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- Volume 7, Issue 1, 2015
African Journal of Health Professions Education - Volume 7, Issue 1, 2015
Volume 7, Issue 1, 2015
Author Vanessa BurchSource: African Journal of Health Professions Education 7, pp 2 –3 (2015) http://dx.doi.org/10.7196/AJHPEnew.7896More Less
The 20th century Flexnerian approach to health professions education (HPE) focused on the need to provide healthcare professionals with a solid foundation of biomedical knowledge. While such knowledge will always underpin clinical practice, health professions educators in the 21st century are grappling with a much broader mandate - the professional behaviour/attributes of healthcare practitioners, i.e. professionalism. As suggested by Wilkinson et al., 'professionalism is about what someone does, rather than what he or she knows.' Miller's pyramid, intended to describe a hierarchical approach to assessment, also serves well in the context of professionalism - we need to move toward 'doing' and away from just 'knowing'.
Strategies to include sexual orientation and gender identity in health professions education : forumAuthor A. MullerSource: African Journal of Health Professions Education 7, pp 4 –7 (2015) http://dx.doi.org/10.7196/AJHPE.359More Less
Background. Sexual orientation and gender identity are not taught in African health professions curricula. In order to improve the quality of care for lesbian, gay, bisexual, transgender and intersex (LGBTI) patients, health professionals need to shift their attitudes towards sexual orientation and gender identity, and learn about specific LGBTI health needs.
Discussion. The curricula of African health professions education provide various opportunities to include teaching about sexual orientation and gender identity. Various disciplines can teach sexual orientation and gender identity issues in their context by challenging heteronormativity and highlighting specific LGBTI health concerns, and can do so more successfully with interactive teaching approaches that hold more potential than formalised lectures. Rights-based teaching frameworks should include sexual orientation and gender identity as markers of difference. To achieve this, educators need to build capacity to teach about these issues, and support LGBTI students in their institutions.
Conclusion. Teaching about sexual orientation and gender identity is urgently needed in African health professions education, but it is complex. This article presents strategies to incorporate sexual orientation and gender identity into the curricula of medical schools, nursing colleges, and the allied health sciences.
An ethical dilemma : a case of student training, intermittent service and impact on service delivery : short reportAuthor P. GovenderSource: African Journal of Health Professions Education 7, pp 8 –9 (2015) http://dx.doi.org/10.7196/AJHPE.405More Less
One of the fundamental precepts in the training of students in a clinical discipline involves appropriate placement and supervision in order for learning outcomes to be achieved. As an academic/clinical educator, one is at times faced with dilemmas in student placement that challenge one's personal and professional ethics. This paper highlights one case example that describes student training and the impact on service delivery.
Source: African Journal of Health Professions Education 7, pp 10 –15 (2015) http://dx.doi.org/10.7196/AJHPE.223More Less
Background. Components of professionalism in undergraduate medical studies at the University of Pretoria (UP) were previously defined as nine 'Golden Threads'. Although specific outcomes were formulated for the threads, the need for more explicit professional standards became increasingly evident. The restructuring of the health system in South Africa contributed to the need for more explicit standards. The Charter for Medical Professionalism was developed during 2006 - 2008 as a reference document within the local context to serve as a standard for professionalism in the medical curriculum. Another aim was to guide academics in medical studies to act as good role models of professional behaviour.
Objective. To document the development of the Charter for Medical Professionalism and to evaluate lecturer and student perceptions on the formulation of the Charter to make appropriate changes and increase acceptance.
Methods. The project took the form of action research, and a working group comprising academics from UP's Faculty of Health Sciences developed the Charter from relevant source documents, employing thematic and content analysis and recursive abstraction. An online survey was conducted to assess lecturer and student acceptance of the Charter.
Results. The outcomes-based approach was perceived as acceptable and appears to broaden the scope of assessment of professionalism.
Conclusion. Inclusion of outcomes proposed by other work groups relating to research, practice management, teaching, mentoring and leadership roles of the medical doctor may be considered in future.
The implementation of the Objective Structured Practical Examination (OSPE) method : students' and examiners' experiences : researchSource: African Journal of Health Professions Education 7, pp 16 –21 (2015) http://dx.doi.org/10.7196/AJHPE.228More Less
Background. Traditionally, physiotherapy practical skills have been assessed by a method that relies on the subjective interpretation of competency by the examiner and lacks the formative benefits of assessment.
Objective. To describe and compare student performance and satisfaction and examiner satisfaction with regard to the Objective Structured Practical Examination (OSPE) and traditional mark sheets during the practical skills assessment.
