The Effect of Aged‐Care Rural Clinical Placements on Health Student Self‐Efficacy: A Mixed‐Methods Evaluation

ABSTRACT

Objective

The objective of this study was to determine the effect of rural clinical placements on allied health students' perceived self‐efficacy in service delivery, as part of a larger evaluation of facilitated student placements in Northern New South Wales residential aged‐care homes.

Methods

A mixed‐methods design was employed. Allied health students from a variety of universities undertook at least five‐week clinical placements in two rural residential aged‐care homes via a programme designed and coordinated by the University Centre for Rural Health in partnership with the Aged Care Residential facility. Quantitative data were collected using a modified Self‐Efficacy in Clinical Performance Scale, pre and post‐placement. Semi‐structured interviews were conducted post‐placement. Self‐efficacy scores were compared using the Wilcoxon Signed‐Rank test, and the effect size was calculated. Reflexive thematic analysis was conducted to identify themes from interview transcripts.

Results

Twenty‐five students completed the surveys, and 12 interviews were included in this study. There was a statistically significant increase, post‐placement compared to pre‐placement, in total self‐efficacy in clinical performance scores, as well as in subscale scores. The subscales related to assessment, diagnosis, and planning and implementation. Two themes were identified from the qualitative interviews: (1) heightened confidence, independence, and work readiness; and (2) confidence and enthusiasm for interprofessional work.

Conclusions

Our findings provide beginning evidence that a well‐resourced and focused programme of clinical placements can improve allied health student self‐efficacy and may stimulate greater enthusiasm for working in the rural aged‐care sector.

Summary.

• What is already known about this subject?

  • ○
    Rural clinical placements are an opportunity to support unmet healthcare needs of rural communities while also meeting health students' learning objectives, curriculum requirements, and professional accreditation standards.
  • ○
    The UCRH and a range of academic institutions have partnered with local aged‐care providers in Northern NSW to address the challenges faced when building an allied health aged‐care workforce in rural settings.
• What does this study add?

  • ○
    A well‐resourced and supported clinical placement in a rural aged‐care facility can increase the self‐efficacy of allied health students.
  • ○
    This study provides beginning evidence that a rural placement can enhance confidence, independence, work readiness, and enthusiasm for interprofessional work for students, while providing increased access to allied health services for aged‐care residents.

1. Introduction

The aged‐care sector within Australia faces enormous pressures in meeting service demands. This is particularly evident in Northern New South Wales (NSW), where 18% of older adults experience challenges in accessing allied health services, 48% face barriers to mental health services, and 43% report difficulty in accessing aged‐specific services [1]. These gaps are attributed to a shortage of allied health professionals and a lack of enthusiasm for careers in the aged‐care sector [1]. To address this problem nationally, University Departments of Rural Health (UDRHs), funded through the Australian Federal Government, have been expanding allied health student placements in aged‐care settings to provide important learning opportunities for students and potentially a future workforce pipeline, as well as to support the current and future healthcare needs of rural communities [2]. Placements are designed to immerse students in real‐world scenarios, allowing them to develop practical skills and self‐efficacy in client care as outlined by professional accrediting authorities [3, 4, 5, 6].

Self‐efficacy is a critical learning outcome of clinical placements, contributing to health students' academic and work performance [7, 8, 9]. According to Bandura's theory, self‐efficacy is an individual's strength of belief in their own ability to perform a task or act, within a specific setting [10]. There are four sources of self‐efficacy: mastery experience, vicarious experience, social persuasion, and physiological and affective states [10, 11]. Mastery experience can be described as coming from students' experience of performing tasks in healthcare settings, while vicarious experience relates to students' observations of peers' learning and practice to gauge their own ability to perform [10]. The third source of self‐efficacy is social persuasion, which refers to the effect of performance feedback from others on a student's confidence in themselves [10]. Physiological and affective states constitute a fourth, albeit less influential, source of self‐efficacy; for example, fatigue and stress can negatively affect students' perception of their competence whereas a calm or positive mode can influence positively [11]. In health education, one approach to enhancing students' self‐efficacy is through clinical placements [12, 13].

Building students' confidence in their capacity to deliver safe, competent care—that is, fostering clinical self‐efficacy—is a central objective of placement‐based learning in health curricula, and numerous empirical studies confirm that well‐designed clinical placements can achieve this outcome [14, 15, 16, 17, 18]. Furthermore, a systematic review of clinical placement studies indicates elements of placement design that are particularly influential. For example, student‐led, block‐based, and collaborative placement models have been associated with students' increased self‐efficacy [19].

