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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
The role of socially accountable universities in improving the selection of medical students from rural and underserved areas : supplement 1 - short reportSource: African Journal of Health Professions Education 7, pp 76 –78 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.504More Less
As rural areas in South Africa have a lack of human resources for health, selecting rural-origin learners for health sciences education can serve to improve the number of health sciences graduates choosing to work in these areas. Schools within rural areas are however characterised by poor infrastructure, limited access to water and electricity and fewer skilled teachers, resulting in poor performance of learners. The poor performance in mathematics and science is a concern as these serve as gateway subjects to the health sciences. The Stellenbosch University Area Health Education Centres (SU-AHEC) focus on interventions in rural and underserved schools with the aim of enhancing learner performance in mathematics and science to improve access to tertiary health professions education. This project is funded by the US President's Emergency Fund for AIDS Relief in South Africa.
When the clinic is not yet built ... the Avian Park Service Learning Centre story : supplement 1 - short reportSource: African Journal of Health Professions Education 7, pp 79 –80 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.506More Less
The Ukwanda Centre for Rural Health (UCRH) opened in 2001, followed 10 years later by the establishment of the Ukwanda Rural Clinical School in one of the rural health districts of the Western Cape. This paper relates the journey of the Faculty with the underserviced community of Avian Park through the provision of healthcare services aimed at addressing needs identified by the local community. It attempts to substantiate the meaning of the word Ukwanda, translated 'to grow' and 'develop within the community' in order to reach the primary goal of being an 'engaged institution'. The Avian Park Service Learning Centre (APSLC) is the culmination of the aspirations of a number of stakeholders who wanted to respond to the community needs for access to basic healthcare while providing learning opportunities for students. Initially only patients with chronic diseases of lifestyle, tuberculosis (TB) and HIV/AIDS were seen by community care-workers (CCWs). Through a number of service-learning initiatives in Avian Park, a variety of health services have developed in the community. CCWs have become teachers, community developers and an integral part of the health service team. They enhance access to the residents, community projects and networking within the community. The APSLC improves the opportunities to integrate theoretical academic work with practical application, providing students with a unique opportunity to be involved in healthcare service design and development (as active participants, not observers) based on community-identified needs. University and community collaboration has been purposeful and aims to strengthen community engagement, while up-skilling residents and affording community-based education opportunities for health professions.
Fit for purpose? A review of a medical curriculum and its contribution to strengthening health systems in South Africa : researchSource: African Journal of Health Professions Education 7, pp 81 –85 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.512More Less
Background. Medical education in the 21st century needs to produce health professionals who can respond to health systems challenges and population health needs. Although research on medical education is increasing, insufficient attention is paid to the outcomes of medical training, in particular graduates' competencies and the effects of their training on healthcare and population health in Africa.
Method. This baseline study assessed whether the current Stellenbosch University medical curriculum enabled graduates to acquire health systems strengthening competencies. The teaching of competencies in public health, evidence-based healthcare, health systems and services research, and infection prevention and control was assessed through a document review of study guides and a survey of recent medical graduates.
Results. We found that teaching of most competencies was included in the curriculum, but appeared fragmented with a lack of continuity across phases of the curriculum. Health systems and health leadership and management teaching was weak, and important public health competencies in human rights and health advocacy received little attention. Recent graduates said their training was 'adequate', but were unable to apply knowledge and skills to address health systems challenges within working environments. They wanted more integrated, practical, problem-based teaching in environments in which they would one day work, and their teachers to be role models for the competencies students were expected to acquire. This study is contributing to improvements to the medical curriculum at Stellenbosch University.
Equipping medical graduates to address health systems challenges in South Africa : an expressed need for curriculum change : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 86 –91 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.511More Less
Background. Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) aims to enhance health systems knowledge and skills to empower medical graduates to address health systems challenges especially in rural and underserved areas.
Objectives. To assess the content of health systems research (HSR) and strengthening, and understand perceptions of medical graduates and faculty about HSR in the undergraduate medical curriculum at Stellenbosch University.