Method. Students and examiners taking part in the second-year physiotherapy practical skills test were invited to participate by completing a series of questionnaires. Performance of techniques was marked using both the OSPE and traditional mark sheets.
Results. Sixty-seven students and nine examiners participated in the study. Students scored an average of 4.6% (SD ± 16.4) better when using the traditional mark sheet. Nonetheless, students and examiners expressed a preference for the OSPE mark sheet.
Conclusion. The OSPE mark sheet allows for increased objectivity, as the specific micro-skills are clearly listed and appropriately weighted. This resulted in increased satisfaction, but a decrease in marks obtained. By assessing the effect of implementation of the OSPE method on performance and satisfaction, change in the current situation can be monitored.
Students' experiences of inter-professional education through International Classification of Functioning-based activities at a community-based rehabilitation centre : researchSource: African Journal of Health Professions Education 7, pp 22 –25 (2015) http://dx.doi.org/10.7196/AJHPE.289More Less
Introduction. The training of healthcare professionals is faced with many challenges. To ultimately strengthen the health system, training has to respond to new health challenges, health science developments and societal needs. The Bishop Lavis Primary Health Care Project was established in 1993 and led to the establishment of the Bishop Lavis Rehabilitation Centre (BLRC). The current inter-professional service delivery at the Centre is based on the World Health Organization's International Classification of Functioning (ICF) model for holistic client-centred care. The objective of this article is to describe the students' experiences of inter-professional education (IPE) through ICF-based activities at BLRC.
Methods. Data were gathered from a retrospective review of student feedback forms from 2010 to 2012. Content analysis was employed to identify key themes regarding IPE.
Results. Inter-professional learning was found to occur spontaneously between the four allied health professions as a result of the ICF model-driven activities at BLRC.
Conclusion. Feedback at the end of the students' clinical placement was open ended and no information was asked specifically about IPE. More than half of the students spontaneously mentioned that learning about working in an inter-professional team as one of the highlights of their placement at BLRC, has prompted the sharing of this information. This article offers a potential framework (ICF) that fosters and supports the IPE philosophy in a clinical setting.
Source: African Journal of Health Professions Education 7, pp 26 –31 (2015) http://dx.doi.org/10.7196/AJHPE.312More Less
Background. Physician leadership is essential for the strengthening of health systems, especially in underserved settings such as sub-Saharan Africa. To be effective, leaders must be perceived as such by their community. It is unknown how perceptions of physician leadership in Botswana compare with those of the Canadian Medical Education Directives for Specialists (CanMEDS) Physician Competency Framework, which is used to shape the training of Botswana's future physicians.
Objective. To examine if the perceived competencies of physician leadership in Botswana are specifically named in the CanMEDS Framework and thereby inform Botswana's graduate medical education.
Methods. We conducted focus groups discussions with nurses, interns, medical officers and specialists at Princess Marina Hospital and Nyangabgwe Referral Hospital. Key questions focused on describing the qualities of physician leadership. For data analysis we used inductive content coding and comparison with the CanMEDS frameworks.
Results. Forty-eight clinicians participated and 111 unique codes were assigned to 503 comments. Eighty-four per cent of comments corresponded to the CanMEDS 2005 competencies; many were captured within the competencies of the medical expert (13.0%), communicator (17.8%), collaborator (15.6%), scholar (14.9%) and professional (31.3%) roles. About 5% of comments mapped to the draft CanMEDS 2015 update, and 11.5% were not specifically described in either version of CanMEDS, including charisma and decisiveness.
Conclusion. The CanMEDS frameworks specifically address most of the competencies perceived as important for physician leadership in Botswana. Additional perceptions were identified that may require the attention of existing and aspiring physician leaders and their teachers to ensure they attain and maintain their effectiveness as leaders.
Identity and attribution as lenses to understand the relationship between transition to university and initial academic performance : researchAuthor W. McMillanSource: African Journal of Health Professions Education 7, pp 32 –38 (2015) http://dx.doi.org/10.7196/AJHPE.356More Less
Background. Most students experience the transition from school to university as challenging. First-generation students are particularly vulnerable, as they receive little preparation for the expectations of university.
Objective. To understand the relationship between preparation for university, transition experiences, and academic performance in the first two years at university.
Methods. Sixteen second-year dentistry students were interviewed in this qualitative pilot study. Their marks for the first 18 months at university were accessed. Two theoretical frameworks were used to analyse the data - academic identity and attribution. Analysis resulted in four groupings: academically competent middle-class students, academically struggling middle-class students, academically struggling working-class students and academically competent working-class students.