Rural clinical placement models for health students are diverse, context‐specific, and continuously evolving to best meet students' learning needs and complexities of locations [19]. Whilst outcomes related to rural placement models (e.g., satisfaction, rural practice retention, competency) have been reported in the literature, few studies, to our knowledge, have investigated self‐efficacy in relation to rural clinical placement performance [15, 16, 17, 18]. The influence of aged‐care placements on self‐efficacy remains poorly understood. A deeper understanding of the influence of rural aged‐care placements on self‐efficacy is particularly important in preparing the future workforce for this context, as we know that in aged‐care settings—where practitioners must independently assess, plan, implement, and evaluate complex care—clinical self‐efficacy is a strong predictor of high‐quality, safe service delivery. Evaluations of allied health student placements in rural aged‐care settings often overlook this critical aspect of students' clinical self‐efficacy [7]. This present study aims to answer: how do the aged‐care rural clinical placements change allied health students’ perceived self‐efficacy in service delivery? This research is timely, as there is pressure to quality assure placement programmes, both nationally (Australian Tertiary Education Quality and Standards Agency) and internationally (UK Quality Assurance Agency) [20, 21].

2. Methods

2.1. Ethics Statement

This project was approved by the University Ethics Committee (Anonymised for Review).

2.2. Study Design

A convergent mixed‐methods design was used to evaluate student self‐efficacy in the context of UCRH‐facilitated student placements in Northern NSW aged‐care settings [22]. This approach was selected to allow for the simultaneous collection and analysis of quantitative (pre‐ and post‐placement surveys) and qualitative (post‐placement interviews) data, providing a comprehensive understanding of changes in student self‐efficacy. The methods were mixed during the interpretation phase, where qualitative findings were used to elaborate and contextualise the survey results, thereby enhancing the explanatory power of the evaluation.

2.3. Settings and Participants

The placements took place at two residential aged‐care homes (RACHs) in Northern NSW, classified as a medium rural town (MM4) and a small rural town (MM5) according to the Modified Monash (MM) Model [23]. Allied health students from six universities participated in these placements, and the majority were in their final years of their degree.

2.4. Placement Design

The UCRH placement model has been co‐designed with key community stakeholders to integrate allied health students, from a range of universities, into service delivery in aged‐care settings, with a focus on enhancing student knowledge and skills in aged care, as well as their empathy and self‐efficacy. Key components of the placement model are evidence‐based, including student‐centred learning, work readiness, interprofessional learning, hybrid supervision (in‐person and long‐arm approaches), peer‐assisted learning, and immersion in the rural context. The UCRH oversees student supervision, placement management, assessments, and student well‐being for its academic partners, while health service partners provide students with access to client data, as well as resources and opportunities for collaboration with staff in delivering services to older clients.

These placements range from 5 to 20 weeks depending on university and discipline‐specific requirements (e.g., physiotherapy: 5 weeks, nutrition and dietetics: 6 weeks, speech pathology: 6–8 weeks, occupational therapy: 7–10 weeks, and social work: 20 weeks). The students receive an orientation to the placement sites and the supervision model by the UCRH before the placements commence. During the placements, students are paired with a peer from the same discipline and access a combination of scheduled on‐site multidisciplinary clinical supervision and on‐demand remote (online) meetings with supervisors. Students are integrated into aged‐care service delivery under the supervision of clinical educators and in collaboration with facility staff, undertaking tasks such as conducting clinical assessments, developing care plans, delivering therapeutic interventions, and supporting residents' rehabilitation.

