The use of peer physical examination in undergraduate health professions education: Exploring the perceptions of students and educators in a multicultural, multiracial institution

Teaching clinical skills is core content of the medical and allied health curricula of the Faculty of Health Sciences (FoHS) at the University of the Free State (UFS) in South Africa. A major pedagogical tool used for this purpose across the faculty is peer physical examination (PPE). Objective. To investigate the lived experience and perceptions of students and educators on the use of PPE in undergraduate health professions education at a multicultural and multiracial institution. Suggestions on guidelines for a PPE policy for the FoHS at the UFS were also obtained from the participants.Methods. This research was designed as a qualitative study that used focus group interviews involving 26 participants (19 students and 7 educators) to obtain verbal statements that described their experience and perceptions of the use of PPE in undergraduate health professions education. Results. Participants reported that PPE was useful to create a safe learning environment and to prepare students for the clinical aspects of their training. Enhancing students' empathy, competency and clinical confidence were among the advantages attributed to using PPE; it also encouraged peer-assisted learning. Some of the disadvantages ascribed to PPE were that it made it difficult to maintain classroom discipline, and that it could promote memorisation over understanding. Finally, participants suggested that a guideline for PPE policy should address matters of consent, confidentiality, participation and gender, cultural, religious and racial considerations.Conclusions. The findings of this study reveal that PPE is an acceptable and useful learning strategy for the majority of students and educators. Issues relating to consent, confidentiality and cultural, religious and racial considerations are some of the potential problems associated with the use of PPE at the UFS. We believe that the suggestions given by the participants of this study will inform the establishment of a PPE policy for the FoHS of the UFS

High-fidelity simulation: A practice model for nurse educators at a South African private higher education institution

Background. The clinical skills development of student nurses is one of many challenges facing nursing education owing to a lack of available clinical placements and learning opportunities. Simulation training as an optional teaching-learning method creates an environment where clinical skills are developed and students are prepared for the nursing profession. The successful implementation of high-fidelity simulation (HFS) strategies as part of the nursing curricula requires nurse educators to have knowledge and skills. At the South African private higher education institution (SAPHEI) where the research for this study was done, it became evident that nurse educators do not have the required knowledge, skills or support to implement HFS. The absence of evidence in the literature of a practice model for a SAPHEI to facilitate the implementation of HFS reveals a gap in the practice base of nursing education.Objective. To develop a practice model for nurse educators at a SAPHEI to facilitate the implementation of HFS.Methods. The researcher used a theory-generative research design. The study was conducted in two phases, with two steps in each phase, to address four objectives in all.Results. Phase 1 identified and described the main and related concepts. A resulting conceptual framework was used for the development of the practice model. Phase 2 addressed the relational meaning of the main and related concepts, as well as the construction of the practice model through theory synthesis.Conclusion. The main aim of this research study was to develop a practice model for nurse educators at a SAPHEI to facilitate the implementation of HFS as part of the clinical skills development of student nurses. The practice model offers a schematic outline that represents HFS as a teaching-learning method. The importance of the outline lies therein that it specifies the context and situations in which the model is useful

Strengths and challenges of community-based clinical training as viewed by academics at the University of KwaZulu-Natal, Durban, South Africa

Background. Community-based education (CBE) is seen as a valuable tool in transforming health professions education by aligning clinical training with graduate competencies and needs of the health system. However, academics involved in the implementation have varied views.Objectives. To explore the experiences and views of academics involved in community-based training in the College of Health Sciences at the University of KwaZulu-Natal, Durban, South Africa. Methods. This qualitative study used interviews and focus group discussions consisting of a purposively selected sample of academics. The interviews were audio taped, transcribed and analysed using thematic analysis.Results. Three main themes emerged from the data analysis: the strengths of CBE, challenges experienced in implementation and academics' suggestions concerning challenges. The strengths included benefits to the institution, students, health system and communities. The main challenges experienced were insufficient support from the institution and the Department of Health (DoH). Suggestions were made by academics to overcome these challenges.Conclusion. The study indicates that CBE is perceived as an important pedagogical approach in transforming health professions education, as it can align clinical training with the business plan of the university and the needs of the health system. However, for the successful implementation of CBE, full support from the university and the DoH is required

Motivated strategies for learning and their association with academic performance of a diverse group of 1st-year medical students

