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- Volume 6, Issue 1, 2014
African Journal of Health Professions Education - Volume 6, Issue 1, 2014
Volume 6, Issue 1, 2014
Author Vanessa BurchSource: African Journal of Health Professions Education 6 (2014) http://dx.doi.org/10.7196/AJHPE.424More Less
In this edition of AJHPE, an article by Treadwell et al. reports on the reflections of 5th-year medical students after participation in an interprofessional learning activity. I was struck by a comment made by one of the students: 'My biggest challenge was remembering what needs to be done ... It was just "chakalaka" and all mixed up.'
Source: African Journal of Health Professions Education 6, pp 3 –5 (2014) http://dx.doi.org/10.7196/AJHPE.231More Less
Background. Teamwork as an outcome for graduates implies the understanding and appreciation of the roles, responsibilities and skills of other professions. An interprofessional education (IPE) event was initiated as a simulated management of a multiply traumatised patient in the acute phases of his injury, relevant to both medical and nursing students. The objective was to explore medical students' reflections on the value of this clinical simulation.
Method. A mixed-methods study was done, using a convenience sample of 5th-year medical students (N=96). Participants wrote a multiple-choice question (MCQ) test and either actively participated in the simulation or observed the actions through a one-way mirror. The simulations were facilitated by experienced skills trainers. On completion, the participants repeated the MCQ test and took part in a facilitator-led debriefing. The latter was audiotaped and students could submit written reflections. Written comments and transcripts of the audiotapes were analysed thematically.
Results. Participants' average test scores improved significantly (p<0.001) from 63.5% before the simulation to 68.6% thereafter. Five themes emerged from the reflections: (i) difficulties with implementing knowledge and skills; (ii) importance of teamwork; (iii) skills necessary for teamwork; (iv) effect of being observed by peers; and (v) IPE in the curriculum.
Conclusions. Medical students gained clinical knowledge during the simulation and became aware of their lack of skills, knowledge, and opportunities to acquire and practise skills required for effective teamwork.
Are further education opportunities for emergency care technicians needed and do they exist? : researchSource: African Journal of Health Professions Education 6, pp 6 –9 (2014) http://dx.doi.org/10.7196/AJHPE.285More Less
Background. A recent review of emergency care education and training in South Africa resulted in the creation of a new 2-year, 240-credit National Qualifications Framework (NQF) level 6 Emergency Care Technician (ECT) qualification. The National Department of Health (NDoH) view ECTs as 'mid-level workers' in the emergency care profession. Concurrently, an existing 3-year National Diploma and a 1-year BTech programme were consolidated to form a single 4-year, 480-credit, NQF level 8 professional Bachelor Degree in Emergency Medical Care (B EMC). This study critically analysed and compared the ECT mid-level worker qualification with the professional B EMC degree to design a framework and bridging programme to support articulation between the two qualifications.
Methods. The researchers used an expository, retrospective critical analysis of existing documentation followed by a focus group discussion and a Delphi questionnaire. These processes ultimately informed the design of the framework and contents of a bridging programme.
Results. Similarities and substantial differences were identified between the ECT and B EMC qualifications in relation to scope, complexity and depth of knowledge. A framework for articulation was designed, which included a bridging programme for ECT graduates wishing to enter the B EMC degree programme.
Conclusion. The study predicted a strong sustained demand from ECTs as mid-level workers for further study and associated professional development. It is possible for graduates of the 2-year ECT programme to articulate directly into the third year of the B EMC degree through successful completion of a bridging programme.
How we see 'Y' : South African health sciences students' and lecturers' perceptions of Generation Y students : researchSource: African Journal of Health Professions Education 6, pp 10 –16 (2014) http://dx.doi.org/10.7196/AJHPE.307More Less
Background. Health sciences education in the 21st century must recognise the changing profile of students, which includes an understanding of the characteristics of Generation Y students (born between 1981 and 2000) as future healthcare professionals.