2.5. Data Collection and Dataset Generation

Data were collected between January and July 2024 from a total of 26 allied health students who participated in RACH placements during this period. The Education Support Officer at the UCRH distributed invitation emails, along with a link containing a Participant Information Statement and online survey, before and after the placements. Print copies of surveys were available upon request. A unique identifier (i.e., last four digits of the phone number and first letter of the mother's name) was requested to match participants' pre‐ and post‐placement responses. The students completed an adapted version of the Self‐Efficacy in Clinical Performance (SECP) Scale [24]. The original instrument is a validated, 37‐item measure of nursing students' self‐efficacy [24]. For this study, an expert panel of allied health clinicians and educators reviewed every item for relevance to placements in physiotherapy, occupational therapy, speech pathology, dietetics, and social work. Items judged inapplicable or redundant were removed, and discipline‐neutral wording was substituted where needed. The revised scale was then piloted with a sample of allied health students to confirm validity and clarity. The final 21‐item version comprises the following domains: assessment (12 items), diagnosis and planning (4 items), implementation (4 items), and evaluation (1 item) (See Data S1). Retaining only the items essential to allied health practice reduced respondent burden within the broader 64‐item placement evaluation questionnaire.

Following completion of the placements, 26 students were invited to participate in a post‐placement interview. Participation was voluntary, and written (or verbal) consent was obtained prior to the interviews. Interviews were conducted either face‐to‐face (at RACHs or UCRH) or online (via Zoom or telephone), depending on student availability and location. Interview durations ranged from 18 to 36 min. All interviews were conducted by a co‐investigator, a research academic at UCRH and the project manager for the study, who was not involved in student supervision or assessment. The interviewer has a background in health sciences and qualitative research, with experience interviewing educators, students, staff, older adults, and family members in both acute and non‐acute care settings. A semi‐structured interview guide was used to frame the discussion. It was deliberately designed by the research team to explore student experiences of the placement and their perceptions of performance on placement based on current literature, reviewed by previous students and clinical educators, and subsequently amended prior to ethics approval. Students were given the opportunity to review their interview transcripts by sharing their contact details on the consent form; however, no participants requested transcript review, and therefore, no changes to the data were made as a result of member checking.

2.6. Data Analysis

The quantitative data were analysed using SPSS Statistics V29. The demographics of participants were described using frequencies and percentages. The data were explored for normality using skewness, kurtosis, and by assessing the normal curves on histograms. Due to the data's non‐normal distribution, non‐parametric tests were used. The Wilcoxon Signed‐Rank and Spearman's rho correlation coefficient (r) were computed using SPSS, with the magnitude of the effect size being understood as r ≥ 0.1 being weak, r ≥ 0.4 being moderate, and r ≥ 0.7 being strong [25].

Following transcription of the interviews by an external transcription provider, the qualitative data was thematically synthesised using six steps of the reflexive thematic analysis method [26]. Familiarisation involved repetitive reading of the full interview scripts by the first author, noting student reflections related to self‐efficacy. The first author conducted initial coding using NVivo 14, while the second author independently coded two interview transcripts to check coding consistency. An inductive method of coding was mostly used, with some early deductive framing using the SECP Scale as a guide. The first author categorised the codes and presented these categories in weekly supervisory team meetings for discussion. Following discussions, initial subthemes and themes were refined, and some were merged. As a next step, subthemes and themes were presented to the project's investigator team and adviser group members for review. The names and presentations of subthemes and themes were finalised based on the feedback from the teams. A constructionist epistemology was adopted when coding, categorising, and generating initial themes, in line with the philosophy of reflexive thematic analysis [26].

The STROBE Statement was used as a guideline to report the quantitative findings (See Data S2), and the RTARG was used to report the qualitative findings (See Data S3).

3. Results

3.1. Demographics

The participant demographics are presented in Table 1. Twenty‐six students completed the pre‐placement questionnaire, yielding a 100% response rate. Most students were female (77%) and undergraduate students (65%). More students were in the 4th year and final year of their undergraduate degree (46%), with 19% in their 3rd undergraduate year, and 35% in the 2nd year of their postgraduate degree. The majority (89%) of students had never completed a rural placement before this one. The students originated from five allied health disciplines: physiotherapy (42%), occupational therapy (31%), speech pathology (15%), nutrition and dietetics (8%), and social work (4%). One participant was lost in follow‐up, so only 25 participants were included in the comparison of pre‐ and post‐placement scores.

TABLE 1.

Descriptive analysis of participant demographic data at pre‐placement.