Methods. We defined HSR and strengthening competencies for medical graduates through a literature review and expert consultations. Learning outcomes in terms of knowledge, skill or attitude in the 64 module guides of the curriculum were compared with the competencies required. A survey of recent medical graduates assessed whether their training equipped them to address health systems challenges. Interviews with faculty assessed their views on teaching health systems competencies.
Results. HSR foundational competencies were covered at a basic knowledge level, with little progression of learning levels, and several key competencies were not taught at all. Teaching was not integrated throughout the curriculum. Of 189 graduates, 63 (33.3%) agreed while 67 (35.4%) disagreed that their training prepared them to address health system challenges; 128 (67.7%) agreed on the importance of learning health systems competencies as undergraduates, and proposed learning areas of health system knowledge, leadership and management, problem solving, community service, evaluation methods and health economics. They wanted more practical, problem-oriented HSR training. Faculty supported the relevance and inclusion of HSR and strengthening in the curriculum.
Conclusion. The curriculum needs adaptation to better equip students with HSR and strengthening competencies.
Capacity-building needs assessment of rural health managers : the what and the how ... : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 92 –97 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.510More Less
Background. There has been a renewed focus on leadership and governance within the South African health workforce as a key to strengthening the health system. Several studies have highlighted that managers feel poorly prepared for their role and responsibilities and argue for support and development for healthcare managers. This study describes a 'training' need assessment conducted for health managers in a rural district which has informed Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) continuing professional development activities.
Objective. To determine the capacity-building needs and preferred approaches to capacity building for health managers in a rural district.
Methods. The study used a mixed method design. A survey was conducted among healthcare managers followed by structured interviews with randomly selected participants. Results were discussed at a workshop and meetings with the district management, which allowed for triangulation and verification of results.
Results. Thirty-two (68%) of the 47 health managers in the district completed the questionnaires. Training needs for competencies related to: leadership; communication and knowledge management; infection prevention and control; community/public health and health systems research and strengthening were slightly higher than other areas. Facility managers were prioritised as a target group for leadership and management capacity development. The preferred learning approach was for more practice-based learning in the workplace, supported by e-learning rather than didactic classroom-based teaching.
Conclusion. Innovative approaches to capacity development and work-based support in developing intrinsic management competencies for front-line managers were highlighted in this needs assessment.
Taking stock of evidence-based healthcare in the undergraduate medical curriculum at Stellenbosch University : combining a review of curriculum documents and input from recent graduates : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 98 –104 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.501More Less
Background. The Stellenbosch University Rural Medical Educational Partnership Initiative (SURMEPI) aims to increase the quality and retention of medical doctors, and regionally relevant research. Strengthening evidence-based healthcare (EBHC) knowledge and skills at an undergraduate level is important within this context.
Objectives. To assess and describe the current undergraduate medical EBHC curriculum in order to identify opportunities to enhance EBHC teaching, and to explore challenges related to EBHC experienced by recently graduated doctors.
Methods. We used methodological triangulation to assess current EBHC teaching and learning through a document review and a survey of recent graduates. We extracted learning outcomes from module guides that related to prespecified EBHC competencies. Our electronic survey collected quantitative data, which were analysed with SPSS, and qualitative data, which were coded with ATLAS.ti and grouped into emerging themes.
Results. EBHC teaching was fragmented and concentrated in the first and last phase of the medical curriculum. Most survey respondents agreed that it was important to learn EBHC at undergraduate level, and that there was a need for increased teaching of certain EBHC competencies. Recently graduated doctors identified lack of access to literature as the main challenge when practising EBHC. Other challenges included time constraints, work overload, lack of EBHC skills, lack of self-motivation, applicability of the evidence and the work environment.
Conclusion. Recent graduates felt that they needed more EBHC learning opportunities within the undergraduate medical curriculum. Existing EBHC teaching and learning for undergraduate medical students need to be enhanced by integrating EBHC into clinical modules and scaffolding it throughout all the phases of the curriculum.