Results. Findings suggest that students' academic performance is influenced by social class and assumptions of controllability and causality. Assumptions about control over their environment influenced how they engaged at university. These assumptions resulted in some students being better positioned for integration into the practices rewarded at university. Irrespective of social class, those who attributed academic performance to factors outside their control performed less well.
Conclusion. The study suggests that interventions are required that help all students to control their academic performance. Attributional retraining (AR) has the potential to assist students who attribute academic performance to causes beyond their control. The article concludes with suggestions for ways in which AR might be implemented to assist all students towards obtaining competent academic performance. Suggestions are also made for further large-scale studies.
The Human Rights Key : an innovative tool for teaching health and human rights in the health sciences : researchAuthor V.A. MitchellSource: African Journal of Health Professions Education 7, pp 39 –42 (2015) http://dx.doi.org/10.7196/AJHPE.366More Less
Background. In response to the need for health and human rights education in undergraduate medical curricula, the Faculty of Health Sciences at the University of Cape Town, South Africa, has included human rights learning in its reformed programme. Drawing on experiences in several curricular initiatives within the Faculty and beyond, I introduce the Human Rights Key as a new heuristic learning tool.
Objective. To share a teaching innovation in an area of need in medical education.
Method. The Key scaffolds and facilitates students' learning through a sequential process of guided self-reflection with probing questions. It illuminates the inter-relationship of key human rights concepts, enabling students to create and make connections between human rights principles, legal mechanisms, their own personal realities and their developing clinical practice.
Discussion. Feedback reflects the effectiveness of the Human Rights Key in supporting transformative learning, suggesting that the Key will remain prominent in students' memory. Online publication of the Key as an open educational resource (OER), with extensions to specific themes, has increased its impact and demonstrated the generalisability of the tool.
Conclusion. I propose the Human Rights Key as a useful visual communication tool to guide students in connecting their classroom learning with the reality of local, regional and international health and human rights issues. As an OER with a Creative Commons licence, the Key is available online for both educators and students to use as a resource with downloadable components.
Discovering the value of personality types in communication training for pharmacy students : researchSource: African Journal of Health Professions Education 7, pp 43 –46 (2015) http://dx.doi.org/10.7196/AJHPE.370More Less
Background. The current movement in the pharmacy profession, from the product towards the patient, demands new educational approaches that support the exit-level outcomes of the South African Pharmacy Council as implemented in 2013. Patient-centred communication calls for an ability to 'walk in the patients' shoes'. Pharmacists, like others, are naturally inclined to think and treat others as they themselves perceive the world, which can result in miscommunication.
Objectives. To determine the prevalence of the 16 different Myers-Briggs Type Indicator® (MBTI®) communication styles, and compare them with the prevalence of these styles in the South African (SA) population. Furthermore, to determine the possibility of a pharmacy student interacting with a patient with a similar communication style.
Method. A novel way to sensitise pharmacists to the differences in people's experiences, behaviours and communication styles is to introduce them to type theory with the MBTI®. A survey design was used to determine 786 pharmacy students' communication styles, using the MBTI®. These students were enrolled for the subject 'Communication for pharmacists' at the largest pharmacy school in SA.
Results. More students were consistently found with Sensing Feeling preferences than in the general SA population. The possibility that a pharmacy student might consult with a patient with a similar style varied between one and 414 chances out of 10 000 consultations.
Conclusion. This study highlights the importance and possibility of using the MBTI® as part of communication training of pharmacy students. Sensitising students to their own preferences and those of their patients empowers them to patient-centred communication.
A lesson in listening : is the student voice heard in the rush to incorporate technology into health professions education? : researchSource: African Journal of Health Professions Education 7, pp 47 –50 (2015) http://dx.doi.org/10.7196/AJHPE.371More Less
Background. Early indications are that blended learning in health professions education has a positive influence on student satisfaction and learning. This is encouraging, as the call to incorporate technology in teaching and learning in higher education is increasing. The student voice in the planning and implementation of blended learning strategies is, however, not adequately addressed in many of the studies to date.
Objective. To utilise videos and blogging in a problem-based learning physiotherapy module to enhance student engagement with content of problem-based cases.
Methods. Students completed a needs-analysis and engagement questionnaire. Videos made by students were uploaded to the learning management system and subsequent use of these videos was recorded. Two focus group discussions were held to evaluate students' perceptions of the blended learning strategies.