Objective. To examine the perceptions of students and lecturers regarding Generation Y students in health sciences that might impact on teaching and learning in a South African setting.
Methods. A quantitative research approach was used to determine undergraduate students' and lecturers' perceptions of Generation Y students in the Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa. Anonymous questionnaires were used to obtain information.
Results. The study population included students (n=616) and lecturers (n=71). Despite some shared perceptions about generational characteristics, students and lecturers differed significantly on many issues. Unlike lecturers, students perceived themselves as being ambitious (not arrogant) and possessing superior cognitive skills. Despite desiring a vibrant and stimulating learning environment, students wanted face-to-face contact with lecturers. Poor intergenerational communication also emerged as a pertinent issue.
Conclusion. Identification of intergenerational issues that may impact on teaching and learning may contribute to developing novel educational approaches acceptable to both lecturers and students.
Do physiotherapy students perceive that they are adequately prepared to enter clinical practice? An empirical study : researchSource: African Journal of Health Professions Education 6, pp 17 –22 (2014) http://dx.doi.org/10.7196/AJHPE.219More Less
Objective. To determine the perceived level of preparedness for clinical practice of third-year physiotherapy students.
Design. A prospective, descriptive study, using questionnaires to determine subjective perceptions and clinical test marks for objective measures of performance, was undertaken. Two different cohorts were recruited of third-year students entering clinical practice for the first time.
Method. A 17-item questionnaire relating to areas of competence was developed. Results of questionnaire scores and test scores from the 2 cohorts were amalgamated and analysed. Participants were grouped according to their clinical placement. The internal consistency of the questionnaire was tested using Cronbach's alpha. As this was high at 0.847, the individual scores were added together and the mean score calculated. Analysis of variance (ANOVA) was used to establish if there was a significant difference in scores across different areas of competency and on test marks, across the different clinical settings.
Main outcomes measure. Means and 95% confidence intervals of the mean scores of each component of competence indicated a significant difference between the scores (p<0.001). One-way ANOVA and post hoc analysis revealed that the students perceived themselves as better prepared in affect (generic skills) than for intervention and overall preparedness ((F(4, 264)=4.8601, p<0.001). There were no significant differences between the competency mean scores (F(4,53)=0.804, p=0.528), or in the mean test scores, across the placements (F(4, 77)=0.438, p=0.781).
Results. Most of the students perceived their level of preparedness as relatively high across all areas of competence, regardless of placement. Students also achieved satisfactory (>60%) test scores, indicating realistic estimations of their ability.
Conclusion. The sense of readiness confirms the alignment of the classroom curriculum and clinical expectations, which has largely come about through the positioning of permanent clinical educators as essential links between the classroom and the clinical setting.
Source: African Journal of Health Professions Education 6, pp 23 –27 (2014) http://dx.doi.org/10.7196/AJHPE.318More Less
Background. The primary aim of undergraduate medical training at South African medical schools is to prepare the graduates adequately for internship. If we are to attain this objective, it is crucial to evaluate the ability of our graduates to cope with the demands of internship.
Objective. To determine the extent to which first-year interns from Stellenbosch University (SU) considered that their undergraduate education prepared them for internship.
Methods. The Preparedness for Internship Questionnaire (PIQUE) is based on Hill's Preparation for Hospital Practice Questionnaire, with additional questions covering core competencies and exit outcomes that SU has determined for its medical curriculum. Participants were asked to respond to a series of statements preceded by 'My undergraduate medical training prepared me to ... ', and also two open-ended questions. SU's MB ChB graduates of 2011 (N=153) were invited to participate in the online survey.
Results. Although the response rate was only 37%, graduates generally thought they had been well prepared for most mainstream clinical activities. However, there were areas in which respondents considered they could have been better prepared, specifically pharmacology, medicolegal work, minor surgery and the non-clinical roles that interns encounter.
