Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study

Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study John A Woods, Kathryn Fitzgerald, Lennelle P Papertalk, Charmaine Green, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4022446/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Nov, 2024 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Together with addressing social determinants of health, culturally safe healthcare provision is essential for closing the health outcomes gap experienced by Aboriginal and Torres Strait Islander (Indigenous) Australians. Rural placements potentially provide students of the health professions with opportunities to enhance their knowledge and skills regarding cultural safety. We used rural placements data systematically collected from allied health students, including commencement- and end-of-placement questionnaire responses, to investigate the determinants of confidence in working with Indigenous people. Methods: The study comprised data from all students who provided survey data at both commencement and end of their first placement directly supervised by the administering University Department of Rural Health during the period 2019–2022. Five-point ordered responses to the question 'How confident do you feel about working with Aboriginal people?' were used to assess student and placement-related determinants of confidence (Confident/Very confident versus other) at baseline and increased confidence (≥1 point) during the placement using crude and adjusted multivariable robust Poisson regression. Results: Participating students (N=453) were from diverse allied health disciplines (including pharmacy n=92; 20.3%; chiropractic and social work each n=59, 13.0%; occupational therapy and physiotherapy each n=56, 12.4%). Confidence in dealing with Aboriginal people was higher at commencement among males compared with females (adjusted relative risk [aRR] 1.51; 95% confidence interval [CI] 1.22–1.86), students of Australian rural origin compared with others (aRR 1.46; CI 1.18–1.80), and those who reported previous experience working with Indigenous people (aRR 1.40; CI 1.13–1.72). Notably, for all three of these categories, complementary subgroup 'catch-up' during the placement was evident. Placement attributes associated with increased confidence working with Indigenous people between placement commencement and end were interaction with Indigenous people within the placement (aRR 2.15; CI 1.17–3.98), placement model reflecting more structured academic supervision (aRR 1.22; CI 1.04–1.43), and placement length (aRR per additional day 1.002; CI 1.001–1.004). Conclusions: While influenced by students’ demographic attributes and prior experiences, confidence of allied health students in working with Indigenous people is enhanced during rural placements, particularly through direct contact with Indigenous people. Health Workforce Australian Aboriginal and Torres Strait Islander Peoples Rural Health Services Education Professional Allied Health Occupations Figures Figure 1 Figure 2 Background Healthcare in Australia, underpinned by a universal insurance system (Medicare), is widely considered to be among the world's best [ 1 , 2 ]. However, there are areas of inequity in service provision, with rural and remote areas often underserved and characterised by high turnover of health workers [ 3 , 4 ]. Moreover, Aboriginal and Torres Strait Islander (henceforth Indigenous) people in Australia experience health outcomes less favourable than those of their non-Indigenous counterparts, with a substantial (> 8 years) life-expectancy deficit in the Indigenous population [ 5 , 6 ]. This outcome gap is multifactorial, and substantially attributable to social and cultural determinants of health [ 7 ] consequent to colonial settlement and associated violence, discrimination, and intergenerational trauma [ 8 , 9 ]. It also reflects health system failures including structural racism [ 10 ] and the underservicing of non-metropolitan areas, particularly more remote areas where many Indigenous people reside. Improved servicing of rural and remote areas requires augmenting the rural health workforce through increased recruitment and retention of health professionals. A key strategy for developing and sustaining a rural health workforce is encouragement of students in the ‘pipeline’ of the health professions [ 11 ]. This includes exposure to rural and remote practice through practicum placements in professional degree programs [ 12 – 15 ] and continues through opportunities for rural employment in the years immediately following graduation [ 16 ]. Nowadays, many Australian health profession students have the opportunity to participate in rural health placements [ 17 ]. Typically, among the objectives of rural placements is creating opportunities to enhance students’ cultural understanding and ability to communicate and work with Indigenous Australians [ 18 ]. However, there is scant evidence on the determinants of efficacy in rural placements for improving students' confidence in this regard. One of nineteen University Departments of Rural Health currently existing nationwide, the Western Australian Centre for Rural Health (WACRH), established in 1998, provides rural placements for undergraduate and postgraduate students of the health professions from multiple institutions. WACRH has its main office based in Geraldton in the Midwest region and another major office based in the more remote Pilbara region of Western Australia. Using data systematically collected from allied health students undertaking placements with WACRH, including responses to questionnaires from the commencement and end of placement, the aims of the current study were to investigate the influence of student attributes and experiences during the placement on developing confidence in working with Indigenous people. Methods Student placements Student rural placements administered by WACRH are undertaken in diverse healthcare settings, including domestic and residential aged-care services, schools and playgroups, and Aboriginal Medical Services. Each placement is based on one of several different models for academic and vocational supervision WACRH has developed a classification system for rural student placements based on the extent to which academic staff are directly involved with coordinating, hosting, supervising the placement and assessing the student's performance. Accordingly, WACRH involvement in placements is categorised as: Comprehensive, Blended, Supported/Liaison, or Assisted (Box 1). Box 1 Western Australian Centre for Rural Health Student (WACRH) Placement Models Placement Type Description Assessment Comprehensive Students coordinated, hosted, supervised and assessed by WACRH staff. WACRH supervisor Blended Students hosted, coordinated and primary supervision provided by WACRH. They may have a small part of their clinical/ fieldwork activities directly supervised from an external supervisor, however the responsibility for placement and clinical fieldwork experience on a day-to-day basis is with the primary WACRH supervisor. WACRH supervisor responsible for assessment. External supervisor may have some input. Supported/Liaison Students placed with an external agency for day-to-day clinical placement/fieldwork with on site, same-discipline supervision. WACRH may add value to placements e.g., coordination, liaison, cultural orientation or other clinics or other activities. An external supervisor is responsible for completing the student assessment. WACRH supervisor may have liaison/ support role in assessment. Assisted Students supported to participate in their rural placement by WACRH but not be directly involved with WACRH staff or programs, though they may be provided accommodation by WACRH. Externally assessed. No WACRH involvement The placements incorporate orientation to Indigenous culture, Indigenous ways of knowing, and Indigenous health issues through modules and workshops that have been developed and led by Indigenous staff. Firstly, students undertaking a placement are recommended/required to complete an online Indigenous cultural orientation training module prior to commencement. WACRH provides face-to-face cultural orientation at the commencement of placements at most sites. For example, the three-hour Aboriginal Miyarnuwimanha Cultural Orientation is recommended for students early in their placement commencement in Geraldton where it is delivered by the local Indigenous staff who developed it. ‘Miyarnuwimanha’ translates to ‘learning’ or ‘becoming knowledgeable’ in the language of the local Wajarri Yamaji people. During the study period, several different approaches to cultural orientation have been provided for students based in the Pilbara. Design, data source and sample WACRH has systematically collected data from all students undertaking rural placements for many years, with substantial ongoing refinements to data collection from 2017. The records used in this study were those of all rural placements that (i) were identifiably a student's first placement coordinated by WACRH (ascertained by lookback to 2013), (ii) were undertaken in the period 01/01/2019–31/12/2022 (because all relevant variables were collected only from 2019 onwards), (iii) were among students who identified both as non-Indigenous and a citizen or permanent resident of Australia, (iv) had provided relevant questionnaire data at both the commencement and the end of their placement, and (v) had no missing values for other study measures (below). Study measures: (i) outcome variable All students who take a placement with WACRH are encouraged to participate in an online questionnaire at both the commencement and end of the placement. The questionnaire at both time points includes items with a five-point ordered response agreement scale in relation to the student's confidence in dealing with several aspects of a rural placement. Among these items, students are asked, 'How confident do you feel about working with Aboriginal people?' The outcome measure for this study indicated the change in a student's confidence working with Indigenous people between the commencement and end of their rural placement. The five-point ordered response to this item was firstly collapsed into binary form ('Confident' or 'Very Confident' versus 'Not at all confident' or 'Not confident' Or 'Neutral'). Secondly, a single-point or greater increase in confidence between the commencement and end questionnaires was considered ‘increased confidence’. In 2022, a technical problem which was not rapidly identified disrupted the distribution of end-of-placement questionnaires, markedly reducing the proportion of students who completed the survey during that year compared with the previous years of the study. Study measures: (ii) other covariates Detailed data on the demographic and educational characteristics of all students undertaking rural placements with WACRH are collected routinely at registration prior to placement commencement. These data include the student's date of birth, from which age in years at placement commencement was calculated. Age was collapsed into binary groups (< 23 years versus ≥ 23 years) for the analysis in consequence of non-linearity in the relationship between age and the outcome variable detected during preliminary regression modelling. Other student characteristics included as covariates in the current study were gender (female, male or other); Aboriginal and/or Torres Strait Islander identification; Australian citizenship/permanent residency status; rural origin (defined dichotomously as having or not having 'lived in a rural area for a total of ten years or for five consecutive years'); and current educational enrolment (including institution, professional discipline of study, undergraduate versus postgraduate level of the degree, and international student enrolment status). An additional item from the placement registration process included as a study covariate was the question, 'Do you have experience working or interacting with Aboriginal and/or Torres Strait Islander peoples?' Placement length in days was calculated arithmetically from commencement and end dates. The end-of-placement questionnaire also includes the two questions, 'During your placement, did you have the opportunity to work or interact with Aboriginal people as clients, co-workers or community members during the clinical/placement practice?' and 'During your placement, did you have the opportunity to work or interact with Aboriginal people as clients, co-workers or community members outside of the clinical/placement practice?' In consideration that the placement model may have influenced students’ experiences during the placement and thereby their responses to end-of-placement questionnaire responses, Placement type was modelled as a covariate in this study and was collapsed into binary form for analysis (Comprehensive or Blended versus Supported/Liaison or Assisted). Finally, the calendar year in which the placement was undertaken was included as a covariate in order to investigate any change over time and specifically to determine any influence of the COVID pandemic (i.e., through comparison of outcomes during each year from 2020 onwards in comparison with the pre-pandemic year of 2019). Statistical analysis Baseline demographic and educational characteristics of student participants were quantified descriptively. Moreover, in order to assess the