Student Rural Placement Questionnaire
Please note: Some information you provide may be used for NSW and Commonwealth Departments of Health funding reports.
1.
Student Number:
2.
Sex:
Female
Male
3.
Are you a local or Full Fee paying (international) student
Local
International
4.
Do you have a rural background (Australia only)?
Please note:
rural = primary family residence in a defined Australian rural area for a minimum of five consecutive or eight cumulative years, from the age of five
No
Yes - where did you spend most of your time?
5.
Type of Attachment
Society and Health
Yr 5 GP
Yr 5 Hospital Term
Yr 5 Obstetrics & Gynaecology
Yr 5 Paediatrics
Yr 5 Psychiatry
Yr 6 Hospital Term
6.
What hospital are you based at?
POW
St George
St Vincent’s
Sutherland
SWSCS
7.
When did you undertake the placement?
Start date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/08
End date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/08
8.
In what town did you complete your placement?
9.
During your placement were you directly supervised by a general practitioner?
No
Yes - How many?
10.
What percentage of your placement did you spend……
In a hospital setting?
%
In a GP surgery?
%
In Community Health?
%
11.
The aims/objectives of the rural placement were clear to me
Strongly Agree
Agree
Disagree
Strongly Disagree
12.
How has this placement influenced your opinion about working in a rural area?
No influence - Already decided to work in a rural area
More likely to consider working in rural area
Less likely to consider working in rural area
No influence - Already decided NOT to work in a rural area
No influence - still undecided
13.
The best features of the placement were……
14.
The placement could be improved by………
15.
What type of accommodation did you stay in? (eg caravan, backpackers, motel, nurses quarters at the hospital, friends/family home)?
16.
Who arranged the accommodation for you?
17.
GP Students only: - If you arranged the accommodation yourself please provide contact details to assist other students looking for accommodation.
18.
How much did the accommodation cost per week?
19.
Would you recommend this accommodation to other students? Why/Why not?
Yes
No
20.
What type of transport did you use to/from Sydney?
Train
Coach
Car
Other (please specify)
Did you travel with others?
Yes
No
21.
What type of transport did you use during the placement?
Car
Train
Bus/Coach
Bicycle
Other (please specify)
If you have any questions about this form or your travel and accommodation reimbursement - please email
rural@med.unsw.edu.au