Conclusion. PIQUE appears to be a useful tool that can assist with curriculum renewal by highlighting areas that graduates feel they could be better prepared for. This challenges us to identify how curricula and teaching can be adjusted accordingly.
Student doctors (umfundi wobugqirha) : the role of student-run free clinics in medical education in Cape Town, South Africa : researchAuthor S.C. MendelsohnSource: African Journal of Health Professions Education 6, pp 28 –32 (2014) http://dx.doi.org/10.7196/AJHPE.311More Less
Background. Since 1943, the Students' Health and Welfare Centres Organisation (SHAWCO) of the University of Cape Town has provided voluntary, student-run free clinics in under-served communities in Cape Town, South Africa, filling major gaps in the city's healthcare services.
Objective. To determine the role SHAWCO clinics play in medical education.
Methods. A mixed-methods study with a predominantly quantitative questionnaire utilising dichotomised Likert scales was performed with 110 clinic volunteers. The Likert scales were converted to population proportions for quantitative analysis. Qualitative data obtained from participants' comments were analysed thematically.
Discussion. SHAWCO clinics provide a controlled environment in which to practise skills acquired in medical school. Over 98% of students attend clinics to increase their clinical exposure. Medical conditions that students encounter are primary care problems, often neglected at tertiary level teaching institutions. The clinics achieve what the formal curriculum struggles to do: humanise medical treatment, allowing one to better understand the socio-economic background of patients.
Conclusion. SHAWCO is best suited in its current role of hands-on, community-based learning to augment the training provided in the formal medical curriculum.
Source: African Journal of Health Professions Education 6, pp 33 –36 (2014) http://dx.doi.org/10.7196/AJHPE.297More Less
Background. Developing the problem-solving skills of student radiographers is imperative for encouraging critical thinking and allowing them to work efficiently in an era of rapidly advancing technology. Students' ability to demonstrate these skills was studied so that the Department of Radiography, at a comprehensive university in South Africa, could develop a more explicit curriculum to facilitate these competencies.
Objective. To assess problem-solving skills of third-year radiography students at a comprehensive South African university.
Methods. The study employed a descriptive exploratory design. The participants' responses to vignettes (in the form of clinical scenarios) were analysed using a Likert scale and action verbs developed for evaluating evidence of problem-solving skills and providing quantitative data. Field notes were made while analysing responses to each question, providing qualitative data.
Results. The findings indicate that the majority of participants demonstrated a minimal ability to problem solve in a vignette. This implies that to improve problem-solving skills of student radiographers, there is a need for curriculum adjustment to nurture and encourage this competency.
Conclusion. Facilitators need to be taught methods to integrate problem solving into the curriculum, and learning material must be adjusted to accommodate problem solving for this skill to become part of the programme outcomes.
Introduction of a learning management system at the Kilimanjaro Christian Medical University College : researchSource: African Journal of Health Professions Education 6, pp 37 –40 (2014) http://dx.doi.org/10.7196/AJHPE.260More Less
Background. Medical schools in Africa face daunting challenges including faculty shortages, growing class sizes, and inadequate resources. Learning management systems (LMS) may be powerful tools for organising and presenting curricular learning materials, with the potential for monitoring and evaluation functions.
Objective. To introduce a LMS for the first-year medical student curriculum at the Kilimanjaro Christian Medical University College (KCMU Co), in Moshi, Tanzania, in partnership with the Duke University School of Medicine (Durham, North Carolina, USA).
Methods. Observations were made on the requisite information technology (IT) infrastructure and human resource needs, and participation in training exercises. LMS utilisation was recorded, and two (student and faculty) surveys were done.