potential for bias arising from the unavoidable restriction of the study sample to students who completed questionnaires at both the commencement and end of their placement, a descriptive comparison was made of the baseline characteristics of (i) all students who participated in the commencement-of-placement questionnaire, and (ii) the subgroup of these who comprised the study sample (i.e., who participated in both commencement and end questionnaires and provided paired commencement/end-of-placement data on confidence working with Aboriginal people). The proportions of students (i) in the overall sample, and (ii) in selected subgroups who reported feeling 'Confident' or 'Very Confident' about working with Aboriginal people at the commencement and end of placement were calculated and presented graphically. Crude and mutually adjusted influences of student baseline demographics and placement characteristics on feeling 'Confident' or 'Very Confident' at placement commencement and of reporting increased confidence at end compared with commencement of placement were analysed using robust Poisson regression models [ 19 ] to determine relative risks directly. Two sensitivity analyses were performed in relation to these crude and multivariable-adjusted estimates. First, the sample was restricted to placement records from the period 2019–2021, considering the potential for exaggerated selection bias among 2022 placements due to the markedly diminished proportion of end-of-placement questionnaire completions during that year. For the second sensitivity analysis, the sample was broadened to include otherwise eligible individuals who had been excluded from the principal analysis because they identified as either an Indigenous Australian or an international student. All data analyses were performed using Stata® Version 16 (Stata Corporation, College Station, Texas, USA). Statistical significance was set at the 5% level. Ethics The University of Western Australia’s Human Research Ethics Committee Ethics provided approval for the study (reference 2023/ET000289), including the justification of waiver for student participants’ informed consent. Two of the authors (LP and CG) are local Indigenous staff raised in the Midwest who deliver cultural learning opportunities for students based in Geraldton. Results Among 959 students undertaking their first placements co-ordinated by WACRH during the years 2019–2022, 453 were eligible for inclusion in the study (Fig. 1). Non-completion of surveys impacted on the sample of eligible students, with 117 of 868 otherwise eligible students (13.5%) failing to complete the commencement survey, followed by substantial further attrition due to 290 (38.6%) of the remaining 751 students failing to complete the end-of-placement survey. Non-completion was especially pronounced in the 2022 student cohort (27.9%, compared with 66.3–78.6% in the previous years, i.e., 2019–2021 [Table S1 ]). [Insert Fig. 1 about here.] Figure 1 Placement record selection procedure WACRH Western Australian Centre for Rural Health The students in the sample were demographically and educationally diverse (Table 1 ). They represented a broad range of allied health disciplines across both undergraduate (n = 308, 68.0%) and postgraduate (n = 145; 32.0%) professional degree programs, with the majority enrolled in pharmacy (n = 92; 20.3%), chiropractic and social work (each n = 59, 13.0%), and occupational therapy and physiotherapy (each n = 56; 12.4%). Table 1 Baseline characteristics of allied health students (N = 453) and their rural placements Range Median Mean SD Age (years) 18–60 23 25.0 6.1 n % Gender Female 325 71.7 Male 128 28.3 Other 0 0.0 Rural origin No 343 75.7 Yes (Australia) 104 23.0 Yes (Overseas) 6 1.3 Qualification Level Undergraduate 308 68.0 Postgraduate 145 32.0 Prior Indigenous experience No 295 65.1 Yes 158 34.9 Placement model Assisted/Supported 256 56.5 Comprehensive/Blended 197 43.5 Placement year 2019 121 26.7 2020 112 24.7 2021 169 37.3 2022 51 11.3 Discipline of study* Audiology 10 2.2 Biomed/Med Science < 5 < 1.0 Chiropractic 59 13.0 Dietetics/Nutrition 14 3.1 Exercise Physiology 27 6.0 Health Promotion 12 2.7 Health Science < 5 < 1.0 Medical Imaging 14 3.1 Music Therapy < 5 < 1.0 Occupational Therapy 56 12.4 Pharmacy 92 20.3 Physiotherapy 56 12.4 Podiatry 22 4.9 Public Health 6 1.3 Social Work 59 13.0 Speech Pathology 22 4.9 *Discipline of student presented to demonstrate diversity of sample but not included as a covariate in analyses. Cell numbers < 5 obscured to protect confidentiality. Feeling ‘Confident’ or ‘Very confident’ working with Aboriginal people at the commencement of the placement (Table 2 ) was independently associated with gender (adjusted relative risk [aRR] for male compared with female students 1.51; 95% confidence interval [95% CI] 1.23–1.86), with reported rural Australian origin compared with no such background (aRR 1.46; 95% CI 1.18–1.80), and with reported previous personal experience with Indigenous people compared with none (aRR 1.40; 95% CI 1.13–1.72), but not with age group, qualification level or year of placement. Table 2 Predictors of a student reporting feeling either ‘Confident’ or ‘Very confident’ at placement commencement Crude Adjusted Relative risk (95% CI) p Relative risk (95% CI) p Age group at registration < 23 years Reference Reference ≥ 23 years 1.13 (0.91–1.40) 0.283 1.11 (0.90–1.38) 0.316 Gender* Male Reference Reference Female 0.72 (0.58–0.89) 0.002 0.66 (0.54–0.82) < 0.001 Rural Australian origin No Reference Reference Yes 1.49 (1.20–1.85) < 0.001 1.46 (1.18–1.80) < 0.001 Qualification level Undergraduate Reference Reference Postgraduate 0.92 (0.73–1.17) 0.487 1.01 (0.85–1.20) 0.931 Previous Indigenous experience No Reference Reference Yes 1.42 (1.15–1.75) 0.001 1.40 (1.13–1.72) 0.002 Placement year 2019 Reference Reference 2020 0.96 (0.72–1.29) 0.786 0.97 (0.73–1.29) 0.843 2021 0.88 (0.67–1.15) 0.340 0.83 (0.64–1.09) 0.181 2022 1.05 (0.74–1.50) 0.768 1.01 (0.73–1.40) 0.937 * No student identified their gender as 'Other'. CI confidence interval The proportion of students who reported feeling Confident’ or ‘Very confident’ working with Aboriginal people increased from 42.4–82.6% between the commencement and end of placement in the overall sample, and increased substantially across most subgroups of students that were investigated, except among those who reported that their placement included no interaction with Indigenous people (Fig. 2). [Insert Fig. 2 about here.] Figure 2 Students who reported feeling 'Confident'/'Very confident' working with Aboriginal people: commencement versus end of placements The baseline characteristics of 747 students who completed the commencement and the subgroup of 453 whose records comprised the principal analysis were similar in all regards except that attrition in survey completion between commencement and end of placement was notably more marked in 2022 compared with the other three years of the study (Table S1 ). In the principal robust Poisson regression model (N = 453 placements; Table 3 ), increased confidence working with Indigenous people between the commencement and end of placement was independently associated with several baseline characteristics of the students as well as with certain attributes of their placements. Students identifying as female compared with males were more likely to report increased confidence (adjusted relative risk [aRR] 1.23; 95% confidence interval [95% CI] 1.02–1.49), but no association with students’ age was evident. Students from a background in rural Australia were less likely than other students to report increased confidence (aRR 0.80; 95% CI 0.65–0.97); those who reported having experience with Indigenous people prior to the placement had a lower likelihood of reporting increased confidence than those without previous experience (aRR 0.82; 95% CI 0.69–0.97). The placement attribute associated most strongly with increased confidence was interaction with Indigenous people within the placement setting (aRR 2.15; 95% CI 1.17–3.98). Students whose placement model was categorised as Blended/ Comprehensive had a higher likelihood of increased confidence than those who placement was categorised as Assisted/Supported (aRR 1.22, 95% CI 1.04–1.43). Placement length was also independently associated with increased confidence in a linear fashion (aRR for each additional day: 1.002; 95% CI 1.001–1.004). Compared with the pre-COVID pandemic year of 2019, increased confidence did not change significantly in any of the three subsequent years of the study period. Table 3 Determinants of increased confidence dealing with Indigenous people during placements Crude Adjusted Relative risk (95% CI) p Relative risk (95% CI) p Age group at registration < 23 years Reference Reference ≥ 23 years 0.93 (0.80–1.09) 0.369 0.97 (0.83–1.14) 0.739 Gender* Male Reference Reference Female 1.26 (1.04–1.54) 0.019 1.23 (1.02–1.49) 0.033 Rural Australian origin No Reference Reference Yes 0.84 (0.68–1.03) 0.096 0.80 (0.65–0.97) 0.025 Qualification level Undergraduate Reference Reference Postgraduate 0.95 (0.80–1.13) 0.569 1.01 (0.85–1.20) 0.931 Previous Indigenous experience No Reference Reference Yes 0.85 (0.72–1.01) 0.069 0.82 (0.69–0.97) 0.024 Placement model* Assisted/Supported Reference Reference Blended/Comprehensive 1.29 (1.11–1.50) 0.001 1.22 (1.04–1.43) 0.015 Indigenous interaction within placement No Reference Reference Yes 2.15 (1.14–4.06) 0.018 2.15 (1.17–3.98) 0.014 Indigenous interaction (external) during placement No Reference Reference Yes 1.01 (0.85–1.19) 0.934 1.02 (0.86–1.20) 0.818 Placement length (days)** 10-day minimum Reference Reference Per additional day 1.003 (1.001–1.005) < 0.001 1.002 (1.001–1.004) 0.005 Placement year 2019 Reference Reference 2020 0.95 (0.75–1.20) 0.688 0.86 (0.69–1.08) 0.207 2021 1.17 (0.96–1.42) 0.111 1.13 (0.94–1.37) 0.194 2022 0.91 (0.66–1.24) 0.541 0.90 (0.68–1.20) 0.486 * No student identified their gender as 'Other'. ** Modelled as a continuous variable; CI to third decimal place displayed for clarity. CI confidence interval. In the sensitivity analysis that excluded 2022 placements (Table 4 ), the adjusted estimates were equivalent or only marginally closer to the null compared with those evident in the principal analysis model, although the statistically significance of these associations was not maintained across all covariates in the 2019–2021 placement data (N = 402). In this smaller sample, increased confidence was not significantly associated with either student sex or previous Indigenous experience. Both placement model and indigenous interaction within the placement, although not placement length, were significantly associated with increased confidence. In the other sensitivity analysis that incorporated additional students who identified as Indigenous (n = 4) or as non-citizens / non-permanent residents (n = 32) (N = 489 students; Table 5 ), results resembled those from the principal analysis in relation to associations between student and placement characteristics and increased confidence. Table 4 Sensitivity analysis: Determinants of increased confidence dealing with Indigenous people during placements (2019–2021 only)* Crude Adjusted Relative risk (95% CI) p Relative risk (95% CI) p Age group at registration < 23 years Reference Reference ≥ 23 years 0.92 (0.78–1.08) 0.285 0.96 (0.82–1.13) 0.643 Gender** Male Reference Reference Female 1.24 (1.01–1.51) 0.040 1.21 (0.99–1.47) 0.058 Rural Australian origin No Reference Reference Yes 0.83 (0.67–1.03) 0.095 0.80 (0.65–0.98) 0.035 Qualification level Undergraduate Reference Reference Postgraduate 0.93 (0.77–1.11) 0.403 0.98 (0.81–1.17) 0.793 Previous Indigenous experience No Reference Reference Yes 0.86 (0.72–1.04) 0.112 0.84 (0.70–1.01) 0.062 Placement model** Assisted/Supported Reference Reference Blended/Comprehensive 1.26 (1.07–1.48) 0.005 1.21 (1.03–1.44) 0.022 Indigenous interaction within placement No Reference Reference Yes 1.93 (0.99–3.76) 0.054 1.97 (1.05–3.68) 0.033 Indigenous interaction (external) during placement No Reference Reference Yes 0.95 (0.80–1.12) 0.522 0.96 (0.82–1.14) 0.673 Placement length (days)*** 10-day minimum Reference Reference Per additional day 1.002 (1.001–1.004) 0.013 1.000 (1.000–1.004) 0.084 Placement year 2019 Reference Reference 2020 0.95 (0.75–1.20) 0.688 0.88 (0.70–1.10) 0.259 2021 1.17 (0.96–1.42) 0.111 1.14 (0.94–1.37) 0.187 * 2022 data removed to investigate potential bias due to high proportion of end-of-placement questionnaire non-completion during that year (N = 402). ** No student identified their gender as 'Other'. *** Modelled as a continuous variable; Confidence interval displayed with third decimal place for clarity. CI confidence interval. Table 5 Sensitivity analysis: Determinants of increased confidence dealing with Indigenous people during placements (including Indigenous/foreign students)* Crude Adjusted Relative risk (95% CI) p Relative risk (95% CI) p Age group at registration < 23 years Reference Reference ≥ 23 years 0.96 (0.83–1.11) 0.564 0.99 (0.85–1.15) 0.884 Gender** Male Reference Reference Female 1.30 (1.07–1.57) 0.007 1.29 (1.07–1.55) 0.006 Rural Australian origin No Reference Reference Yes 0.81 (0.66–1.00) 0.049 0.79 (0.65–0.96) 0.022 Qualification level Undergraduate Reference Reference Postgraduate 0.95 (0.81–1.12) 0.532 0.97 (0.82–1.14) 0.722 Previous Indigenous experience No Reference Reference Yes 0.84 (0.71–0.98) 0.031 0.83 (0.70–0.98) 0.028 Placement model Assisted/Supported Reference Reference Blended/Comprehensive 1.25 (1.08–1.45) 0.003 1.17 (1.00–1.36) 0.047 Indigenous interaction within placement No Reference Yes 2.35 (1.23–4.46) 0.009 2.32 (1.24–4.34) 0.009 Indigenous interaction (external) during placement No Reference Reference Yes 1.03 (0.87–1.20) 0.759 1.05 (0.90–1.22) 0.555 Placement length (days)*** 10-day minimum Reference Reference Per additional day 1.003 (1.002–1.005) < 0.001 1.002 (1.001–1.004) 0.008 Placement year 2019 Reference Reference 2020 0.95 (0.76–1.18) 0.658 0.89 (0.72–1.10) 0.284 2021 1.17 (0.98–1.40) 0.086 1.17 (0.98–1.40) 0.091 2022 0.88 (0.65–1.20) 0.415 0.91 (0.68–1.20) 0.497 Indigenous identification No Reference Reference Yes 0.42 (0.08–2.31) 0.321 0.52 (0.10–2.62) 0.430 Australian citizenship/permanent residency No Reference Reference Yes 0.85 (0.66–1.08) 0.185 0.87 (0.68–1.10) 0.240 * Model (n = 489) includes students identifying as Indigenous (n = 4) or as non-citizens/non-permanent residents (n = 32). ** No student identified their gender as 'Other'. *** Modelled as a continuous variable; CI to third decimal place displayed for clarity. CI confidence interval Discussion Based on the findings of this Western Australian study of diverse allied health students, a substantial increase in the proportion of students who self-report confidence in working with Indigenous people can be achieved during rural placements. The likelihood of this change is associated with several attributes of the placement as well as with characteristics of the students themselves. The most influential determinant of increased confidence is inclusion within the placement of opportunities to interact directly with Indigenous people, which in this study was independently associated with a doubled frequency of increased confidence compared with placements that involved no such interaction. Students whose placement was categorised as ‘comprehensive/blended’, indicating a high level of contact with WACRH staff, had a higher likelihood of increased confidence than those who did not. Notably, WACRH employed a number of Aboriginal staff (ranging from two to seven at any one time) throughout the study period; two of these have been employed by WACRH for over ten years. Although these staff have generally not had clinical backgrounds, several have provided direct input into student placements, particularly in relation to cultural orientation and ‘clinical yarning’. WACRH staff also have ongoing opportunities to learn from Indigenous staff colleagues. Students from subgroups associated with lower confidence working with Indigenous people at the commencement of a rural placement caught up disproportionately during the placement. These included female students, students who had not lived in rural areas for an extended period previously, and those with no previous experience working or otherwise interacting with Indigenous Australian people. The results were generally robust across the sensitivity analyses, except that not all of the statistically significant differences evident in the principal analysis were maintained in the smaller sample-sized model that excluded 2022 data. The findings of this study complement those of previously published qualitative research on the various aspects of placements that foster attitudes and skills that promote cultural safety among students of the health professions. From a broad international perspective, development of cultural competence during clinical placements is understood to be an individually varying process dependent on characteristics of both the placement and the student, through the four interrelated pathways of immersion in suitable healthcare environments, opportunities for interpersonal interaction while in these environments, observation by students of the cultural practices of others, and reflection by the student [ 20 ]. It has been recognised that in Australia, as in similar countries with a history of colonisation of Indigenous peoples such as New Zealand and Canada, universities have a responsibility to provide students of the health professions with teaching and learning that engenders culturally safe practice. This can be achieved through curricula that incorporate ‘Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities’ [ 21 ] [p110]. Although the influences on development of cultural competence among health professionals and students remain uncertain [ 20 ], there is evidence that various components of curriculum and student experience contribute, including single workshops [ 22 ] and single compulsory teaching units [ 23 ], as well as immersive service learning in an Indigenous community [ 24 , 25 ]. Placement length is important in enabling students to experience a wider variety of sites and interactions with local people. The importance of increasing placement length to enhance students’ experiences and understandings needs to be emphasised while also recognising that it is often determined by specific professional accreditation requirements and therefore not determined by rurally based academics working to build the rural workforce. However, the length of WACRH placements—and to some extent the type of placement—is substantially dependent on the students’ discipline of study. For example, placements of speech pathology and social work students often extend across ≥ 14 weeks, whereas chiropractic and physiotherapy placements are always two- and five-weeks respectively. Given the large number of different disciplines (seventeen, some with very small student numbers) and the associations of discipline with placement type and length, the multivariable regression estimates were potentially biased when discipline was included as a covariate during preliminary analysis. The importance of the findings depends on how self-reported confidence in the immediate term translates into long term attitudes and proficiency of performance. While the current study does not incorporate longitudinal follow-up data to address the durability of attitudinal changes associated with student placement, qualitative findings from other research on the outcomes of WACRH placements indicate that the personal and professional development legacy of placements can be enduring, at least in some students [ 26 ]. There is also evidence that at least for some health students who during their training become aware of the issues of Indigenous people related to life adversity and racism, this experience continues to inform their delivery of care and advocacy for better healthcare systems [ 27 ]. Ultimately, the attitudes and skills of individual health professionals are only one element of culturally safe healthcare for Indigenous people, which depends also attention to the voices of Indigenous people and their inclusion within health workforce and sustained support for culturally safe care across healthcare organisations and systems [ 28 ]. The baseline findings in relation to the demographic attributes of students are largely intuitive, insofar as prior direct experience with Indigenous people and an upbringing in rural Australia more broadly are predictably determinants of familiarity with Indigenous issues. The diminished confidence of female compared with male students at baseline is less straightforward, as there is some evidence that female health students report globally less confidence across diverse domains of performance including those interpersonal and communication skills [ 29 ], while there are conflicting findings that female students have greater confidence than males in relation to interpersonal matters [ 30 ]. Strengths and limitations This study was strengthened by the relatively large size of the overall sample, with the generalisability of findings enhanced by the demographic and professional diversity of the students. Limitations of the study are the inherently subjective nature of self-reported confidence as a proxy of a student's proficiency in the care Indigenous people, the uncertainty of long-term consequences for the students' future work choices and performance in relation to caring for Indigenous Australian people. The incomplete participation of eligible students in the surveys, particularly the considerable sample attrition between the commencement and end of placement in this regard, is a source of potential bias in ascertainment of students' perspectives although no systematic disparity in completion surveys by baseline characteristics was evident. Conclusions The findings of this study of a demographically and educationally diverse group of allied health students undertaking a rural placement suggest that a gain in confidence working with Indigenous Australian people during the placement is influenced both by attributes of the students themselves and by features of the placement. Individuals from student subgroups with lower confidence at baseline appear to have greater gains. Importantly, the opportunity to interact with Indigenous people during the course of the placement is the key attribute of placements that enhances gain in confidence. Longer placements, along with structured support, allow more opportunities for interaction and engagement with Indigenous people. Future studies need to address the long-term implications of this increased confidence in relation to development of cultural competence and rural intention among health professional graduates, and ultimately for the impact on health outcomes among Indigenous Australian people. Abbreviations aRR Adjusted relative risk CI 95% confidence interval WACRH Western Australian Centre for Rural Health Declarations Ethics approval and consent to participate The University of Western Australia’s Human Research Ethics Committee has approved the research project (reference 2023/ET000289), including the justification of waiver for participants’ informed consent. Consent for publication N/A Availability of data and materials The dataset analysed for the current study is not publicly available due to confidentiality considerations, but the corresponding author can be contacted with requests related to data access. Competing interests All authors declare that they have no competing interests. Funding Student rural placements with WACRH are funded by the Australian Government through the Rural Health Multidisciplinary Training (RHMT) program. The funder had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript. Authors' contributions JW contributed to data curation, co-designed the study, performed the formal analysis, and drafted the manuscript. KF, LP, CG, RR, and MM contributed to student placements. SB managed the data collection and curation. KF, RR, MM, SB and ST all contributed to the development of the survey and data collection. ST conceived, co-designed and supervised the study. All authors contributed to interpretation of the data, reviewed the manuscript, and approved the final version. Acknowledgements We acknowledge the students who completed surveys allowing for this research exploring the impact of placement experiences, and the many staff at WACRH and placement sites who provide learning opportunities and support to students. WACRH receives funding from the Australian Government Department of Health and Aged care under the Rural Multidisciplinary Training Program. Authors' information Lenelle (Lenny) Papertalk is a Yamatji woman who grew up in Mullewa (98 kilometres east-northeast of Geraldton) and has lived in Geraldton for over 25 years. Dr Charmaine Green is a Wajarri, Badimaya and Wilunyu woman of the Yamaji Nation who grew up in Mullewa, and is a Research Fellow with the Western Australian Centre for Rural Health in Geraldton. Both Lenny and Charmaine deliver cultural learning and community engagement opportunities for students undertaking placements in Geraldton and the Midwest of Western Australia. References Briggs D. Challenges for Health Systems: Australian Perspectives. Public Adm Policy 2017; 20:6-17. Dixit SK, Sambasivan M. A review of the Australian healthcare system: A policy perspective. SAGE Open Med 2018;6:2050312118769211. McGrail MR, Humphreys JS. Spatial access disparities to primary health care in rural and remote Australia. Geospat Health 2015;10:138-143. Wakerman J, Humphreys J, Russell D, Guthridge S, Bourke L, Dunbar T, et al. Remote health workforce turnover and retention: What are the policy and practice priorities? Hum Resour Health 2019; 17:99. Australian Institute of Health and Welfare. Indigenous health and wellbeing. Commonwealth of Australia. 2022. https://www.aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing. Accessed March 1 2024. Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander life expectancy. Commonwealth of Australia. 