Financial Implications of Unpaid Clinical Placements for Allied Health, Dentistry, Medical, and Nursing Students in Australia: a Scoping Review with Recommendations for Policy, Research, and Practice

Background: Investing in allied health, dentistry, medical, and nursing undergraduate and postgraduate qualifying education is critical to meet a growing demand on global health care systems. Clinical placements are an integral component of qualifying training and are conventionally unpaid. Widespread economic challenges, attributed to a post-COVID-19 pandemic recovery era and global unrest, have led to growing economic hardship for populations, even in high-income countries like Australia. Allied health, dentistry, medical, and nursing undergraduate and postgraduate students undertaking unpaid clinical placements are not immune from these stressors, which has implications for education providers, ageing populations, the future health care system, and policy-makers. The purpose of this review was to better understand these stressors by scoping the financial implications of unpaid clinical placements for allied health, dentistry, medical, and nursing students in Australian research.

Methods: The Joanna Briggs Institute's scoping review methodology was used. This involved a search of academic databases and an extensive search of grey literature sources. Literature published from 1 January 2014 was included. Citations were independently screened by two reviewers.

Results: Thirty-three research studies were included. Most studies focused on allied health students (n = 12), followed by nursing (n = 11), and medical students (n = 5), with an additional five studies focused on multiple disciplines, including dentistry. One study had an interventional component. Findings were grouped around four concepts: reliance on self-reported measures of financial implications, costs of unpaid clinical placements for students, implications of costs for students, and an urgent need for targeted strategies to redress.

Conclusions: The financial implications of unpaid clinical placements for allied health, dentistry, medical, and nursing students in Australia are well-established in research. Impacts are significant for the future of Australia's health workforce and health system. Research findings have been consistent over the past decade in advocating for greater financial support for students undertaking unpaid clinical placements and flexibility of placement models to mitigate the indirect costs of placements. Collaboration between state and federal government, universities, peak professional bodies, and placement host organisations is imperative to implement a suite of strategies to redress the financial burden experienced by students and secure the future of Australia's health workforce.