Results. The KCMU Co IT infrastructure was upgraded, and an expert team trained for LMS implementation. An introductory LMS workshop for faculty had 7 out of 25 invitees, but attendance improved to more than 50% in subsequent workshops. Student attendance at workshops was mandatory. Use of the LMS by students rapidly expanded, and growing faculty utilisation followed later. By the end of the second semester, online examinations were offered, resulting in greater student and faculty satisfaction owing to rapid availability of results. A year after LMS introduction, 90% of students were accessing the LMS at least 4 days/week. A student survey identified high levels of satisfaction with the LMS software, quality of content, and learning enhancement.
Conclusion. LMS can be a useful and efficient tool for curriculum organisation, administration of online examinations, and continuous monitoring. The lessons learned from KCMU Co may be useful for similar academic settings.
Medical and dental students' willingness to administer treatments and procedures for patients living with AIDS : researchSource: African Journal of Health Professions Education 6, pp 41 –44 (2014) http://dx.doi.org/10.7196/AJHPE.201More Less
Background. Nearly three decades after the discovery of the human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) epidemics continue to pose significant challenges to low-income countries in sub-Saharan Africa.
Objective. To assess medical and dental students' willingness to perform specific techniques and procedures on people living with AIDS (PLWA).
Methods. A survey was done among medical and dental students (N=304) at a Nigerian University using a 21-item questionnaire that elicited responses on sociodemographic characteristics and willingness to perform specific techniques and procedures. Analysis of variance (ANOVA) and an independent t-test were used to determine the influence of sociodemographic variables. Multiple regression analyses were used to determine the predictors of willingness.
Results. The cohort of medical and dental students was willing to care for PLWA. Almost all medical students were either undecided or unwilling to perform mouth-to-mouth resuscitation. A higher proportion of dental students were either undecided or unwilling to assist during surgery, tooth extractions and other procedures they considered to be invasive. More medical than dental students were willing to carry out surgical procedures. Previous personal encounters with AIDS patients, religion, and satisfaction with instructions influenced medical and dental students' willingness to care for PLWA, while knowing a family member living with AIDS (R2=0.22, p<0.001) was the strongest predictor of willingness to care for PLWA.
Conclusion. Extensive use of clinical clerkships and exposure through direct experience are viable strategies necessary for optimising and enhancing medical and dental students' dispositions to perform procedures and care for PLWA.
Source: African Journal of Health Professions Education 6, pp 45 –47 (2014) http://dx.doi.org/10.7196/AJHPE.226More Less
Background. Undergraduate students at universities have different learning styles. To perform optimally, both they and their educators should be made aware of their preferred learning styles and problem-solving abilities. Students have different backgrounds, strengths, weaknesses, interests, ambitions, levels of motivation and approaches to studying and educators should therefore aim to become more aware of the diverse approaches to learning.
Objective. To identify the various learning styles and problem-solving abilities of physiotherapy students at the University of the Western Cape, South Africa.
Methods. Undergraduate physiotherapy students (N=246) who were registered for the 2012 academic year participated in the study. Three valid and reliable questionnaires, including the Index of Learning Styles (ILS), the Problem-Solving Style Questionnaire (PSSQ) and the Learning Style Questionnaire (LSQ), were used. Responses were analysed statistically to establish the association between learning styles and problem-solving ability.
Results. A response rate of 72% was reported (n=177). For first-, second-, third- and fourth-year students the response rates were 65/85 (76%), 53/67 (79%), 31/58 (53%) and 28/36 (78%), respectively. Forty-five (25%) participants were male, 124 (70%) were female and 8 (0.04%) did not indicate their gender. The prominent learning styles were feeling (PSSQ), kinaesthetic (LSQ) and visual-verbal (ILS). Males were prone to using the kinaesthetic learning style and females to a more visual learning style. The feeling group constituted 47% of the sample (39% males and 43% females).
Conclusion. The majority of students seem to learn by doing, although facts are important to them. It therefore might be important to first teach physiotherapy students concepts and then assist them to apply these in practice.
