, Damianakis T, Barrett B, Matin S, Ahern C. Trans-
formative learning in eld education: students bridging the theory/practice
gap. Br J Social Work. 2021;51(7):2419–38.
43. Bessarab D. The supervisory yarn: embedding indigenous epistemology in
supervision. Our voices: Aboriginal and Torres Strait Islander Social Work.
Palgrave Macmillan; 2013. pp. 73–92.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 19 of 19
Odgers-Jewell et al. BMC Medical Education (2024) 24:1446
44. Reath J, Abbott P, Kurti L, Morgan R, Martin M, Parry A, et al. Supporting
aboriginal and Torres Strait islander cultural educators and cultural mentors
in Australian general practice education. BMC Med Educ. 2018;18:1–11.
45. Lucas C, Aly M, Power T. Pharmacy students’ learnings and reections to
inform the development of the ‘Working respectfully with Aboriginal
Peoples’(WRAP) Toolkit. Reective Pract. 2021;22(1):86–100.
46. Wilson AM, Magarey AM, Jones M, O’Donnell K, Kelly J. Attitudes and charac-
teristics of health professionals working in Aboriginal health. Rural Remote
Health. 2015;15(1):1–14.
47. Maddison S. Beyond white guilt: The real challenge for black-white relations
in Australia: ReadHowYouWant. com; 2011.
48. Rossi T, Rynne S. Sport development programmes for indigenous australians:
innovation, inclusion and development, or a product of ‘white guilt’? Sport.
Race and Ethnicity: Routledge; 2017. pp. 36–51.
49. Williams R. Why should I feel Guilty? Reections on the workings of Guilt in
White-Aboriginal relations. Australian Psychol. 2000;35(2):136–42.
50. Edjoc R. Key health inequalities in Canada: a national portrait. Public Health
Agency of Canada; 2018.
51. World Health Organization. Framework for action on interprofessional educa-
tion and collaborative practice. World Health Organization; 2010.
52. Durey A, Thompson S, Wood M. Time to bring down the twin towers in poor
Aboriginal hospital care: addressing institutional racism and misunderstand-
ings in communication. Intern Med J. 2012;42(1):17–22.
53. Smedts AM, Campbell N, Sweet L. Work-integrated learning (WIL) supervisors
and non-supervisors of allied health professional students. Rural Remote
Health. 2013;13(1):6–18.
54. Liaw S-T, McGrath B, Jones G, Russell U, Bourke L, Hsu-Hage B. A compulsory
experiential and inter-professional rural health subject for undergraduate
students. Rural Remote Health. 2005;5(4):1–7.
55. Bazen JJ, Kruger E, Dyson K, Tennant M. An innovation in Australian dental
education: rural, remote and indigenous pre-graduation placements. Rural
Remote Health. 2007;7(3):1–9.
56. McDonald H, Browne J, Perruzza J, Svarc R, Davis C, Adams K, et al.
Transformative eects of Aboriginal health placements for medical,
nursing, and allied health students: a systematic review. Nurs Health Sci.
2018;20(2):154–64.
57. Thackrah RD, Thompson SC. Learning from follow-up of student placements
in a remote community: a small qualitative study highlights personal and
workforce benets and opportunities. BMC Med Educ. 2019;19(1):1–9.
58. Lucas C, Aly M, Power T. Clinical partners’ reections on indigenous curricula
in health education and the development of a pre-clinical placement stu-
dent toolkit. Reective Pract. 2021;22(2):263–77.
59. West R, Mills K, Rowland D, Creedy DK. Validation of the rst peoples cultural
capability measurement tool with undergraduate health students: a descrip-
tive cohort study. Nurse Educ Today. 2018;64:166–71.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional aliations.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
Available via license: CC BY-NC-ND 4.0
Content may be subject to copyright.
