A peer evaluation of the community-based education programme for medical students at the University of Zimbabwe College of Health Sciences: A southern African Medical Education Partnership Initiative (MEPI) collaboration

Background. The University of Zimbabwe College of Health Sciences (UZCHS), Harare, which has a long tradition of community-based education (CBE), has not been evaluated since 1991. An innovative approach was used to evaluate the programme during 2015.Objectives. To evaluate the CBE programme, using a peer-review model of evaluation and simultaneously introducing and orientating participating colleagues from other medical schools in southern Africa to this review process.Methods. An international team of medical educators, convened through the Medical Education Partnership Initiative, worked collaboratively to modify an existing peer-review assessment method. Data collection took the form of pre-visit surveys, on-site and field-visit interviews with key informants, a review of supporting documentation and a post-review visit.Results. All 5 years of the medical education curriculum at UZCHS included some form of CBE that ranged from community exposure in the 1st year to district hospital-based clinical rotations during the clinical years. Several strengths, including the diversity of community-based activities and the availability of a large teaching platform, were identified. However, despite the expression of satisfaction with the programme, the majority of students indicated that they do not plan to work in rural areas in Zimbabwe. Several key recommendations were offered, central to which was strengthening the academic co-ordination of the programme and curriculum renewal in the context of the overall MB ChB curriculum.Conclusion. This evaluation demonstrated the value of peer review to bring a multidimensional, objective assessment to a CBE programme

Strengthening Rural Health Placements for Medical Students: Lessons for South Africa from International Experience

BACKGROUND:This article derives lessons from international experience of innovative rural health placements for medical students. It provides pointers for strengthening South African undergraduate rural health programmes in support of the government's rural health; primary healthcare and National Health Insurance strategies.METHODS:The article draws on a review of the literature on 39 training programmes around the world; and the experiential knowledge of 28 local and international experts consulted through a structured workshop.RESULTS:There is a range of models for rural health placements: some offer only limited exposure to rural settings; while others offer immersion experiences to students. Factors facilitating successful rural health placements include faculty champions who drive rural programmes and persuade faculties to embrace a rural mission; preferential selection of students with a rural background; positioning rural placements within a broader rural curriculum; creating rural training centres; the active nurturing of rural service staff; assigning students to mentors; the involvement of communities; and adapting rural programmes to the local context. Common obstacles include difficulties with student selection; negative social attitudes towards rural health; shortages of teaching staff; a sense of isolation experienced by rural students and staff; and difficulties with programme evaluation.CONCLUSIONS:Faculties seeking to expand rural placements should locate their vision within new health system developments; start off small and create voluntary rural tracks; apply preferential admission for rural students; set up a rural training centre; find practical ways of working with communities; and evaluate the educational and clinical achievements of rural health placements

Evaluation of the parallel rural community curriculum at flinders university of south Australia: lessons learnt for Africa

Objectives. To review data collected during an evaluation of the Flinders University Parallel Rural Community Curriculum (PRCC) in order to reflect on its relevance for medical education in Africa.Setting. The PRCC offers a community-based longitudinal curriculum as an alternative for students in their pre-final year of medical training. Design. Individual and focus group interviews were conducted with students; staff; health service managers; preceptors and community members. Results. Students are exposed to comprehensive; holistic; relationship-based care of patients; with a graded increase in responsibility. Students have varying experience at different sites; yet achieve the same outcomes. There is a strong partnership with the health service.Conclusions. The principle of balancing sound education and exposure to a variety of contexts; including longitudinal community-based attachments; deserves consideration by medical educators in Africa

An Approach to Clinical Problem Solving for Primary Health Care Student Nurses

The article provides a description of a method of teaching a clinical problem-solving process to primary health care nurses/clinical nurse practitioners (PHC nurses). The process was developed in the Soweto PHC Nurse Training Unit over the past 30 years as a result of the changing availability and role of nurse and doctor teaching staff. Students doing the diploma for nurse clinicians (Diploma in Clinical Nursing Science; Health Assessment; Treatment and Care) are guided in the use of mind maps; assisted by constant clinical practice and group discussions to develop their clinical problem-solving process. This method has assisted in clinical training

Understanding Participation in a Hospital-Based HIV Support Group in Limpopo Province; South Africa