Health-promoting schools as a service learning platform for teaching health-promotion skills : researchSource: African Journal of Health Professions Education 6, pp 48 –51 (2014) http://dx.doi.org/10.7196/AJHPE.250More Less
Background. Health sciences students have traditionally been taught their practical skills in community health facilities. However, clinics and hospitals are not necessarily ideal settings for teaching students health-promotion skills.
Objective. To explore health-promoting schools (HPSs) to teach Stellenbosch University (SU) undergraduate dietetic students health-promotion skills.
Methods. In this descriptive, cross-sectional study, students completed structured reflective journals and conducted interviews with teachers. The chief professional nurse interviewed the school principals.
Results. The students were positive about HPSs, but only fully understood its implementation and practice after entering the school setting. They felt that they could play a role in increasing its efficacy. The teachers were positive about the initiative and thought that they had adequate knowledge to take it further, but were open to gaining more knowledge and insight. Teachers and students had similar views on the role that students could play in HPSs, including educating learners, parents and teachers on health and nutrition, assisting with growth monitoring and promotion, developing educational tools, obtaining various resources for schools, planning menus, budgeting for meals, and growing vegetables. Resources required by the schools could best be addressed by a team of healthcare professionals in collaboration with government departments and with community support.
Conclusion. HPSs offer extensive opportunities where SU undergraduate dietetic students, and possibly other healthcare profession students, could serve the needs of communities while learning and practising health-promotion skills.
Using graduates as key stakeholders to inform training and policy in health professions : the hidden potential of tracer studies : researchSource: African Journal of Health Professions Education 6, pp 52 –55 (2014) http://dx.doi.org/10.7196/AJHPE.302More Less
Background. Tracer studies are alumni surveys that attempt to track activities of graduates of an educational institution, which enable the contextualisation of these professionals through a dynamic and reliable system to determine their career progression. It also enables the gathering of information to feed back into training institutions and to inform policy bodies on key issues. The purpose of this study was to track career paths of radiography graduates in Uganda, examine their contribution to their profession, and establish their opinions on how to improve training and inform policy.
Methods. A cross-sectional descriptive survey of radiography graduates who completed their training between 2001 and 2011 was conducted. Names of graduates were obtained from university records and contact details were sought from the register of the Uganda Radiographers Association, Facebook, Twitter, and friends. Data were collected using a self-administered questionnaire distributed electronically to the students. In a few instances, the survey was completed telephonically.
Results. A total of 90 questionnaires were sent out; 72 (80%) were returned. The majority of the respondents (95.8%) were employed as radiographers at the time of the survey and were all satisfied with their work. A significant number were employed abroad, while those who remained in the country worked for private health facilities and only a few worked in government health facilities. Key suggestions were identified to improve training and influence policy.
Conclusion. Graduate radiographers were generally satisfied with their current work. Many trained radiographers, however, are leaving the country, thereby creating a skills shortage in the government healthcare system.
The effect of characterisation training on the congruence of standardised patient portrayals : researchSource: African Journal of Health Professions Education 6, pp 56 –59 (2014) http://dx.doi.org/10.7196/AJHPE.193More Less
Background. Incongruence of standardised patient (SP) portrayals is worsened when SPs are given basic scenarios and too little background information on short notice. Consequently, SPs are confronted with questions they find difficult to answer owing to a lack of insight, internalisation and association with the role.
Objective. To determine whether training in characterisation enhances the congruence of SP portrayals.
Methods. SP encounters were recorded, after which the participating SPs and students reflected on the congruence of the SPs' performances. The researchers analysed the videorecordings and reflections for incongruent behaviours. The findings were triangulated and themes of incongruency were established. The intervention comprised training of SPs in the creation of subtext (the story behind the story), characterisation, and linking to and making use of emotion memory, with the aim of rectifying the observed incongruent behaviours. Pre-training activities were repeated with Cohort 2 students.
Results. Two themes depicting congruence, i.e. internalisation of character and congruence of verbal and non-verbal communication, were identified. Post-training outcomes revealed an improvement in all subthemes. Applicable and real emotions, complementing verbal and non-verbal cues, gestures and appropriate use of voice and facial expression, led to believable/congruent role play and improved communication on various levels.