	Pre‐placement (N = 26)
Gender
Male	6 (23.1%)
Female	20 (76.9%)
Discipline
Occupational therapy	8 (30.8%)
Physiotherapy	11 (42.3%)
Nutrition & dietetics	2 (7.7%)
Speech pathology	4 (15.4%)
Social work	1 (3.8%)
Enrolment
Undergraduate	17 (65.4%)
Postgraduate	9 (34.6%)
Year of Study
Undergraduate 3rd year	5 (19.2%)
Undergraduate 4th year	12 (46.2%)
Postgraduate 2nd year	9 (34.6%)
Previous rural placement
No	23 (88.5%)
Yes	3 (11.5%)

Note: Data presented as frequency (percentage). The final analysis of pre‐ and post‐placement scores includes data from 25 participants because of one drop out.

3.2. Quantitative Findings

The students' median scores for all subscales except evaluation, as well as their total self‐efficacy scores, increased from pre‐ to post‐placement (Table 2). The participants' median scores for assessment, diagnosis and planning, and implementation subscales showed a statistically significant increase in post‐placement scores compared to pre‐placement scores with moderate effect sizes. The evaluation subscale scores showed no change between pre‐ and post‐placement. There was a statistically significant increase in the total self‐efficacy score.

TABLE 2.

Change in participant scores in the modified version of the Self‐Efficacy in Clinical Performance Scale from pre‐placement to post‐placement.

Self‐efficacy domains	Pre‐placement (N = 25)	Post‐placement (N = 25)	Paired samples
	Median (IQR)	Median (IQR)	Wilcoxon signed ranks	2‐tailed p	Spearman's rho correlation coefficient	2‐tailed p
Assessment	2.75 (2.29, 3.20)	3.25 (2.88, 3.58)	Z = −3.734	p < 0.001	r = 0.52	p = 0.007
Diagnosis & Planning	2.75 (2.25, 3.25)	3.00 (2.88, 3.63)	Z = −2.011	p = 0.044	r = 0.58	p = 0.002
Implementation	3.00 (2.25, 3.25)	3.25 (3.00, 3.88)	Z = −3.017	p = 0.003	r = 0.68	p < 0.001
Evaluation	3.00 (3.00, 3.00)	3.00 (3.00, 4.00)	Z = −1.462	p = 0.144	r = 0.16	p = 0.433
Total score of self‐efficacy	59.00 (48.50, 68.00)	69.00 (61.00, 76.00)	Z = −3.528	p < 0.001	r = 0.68	p < 0.001

Note: Data presented as median (IQR).

Abbreviation: IQR, interquartile range.

3.3. Qualitative Findings

Twelve students from three disciplines [physiotherapy (six), occupational therapy (four), and speech pathology (two)] participated in interviews. The majority were female students and students attending their first rural placement, with an even balance of undergraduate and postgraduate students. We identified two main themes from students' interviews.

3.3.1. Theme 1: Heightened Confidence, Independence and Work Readiness

3.3.1.1. Increased Clinical Confidence

Students reported increased clinical confidence following the placements, through feeling more empowered within the RACHs, “I feel like I'm definitely more confident in running OT sessions. I'm more confident to talk to people and advocate for OT (…) so I feel like I'm a lot more confident in my abilities now than I was at the start of this placement” (S1‐OT). While students often found the long‐arm supervision approach challenging at the beginning of their placements, being pushed out of their comfort zone was considered beneficial in developing their confidence in their abilities. Students perceived the supervision approach to put the responsibility on them to seek out their supervisor's input, which encouraged a more self‐directed learning in the students rather than adhering to a rigid schedule. “Supervision was great. I liked how it was very independent‐based, … we were in charge of our own learning … we could go coordinate with staff, call the family, like to do whatever we needed to help them (residents)” (S11‐ SP). They also found it rewarding to autonomously assess, plan, and implement their own ideas, especially over the course of weeks or months. This freedom meant that they were able to see long‐term concrete results for principles which may only have been theoretical for them until then, “I definitely think the freedom of letting us just go at it (…), these improvements I saw were something from a lot of consistent sessions and stuff that could only be achieved over this 10‐week time” (S4‐OT). The students also saw themselves as able to provide a valuable outside perspective, “It was definitely my highlight (…) incorporating hydrotherapy into a treatment plan, because they hadn't ever done that before, (it's) just fresh eyes really, (and saying) hold on, why can't we do this?” (S5‐PT).