2023. https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/aboriginal-and-torres-strait-islander-life-expectancy/latest-release. Accessed March 1 2024. Mitrou F, Cooke M, Lawrence D, Povah D, Mobilia E, Guimond E et al. Gaps in Indigenous disadvantage not closing: A census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981-2006. BMC Public Health 2014;14:201. Griffiths K, Coleman C, Lee V, Madden R. How colonisation determines social justice and Indigenous health—a review of the literature. J Popul Res 2016;33:9-30. Menzies K. Understanding the Australian Aboriginal experience of collective, historical and intergenerational trauma. Int Soc Work 2019; 62:1522-1534. Durey A, Thompson SC. Reducing the health disparities of Indigenous Australians: Time to change focus. BMC Health Serv Res 2012;12:151. Durey A, Haigh M, Katzenellenbogen JM. What Role Can the Rural Pipeline Play in the Recruitment and Retention of Rural Allied Health Professionals? Rural Remote Health 2015; 15:1-11. Brown L, Smith T, Wakely L, Wolfgang R, Little A, Burrows J. Longitudinal tracking of workplace outcomes for undergraduate allied health students undertaking placements in Rural Australia. J Allied Health 2017;46:79-87. Moran A, Nancarrow S, Cosgrave C, Griffith A, Memery R. What works, why and how? A scoping review and logic model of rural clinical placements for allied health students. BMC Health Serv Res 2020;20:866. Skinner TC, Semmens L, Versace V, Bish M, Skinner IK. Does undertaking rural placements add to place of origin as a predictor of where health graduates work? Aust J Rural Health 2022;30:529-535. Thomas J, Butler S, Battye K, Sefton C, Smith J, Skinner I, et al. Rural placements during undergraduate training promote future rural work by nurses, midwives and allied health professionals. Aust J Rural Health 2021;29:253-258. Playford D, Moran MC, Thompson S. Factors associated with rural work for nursing and allied health graduates 15-17 years after an undergraduate rural placement through the University Department of Rural Health program. Rural Remote Health 2020;20:5334. Humphreys J, Lyle D, Barlow V. University departments of rural health: Is a national network of multidisciplinary academic departments in Australia making a difference? Rural Remote Health 2018;18:4315. Walsh SM, Versace VL, Thompson SC, Browne LJ, Knight S, Lyle DM, et al. Supporting nursing and allied health student placements in rural and remote Australia: a narrative review of publications by university departments of rural health. Med J Aust 2023; 219:S14-S19. Chen W, Qian L, Shi J, Franklin M. Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification. BMC Med Res Methodol 2018;18:63. Liu J, Li S. An ethnographic investigation of medical students’ cultural competence development in clinical placements. Adv Health Sci Educ 2023;28:705-739. Anstice NS, Alam K, Armitage JA, Biles B, Black JM, Boon MY et al. Developing culturally safe education practices in optometry schools across Australia and Aotearoa New Zealand. Clin Exp Optom 2023;106:110-118. Durey A, Halkett G, Berg M, Lester L, Kickett M. Does one workshop on respecting cultural differences increase health professionals' confidence to improve the care of Australian Aboriginal patients with cancer? An evaluation. BMC Health Serv Res 2017;17:660. Flavell H, Thackrah R, Hoffman J. Developing Indigenous cultural competence: A model for implementing Indigenous content into curricula. J Teach Learning Grad Employab 2013;4:39-63. Thackrah RD, Thompson SC, Durey A. "Listening to the silence quietly": Investigating the value of cultural immersion and remote experiential learning in preparing midwifery students for clinical practice. BMC Res Notes 2014;7:685. West M, Sadler S, Hawke F, Munteanu SE, Chuter V. Effect of a culturally safe student placement on students’ understanding of, and confidence with, providing culturally safe podiatry care. J Foot Ankle Res 2021;14:9. Thackrah RD, Thompson SC. Learning from follow-up of student placements in a remote community: A small qualitative study highlights personal and workforce benefits and opportunities. BMC Med Educ 2019;19:331. Thackrah RD, Wood J, Thompson SC. Longitudinal follow up of early career midwives: Insights related to racism show the need for increased commitment to cultural safety in aboriginal maternity care. Int J Environ Res Public Health 2021;18:1-14. De Zilva S, Walker T, Palermo C, Brimblecombe J. Culturally safe health care practice for Indigenous Peoples in Australia: A systematic meta-ethnographic review. J Health Serv Res Policy 2022;27:74-84. Vajapey SP, Weber KL, Samora JB. Confidence gap between men and women in medicine: A systematic review. Curr Orthop Pract 2020;31:494-502. Papyrina V, Strebel J, Robertson B. The student confidence gap: Gender differences in job skill self-efficacy. J Educ Bus 2021;96:89-98. Additional Declarations No competing interests reported. Supplementary Files WoodsJAetal2024Supplementaryfile.docx Cite Share Download PDF Status: Published Journal Publication published 01 Nov, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 21 Aug, 2024 Reviews received at journal 24 May, 2024 Reviewers agreed at journal 12 May, 2024 Reviews received at journal 05 Apr, 2024 Reviewers agreed at journal 27 Mar, 2024 Reviewers agreed at journal 24 Mar, 2024 Reviewers invited by journal 20 Mar, 2024 Editor assigned by journal 20 Mar, 2024 Editor invited by journal 15 Mar, 2024 Submission checks completed at journal 15 Mar, 2024 First submitted to journal 06 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4022446","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280685051,"identity":"0a63f05e-f823-4cbc-b610-a139e98ca6e4","order_by":0,"name":"John A Woods","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBACxgYeKOsA8wEog3gtbAnEaWFggGvhMSBOC3N777EHjG02cnznz3yT5qlhkOO7kcD4mQePFsaec+kGjG1pxpI3crdJ8xxjADISmKXxapmRYybBuO1w4oYbvNukc9gYgIwEBiK1nD/zTDrnH0M9UAvzb+K0HMhhk85tY0gwuJHAht+WnjNmEon/QH5JM7b+2ydhOPPMwzbLOXi0GLb3mEl8OAMKscMPb874ZiPPdzz58I03+LQ0AIkEBF8CZHMDHg0MDPJ4ZUfBKBgFo2AUgAAAlvdNO5G3TsgAAAAASUVORK5CYII=","orcid":"","institution":"Western Australian Centre for Rural Health, The University of Western Australia","correspondingAuthor":true,"prefix":"","firstName":"John","middleName":"A","lastName":"Woods","suffix":""},{"id":280685052,"identity":"4f11635a-fe4a-4d2d-acf4-12601ef2a7e5","order_by":1,"name":"Kathryn Fitzgerald","email":"","orcid":"","institution":"Western Australian Centre for Rural Health, The University of Western Australia","correspondingAuthor":false,"prefix":"","firstName":"Kathryn","middleName":"","lastName":"Fitzgerald","suffix":""},{"id":280685053,"identity":"5fdb3d64-f334-4af8-9bc7-fad35097263f","order_by":2,"name":"Lennelle P Papertalk","email":"","orcid":"","institution":"Western Australian Centre for Rural Health, The University of Western Australia","correspondingAuthor":false,"prefix":"","firstName":"Lennelle","middleName":"P","lastName":"Papertalk","suffix":""},{"id":280685054,"identity":"97c76ca8-da31-446f-812b-04459c1b3323","order_by":3,"name":"Charmaine Green","email":"","orcid":"","institution":"Western Australian Centre for Rural Health, The University of Western Australia","correspondingAuthor":false,"prefix":"","firstName":"Charmaine","middleName":"","lastName":"Green","suffix":""},{"id":280685055,"identity":"522dadbf-8765-4207-be28-3a8aded0efc0","order_by":4,"name":"Rohan L Rasiah","email":"","orcid":"","institution":"Western Australian Centre for Rural Health, The 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University of Western Australia","correspondingAuthor":false,"prefix":"","firstName":"Sandra","middleName":"C","lastName":"Thompson","suffix":""}],"badges":[],"createdAt":"2024-03-07 00:48:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4022446/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4022446/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-06207-2","type":"published","date":"2024-11-01T16:20:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":52961260,"identity":"8c29177a-05b6-4685-9e63-4e57876c9016","added_by":"auto","created_at":"2024-03-19 06:20:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":93396,"visible":true,"origin":"","legend":"\u003cp\u003ePlacement record selection procedure\u003c/p\u003e","description":"","filename":"WoodsJAetal2024Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4022446/v1/27a1804ec81d59038981eae3.png"},{"id":52961259,"identity":"cf8285a3-7aa1-4e31-b429-7f222e0f0a78","added_by":"auto","created_at":"2024-03-19 06:20:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20931,"visible":true,"origin":"","legend":"\u003cp\u003eStudents who reported feeling 'Confident'/'Very confident' working with Aboriginal people: commencement versus end of placements\u003c/p\u003e","description":"","filename":"WoodsJAetal2024Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4022446/v1/fd83ecf1e5f2f4160b33c0cb.png"},{"id":68207231,"identity":"9b2d1298-700e-4b06-a3d5-857d553d0906","added_by":"auto","created_at":"2024-11-04 16:36:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1344750,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4022446/v1/b5414c62-752c-4e97-9ff9-25e852a6ab20.pdf"},{"id":52961223,"identity":"b7b7c8cc-a5d1-42e2-b788-69e85029a74d","added_by":"auto","created_at":"2024-03-19 06:20:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20785,"visible":true,"origin":"","legend":"","description":"","filename":"WoodsJAetal2024Supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-4022446/v1/b0048c66b7db27bacef12068.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study","fulltext":[{"header":"Background","content":"\u003cp\u003eHealthcare in Australia, underpinned by a universal insurance system (Medicare), is widely considered to be among the world's best [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, there are areas of inequity in service provision, with rural and remote areas often underserved and characterised by high turnover of health workers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Moreover, Aboriginal and Torres Strait Islander (henceforth Indigenous) people in Australia experience health outcomes less favourable than those of their non-Indigenous counterparts, with a substantial (\u0026gt;\u0026thinsp;8 years) life-expectancy deficit in the Indigenous population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This outcome gap is multifactorial, and substantially attributable to social and cultural determinants of health [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] consequent to colonial settlement and associated violence, discrimination, and intergenerational trauma [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It also reflects health system failures including structural racism [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and the underservicing of non-metropolitan areas, particularly more remote areas where many Indigenous people reside.\u003c/p\u003e \u003cp\u003eImproved servicing of rural and remote areas requires augmenting the rural health workforce through increased recruitment and retention of health professionals. A key strategy for developing and sustaining a rural health workforce is encouragement of students in the \u0026lsquo;pipeline\u0026rsquo; of the health professions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This includes exposure to rural and remote practice through practicum placements in professional degree programs [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and continues through opportunities for rural employment in the years immediately following graduation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Nowadays, many Australian health profession students have the opportunity to participate in rural health placements [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTypically, among the objectives of rural placements is creating opportunities to enhance students\u0026rsquo; cultural understanding and ability to communicate and work with Indigenous Australians [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, there is scant evidence on the determinants of efficacy in rural placements for improving students' confidence in this regard.\u003c/p\u003e \u003cp\u003eOne of nineteen University Departments of Rural Health currently existing nationwide, the Western Australian Centre for Rural Health (WACRH), established in 1998, provides rural placements for undergraduate and postgraduate students of the health professions from multiple institutions. WACRH has its main office based in Geraldton in the Midwest region and another major office based in the more remote Pilbara region of Western Australia.\u003c/p\u003e \u003cp\u003eUsing data systematically collected from allied health students undertaking placements with WACRH, including responses to questionnaires from the commencement and end of placement, the aims of the current study were to investigate the influence of student attributes and experiences during the placement on developing confidence in working with Indigenous people.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudent placements\u003c/h2\u003e \u003cp\u003eStudent rural placements administered by WACRH are undertaken in diverse healthcare settings, including domestic and residential aged-care services, schools and playgroups, and Aboriginal Medical Services. Each placement is based on one of several different models for academic and vocational supervision WACRH has developed a classification system for rural student placements based on the extent to which academic staff are directly involved with coordinating, hosting, supervising the placement and assessing the student's performance. Accordingly, WACRH involvement in placements is categorised as: Comprehensive, Blended, Supported/Liaison, or Assisted (Box 1).