Does undergraduate teaching of infection prevention and control adequately equip graduates for medical practice? : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 105 –110 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.500More Less
Background. Knowledge, skills and desirable clinical practices in infection prevention and control (IPC) should be acquired during undergraduate medical training. Although knowledge and skills are learnt in the formal curriculum, attitudes and practices are assimilated by observation and modelling. We investigated whether undergraduate teaching and learning of IPC at Stellenbosch University adequately prepared graduates for medical practice.
Methods. A situational analysis of IPC teaching was conducted, including development of IPC competencies, a curriculum review, an email survey of MB,ChB graduates and semistructured focus group or personal interviews with teaching faculty. Qualitative data were assessed using a framework analysis approach.
Results. All graduate survey respondents who completed the IPC-related questions (n=180) agreed that teaching of IPC was important and most (156; 87.8%) felt that IPC teaching had adequately prepared them for practice. Despite this perception, graduates encountered difficulty implementing IPC best practice owing to lack of management support for IPC and resource constraints. Faculty members disagreed regarding the adequacy of IPC teaching and some were concerned that the curriculum failed to prepare graduates for medical practice. Graduates and faculty felt strongly that undergraduate IPC teaching and learning could be improved by addressing suboptimal IPC practices and lack of clinician role models for IPC at training institutions.
Conclusion. IPC knowledge transfer appears adequate in most competency areas. However graduates struggled to implement IPC best practice in the clinical field. Undergraduate IPC teaching and learning could be enhanced by development of clinician role models for IPC and strengthened IPC practices in training institutions.
Source: African Journal of Health Professions Education 7, pp 111 –114 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.508More Less
Background Stellenbosch University established a rural clinical school (RCS) in 2011 whereby fifth-year MB,ChB students can choose to spend their final year on a rural platform in the Cape Winelands/Overberg districts, either in traditional, specialty-based rotations or in an integrated programme under the supervision of the district hospital family physician. The present study aims to gain a deeper understanding of the factors influencing medical students' choice of placement.
Methods A survey questionnaire was designed to determine demographics, future practice intentions and the factors regarded as important in choice of site. A set of open-ended questions was provided regarding students' choice and ways to make the RCS more attractive.
Results Questionnaires were issued to 168 fifth-year students and completed by 109 (65%) students, all of whom had already decided not to come to the RCS. The students considered that 13 of the 15 factors determining choice of site would be better met in the urban environment, while only two needs were perceived to be better met at the RCS. However, other than access to subspecialist tutorials, opinion was divided about where these needs would be better met. Other issues emerged from open-ended questions: a perceived higher standard of education at the urban teaching hospital, fear of the demands of the RCS, uncertainty about the RCS programme, and a preference for an urban lifestyle.
Conclusion. In addition to family and social reasons for not joining the rural platform, many students still feel they will be placed at an academic disadvantage by choosing the RCS, despite evidence to the contrary. More needs to be done to communicate the maintained academic standards at the RCS.
Academic achievement of final-year medical students on a rural clinical platform : can we dispel the myths? : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 115 –118 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.513More Less
Background. There is a growing body of literature relating to the establishment of rural clinical training platforms for medical students describing many positive outcomes, particularly in the case of extended placements. However, students' fears about their academic achievement while at these sites remain a key concern.
Objectives. The study set out to compare the academic achievement in end-of-rotation assessments and final examinations of final-year medical students at a rural clinical school (RCS) with those of their peers at the academic hospital complex (AHC).
Methods. A cross-sectional study, comparing the marks of three successive cohorts of RCS and AHC students (2011-2013) using t-tests and confirmed with non-parametric rank-sum tests, was conducted. The consistency of the effect of these results across cohorts was assessed by fitting regression models with interaction terms between cohort and group, and tested for significance using F-tests. Independent t-tests were conducted to evaluate differences in the mark attained between the two groups. A p-value <0.05 was considered statistically significant.