3.3.1.2. Increased Confidence in Application of Skills Learnt at University

The placements provided the students with opportunities to apply in a clinical setting, skills learnt at university, and the students often stated that these skills were different in theory than in practice, especially when working with older adults with comorbidities. “Skills that we learnt at university (…) we were able to apply those outside of the clinic and realise that not everyone is as healthy as a 24 year old physio at university, applying that onto someone who may not be able to walk 500 metres or may not be able to get out of bed in the morning, it's very different to what we experience at uni” (S6‐PT). Students learnt how to initiate contact with patients, advocate for their disciplines, and manage their daily schedules and appointments. They felt more confident in coordinating with staff and residents, and calling the residents' families, if necessary, “Over time my confidence really increased, and I was able to do more structured sessions with people and catch them at better times and manage my time better” (S3‐OT). The students also felt they left the placement more secure in the knowledge that they had the skills to build strong relationships with residents in a way which assisted the treatment process. “It's helped me to grow my confidence. I think it's really established the importance of building strong relationships with residents, (…) just really building the confidence that I can do that. Because it's a very different thing in theory to in practice” (S9‐PT).

For most students, this was their first time working with older adults and in rural RACHs. They therefore had to gain confidence in their ability to communicate effectively with the residents, “You'd learn on paper how to speak to (people with cognitive deficits), but until you can actually (…) have interactions (with them), then that's what I've learnt the most. (…) that's the main thing I could take away, is the communication skills” (S12‐SP). They also gained an appreciation for the importance of building strong connections with residents for effective service provision “The big thing for me was just the value of building really strong relationships and understanding residents on quite a deep level (…) you need that to go through the therapy process (…) I've got a bit more confidence in being able to build those. So I think that will help me” (S4‐OT).

3.3.1.3. Slowness of Pace Encouraging Flexibility and Thorough Care

The full‐time hours which the students attended on placement, as well as the relative slowness of pace and flexibility in their daily schedules meant that students could adapt their time management, “The flexibility of it allowed me that I could spend my time as I wanted. So if I wanted to see someone for a long time, a little time, multiple times, I could do that. (…) I think the service placement type, being aged care, made it a little bit easier for me to be flexible and a bit more thorough” (S10‐PT). This slowness of pace also allowed them to think more deeply and creatively, “When we're less stressed and we feel like things are manageable (that's) when the padlock unlocks to actually learning more (…) I've been able to seek and ask questions and really get creative” (S11‐SP), “Going from a fast pace environment to a much slower pace environment (…) did make me feel like I could get creative and seek out–be responsible as well for my own learning” (S1‐OT).

3.3.2. Theme 2: Confidence and Enthusiasm for Interprofessional Work

3.3.2.1. Interprofessional Skill Development

Most students reported that the placement provided novel interprofessional work experiences, “I haven't had that experience in the past, working with other disciplines like OTs, speech pathologists, nutritionists, EPs (…) it was good to see how it'll be a multidisciplinary approach” (S8‐PT). The students had to behave in a professional manner when working as a team, with both staff and other students, and it was clear in the students' interviews that they had put thought into respectful communication. “Very carefully re‐educating them, but also being empathetic. So, there's a fine balance between being empathetic, but also trying to tear down something they already think is correct. So, you don't want to come across as arrogant. So, you've got to really be careful about the way you weave around re‐educating someone” (S3‐OT).

3.3.2.2. Feelings of Appreciation for and Responsibility Within the Multidisciplinary Team

Students felt responsibility to contribute as part of the multidisciplinary care team, and appreciated how other team members could help them achieve their goals. They felt a need to play a useful role in the RACH, “We definitely reduced their workload. (…) We have all the time in the world, (the staff) don't. So I think just making sure that we share the workload equally was something that we brought to the table” (S6‐PT). They also learnt the importance of each discipline's input in resident care to help them achieve their own goals. Occupational therapy students often spoke of recognising the value of referring to their physiotherapy peers to help the residents engage in their own treatment plans more readily, “(physiotherapy students) really help with improving physical, which enables us to do what we want to do” (S2‐OT). All students valued having peers to brainstorm with, “I think that comes back to confidence as well. Just having someone to share these things with and build therapy plans” (S11‐SP).

3.3.2.3. Reciprocal Teaching and Increased Awareness of Other Disciplines

Students enjoyed the reciprocal teaching opportunities and increased awareness of other disciplines the placements provided them with. Students often spoke of lacking an understanding of other disciplines' scope, “If you'd asked me six weeks ago what an occupational therapist does, I could not have answered it. I think now I've got a much better understanding of their scope (…) I've learnt a lot from (physiotherapy students) about fall prevention and balance” (S11‐SP). They also expressed an appreciation of opportunities to exchange knowledge relevant to working in RACHs, “There were many opportunities to educate staff, patients, colleagues, myself as educator, (my peer) educated me, which was important too. (…) I ended up educating the OTs on four‐wheel walker height and manual devices, because they had never learnt it at uni” (S6‐PT).