Background: Support groups are an appropriate way of delivering psychosocial support to people living with HIV/AIDS; especially in low-resource countries. The aim of the study was to understand why people with HIV attended psychosocial support groups. Methods: This was a qualitative study design using focus-group discussions in which support-group members volunteered to participate. Five focus groups were involved in the study. Results: The participants attended because they were referred by a health-care worker; wanted information; wanted emotional support; accompanied an ill relative or knew about the support group. Perceived benefits included receiving psychological support; accepting one's HIV status; reducing stigma and isolation; increasing hope; forging new friendships; helping others; obtaining HIV-related information; developing strategies to change behaviour; gaining access to medical care at the adjoining HIV clinic and receiving food donations. Negative aspects of attending the support group included the large size of the support group; long queues at the HIV clinic; concerns about confidentiality and negative staff attitudes towards the participants. Leaders were concerned about conflict; burn-out and impractical protocols. Access to disability grants was also a concern. Conclusions: Support groups can assist members to cope with the various challenges associated with living with HIV/ AIDS through offering structured emotional; informational; instrumental and material support. Support group sizes should be limited. A structured curriculum containing up-to-date information about ART should also be offered to support groups. Social workers should furthermore be involved to facilitate access to appropriate social grants. Finally; support group leaders should receive appropriate training and regular debriefing

Exposure to Primary Healthcare for Medical Students: Experiences of Final-Year Medical Students

Introduction: Recognising the importance of primary healthcare in the achievement of the 1997 White Paper for the Transformation of the Health System and the Millennium Development Goals; the Faculty of Health Sciences of the University of the Witwatersrand introduced an integrated primary care (IPC) block. In a six-week final year preceptorship; medical students are placed in primary healthcare centres in rural and underserved areas. This article describes the experiences of medical students during their six weeks in the IPC block. Methods: The study was qualitative; based on data collected from the logbooks completed by the students during the IPC rotation. A total of 192 students were placed in 10 health centres in the North West and Gauteng provinces in the 2006 academic year. These centres included district hospitals; clinics and NGO community health centres. Results: The students reported that the practical experience enhanced their skills in handling patients in primary care settings. They developed an appreciation of primary healthcare as a holistic approach to healthcare. The students attained increased levels of confidence in handling undifferentiated patients; and became more aware of community health needs and problems in health service delivery. Conclusions: Exposure to the IPC block provided a valuable experience for final-year students; as it is critical for orienting students to the importance of primary healthcare; which is essential for the realisation of targets identified in the national health policy

Rural Origin Health Science Students in South African Universities

Background. Rural areas in all countries suffer from a shortage of health care professionals. In South Africa; the shortage is particularly marked; some rural areas have a doctor-topopulation ratio of 5.5:100 000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages; as the students are more likely to work in rural areas after graduating. Objective. To determine the proportion of rural- origin students at all medical schools in South Africa. Design. A retrospective descriptive study was conducted in 2003. Lists of undergraduate students admitted from 1999 to 2002 for medicine; dentistry; physiotherapy and occupational therapy were obtained from 9 health science faculties. Origins of students were classified as city; town and rural by means of postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3). Results. Of the 7 358 students; 4 341 (59) were from cities; 1 107 (15) from towns and 1 910 (26) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine - 27.4; physiotherapy - 22.4; occupational therapy - 26.7; and dentistry - 24.8. Conclusion. The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas

Building consensus on clinical procedural skills for South African family medicine training using the Delphi technique

Background: The development of registrar training as part of the newly created speciality of family medicine in South Africa requires the development of a national consensus on the clinical procedural skills outcomes that should be expected of training programmes.Methods This study utilized a Delphi technique to establish a national consensus between 35 experts from training institutions; those already in family practice and managers who might be employing family physicians in both private and public sector contexts. Results: Consensus was reached on 214 core skills at different levels of desired competency and 23 elective skills. The core skills were divided into 58 that should be taught by family physicians; 101 that should be performed independently and 55 that should be performed during training under supervision. The panel were unable to reach consensus on a further 21 skills.ConclusionThis is the first study that has proposed a set of essential clinical procedural skills for the training of family physicians in South Africa. The findings will act as a benchmark for programmes in South Africa and through the new initiative of `FaMEC in Africa' may influence curriculum development in other African countries. They may be used as a guide for curriculum planning; as a way of monitoring skills development and as an indication to registrars of the skills they need to achieve for assessment purposes. The findings may also inform the planning of training programmes for the proposed mid-level health worker (clinical associate) in South Africa as their skills will be a sub-set of these skills and will be taught by family physicians within district hospitals. Training programmes for undergraduates and interns in family medicine may also want to position themselves as stepping stones in line with these final outcomes of postgraduate training

