INTRODUCTIONInterprofessional learning (IPL) in health professional education is based on the notion that learning together will support more effective ways of working together. 1 IPL has the potential to improve interprofessional collaboration and the effectiveness and quality of patient care. Practice-based, rather than classroom-based, collaborative learning has been commended as an effective application of IPL. [2][3][4][5][6][7] However, it can be cumbersome to arrange and supervise. 8 In rural Australia with its relative workforce shortage, sustainable, practice-based IPL can be particularly challenging.
9In this paper, we describe a model of IPL -the Health 'Hubs and Spokes' (HHS) Project -which was based in rural towns and organised around locally-relevant priorities. HHS involved small teams of students from different disciplines, working together on a project identified by the host organisation. It was designed to be a sustainable model of interprofessional education using service learning -a type of practice-based learning where students engage with a community partner to collaborate, reflect and develop outcomes of real world benefit. 10 Although service learning is relatively new to Australian higher education settings, it is increasingly being adopted and is particularly well suited to students in the health professions.
11-12In theory service learning can lead to mutual benefits and outcomes for community organisations, universities and students, as a result of engaged scholarship and partnerships focused on clearlyarticulated local needs and service gaps. 13 A risk of university-community partnerships is that university needs may be prioritised over those of the community. 14 To avoid this, HHS focused on aspects of social capital that are particularly relevant for rural communities: the Project worked within networks of trusted agents in the community (community-based facilitators, and clinical supervisors) 15 and through its projects attempted to support the service-capacity of essential health institutions in the community. 16 Thus social capital was both an integral factor in the working of HHS and in the outcome of the individual team projects. Students' reactions, change in perceptions, and the impact of HHS on their behaviour have been described elsewhere. 17,18 In this paper, we describe the outcomes of the HHS at the level of the rural health service or community, and discuss potential programmatic tensions between focusing on service level outcomes, and outcomes that relate to individual attitudinal and behavioural characteristics.
METHODSThe Health 'Hubs and Spokes' Project is described in Box 1.Study type. This was a qualitative study using semi-structured interviews with 43 local facilitators, academic staff and health professionals (ascertainment, 80% of those involved in delivering the project), and 14 representatives of local health or community services (Table 1).Setting. Six rural towns in South East NSW, the location for 37 IPL teams of 89 students (82% of the 108 students who ...