Results. Students perceived the level of engagement during case presentation periods to be satisfactory, but unsatisfactory outside of such periods. Focus group discussions identified the technology used in this study as being inappropriate for this population. Students had specific expectations of the roles of staff and students. There was a perceived lack of skill with regard to the use of the technology chosen.
Conclusion. There is a need for the student voice to be heard with regard to both the rationale for implementation and the type of technology used in blended learning strategy innovations. This study recommends that student-generated videos of clinical skills could be implemented successfully with adequate support from staff.
Curriculum challenges faced by rural-origin health science students at South African medical schools : researchSource: African Journal of Health Professions Education 7, pp 51 –54 (2015) http://dx.doi.org/10.7196/AJHPE.390More Less
Background. The current shortage of healthcare workers in rural communities demands attention. The sourcing of rural-origin students (ROSs) has been suggested, but retention of these students in their chosen degrees is crucial. Addressing the tertiary education challenges that ROSs face is critical to ensuring their success.
Objective. To focus on the various challenges influencing throughput of ROSs.
Method. This article is one of a series of investigations into various aspects of university life and career choices of health science students. Data were collected at three South African universities by the Collaboration for Health Equity through Education and Research (CHEER) collaborators. Ethical permission was sought from each institution. Health science students at the relevant institutions consented to completing a self-administered questionnaire. The data were analysed on SPSS and χ2 tests were used to describe the statistical significance of the results.
Results. Academic course content was the greatest challenge as perceived by students. Differences between rural and urban students were significant in all aspects of university life studied. Technological challenges were five times more common for ROSs. Differences between first- and final-year students were not as marked, although the personal challenges and academic course content became easier as students progressed through their degree.
Conclusion. Although ROSs face similar challenges as students of urban origin, in some instances these are enhanced and magnified. These students are more likely to find various aspects of university life challenging. To improve the success and retention of ROSs, adequate support structures are essential.
Learning approaches used by students in an undergraduate emergency medical care programme : researchSource: African Journal of Health Professions Education 7, pp 55 –57 (2015) http://dx.doi.org/10.7196/AJHPE.393More Less
Background. Students may primarily use either a deep learning approach (DLA) or surface learning approach (SLA) in response to their perceptions of the intrinsic and extrinsic factors within a given learning environment. By determining the learning approaches of students, one can provide important information on how they learn within an educational programme - information that can be used for various applications with regard to future structure and presentation of programme content.
Objectives. To determine which learning approaches (DLA or SLA) were being used by students in the Bachelor of Emergency Medical Care programme at the University of Johannesburg, South Africa, in each academic year of study. Further objectives were to determine which intrinsic and extrinsic factors influenced these choices and to assess whether learning approaches differed significantly between academic years of study.
Methods. This study was conducted using a quantitative design and a validated 20-question survey instrument. Data analysis was primarily descriptive, but also focused on whether there was a significant difference in learning approaches between the four years of study.
Results. Seventy students participated in the study, giving an overall response rate of 85%. Results showed that most students predominantly used a DLA, and that there was no significant difference between the four academic years of study with regard to the predominant learning approach. More students appeared to be influenced to use a DLA by extrinsic factors than intrinsic factors.
Conclusion. Further research is needed to determine why students choose SLAs or DLAs, and the influence of the educational environment on this process.
Development of an evaluation matrix for a community-based interdisciplinary health-promotion course : researchAuthor F. WaggieSource: African Journal of Health Professions Education 7, pp 58 –63 (2015) http://dx.doi.org/10.7196/AJHPE.432More Less
Background. In order to conduct a thorough and comprehensive evaluation of a curriculum, there must be a framework to guide the process that is needed to evaluate various aspects of the education programme. The Concept-Indicator-Method was chosen and modified as the conceptual framework that steered the evaluation process of a community-based interdisciplinary health-promotion course.
Objective. This article draws attention to the development of an appropriate evaluation matrix based on the Concept-Indicator-Method, which served as the organising framework for the evaluation. The focus of the evaluation was on assessing the perceived effectiveness and impact on the stakeholders of the course so as to direct the teaching and learning of health promotion at higher education institutions.
Methods. The mixed-methods approach was selected as the most appropriate research design for data collection and analysis. The use of multiple data collection instruments and sources provided a broader perspective and deeper understanding of the core concepts of the evaluation from the perspective of multiple sources.
Results. Three core concepts were identified in the evaluation of this community-based undergraduate programme: (i) curriculum; (ii) community-based learning; and (iii) university-school collaboration. Furthermore, associated key indicators for each core concept were developed.