Building Consensus on Clinical Procedural Skills for South African Family Medicine Training Using the Delphi Technique

Background: The development of registrar training as part of the newly created speciality. Methods: This study utilized a Delphi technique to establish a national consensus between 35 experts from training institutions; those already in family practice and managers who might be employing family physicians in both private and public sector contexts of family medicine in South Africa requires the development of a national consensus on the clinical procedural skills outcomes that should be expected of training programmes.Results: Consensus was reached on 214 core skills at different levels of desired competency and 23 elective skills. The core skills were divided into 58 that should be taught by family physicians; 101 that should be performed independently and 55 that should be performed during training under supervision. The panel were unable to reach consensus on a further 21 skills.Conclusion: This is the first study that has proposed a set of essential clinical procedural skills for the training of family physicians in South Africa. The findings will act as a benchmark for programmes in South Africa and through the new initiative of 'FaMEC in Africa' may influence curriculum development in other African countries. They may be used as a guide for curriculum planning; as a way of monitoring skills development and as an indication to registrars of the skills they need to achieve for assessment purposes. The findings may also inform the planning of training programmes for the proposed mid-level health worker (clinical associate) in South Africa as their skills will be a sub-set of these skills and will be taught by family physicians within district hospitals. Training programmes for undergraduates and interns in family medicine may also want to position themselves as stepping stones in line with these final outcomes of postgraduate training

The involvement of private general practitioners in visiting primary healthcare clinics

Background: The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team; particularly nurses. A successful collaboration at this level brings benefit to everyone involved; particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork; thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics; but their workload; staff shortages and transport often interfere with these visits. As a form of private-public partnership; local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported; including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time. Methods A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors; clinic nurses; district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers; lengths of the visits; remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes. Results: The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills; patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints; such as a shortage of medicines and equipment; which reduce the success of these visits. Conclusion: The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level

The Involvement of Private General Practitioners in Visiting Primary Healthcare Clinics

Background: The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team; particularly nurses. A successful collaboration at this level brings benefit to everyone involved; particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork; thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics; but their workload; staff shortages and transport often interfere with these visits. As a form of private-public partnership; local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported; including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time.Methods: A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors; clinic nurses; district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers; lengths of the visits; remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes.Results: The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills; patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints; such as a shortage of medicines and equipment; which reduce the success of these visits.Conclusion: The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level

A Qualitative Study Of The Reasons Why Ptb Patients; At Clinics In The Wellington Area; Stop Their Treatment

"Background: Tuberculosis (TB) remains the leading infectious cause of adult mortality; despite 60 years of effective chemotherapy. One reason for this is the problem caused by the interruption and failure of treatment; which usually are related to non-adherence. The reasons for non-adherence to TB treatment are multifaceted; ranging from the personalities of the patients to the social and economic environment. In South Africa; the most common problems have been shown to be the erratic way in which the treatment is taken; and not patients absconding from the treatment program. There is a strong suspicion that the disability grants issued to TB patients are acting as a disincentive to finish anti-tuberculosis medication. TB is a stigmatised disease and the lack of support from health workers; family and friends; as well as the length of the treatment period; all contribute to the temptation to discontinue TB therapy. This research was undertaken in Van Wyksvlei; a sub-economic area of Wellington. Wellington is part of the Drakenstein Municipality in the Western Cape; South Africa and is mainly an agricultural area. The aim of the study was to explore and describe the reasons why patients in the Wellington area do not complete their TB treatment; and then to make recommendations to improve adherence. Methods The method used in this study was a descriptive qualitative one. Free attitude interviews were conducted with six non-adherent patients from Van Wyksvlei; a sub-economic area. The exploratory question was: ""Which circumstances resulted in your interruption of your treatment?"" The patients' responses were recorded and transcribed; and analysed to identify common themes.ResultsThe major themes that were identified were priorities; motivation and support. Priorities imply definite choices the TB patient has to make from the day the diagnosis is made. The patients are poorly equipped with decision-making and coping skills. A lack of motivation resulted from an improvement in the symptoms while on medication; group pressure; poor self-esteem; distance from clinic and lack of continuity of care. The support theme centred on lack of support from both the family and the community.ConclusionPatients should not carry primary responsibility for their adherence; but be part of a team. If TB treatment is to be optimised; patient cooperation and information need to be addressed; as these are essential for success. Existing services need to be made more accessible and acceptable. Additional effort needs to be made to educate the community."