A realist exploration of co-designed practice-placement models that ‘worked’ in shifting contexts of allied health industry, workforce and policy

Abstract Practice placements are a substantive component of allied health student curriculum that are critical for developing allied health professional competence. Students are situated in practice settings during placement, where their learning opportunities are opportunistic, and shaped according to population, industry, and policy needs: which change over time and in relation to each other as well as external forces. Allied health practice-placements must respond and adapt to the complex and evolving landscapes of practice; and evidence about the processes and products of such innovation is critical. Realist exploration of practice placements as open systems that occur within broader open systems, helps to expose and explore the changing factors that enfold practice placements and render them workable for service providers who manage competing priorities.We contribute a realist exploration of placement models developed for allied health learning during a profound transition of the Australian disability sector: from centrally- to recipient-controlled funding. In the context of declining placement offerings and reports of practitioner fatigue and administrative load, we facilitated an action-research workforce project with university and placement providers of allied health services to develop and trial quality placement education amidst transitional policy implementation. Our investigation seeks to understand the context-mechanism-outcome-configurations of innovative placement models that ‘worked’ for placement providers and students during a time of policy and industry turbulence. We apply layered realist inference to explore qualitative data collection with 40 students, practitioners, educators and placement facilitators about the process/es of innovating student placements (n = 50 instances); novel placement features co-designed during the project; and the role of placement facilitation within processes of co-design.Our key findings show that a collaborative approach to practice-placement education supports reflection about novel models and helps the needs of students and service recipients to become more visible in the relevant context/s of service provision. We further show the importance of developing reciprocity and partnerships for quality placement outcomes, without the need for resource-intensive placement facilitation approaches. This evidence is useful for promoting quality allied health education as the profession continues to expand and evolve, amidst open systems of policy and industry that influence practice and education.