title: "Listening to the silence quietly": investigating the value of cultural immersion and remote experiential learning in preparing midwifery students for clinical practice.
abstract: BACKGROUND
  Cultural immersion programs are increasingly offered to medical and health science students in an effort to provide experiential learning opportunities that focus on 'the self' as well as 'the other'. Immersion programs encourage self-reflection on attitudes towards cultural differences, provide opportunities to build relationships and work with community members, and allow students to apply knowledge and skills learned in training programs in a supervised practice setting. The aim of this paper is to describe midwifery students' reflections on a remote Aboriginal clinical placement that has been offered at a Western Australian university since 2010.
  
  
  METHODS
  Interviews were conducted over a period of 15 months with the first seven participants who completed the program. At the time of interview, four participants were in the final year of their undergraduate degree and three were practicing midwives. In addition, access was given to a detailed journal kept by one participant during the placement. Interviews also were conducted with midwifery staff at the university and practice setting, although the focus of this paper is upon the student experience.
  
  
  RESULTS
  Student selection, preparation and learning experiences as well as implications of the placement for midwifery practice are described. The remote clinical placement was highly valued by all students and recommended to others as a profound learning experience. Highlights centred on connections made with community members and cultural knowledge learned experientially, while challenges included geographic and professional isolation and the complexities of health care delivery in remote settings, especially to pregnant and birthing Aboriginal women. All students recognised the transferability of the knowledge and skills acquired to urban settings, and some had already incorporated these learnings into clinical practice.
  
  
  CONCLUSIONS
  Cultural immersion programs have the potential to provide students with rich learning experiences that cannot be acquired in classroom settings. In Aboriginal communities on the Ngaanyatjarra Lands students gained valuable insights into the impact of isolation on health service delivery, the extent and strength of cultural traditions in the region, and a heightened awareness of the difficulties encountered by pregnant and birthing Aboriginal women in remote locations.
authors.affiliation: Western Australian Centre for Rural Health, University of Western Australia and Adjunct Senior Teaching Fellow, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia. rosalie.thackrah@research.uwa.edu.au.
authors.forename: Rosalie D
authors.initials: RD
authors.lastname: Thackrah
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
authors.forename: Angela
authors.initials: A
authors.lastname: Durey
mesh_terms: D001315:Australia; D003469:Culture; D005006:Ethnicity; D005843:Geography; D006801:Humans; D008880:Midwifery; D009042:Motivation; D010818:Practice Patterns, Physicians'; D018794:Problem-Based Learning; D013337:Students, Medical