\u003c/p\u003e \u003cp\u003e \u003cb\u003eBox 1\u003c/b\u003e Western Australian Centre for Rural Health Student (WACRH) Placement Models\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacement Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssessment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComprehensive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents coordinated, hosted, supervised and assessed by WACRH staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWACRH supervisor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlended\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents hosted, coordinated and primary supervision provided by WACRH. They may have a small \u003cem\u003epart\u003c/em\u003e of their clinical/ fieldwork activities directly supervised from an external supervisor, however the responsibility for placement and clinical fieldwork experience on a day-to-day basis is with the primary WACRH supervisor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWACRH supervisor responsible for assessment. External supervisor may have some input.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSupported/Liaison\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents placed with an external agency for day-to-day clinical placement/fieldwork with on site, same-discipline supervision. WACRH may add value to placements e.g., coordination, liaison, cultural orientation or other clinics or other activities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAn external supervisor is responsible for completing the student assessment. WACRH supervisor may have liaison/ support role in assessment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssisted\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudents supported to participate in their rural placement by WACRH but not be directly involved with WACRH staff or programs, though they may be provided accommodation by WACRH.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExternally assessed. No WACRH involvement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe placements incorporate orientation to Indigenous culture, Indigenous ways of knowing, and Indigenous health issues through modules and workshops that have been developed and led by Indigenous staff. Firstly, students undertaking a placement are recommended/required to complete an online Indigenous cultural orientation training module prior to commencement. WACRH provides face-to-face cultural orientation at the commencement of placements at most sites. For example, the three-hour Aboriginal Miyarnuwimanha Cultural Orientation is recommended for students early in their placement commencement in Geraldton where it is delivered by the local Indigenous staff who developed it. \u0026lsquo;Miyarnuwimanha\u0026rsquo; translates to \u0026lsquo;learning\u0026rsquo; or \u0026lsquo;becoming knowledgeable\u0026rsquo; in the language of the local Wajarri Yamaji people. During the study period, several different approaches to cultural orientation have been provided for students based in the Pilbara.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDesign, data source and sample\u003c/h2\u003e \u003cp\u003eWACRH has systematically collected data from all students undertaking rural placements for many years, with substantial ongoing refinements to data collection from 2017. The records used in this study were those of all rural placements that (i) were identifiably a student's first placement coordinated by WACRH (ascertained by lookback to 2013), (ii) were undertaken in the period 01/01/2019\u0026ndash;31/12/2022 (because all relevant variables were collected only from 2019 onwards), (iii) were among students who identified both as non-Indigenous and a citizen or permanent resident of Australia, (iv) had provided relevant questionnaire data at both the commencement and the end of their placement, and (v) had no missing values for other study measures (below).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy measures: (i) outcome variable\u003c/h2\u003e \u003cp\u003eAll students who take a placement with WACRH are encouraged to participate in an online questionnaire at both the commencement and end of the placement. The questionnaire at both time points includes items with a five-point ordered response agreement scale in relation to the student's confidence in dealing with several aspects of a rural placement. Among these items, students are asked, 'How confident do you feel about working with Aboriginal people?' The outcome measure for this study indicated the change in a student's confidence working with Indigenous people between the commencement and end of their rural placement. The five-point ordered response to this item was firstly collapsed into binary form ('Confident' or 'Very Confident' versus 'Not at all confident' or 'Not confident' Or 'Neutral'). Secondly, a single-point or greater increase in confidence between the commencement and end questionnaires was considered \u0026lsquo;increased confidence\u0026rsquo;. In 2022, a technical problem which was not rapidly identified disrupted the distribution of end-of-placement questionnaires, markedly reducing the proportion of students who completed the survey during that year compared with the previous years of the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy measures: (ii) other covariates\u003c/h2\u003e \u003cp\u003eDetailed data on the demographic and educational characteristics of all students undertaking rural placements with WACRH are collected routinely at registration prior to placement commencement. These data include the student's date of birth, from which age in years at placement commencement was calculated. Age was collapsed into binary groups (\u0026lt;\u0026thinsp;23 years versus \u0026ge;\u0026thinsp;23 years) for the analysis in consequence of non-linearity in the relationship between age and the outcome variable detected during preliminary regression modelling. Other student characteristics included as covariates in the current study were gender (female, male or other); Aboriginal and/or Torres Strait Islander identification; Australian citizenship/permanent residency status; rural origin (defined dichotomously as having or not having 'lived in a rural area for a total of ten years or for five consecutive years'); and current educational enrolment (including institution, professional discipline of study, undergraduate versus postgraduate level of the degree, and international student enrolment status). An additional item from the placement registration process included as a study covariate was the question, 'Do you have experience working or interacting with Aboriginal and/or Torres Strait Islander peoples?'\u003c/p\u003e \u003cp\u003ePlacement length in days was calculated arithmetically from commencement and end dates.\u003c/p\u003e \u003cp\u003eThe end-of-placement questionnaire also includes the two questions, 'During your placement, did you have the opportunity to work or interact with Aboriginal people as clients, co-workers or community members during the clinical/placement practice?' and 'During your placement, did you have the opportunity to work or interact with Aboriginal people as clients, co-workers or community members outside of the clinical/placement practice?'\u003c/p\u003e \u003cp\u003eIn consideration that the placement model may have influenced students\u0026rsquo; experiences during the placement and thereby their responses to end-of-placement questionnaire responses, Placement type was modelled as a covariate in this study and was collapsed into binary form for analysis (Comprehensive or Blended versus Supported/Liaison or Assisted).\u003c/p\u003e \u003cp\u003eFinally, the calendar year in which the placement was undertaken was included as a covariate in order to investigate any change over time and specifically to determine any influence of the COVID pandemic (i.e., through comparison of outcomes during each year from 2020 onwards in comparison with the pre-pandemic year of 2019).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eBaseline demographic and educational characteristics of student participants were quantified descriptively. Moreover, in order to assess the potential for bias arising from the unavoidable restriction of the study sample to students who completed questionnaires at both the commencement and end of their placement, a descriptive comparison was made of the baseline characteristics of (i) all students who participated in the commencement-of-placement questionnaire, and (ii) the subgroup of these who comprised the study sample (i.e., who participated in both commencement and end questionnaires and provided paired commencement/end-of-placement data on confidence working with Aboriginal people).\u003c/p\u003e \u003cp\u003eThe proportions of students (i) in the overall sample, and (ii) in selected subgroups who reported feeling 'Confident' or 'Very Confident' about working with Aboriginal people at the commencement and end of placement were calculated and presented graphically.\u003c/p\u003e \u003cp\u003eCrude and mutually adjusted influences of student baseline demographics and placement characteristics on feeling 'Confident' or 'Very Confident' at placement commencement and of reporting increased confidence at end compared with commencement of placement were analysed using robust Poisson regression models [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] to determine relative risks directly. Two sensitivity analyses were performed in relation to these crude and multivariable-adjusted estimates. First, the sample was restricted to placement records from the period 2019\u0026ndash;2021, considering the potential for exaggerated selection bias among 2022 placements due to the markedly diminished proportion of end-of-placement questionnaire completions during that year. For the second sensitivity analysis, the sample was broadened to include otherwise eligible individuals who had been excluded from the principal analysis because they identified as either an Indigenous Australian or an international student. All data analyses were performed using Stata\u0026reg; Version 16 (Stata Corporation, College Station, Texas, USA). Statistical significance was set at the 5% level.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003e The University of Western Australia\u0026rsquo;s Human Research Ethics Committee Ethics provided approval for the study (reference 2023/ET000289), including the justification of waiver for student participants\u0026rsquo; informed consent. Two of the authors (LP and CG) are local Indigenous staff raised in the Midwest who deliver cultural learning opportunities for students based in Geraldton.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 959 students undertaking their first placements co-ordinated by WACRH during the years 2019\u0026ndash;2022, 453 were eligible for inclusion in the study (Fig.\u0026nbsp;1). Non-completion of surveys impacted on the sample of eligible students, with 117 of 868 otherwise eligible students (13.5%) failing to complete the commencement survey, followed by substantial further attrition due to 290 (38.6%) of the remaining 751 students failing to complete the end-of-placement survey. Non-completion was especially pronounced in the 2022 student cohort (27.9%, compared with 66.3\u0026ndash;78.6% in the previous years, i.e., 2019\u0026ndash;2021 [Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e]).\u003c/p\u003e \u003cp\u003e[Insert Fig.\u0026nbsp;1 about here.]\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1\u003c/b\u003e Placement record selection procedure\u003c/p\u003e \u003cp\u003eWACRH Western Australian Centre for Rural Health\u003c/p\u003e \u003cp\u003eThe students in the sample were demographically and educationally diverse (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). They represented a broad range of allied health disciplines across both undergraduate (n\u0026thinsp;=\u0026thinsp;308, 68.0%) and postgraduate (n\u0026thinsp;=\u0026thinsp;145; 32.0%) professional degree programs, with the majority enrolled in pharmacy (n\u0026thinsp;=\u0026thinsp;92; 20.3%), chiropractic and social work (each n\u0026thinsp;=\u0026thinsp;59, 13.0%), and occupational therapy and physiotherapy (each n\u0026thinsp;=\u0026thinsp;56; 12.4%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of allied health students (N\u0026thinsp;=\u0026thinsp;453) and their rural placements\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange Median\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;60 23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRural origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (Australia)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (Overseas)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQualification Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrior Indigenous experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement model\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssisted/Supported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComprehensive/Blended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscipline of study*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAudiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiomed/Med Science\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChiropractic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDietetics/Nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExercise Physiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Promotion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Science\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Imaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMusic Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccupational Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePodiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial Work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpeech Pathology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Discipline of student presented to demonstrate diversity of sample but not included as a covariate in analyses. Cell numbers\u0026thinsp;\u0026lt;\u0026thinsp;5 obscured to protect confidentiality.