Results. Comparison of student marks attained across six of the disciplines offered at the RCS suggested there was no difference between the RCS and AHC in each of the three cohorts at baseline. A comparison of the end-of-rotation means showed that RCS students achieved significantly better results in some disciplines. A similar trend was observed for the final examination results across all seven disciplines.
Conclusion. Despite small numbers, this study suggests that students who spend their final year at the RCS are not disadvantaged in terms of their academic achievement. Medical students' concerns regarding academic achievement for those placed at rural clinical sites appear to be unfounded. Students who potentially could be placed at these sites should be made aware of this evidence.
'We have to flap our wings or fall to the ground' : the experiences of medical students on a longitudinal integrated clinical model : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 119 –124 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.507More Less
Background. In 2011, Stellenbosch University introduced a district hospital-based longitudinal integrated model for final-year students as part of its rural clinical school. The present study is an analysis of students' experiences during the first 3 years of the programme.
Methods. All 13 students who started the programme between 2011 and 2013 were interviewed. Thematic networks linking recurrent issues were developed and transcripts were analysed against this framework using ATLAS.ti.
Results. Two major themes emerged. These were 'preparation for being a doctor' and 'academic/exam preparation'. Students were overwhelmingly positive about the working atmosphere and their preparation for clinical practice and felt that their learning had been facilitated by the flexibility of the programme and the requirement to take responsibility. This contrasted with their academic ('book') learning, which was characterised by uncertainty about expectations, particularly regarding exams and parity with learning at the central teaching hospital. The flexibility of the integrated approach was seen as a problematic lack of structure when it came to academic learning. Negative academic emotions were compounded by some frustration about administrative issues early in the programme.
Conclusions. The district hospital-based longitudinal integrated model has great potential as a teaching platform for final-year students; however, students remain concerned about academic learning. Potential strategies to reduce student anxiety include more opportunities for dialogue between rural students and specialist teaching platforms, clearly communicated expectations - both about what the students can expect from the programme and about what is expected from them - and administrative excellence.
Enhanced podcasting for medical students : progression from pilot to e-learning resource : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 125 –129 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.505More Less
Background. We recorded enhanced podcasts consisting of the lecturer's audio talk and images from the computer screen (usually PowerPoint). The process we used, as well as the software and infrastructure required, are described.
Objective. The study had two objectives: to determine whether undergraduate medical students found enhanced podcasting useful (discussed here); and how enhanced podcasts influenced students' learning (discussed in a separate article).
Methods. We progressed from podcasting a single lecture block of 6 weeks to capturing all lectures for the entire medical undergraduate curriculum encompassing all 6 years, as well as podcasts of clinical tutorials. The podcasts are hosted on a content management system (http://fmhspod.sun.ac.za) for students to view or download.
Results. Student enthusiasm in adopting enhanced podcasts and using them to assist their learning has led to the project developing into a web-based resource for the entire undergraduate medical programme.
Conclusions. Enhanced podcasts are now an essential part of the curriculum. The project has the potential to become self-sustainable by hosting other formerly printed files on the website, thus saving on printing costs.
How podcasts influence medical students' learning - a descriptive qualitative study : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 130 –133 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.502More Less
Background. Podcasting of lectures is increasingly used in higher education. It is popular with students as it provides a modern e-learning tool that reinforces learning and facilitates engagement with learning material. Podcasts have, however, not been used much in medical education in Africa. This article explores the influence podcasts have on how students in an African medical school approach their learning material.
Methods. This is a descriptive qualitative study encompassing six focus group discussions with a total of 38 students from each of the six study years in the medical programme.
Results. The feedback from the students called for continuous and extensive implementation. Themes identified included: a novel way to learn; complementing classroom learning; providing ease of mind (a safety net); and the influence of the lecturer on student learning. Students did not find that podcasts negatively influenced class attendance. Enthusiastic acceptance translated into active engagement with the learning material.
