ABSTRACT
Objectives: There are challenges when it is considered that a main role of a rural clinical attachment for medical students is to encourage students to return after graduation to practise in rural areas. This view may lead to the relative neglect of other potential valuable roles with regard to rural exposure. This paper draws on the Force Field Model of teacher development to describe medical students' experiences; illustrate the complexity of interacting factors during rural exposure; caution that experiences cannot be predicted and highlight the positive incentives of a rural clinical attachment. Design: The design was explorative; descriptive and qualitative. Setting: The study setting was a district hospital in rural KwaZulu-Natal. Subjects: The participants were four final-year medical students who had completed a compulsory attachment during their Family Medicine rotation. Results: The participants felt that overall the experience was positive. The effect of biography and contextual forces were not as strong as expected. Institutional forces were important and programmatic forces tended to have a negative effect on experiences. The participants particularly enjoyed being acknowledged and felt empathy for the difficult tasks of doctors
Subject(s)
Clinical Medicine , Qualitative Research , Rural Health , StudentsABSTRACT
Background. In general; the principles of palliative care suggest that; at some stage; patients should be given 'bad news' about poor illness prognosis. The information is often important for care planning; especially when it involves disclosure to children. Although there are ongoing debates about whether to tell or not to tell children bad news; these debates have largely been informed by patients who live in a developed-world context. In contrast; this paper focuses on telling bad news to children and their families from a rural; developing-world context.Objective. The objective was to analyse the experiences of providers of palliative care to children when they attempted to fulfil one of their roles as palliative caregivers; i.e. to prepare patients and families for a child's poor illness prognosis. Method. This was an exploratory study that was approached qualitatively. Five nurses and eight home-based care workers who provided palliative care for children in rural areas of South Africa formed a purposive; information-rich; self-selected sample. Data were produced through discussions with participants; using photographs taken by the caregivers to stimulate and contextualise the discussions.Results. Participants experienced four dilemmas with regard to telling bad news: when families did not want to be told any bad news; when participants felt uncomfortable about telling bad news; when participants and patients shared dissimilar values about telling bad news; and when participants were unsure about when to tell bad news.Conclusion. In the rural areas where the study was conducted; children are not usually given bad news about their illness. Disclosing poor prognosis led to the dilemmas faced by caregivers. The result was that the emotionally charged work of caring for children reaching the end of their lives became more challenging for the caregivers because they were not prepared for cultural complexities. In view of the findings of this study; there is a need for ongoing research into paediatric palliative caregiving in context