\u003c/p\u003e \u003cp\u003eFeeling \u0026lsquo;Confident\u0026rsquo; or \u0026lsquo;Very confident\u0026rsquo; working with Aboriginal people at the commencement of the placement (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) was independently associated with gender (adjusted relative risk [aRR] for male compared with female students 1.51; 95% confidence interval [95% CI] 1.23\u0026ndash;1.86), with reported rural Australian origin compared with no such background (aRR 1.46; 95% CI 1.18\u0026ndash;1.80), and with reported previous personal experience with Indigenous people compared with none (aRR 1.40; 95% CI 1.13\u0026ndash;1.72), but not with age group, qualification level or year of placement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of a student reporting feeling either \u0026lsquo;Confident\u0026rsquo; or \u0026lsquo;Very confident\u0026rsquo; at placement commencement\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelative risk (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRelative risk (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAge group at registration\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.13 (0.91\u0026ndash;1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.11 (0.90\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72 (0.58\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66 (0.54\u0026ndash;0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRural Australian origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.49 (1.20\u0026ndash;1.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.46 (1.18\u0026ndash;1.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQualification level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.92 (0.73\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01 (0.85\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious Indigenous experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.42 (1.15\u0026ndash;1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.40 (1.13\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96 (0.72\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97 (0.73\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88 (0.67\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83 (0.64\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.05 (0.74\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01 (0.73\u0026ndash;1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*\u003c/b\u003e No student identified their gender as 'Other'. CI confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe proportion of students who reported feeling Confident\u0026rsquo; or \u0026lsquo;Very confident\u0026rsquo; working with Aboriginal people increased from 42.4\u0026ndash;82.6% between the commencement and end of placement in the overall sample, and increased substantially across most subgroups of students that were investigated, except among those who reported that their placement included no interaction with Indigenous people (Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003e[Insert Fig.\u0026nbsp;2 about here.]\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 2\u003c/b\u003e Students who reported feeling 'Confident'/'Very confident' working with Aboriginal people: commencement versus end of placements\u003c/p\u003e \u003cp\u003eThe baseline characteristics of 747 students who completed the commencement and the subgroup of 453 whose records comprised the principal analysis were similar in all regards except that attrition in survey completion between commencement and end of placement was notably more marked in 2022 compared with the other three years of the study (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the principal robust Poisson regression model (N\u0026thinsp;=\u0026thinsp;453 placements; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), increased confidence working with Indigenous people between the commencement and end of placement was independently associated with several baseline characteristics of the students as well as with certain attributes of their placements. Students identifying as female compared with males were more likely to report increased confidence (adjusted relative risk [aRR] 1.23; 95% confidence interval [95% CI] 1.02\u0026ndash;1.49), but no association with students\u0026rsquo; age was evident. Students from a background in rural Australia were less likely than other students to report increased confidence (aRR 0.80; 95% CI 0.65\u0026ndash;0.97); those who reported having experience with Indigenous people prior to the placement had a lower likelihood of reporting increased confidence than those without previous experience (aRR 0.82; 95% CI 0.69\u0026ndash;0.97). The placement attribute associated most strongly with increased confidence was interaction with Indigenous people within the placement setting (aRR 2.15; 95% CI 1.17\u0026ndash;3.98). Students whose placement model was categorised as Blended/ Comprehensive had a higher likelihood of increased confidence than those who placement was categorised as Assisted/Supported (aRR 1.22, 95% CI 1.04\u0026ndash;1.43). Placement length was also independently associated with increased confidence in a linear fashion (aRR for each additional day: 1.002; 95% CI 1.001\u0026ndash;1.004). Compared with the pre-COVID pandemic year of 2019, increased confidence did not change significantly in any of the three subsequent years of the study period.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDeterminants of increased confidence dealing with Indigenous people during placements\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelative risk (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRelative risk (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAge group at registration\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93 (0.80\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97 (0.83\u0026ndash;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.26 (1.04\u0026ndash;1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23 (1.02\u0026ndash;1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRural Australian origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.68\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80 (0.65\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQualification level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.80\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01 (0.85\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious Indigenous experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85 (0.72\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82 (0.69\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement model*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssisted/Supported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlended/Comprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.29 (1.11\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.22 (1.04\u0026ndash;1.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndigenous interaction within placement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.15 (1.14\u0026ndash;4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.15 (1.17\u0026ndash;3.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndigenous interaction (external) during placement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01 (0.85\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.934\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02 (0.86\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.818\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement length (days)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10-day minimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePer additional day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.003 (1.001\u0026ndash;1.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.002 (1.001\u0026ndash;1.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.75\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86 (0.69\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17 (0.96\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.13 (0.94\u0026ndash;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91 (0.66\u0026ndash;1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90 (0.68\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e*\u003c/b\u003eNo student identified their gender as 'Other'. \u003cb\u003e**\u003c/b\u003e Modelled as a continuous variable; CI to third decimal place displayed for clarity. CI confidence interval.\u003c/p\u003e \u003cp\u003eIn the sensitivity analysis that excluded 2022 placements (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), the adjusted estimates were equivalent or only marginally closer to the null compared with those evident in the principal analysis model, although the statistically significance of these associations was not maintained across all covariates in the 2019\u0026ndash;2021 placement data (N\u0026thinsp;=\u0026thinsp;402). In this smaller sample, increased confidence was not significantly associated with either student sex or previous Indigenous experience. Both placement model and indigenous interaction within the placement, although not placement length, were significantly associated with increased confidence. In the other sensitivity analysis that incorporated additional students who identified as Indigenous (n\u0026thinsp;=\u0026thinsp;4) or as non-citizens / non-permanent residents (n\u0026thinsp;=\u0026thinsp;32) (N\u0026thinsp;=\u0026thinsp;489 students; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), results resembled those from the principal analysis in relation to associations between student and placement characteristics and increased confidence.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity analysis: Determinants of increased confidence dealing with Indigenous people during placements (2019\u0026ndash;2021 only)*\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelative risk (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRelative risk (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAge group at registration\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.92 (0.78\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96 (0.82\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.24 (1.01\u0026ndash;1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.21 (0.99\u0026ndash;1.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRural Australian origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.83 (0.67\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80 (0.65\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQualification level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93 (0.77\u0026ndash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98 (0.81\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious Indigenous experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86 (0.72\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84 (0.70\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement model**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssisted/Supported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlended/Comprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.26 (1.07\u0026ndash;1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.21 (1.03\u0026ndash;1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndigenous interaction within placement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.93 (0.99\u0026ndash;3.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.97 (1.05\u0026ndash;3.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndigenous interaction (external) during placement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.80\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96 (0.82\u0026ndash;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement length (days)***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10-day minimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePer additional day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.002 (1.001\u0026ndash;1.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000 (1.000\u0026ndash;1.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.75\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88 (0.70\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17 (0.96\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14 (0.94\u0026ndash;1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e* 2022 data removed to investigate potential bias due to high proportion of end-of-placement questionnaire non-completion during that year (N\u0026thinsp;=\u0026thinsp;402). \u003cb\u003e**\u003c/b\u003e No student identified their gender as 'Other'. \u003cb\u003e***\u003c/b\u003e Modelled as a continuous variable; Confidence interval displayed with third decimal place for clarity. CI confidence interval.