Conclusion. The post-training outcomes showed clear improvement regarding the congruence of SP portrayals. The changes can be contributed to SP training focused on 3D character development by creating subtext, providing basic clinical information, emotion memory, acting skills, managing energy levels, and not focusing on the scenario alone.
Source: African Journal of Health Professions Education 6, pp 60 –63 (2014) http://dx.doi.org/10.7196/AJHPE.268More Less
Background. Training and re-training of healthcare workers is pivotal to improved service delivery.
Objective. To determine the proportion of practising medical laboratory scientists with in-service training in Benin City, Nigeria and areas covered by these programmes.
Methods. Medical laboratory scientists from Benin City (N=127) (public (n=79) and private (n=48) sectors) were recruited for this study. A detailed questionnaire was used to obtain relevant information from all enlisted participants.
Results. Eighty-four (66.1%) of all medical laboratory scientist volunteers (N=127) reported to have attended an in-service training programme. This was significantly associated with gender (male v. female: 80.9% v. 58.8%; odds ratio (OR) 6.071; 95% confidence interval (CI) 2.510 - 14.685; p<0.0001). Only 9/84 (10.7%) participants reported to have had at least one in-service training session during the last 12 months. Attendance was significantly affected by qualification (p=0.029), area of specialisation (p=0.003) and affiliation (p=0.005). Irrespective of affiliation, self-sponsorship of in-service training programmes was most frequently reported by study participants. Training received by respondents was mainly in instrumentation and diagnostic techniques.
Conclusion. Attendance of in-service training programmes during the last 12 months was poor. Training programmes were mostly funded by participants. Regular training of medical laboratory scientists by the relevant authorities and agencies is advocated.
Physiotherapy clinical students' perception of their learning environment : a Nigerian perspective : researchSource: African Journal of Health Professions Education 6, pp 64 –68 (2014) http://dx.doi.org/10.7196/AJHPE.248More Less
Background. A favourable environment has a positive and significant impact on students' learning, academic progress and well-being. The present study was undertaken to identify the perceptions of physiotherapy students in their clinical years of their learning environment at the College of Medicine, University of Ibadan, Nigeria.
Methods. A focus group discussion involving 12 undergraduate physiotherapy students was used to obtain information about their perception of their learning environment. Six students from two clinical levels of study were recruited through a simple random sampling technique. The focus interview guide was developed based on information obtained from the DREEM questionnaire and literature review. The interviews were analysed using the identified themes from DREEM and grounded theory for emerging subcategories.
Results. Five descriptive themes and several subcategories were identified: (i) context of learning (course objectives, student focused/teacher centred, active learning); (ii) context of teachers (knowledgeable teachers, provision of formative assessment, approachable lecturers, cordial teacher-student relationship); (iii) context of students' perception of their academic skills (understanding the subject); (iv) context of atmosphere (adequacy of facilities, e.g. chairs, classrooms, library, books); and (v) context of social life (religious activities, social functions, school-related social activities).
Conclusion. Most students perceived their learning environment as good, especially with regard to student-teacher relationships. Some of the teachers were described as knowledgeable, and as providing formative assessment. However, students perceived their learning as being teacher centred. To facilitate an excellent learning environment, particular attention needs to be paid to availability of physiotherapy textbooks in the college library, sufficient appropriate furniture in classrooms, and provision of a functioning departmental library. The findings from this study may provide insights for teachers who wish to enhance the effectiveness of their teaching and of their students' learning.
Sixth National Conference of the South African Association of Health Educationalists (SAAHE) : 'Information to Transformation', Umhlanga, 27 - 29 June 2013 : abstractsSource: African Journal of Health Professions Education 6, pp 69 –113 (2014) http://dx.doi.org/10.7196/AJHPE.419More Less