4. Discussion

This mixed‐methods evaluation contributes to the body of knowledge on the impact of rural aged‐care placements on allied health students' self‐efficacy in services delivery. These findings extend upon Longman and colleagues' exploration of 4–10 weeks allied health student placements in Northern NSW schools and RACHs [9], in which students reported feeling more confident in their work readiness and their ability to work autonomously after completing their placements. The integration of quantitative and qualitative results occurred during the interpretation phase. The quantitative results of this study showed a statistically significant difference between pre‐ and post‐placement self‐efficacy in health service delivery. Qualitative findings confirmed and extended the quantitative findings in how clinical placement in rural RACHs enhanced student self‐efficacy. Specifically, interview data revealed that students' enhanced self‐efficacy was shaped not only by opportunities to apply clinical skills, but also by meaningful engagement in interprofessional teamwork, effective communication with patients and staff, and goal‐oriented care planning. These narratives contextualised the survey results by highlighting the relational and experiential dimensions of learning that underpinned the observed quantitative changes. The factors influencing allied health students' self‐efficacy in this study align with Bandura's (1997) self‐efficacy theory [10, 11].

Direct performance accomplishments–mastery experience–has direct influence on students' increased self‐efficacy (Bandura, 1997) [10, 11]. In this study, allied health students demonstrated significant increases in overall self‐efficacy, and in areas of clinical assessment, diagnosis and planning, and service implementation, following their direct engagement in service delivery during placements. While placement settings, durations, and measurement scales used varied, these findings are consistent with previous studies [9, 13, 17, 27, 28]. which reported improvements in self‐efficacy in assessment, communication, decision making, and patient management. This is in line with evidence from rural medical education showing improved self‐efficacy when students engage in hands‐on clinical tasks [29]. However, a systematic review of 39 quasi‐experimental studies and eight RCTs found that only seven studies showed positive changes in nursing students' self‐efficacy from educational interventions with a large effect size [30]. This present study aligns with 10 studies of the systematic review that reported a moderate effect size, suggesting that while rural aged‐care placements did improve students' self‐efficacy, there are areas to improve in how placements are structured to maximise mastery.

Students reported that learning through observation of, and collaboration with, experienced staff and peers enhanced their self‐efficacy in service delivery, aligning with Bandura's (1997) concept of vicarious learning [10, 11]. Observing staff and peers playing a role, especially in navigating complex aged‐care scenarios, influenced their ability to apply theoretical knowledge and skills and adjust treatment plans. The UCRH's and similar UDRHs' placements engage students in real‐time service delivery in under‐resourced aged‐care environments, offering them valuable experiential and observational learning [31]. This mirrors findings in previous studies of allied health students in aged‐care settings and schools [16, 32, 33], nursing students in RACHs [34], and nutrition and dietetics students in work‐integrated placements [35]. The hybrid supervision approach, combined with a supportive learning and practice environment, allowed students to observe aged‐care staff roles and seek help when necessary, meaning that their personal observations during placements likely contributed to increased feelings of self‐efficacy.

Drawing on Bandura's (1997) concept of social persuasion, students benefited from constructive feedback provided by peers, clinical supervisors, and aged‐care staff. Feedback was valuable as students applied skills—such as manual handling—that they had previously learnt theoretically but found more complex in real‐life practice. Interprofessional supervision and peer‐assisted learning promoted mutual appreciation and respect for each discipline's role, improving collaborative confidence. These findings align with research on interprofessional education showing that structured interdisciplinary teamwork fosters students' readiness to contribute effectively to patient care [36, 37, 38]. Furthermore, encouragement from experienced clinicians can be impactful in rural clinical settings where allied health students are integrated in services that would otherwise be unavailable to residents. However, some students may receive inconsistent feedback or limited mentoring, potentially weakening this source of self‐efficacy—a concern echoed in critiques of variable placement quality across regions [9].