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity analysis: Determinants of increased confidence dealing with Indigenous people during placements (including Indigenous/foreign students)*\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelative risk (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRelative risk (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group at registration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96 (0.83\u0026ndash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99 (0.85\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.30 (1.07\u0026ndash;1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.29 (1.07\u0026ndash;1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRural Australian origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.81 (0.66\u0026ndash;1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79 (0.65\u0026ndash;0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQualification level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.81\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97 (0.82\u0026ndash;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious Indigenous experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.71\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83 (0.70\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement model\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssisted/Supported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlended/Comprehensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25 (1.08\u0026ndash;1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.17 (1.00\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndigenous interaction within placement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.35 (1.23\u0026ndash;4.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.32 (1.24\u0026ndash;4.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndigenous interaction (external) during placement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.03 (0.87\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.05 (0.90\u0026ndash;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement length (days)***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10-day minimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePer additional day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.003 (1.002\u0026ndash;1.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.002 (1.001\u0026ndash;1.004)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlacement year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.76\u0026ndash;1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89 (0.72\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.17 (0.98\u0026ndash;1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.17 (0.98\u0026ndash;1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88 (0.65\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91 (0.68\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndigenous identification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.42 (0.08\u0026ndash;2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52 (0.10\u0026ndash;2.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAustralian citizenship/permanent residency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85 (0.66\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87 (0.68\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*\u003c/b\u003e Model (n\u0026thinsp;=\u0026thinsp;489) includes students identifying as Indigenous (n\u0026thinsp;=\u0026thinsp;4) or as non-citizens/non-permanent residents (n\u0026thinsp;=\u0026thinsp;32). \u003cb\u003e**\u003c/b\u003e No student identified their gender as 'Other'. \u003cb\u003e***\u003c/b\u003e Modelled as a continuous variable; CI to third decimal place displayed for clarity. CI confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBased on the findings of this Western Australian study of diverse allied health students, a substantial increase in the proportion of students who self-report confidence in working with Indigenous people can be achieved during rural placements. The likelihood of this change is associated with several attributes of the placement as well as with characteristics of the students themselves. The most influential determinant of increased confidence is inclusion within the placement of opportunities to interact directly with Indigenous people, which in this study was independently associated with a doubled frequency of increased confidence compared with placements that involved no such interaction. Students whose placement was categorised as \u0026lsquo;comprehensive/blended\u0026rsquo;, indicating a high level of contact with WACRH staff, had a higher likelihood of increased confidence than those who did not. Notably, WACRH employed a number of Aboriginal staff (ranging from two to seven at any one time) throughout the study period; two of these have been employed by WACRH for over ten years. Although these staff have generally not had clinical backgrounds, several have provided direct input into student placements, particularly in relation to cultural orientation and \u0026lsquo;clinical yarning\u0026rsquo;. WACRH staff also have ongoing opportunities to learn from Indigenous staff colleagues. Students from subgroups associated with lower confidence working with Indigenous people at the commencement of a rural placement caught up disproportionately during the placement. These included female students, students who had not lived in rural areas for an extended period previously, and those with no previous experience working or otherwise interacting with Indigenous Australian people. The results were generally robust across the sensitivity analyses, except that not all of the statistically significant differences evident in the principal analysis were maintained in the smaller sample-sized model that excluded 2022 data.\u003c/p\u003e \u003cp\u003eThe findings of this study complement those of previously published qualitative research on the various aspects of placements that foster attitudes and skills that promote cultural safety among students of the health professions. From a broad international perspective, development of cultural competence during clinical placements is understood to be an individually varying process dependent on characteristics of both the placement and the student, through the four interrelated pathways of immersion in suitable healthcare environments, opportunities for interpersonal interaction while in these environments, observation by students of the cultural practices of others, and reflection by the student [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. It has been recognised that in Australia, as in similar countries with a history of colonisation of Indigenous peoples such as New Zealand and Canada, universities have a responsibility to provide students of the health professions with teaching and learning that engenders culturally safe practice. This can be achieved through curricula that incorporate \u0026lsquo;Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities\u0026rsquo; [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] [p110]. Although the influences on development of cultural competence among health professionals and students remain uncertain [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], there is evidence that various components of curriculum and student experience contribute, including single workshops [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and single compulsory teaching units [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], as well as immersive service learning in an Indigenous community [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePlacement length is important in enabling students to experience a wider variety of sites and interactions with local people. The importance of increasing placement length to enhance students\u0026rsquo; experiences and understandings needs to be emphasised while also recognising that it is often determined by specific professional accreditation requirements and therefore not determined by rurally based academics working to build the rural workforce. However, the length of WACRH placements\u0026mdash;and to some extent the type of placement\u0026mdash;is substantially dependent on the students\u0026rsquo; discipline of study. For example, placements of speech pathology and social work students often extend across \u0026ge;\u0026thinsp;14 weeks, whereas chiropractic and physiotherapy placements are always two- and five-weeks respectively. Given the large number of different disciplines (seventeen, some with very small student numbers) and the associations of discipline with placement type and length, the multivariable regression estimates were potentially biased when discipline was included as a covariate during preliminary analysis.\u003c/p\u003e \u003cp\u003eThe importance of the findings depends on how self-reported confidence in the immediate term translates into long term attitudes and proficiency of performance. While the current study does not incorporate longitudinal follow-up data to address the durability of attitudinal changes associated with student placement, qualitative findings from other research on the outcomes of WACRH placements indicate that the personal and professional development legacy of placements can be enduring, at least in some students [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. There is also evidence that at least for some health students who during their training become aware of the issues of Indigenous people related to life adversity and racism, this experience continues to inform their delivery of care and advocacy for better healthcare systems [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Ultimately, the attitudes and skills of individual health professionals are only one element of culturally safe healthcare for Indigenous people, which depends also attention to the voices of Indigenous people and their inclusion within health workforce and sustained support for culturally safe care across healthcare organisations and systems [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe baseline findings in relation to the demographic attributes of students are largely intuitive, insofar as prior direct experience with Indigenous people and an upbringing in rural Australia more broadly are predictably determinants of familiarity with Indigenous issues. The diminished confidence of female compared with male students at baseline is less straightforward, as there is some evidence that female health students report globally less confidence across diverse domains of performance including those interpersonal and communication skills [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], while there are conflicting findings that female students have greater confidence than males in relation to interpersonal matters [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003e This study was strengthened by the relatively large size of the overall sample, with the generalisability of findings enhanced by the demographic and professional diversity of the students. Limitations of the study are the inherently subjective nature of self-reported confidence as a proxy of a student's proficiency in the care Indigenous people, the uncertainty of long-term consequences for the students' future work choices and performance in relation to caring for Indigenous Australian people. The incomplete participation of eligible students in the surveys, particularly the considerable sample attrition between the commencement and end of placement in this regard, is a source of potential bias in ascertainment of students' perspectives although no systematic disparity in completion surveys by baseline characteristics was evident.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings of this study of a demographically and educationally diverse group of allied health students undertaking a rural placement suggest that a gain in confidence working with Indigenous Australian people during the placement is influenced both by attributes of the students themselves and by features of the placement. Individuals from student subgroups with lower confidence at baseline appear to have greater gains. Importantly, the opportunity to interact with Indigenous people during the course of the placement is the key attribute of placements that enhances gain in confidence. Longer placements, along with structured support, allow more opportunities for interaction and engagement with Indigenous people. Future studies need to address the long-term implications of this increased confidence in relation to development of cultural competence and rural intention among health professional graduates, and ultimately for the impact on health outcomes among Indigenous Australian people.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eaRR Adjusted relative risk\u003c/p\u003e\n\u003cp\u003eCI 95% confidence interval\u003c/p\u003e\n\u003cp\u003eWACRH Western Australian Centre for Rural Health\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Western Australia’s Human Research Ethics Committee has approved the research project (reference 2023/ET000289), including the justification of waiver for participants’ informed consent. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eN/A\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset analysed for the current study is not publicly available due to confidentiality considerations, but the corresponding author can be contacted with requests related to data access.