Discussion. The way the students used the podcasts fits the active learning double tenet of student activity and student engagement in using a particular instructional method. The podcasts allowed the students to be more adventurous in their learning and changed the way they approached their learning. Situating the learning in the students' context and within their control played an important role in this.
Conclusion. Medical education in Africa is moving towards larger classes and increasingly decentralised clinical training. Podcasts of medical lectures in medical schools in Africa are an innovative and effective tool to enhance medical students' learning.
Identifying approaches and tools for evaluating community-based medical education programmes in Africa : supplement 1 - researchSource: African Journal of Health Professions Education 7, pp 134 –139 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.568More Less
Background. The US President's Emergency Plan for AIDS Relief (PEPFAR)-funded Medical Education Partnership Initiative (MEPI) aims to support medical education and research in sub-Saharan African institutions. The intention is to increase the quantity, quality and retention of graduates with specific skills addressing the health needs of their populations. While many MEPI programmes include elements of community-based education (CBE), such as community placements, clinical rotations in underserved locations, community medicine, or primary healthcare, the challenge identified by MEPI-supported schools was the need for appropriate approaches and tools to evaluate these activities. This article outlines the process of identifying tools that, with modification, could assist in the evaluation of CBE programmes in participating MEPI schools.
Methods. A literature search was carried out to identify approaches and tools that could be used in Africa to evaluate CBE programmes. The search included published, peer-reviewed literature as well as grey literature and websites. Evaluation tools considered appropriate were obtained from the articles or their authors for inclusion in a compendium of example CBE evaluation tools. All tools sourced through the search were entered into a CBE evaluation matrix, which included an analysis of the tool in relation to Kirkpatrick's four levels of evaluation.
Results. Out of 37 sources included as appropriate, 8 sets of CBE evaluation tools were obtained for the compendium. Most of the evaluations were quantitative, relied on Likert-type scales, and focused on measuring CBE activities and intermediate outcomes in terms of student learning. When categorised according to the level of the evaluation, the evaluations largely focused on levels 1 and 2 of the Kirkpatrick model, as measured through students' reactions to and learning from the CBE programmes. Tools that focused on student assessment, rather than programme evaluation, were excluded from the final set.
Conclusion. With the shortage of published literature on CBE evaluation, the findings of this literature review will assist African medical schools in developing appropriate evaluation approaches and tools.
Evaluating community-based medical education programmes in Africa : a workshop report : supplement 1 - workshop reportSource: African Journal of Health Professions Education 7, pp 140 –144 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/AJHPE.475More Less
Background. The Medical Education Partnership Initiative (MEPI) supports medical schools in Africa to increase the capacity and quality of medical education, improve retention of graduates, and promote regionally relevant research. Many MEPI programmes include elements of community-based education (CBE) such as: community placements; clinical rotations in underserved locations, community medicine, or primary health; situational analyses; or student-led research.
Methods. CapacityPlus and the MEPI Coordinating Center conducted a workshop to share good practices for CBE evaluation, identify approaches that can be used for CBE evaluation in the African context, and strengthen a network of CBE collaborators. Expected outcomes of the workshop included draft evaluation plans for each school and plans for continued collaboration among participants. The workshop focused on approaches and resources for evaluation, guiding exploration of programme evaluation including data collection, sampling, analysis, and reporting. Participants developed logic models capturing inputs, activities, outputs, and expected outcomes of their programmes, and used these models to inform development of evaluation plans. This report describes key insights from the workshop, and highlights plans for CBE evaluation among the MEPI institutions.
Results. Each school left the workshop with a draft evaluation plan. Participants agreed to maintain communication and identified concrete areas for collaboration moving forward. Since the workshop's conclusion, nine schools have agreed on next steps for the evaluation process and will begin implementation of their plans.
Conclusion. This workshop clearly demonstrated the widespread interest in improving CBE evaluation efforts and a need to develop, implement, and disseminate rigorous approaches and tools relevant to the African context.