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'Us and Them': Does rural health education create unwilling practitioners

Dalton, L, Bell, LR, Bull, R and Orpin, P 2007 , ''Us and Them': Does rural health education create unwilling practitioners', paper presented at the 9th National Rural Health Conference, 7-10 March 2007, Albury NSW.

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In order to gather information about how rural health education works as a socialising process, interviews were conducted with academics teaching undergraduate students of nursing, pharmacy and medicine. With these data it was also necessary to gather information about how undergraduate students’ identity formation occurs. To achieve this undergraduate nursing, pharmacy and medical students were observed and interviewed during their rural placements. The observational field notes and transcripts of semi-structured interviews were analysed using critical discourse analytic techniques. Foucault’s writings about ‘the gaze’ as an effect of power is used to examine the inherent values and meaning systems in rural health education which shape undergraduate students’ construction of their personal and profession identity. Such an analysis has value because it allows us to better understand existing rural education strategies, and what is required to improve them.
In rural health education it is normal to understand rural communities as different from mainstream society because they are disadvantaged in terms of health status and resource distribution. These normalised assumptions manifest in the pedagogical work of rural health education. The efforts of educators to demonstrate the uniqueness of rural health, rural communities and rural practice create distinctions between them (rural) and us (not rural). These distinctions perpetuate relations of difference between those who are not from rural areas (which represents the majority of undergraduate students) and people who live in rural areas, which is reinforced by many people at all levels. Some of these relations of difference do not appear to be productive for an implicit goal of rural health education: to encourage undergraduate students to consider rural practice as a
positive career choice. The majority of undergraduate nursing, pharmacy and medical students participate in short term rural placement experiences that are part of other subject units. By simply ‘adding in’ a rural dimension to undergraduate programs, rural health education in Tasmania is contributing to an ‘us and them’ dichotomy active in the formation of students’ professional and personal identities. In these data, this ‘us and them’ dichotomy shapes students’ experiences of the rural placement, their view of their future as a health professional, and their personal and professional identities.
Research examining undergraduate medical, nursing and pharmacy students’ intention to take up rural careers have mixed and inconclusive findings. While some studies indicate students who participate in rural health education may take up rural practice others show students are not interested in rural careers. The findings of this research suggest that instead of encouraging new graduates to take up rural careers, current rural health education practices seem to be counterproductive to achieving this goal. Current delivery of rural health education and the discourses that influence and support it contribute to the development of a personal and professional identity in which students are at ease in a framework that normalises urban primacy and rural difference.

Item Type: Conference or Workshop Item (Paper)
Authors/Creators:Dalton, L and Bell, LR and Bull, R and Orpin, P
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