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudent rural placements with WACRH are funded by the Australian Government through the Rural Health Multidisciplinary Training (RHMT) program. The funder had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eJW contributed to data curation, co-designed the study, performed the formal analysis, and drafted the manuscript. KF, LP, CG, RR, and MM contributed to student placements. SB managed the data collection and curation. KF, RR, MM, SB and ST all contributed to the development of the survey and data collection. ST conceived, co-designed and supervised the study. All authors contributed to interpretation of the data, reviewed the manuscript, and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the students who completed surveys allowing for this research exploring the impact of placement experiences, and the many staff at WACRH and placement sites who provide learning opportunities and support to students. WACRH receives funding from the Australian Government Department of Health and Aged care under the Rural Multidisciplinary Training Program.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' information\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLenelle (Lenny) Papertalk is a Yamatji woman who grew up in Mullewa (98 kilometres east-northeast of Geraldton) and has lived in Geraldton for over 25 years. Dr Charmaine Green is a Wajarri, Badimaya and Wilunyu woman of the Yamaji Nation who grew up in Mullewa, and is a Research Fellow with the Western Australian Centre for Rural Health in Geraldton. Both Lenny and Charmaine deliver cultural learning and community engagement opportunities for students undertaking placements in Geraldton and the Midwest of Western Australia.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBriggs D. Challenges for Health Systems: Australian Perspectives. Public Adm Policy 2017; 20:6-17.\u003c/li\u003e\n \u003cli\u003eDixit SK, Sambasivan M. A review of the Australian healthcare system: A policy perspective. SAGE Open Med 2018;6:2050312118769211.\u003c/li\u003e\n \u003cli\u003eMcGrail MR, Humphreys JS. Spatial access disparities to primary health care in rural and remote Australia. Geospat Health 2015;10:138-143.\u003c/li\u003e\n \u003cli\u003eWakerman J, Humphreys J, Russell D, Guthridge S, Bourke L, Dunbar T, et al. Remote health workforce turnover and retention: What are the policy and practice priorities? Hum Resour Health 2019; 17:99.\u003c/li\u003e\n \u003cli\u003eAustralian Institute of Health and Welfare. Indigenous health and wellbeing. Commonwealth of Australia. 2022. https://www.aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing. Accessed March 1 2024.\u003c/li\u003e\n \u003cli\u003eAustralian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander life expectancy. Commonwealth of Australia. 2023. https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/aboriginal-and-torres-strait-islander-life-expectancy/latest-release. Accessed March 1 2024.\u003c/li\u003e\n \u003cli\u003eMitrou F, Cooke M, Lawrence D, Povah D, Mobilia E, Guimond E et al. Gaps in Indigenous disadvantage not closing: A census cohort study of social determinants of health in Australia, Canada, and New Zealand from 1981-2006. BMC Public Health 2014;14:201.\u003c/li\u003e\n \u003cli\u003eGriffiths K, Coleman C, Lee V, Madden R. How colonisation determines social justice and Indigenous health\u0026mdash;a review of the literature. J Popul Res 2016;33:9-30.\u003c/li\u003e\n \u003cli\u003eMenzies K. Understanding the Australian Aboriginal experience of collective, historical and intergenerational trauma. Int Soc Work 2019; 62:1522-1534.\u003c/li\u003e\n \u003cli\u003eDurey A, Thompson SC. Reducing the health disparities of Indigenous Australians: Time to change focus. BMC Health Serv Res 2012;12:151.\u003c/li\u003e\n \u003cli\u003eDurey A, Haigh M, Katzenellenbogen JM. What Role Can the Rural Pipeline Play in the Recruitment and Retention of Rural Allied Health Professionals? Rural Remote Health 2015; 15:1-11.\u003c/li\u003e\n \u003cli\u003eBrown L, Smith T, Wakely L, Wolfgang R, Little A, Burrows J. Longitudinal tracking of workplace outcomes for undergraduate allied health students undertaking placements in Rural Australia. J Allied Health 2017;46:79-87.\u003c/li\u003e\n \u003cli\u003eMoran A, Nancarrow S, Cosgrave C, Griffith A, Memery R. What works, why and how? A scoping review and logic model of rural clinical placements for allied health students. BMC Health Serv Res 2020;20:866.\u003c/li\u003e\n \u003cli\u003eSkinner TC, Semmens L, Versace V, Bish M, Skinner IK. Does undertaking rural placements add to place of origin as a predictor of where health graduates work? Aust J Rural Health 2022;30:529-535.\u003c/li\u003e\n \u003cli\u003eThomas J, Butler S, Battye K, Sefton C, Smith J, Skinner I, et al. Rural placements during undergraduate training promote future rural work by nurses, midwives and allied health professionals. Aust J Rural Health 2021;29:253-258.\u003c/li\u003e\n \u003cli\u003ePlayford D, Moran MC, Thompson S. Factors associated with rural work for nursing and allied health graduates 15-17 years after an undergraduate rural placement through the University Department of Rural Health program. Rural Remote Health 2020;20:5334.\u003c/li\u003e\n \u003cli\u003eHumphreys J, Lyle D, Barlow V. University departments of rural health: Is a national network of multidisciplinary academic departments in Australia making a difference? Rural Remote Health 2018;18:4315.\u003c/li\u003e\n \u003cli\u003eWalsh SM, Versace VL, Thompson SC, Browne LJ, Knight S, Lyle DM, et al. Supporting nursing and allied health student placements in rural and remote Australia: a narrative review of publications by university departments of rural health. Med J Aust 2023; 219:S14-S19.\u003c/li\u003e\n \u003cli\u003eChen W, Qian L, Shi J, Franklin M. Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification. BMC Med Res Methodol 2018;18:63.\u003c/li\u003e\n \u003cli\u003eLiu J, Li S. An ethnographic investigation of medical students\u0026rsquo; cultural competence development in clinical placements. Adv Health Sci Educ 2023;28:705-739.\u003c/li\u003e\n \u003cli\u003eAnstice NS, Alam K, Armitage JA, Biles B, Black JM, Boon MY et al. Developing culturally safe education practices in optometry schools across Australia and Aotearoa New Zealand. Clin Exp Optom 2023;106:110-118.\u003c/li\u003e\n \u003cli\u003eDurey A, Halkett G, Berg M, Lester L, Kickett M. Does one workshop on respecting cultural differences increase health professionals\u0026apos; confidence to improve the care of Australian Aboriginal patients with cancer? An evaluation. BMC Health Serv Res 2017;17:660.\u003c/li\u003e\n \u003cli\u003eFlavell H, Thackrah R, Hoffman J. Developing Indigenous cultural competence: A model for implementing Indigenous content into curricula. J Teach Learning Grad Employab 2013;4:39-63.\u003c/li\u003e\n \u003cli\u003eThackrah RD, Thompson SC, Durey A. \u0026quot;Listening to the silence quietly\u0026quot;: Investigating the value of cultural immersion and remote experiential learning in preparing midwifery students for clinical practice. BMC Res Notes 2014;7:685.\u003c/li\u003e\n \u003cli\u003eWest M, Sadler S, Hawke F, Munteanu SE, Chuter V. Effect of a culturally safe student placement on students\u0026rsquo; understanding of, and confidence with, providing culturally safe podiatry care. J Foot Ankle Res 2021;14:9.\u003c/li\u003e\n \u003cli\u003eThackrah RD, Thompson SC. Learning from follow-up of student placements in a remote community: A small qualitative study highlights personal and workforce benefits and opportunities. BMC Med Educ 2019;19:331.\u003c/li\u003e\n \u003cli\u003eThackrah RD, Wood J, Thompson SC. Longitudinal follow up of early career midwives: Insights related to racism show the need for increased commitment to cultural safety in aboriginal maternity care. Int J Environ Res Public Health 2021;18:1-14.\u003c/li\u003e\n \u003cli\u003eDe Zilva S, Walker T, Palermo C, Brimblecombe J. Culturally safe health care practice for Indigenous Peoples in Australia: A systematic meta-ethnographic review. J Health Serv Res Policy 2022;27:74-84.\u003c/li\u003e\n \u003cli\u003eVajapey SP, Weber KL, Samora JB. Confidence gap between men and women in medicine: A systematic review. Curr Orthop Pract 2020;31:494-502.\u003c/li\u003e\n \u003cli\u003ePapyrina V, Strebel J, Robertson B. The student confidence gap: Gender differences in job skill self-efficacy. J Educ Bus 2021;96:89-98.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health Workforce, Australian Aboriginal and Torres Strait Islander Peoples, Rural Health Services, Education, Professional, Allied Health Occupations","lastPublishedDoi":"10.21203/rs.3.rs-4022446/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4022446/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTogether with addressing social determinants of health, culturally safe healthcare provision is essential for closing the health outcomes gap experienced by Aboriginal and Torres Strait Islander (Indigenous) Australians. Rural placements potentially provide students of the health professions with opportunities to enhance their knowledge and skills regarding cultural safety. We used rural placements data systematically collected from allied health students, including commencement- and end-of-placement questionnaire responses, to investigate the determinants of confidence in working with Indigenous people.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe study comprised data from\u003cstrong\u003e \u003c/strong\u003eall students\u003cstrong\u003e \u003c/strong\u003ewho provided survey data at both commencement and end of their first placement directly supervised by the administering University Department of Rural Health during the period 2019–2022. Five-point ordered responses to the question 'How confident do you feel about working with Aboriginal people?' were used to assess student and placement-related determinants of confidence (Confident/Very confident versus other) at baseline and increased confidence (≥1 point) during the placement using crude and adjusted multivariable robust Poisson regression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eParticipating students (N=453) were from diverse allied health disciplines (including pharmacy n=92; 20.3%; chiropractic and social work each n=59, 13.0%; occupational therapy and physiotherapy each n=56, 12.4%). Confidence in dealing with Aboriginal people was higher at commencement among males compared with females (adjusted relative risk [aRR] 1.51; 95% confidence interval [CI] 1.22–1.86), students of Australian rural origin compared with others (aRR 1.46; CI 1.18–1.80), and those who reported previous experience working with Indigenous people (aRR 1.40; CI 1.13–1.72). Notably, for all three of these categories, complementary subgroup 'catch-up' during the placement was evident. Placement attributes associated with increased confidence working with Indigenous people between placement commencement and end were interaction with Indigenous people within the placement (aRR 2.15; CI 1.17–3.98), placement model reflecting more structured academic supervision (aRR 1.22; CI 1.04–1.43), and placement length (aRR per additional day 1.002; CI 1.001–1.004).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eWhile influenced by students’ demographic attributes and prior experiences, confidence of allied health students in working with Indigenous people is enhanced during rural placements, particularly through direct contact with Indigenous people.\u003c/p\u003e","manuscriptTitle":"Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-19 06:20:06","doi":"10.21203/rs.3.rs-4022446/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-21T14:02:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-24T09:19:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269907347120363723388666725240209019687","date":"2024-05-12T21:08:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-05T15:24:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9c2f363d-c9da-4052-a759-27ddf655018e","date":"2024-03-27T23:49:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5a742aab-3965-4978-8934-5ad1c6dee810","date":"2024-03-24T23:55:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-20T23:53:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-20T23:34:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-15T04:31:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-15T04:23:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-03-07T00:44:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"494a511a-a9b8-4da0-b764-79da10ccb970","owner":[],"postedDate":"March 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-04T16:27:01+00:00","versionOfRecord":{"articleIdentity":"rs-4022446","link":"https://doi.org/10.1186/s12909-024-06207-2","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-11-01 16:20:20","publishedOnDateReadable":"November 1st, 2024"},"versionCreatedAt":"2024-03-19 06:20:06","video":"","vorDoi":"10.1186/s12909-024-06207-2","vorDoiUrl":"https://doi.org/10.1186/s12909-024-06207-2","workflowStages":[]},"version":"v1","identity":"rs-4022446","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4022446","identity":"rs-4022446","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}