Background. Most instruments; including the well-known Motivated Strategies for Learning Questionnaire (MSLQ); have been designed in western homogeneous settings. Use of the MSLQ in health professions education is limited. Objective. To assess the MSLQ and its association with the academic performance of a heterogeneous group of 1st-year medical students.Methods. Eighty-three percent of 1st-year medical students consented to participate in this quantitative study. The MSLQ consisted of a motivation strategies component with six subscales; while the learning strategies component had nine subscales. Demographic and academic achievement information of the students was also collected. Stata version 13 (StataCorp LP; USA) was used for the statistical analyses of all data.Results. Female students displayed significantly higher motivational scores. Students with prior educational experience and those who attended peer-mentoring sessions had significantly higher learning strategy scores. Significant but moderate relationships were found between academic performance and the motivation strategies subsumed within the categories 'task value' and 'self-efficacy for learning performance'. In terms of the 'learning strategy component'; 'critical thinking'; and 'time and study environment'; the composite score was significantly but poorly correlated to academic performance. Conclusion. Overall; limited correlations were found between the MSLQ scores and academic performance. Further investigation of the use of the MSLQ and its association with academic achievement is recommended; with greater focus on specific learning events than on course outcomes. This study highlights the importance of evaluating an instrument in a specific context before accepting the findings of others with regard to the use of the instrument and its correlation with academic performance

Trends in task shifting in HIV treatment in Africa: effectiveness, challenges and acceptability to the health professions

Background: Task shifting has been suggested to meet the demand for initiating and managing more patients on antiretroviral therapy. Although the idea of task shifting is not new; it acquires new relevance in the context of current healthcare delivery.Aim: To appraise current trends in task shifting related to HIV treatment programmes in order to evaluate evidence related to the effectiveness of this strategy in addressing human resource constraints and improving patient outcomes; challenges identified in practice and the acceptability of this strategy to the health professions. Method: Electronic databases were searched for studies published in eng between January 2009 and December 2014. Keywords such as 'task shifting'; 'HIV treatment'; 'human resources' and 'health professions' were used.Results: Evidence suggests that task shifting is an effective strategy for addressing human resource constraints in healthcare systems in many countries and provides a cost-effective approach without compromising patient outcomes. Challenges include inadequate supervision support and mentoring; absent regulatory frameworks; a lack of general health system strengthening and the need for monitoring and evaluation. The strategy generally seems to be accepted by the health professions although several arguments against task shifting as a long-term approach have been raised.Conclusion: Task shifting occurs in many settings other than HIV treatment programmes and is viewed as a key strategy for governing human resources for healthcare. It may be an opportune time to review current task shifting recommendations to include a wider range of programmes and incorporate initiatives to address current challenges

Things may not be as Expected: Surprising Findings when Updating Work Load at the Wits Human Research Ethics Committee (Medical)

Objectives. To compare numbers of applications to the University of the Witwatersrand Human Research Ethics Committee (Medical) for clearance by the full committee during 2011 - 2013; to see the proportion of clinical Master's applications in 2013 and to look for the influence of eight variables in applications reviewed from January to June 2013.Methods. A retrospective extraction of data from committee minutes (2011-2013) and application forms (January - June 2013) was done. Statistical analysis was completed using SAS for Windows (version 9.4). Variables examined were committee decision; choice of research method; supervision or not; supervisors' research degree; supervisors' publication group; university administrative entity; registered degree and month of approval after first review.Results. Total numbers were 685 (2011); 845 (2012; a 23.4% increase from 2011) and 769 (2013; a 9.0% decrease on the previous year). In 2013; 22% of applications were for clinical Master's degrees required by the Health Professions Council of South Africa (HPCSA) for specialist registration. A number of cross-tabulations of variables are presented. Logistic regression analysis (Proc Catmod) showed that three variables significantly influenced the committee's initial review decision; namely school (p=0.03); applicants' registered degree (p=0.01) and the research method chosen (p=0.03). The month of committee approval was also significantly affected by school (p=0.002). Preferred research methodologies for supervised and independent research applications differed within and between schools.Conclusion. A predicted continuous increase in number of applications from 2011 to 2013 did not happen for unknown reasons. Research method; school; and registered degree significantly influenced the committee's decision at the initial review of applications. For clinical Masters; and other Masters; a supervisor's degree had no effect on the committee's decision at the initial review of applications; however undergraduate and honours applicants having supervisors without a research degree had more than double the approval rate at first review than when supervisors had either a Doctorate or a Master's (p=0.008). Supervisors' possession of a research degree did not increase approval rate of applications nor did a supervisor's publication grouping

An Audit of Otorhinolaryngological Practice in a Tertiary Institution in the Niger Delta Region of Nigeria