The RACH was an unfamiliar placement setting for most allied health students, and as Bandura (1997) noted, emotional responses to such environments can influence their self‐efficacy [10]. The slower pace and supportive culture in RACHs allowed students to process and reflect on their learning, mirroring literature indicating that a calm clinical environment enhances performance and well‐being [39]. This supports the idea that emotional regulation and stress management are crucial for effective learning in clinical education. However, for students placed in high‐pressure or poorly structured environments, stress may undermine their learning experience, suggesting that tailored student support is critical to maximising placement impact.

4.1. Strengths and Limitations

Using a self‐efficacy scale for clinical performance—originally validated with health professionals—added reliability to the measurement, while its subscales offered finer detail for analysing changes in students' confidence. However, adapting the original scale constrained the study's ability to capture the breadth of students' clinical self‐efficacy, most notably in the evaluation domain, which was represented by only a single item. As a next step, further research is needed to quantitatively assess the reliability and validity of the shortened tool, which was not possible with the small sample of the study. The interview guide was designed to evaluate the program as a whole and did not specifically probe students' perceptions of self‐efficacy. This is a strength, as the findings extracted from the interviews were offered by students without prompting. However, limited probing about shifts in students' clinical self‐efficacy may have caused us to miss valuable insights, especially their perspectives on barriers to strengthening professional self‐efficacy. Additionally, a larger sample size would have been preferable. All placements were conducted in the same geographical region and in partnership with one aged‐care provider (across two locations); therefore limiting the generalisability of these results.

4.2. Implications

The positive results of this study, in combination with the strength of self‐efficacy as a predictor for student performance and the important effect of rural clinical placements on student practice and retention in rural areas [24, 40], may imply that the UCRH‐facilitated placements will contribute to a competent and resilient aged‐care workforce in Northern NSW. The students' appreciation of the supervision model and of the opportunities unique to RACHs supports the placements' educational value for student work readiness. While this study did not have a large enough sample size to draw conclusions about the difference between student demographic groups, further studies with larger sample sizes would provide valuable insight.

5. Conclusions

The findings of this study showed a significant increase in allied health students' self‐efficacy in service delivery, likely enabled through the UCRH‐facilitated placements in rural RACHs in Northern NSW. The autonomy created by the supervision model, the slowness of pace of the setting, as well as interprofessional work opportunities, may have contributed to the increase in self‐efficacy. This included enhanced abilities in applying clinical skills, delivering health services, communication, and achieving care goals as a team. These factors allow students to feel more confident entering the workforce, preparing them to deliver safe, high‐quality care to older rural Australians.

Author Contributions

Alizée McGregor: conceptualisation, formal analysis, methodology, software, visualisation, writing – original draft preparation. Mohammad Hamiduzzaman: conceptualisation, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualisation, writing – original draft preparation, writing – review and editing. Vanette McLennan: conceptualisation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualisation, writing – review and editing. Sarah Miles: conceptualisation, investigation, methodology, validation, writing – review and editing. Sarah Crook: conceptualisation, investigation, methodology, validation, visualisation, writing – review and editing. Lewis Grove: conceptualisation, investigation, methodology, validation, writing – review and editing. Frances Barraclough: conceptualisation, investigation, methodology, validation, writing – review and editing. Jennie Hewitt: conceptualisation, investigation, methodology, validation, writing – review and editing. Gillian Nisbet: conceptualisation, investigation, methodology, validation, writing – review and editing. Karn Nelson: conceptualisation, investigation, methodology, validation, writing – review and editing. Marianne Wallis: conceptualisation, investigation, methodology, validation, writing – review and editing. Nerida Volker: conceptualisation, investigation, methodology, validation, writing – review and editing. Victoria Flood: conceptualisation, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, visualisation, writing – review and editing.

Ethics Statement

This project was approved by the University of Sydney Human Research Ethics Committee (Application Identifier: 2023/780).

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: ajr70083‐sup‐0001‐DataS1.docx.

Data S2: ajr70083‐sup‐0002‐DataS2.docx.

Data S3: ajr70083‐sup‐0003‐DataS3.docx.

McGregor A., Hamiduzzaman M., McLennan V., et al., “The Effect of Aged‐Care Rural Clinical Placements on Health Student Self‐Efficacy: A Mixed‐Methods Evaluation,” Australian Journal of Rural Health 33, no. 4 (2025): e70083, 10.1111/ajr.70083.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.