Conclusion. The evaluation matrix may be of particular interest to those who are seeking an evaluation tool for evaluating a community-based course.
The Primary Health Care Approach and Restructuring of the MB ChB : A Case Study at the Faculty of Health Sciences, University of Cape Town, Nadia Hartman : book reviewAuthor Steve ReidSource: African Journal of Health Professions Education 7 (2015)More Less
This is a significant book in many ways, and essential reading for anyone involved in health sciences education. It is important for three reasons: firstly, it is a South African product, and more scholarship grounded in the African context is sorely needed. Secondly, it is originally conceptualised and rigorously constructed, based on the challenging experience of curriculum restructuring over a number of years, 'wrested from the vicissitudes of curriculum reform', as a colleague put it. And, thirdly, but most importantly, it succeeds in doing what many might imagine as impossible, namely to measure the primary healthcare approach (PHCA) in education.
Author Marlize SwanepoelSource: African Journal of Health Professions Education 7 (2015) http://dx.doi.org/10.7196/AJHPE.542More Less
Medical education to strengthen health systems in Africa : MEPI as a catalyst for change : supplement 1 - editorialAuthor Susan Van SchalkwykSource: African Journal of Health Professions Education 7, pp 68 –69 (2015) http://dx.doi.org/10.7196/AJHPE.628More Less
The announcement of the Medical Education Partnership Initiative (MEPI) that committed more than USD132 million to medical schools in sub-Saharan Africa (SSA) over a 5-year period coincided with the publication of a seminal article in the Lancet that called for the strengthening of health systems through transformative education. The significance of these two events has been considerable for the Faculty of Medicine and Health Sciences (FMHS) at Stellenbosch University (SU). While MEPI was to provide substantial resources that would lead to the establishment of the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI), Frenk et al.'s work would offer a theoretical premise for our thinking and a model for our practice. In this edition of the AJHPE we endeavour to showcase some of the work and research that has emanated from the initiative. The articles provide a snapshot in time, reflecting activities that characterised the first few years of SURMEPI.
Innovative strategies to improve human resources for health in Africa : the SURMEPI story : supplement 1 - forumSource: African Journal of Health Professions Education 7, pp 70 –72 (2015) http://dx.doi.org/10.7196/AJHPE.503More Less
The US President's Emergency Fund for AIDS Relief (PEPFAR) has responded to the need for the upscaling of Africa's health workforce by investing in medical education on the African continent. The Medical Education Partnership Initiative (MEPI) aims to: enhance the quality of medical education and quantity of medical graduates; facilitate retention of medical faculty and graduates; and enhance locally relevant research. Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) strives to develop, implement and evaluate innovative, workable and effective medical education models, in order to strengthen medical education and health systems within rural and resource-constrained environments. The purpose of this forum piece is to describe the SURMEPI project as background to the research articles emanating from SURMEPI in this AJHPE edition. SURMEPI's overall focus is on innovations and interventions in high schools, undergraduate medical education, postgraduate and continuing medical education, e-learning and collaborations, of which some highlights and challenges are described here.
Impact of a quality improvement project to strengthen infection prevention and control training at rural healthcare facilities : supplement 1 - short reportSource: African Journal of Health Professions Education 7, pp 73 –75 (2015) http://dx.doi.org/10.7196/AJHPE.499More Less
Background. South Africa (SA) has a dire shortage of skilled infection prevention and control (IPC) practitioners with limited opportunities for IPC training, especially in rural areas.
Methods. This quality improvement research-based case study surveyed healthcare workers' IPC training needs and measured the impact of a targeted IPC training intervention at four healthcare facilities in a rural sub-district in the Western Cape Province of SA. Transfer and implementation of IPC knowledge and best practice were evaluated at the participating facilities, both pre and post intervention.
Results. Most survey respondents (239/271; 88.2%) practised in rural districts and reportedly received infrequent (either annual or no) in-service training in IPC (138/271; 51%). The IPC education intervention (five short courses) was attended by almost one-third of clinical staff (129/422; 30.6%) at the four rural healthcare facilities. The pre-intervention IPC assessment identified the following: poor knowledge and implementation of tuberculosis-IPC measures; limited knowledge of medical device decontamination; high rates of needle-stick injuries; low hand-hygiene compliance rates and poor compliance with personal protective equipment use. At the post-intervention assessment, IPC knowledge scores and hand-hygiene compliance rates improved significantly but some IPC practices were unchanged.
Conclusion. A structured IPC training programme in rural healthcare facilities can improve healthcare workers' IPC knowledge, but has limited impact on clinical practice.