The Niger Delta University Teaching Hospital (NDUTH) is a young tertiary hospital with recently established department in various specialties. In spite of this it caters for the health needs of a lot of the patients in Bayelsa state and its environs. The aim of this study therefore is to audit the otorhinolaryngological (ORL) practice in this center with the aim of establishing the pattern of ORL disease which is useful for the planning of effective ORL services Methods: This is a retrospective study of patients that presented to the ear; nose and throat department of NDUTH from January 2007 to December 2011. The patient's folders and clinic records were the source of data.Results: There were 2;275 patients seen within the period under study. The age ranged from 3months to 80 years. Patients who were in the 21-30 year age group (21.1) were the most frequently seen. There were 1;150(50.55) males and 1;125(49.45) females with a male female ratio of 1.02:1. The adults were 1;725(75.82) while the children were 550(24.18). Otologic conditions ranked highest in the clinic presentations with wax impaction being the commonest ear disorder encountered. There were about 573 (25.19) procedures done within this period. Aural syringing was the commonest procedure. There was no major theatre procedures carried out.Conclusion: The otorhinolaryngologic practice in the centre is growing and otologic diseases appear to be the most common conditions seen. There is therefore need to equip both the theatre and clinic so as to offer effective care. Audiololgical services also are relevant for the rehabilitation of these patients in view of the considerable number with hearing loss. The ORL practice here appears quite elementary. Therefore there is a need to vigorously equip the department

MB ChB Curriculum Modernisation in South Africa - Growing Doctors for Africa

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Moving beyond description: research that helps improve teaching and learning

This paper is premised on the assumption that education research; in order to be relevant; needs to generate explanations that have educational significance and applicability. It argues that much of the health sciences education research show cased at conferences falls short of generating explanations that have practical applicability because the reported studies do not move beyond description. The paper suggests ways in which health professions educators might move beyond description in order to generate explanations of teaching and learning that can be used to inform `best practice' in education. The paper commences with a discussion of the role of theory in education research. Three forms of theory are identified personal theoretical assumptions; theory from literature; and generation of theory from research. The paper highlights the limitations of rearch without theory and the role that theory might play in generating understandings of teaching and learning. Practical ways to ensure theoretical rigor in education research are suggested

The Perception of Health on Causes of Inter professional Conflict in a Tertiary Health Institution in Abakaliki; Southeast Nigeria

"BACKGROUND: Interprofessional conflict in university teaching hospitals in Nigeria is on the increase. This study was aimed at assessing the health professions' perception of factors responsible for conflict. METHODOLOGY: A cross-sectional descriptive survey among six health professions. RESULTS: The perceived causes of conflict include differential salary between doctors and others; physician intimidation and discrimination of other professions; ""inordinate ambition"" of the other professions to lead the health team; and envy of the doctor by the other professions. Doctors differed significantly from the other professions on the role of each of these in causing conflict. Mutual respect for each other's competence; proper remuneration and clear delineation of duties for all; and other groups appreciating the salary differential between them and doctors were perceived as means of resolving the conflict. While all accepted mutual respect and proper remuneration as effective; other health workers differed significantly from doctors on the effectiveness of appreciating salary differential between them and doctors in resolving the conflict. CONCLUSION : Differential salary between the doctor and the other health workers is the main factor perceived to cause interprofessional conflict. The government and all health professions should accept; and maintain the relativity in salary differential between doctors and other health professions."

Hippocratic Oath Revisited - Where do we stand?

The medical profession is said to be a natural art conceived in sympathy and born of necessity. It entails compassion and understanding in handling patients as whole human beings with dignity and decency. The forefathers in the profession ensured nobility by adhering to the Hippocratic oath and stressed a dignified moral conduct towards patients and upholding the sanctity of life. They were therefore able to draw much respect from the society. The issue now is whether doctors have lived up to the standards of our forebearers. Hippocrates (460-377 BC) is generally regarded as the father of scientific medicine. He separated medicine from magic and mythology of Galenic times; and introduced ethics in medicine with the formulation of the Hippocratic Oath (1;2;3;4). any doctor who draduates from medical school is sworn by that oath or any of its derived variations of his graduation day as a reminder of decent professional conduct (2). It is about a doctor's responsibility and obligation in upholding human life first and above anything else; keeping above board in conduct and relation to patients; the general public and with colleagues

Health manpower development : the need for specialist training in Sierra Leone

This study was undertaken to determine the number of doctors trained and those willing the train in the various clinical and public health specialities. There are in all 170 trained doctors in various specialities. Of those; only 70 (41 per cent) are in government service. A projection of the number of specialist doctors expected by 1977 shows that there will be less doctors specializing in the clinical disciplines and more in the public health sector. Surgeons and public health specialists tend to prefer working for the government than doctors in other specialities. Doctors in general prefer to specialize in public health than in the clinical disciplines. The consequences of those findings are discussed

The need for a training programme in community-oriented education for health personnel in Sierra Leone

There is a pressing need for a community-oriented medical training in Sierra Leone to cope with the country's health problems. To enable a community-oriented training programme to be succesfully implemented; it is first necessary to clarify the basic concepts of a community-oriented training programme in order to remove some misconceptions. The following is therefore an attempt aimed at clarifying the situation by giving a brief backgroung to the health needs of Sierra Leone followed by a definition of community-oriented medical education