Medical education and the quality improvement spiral: a case study from Mpumalanga, South Africa

Background: The short timeframe of medical students' rotations is not always conducive to successful; in-depth quality-improvement projects requiring a more longitudinal approach.Aim: To describe the process of inducting students into a longitudinal quality-improvement project; using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies.Setting: Mpumalanga clinical learning centres; where University of Pretoria medical students did their district health rotations.Method: Consecutive student groups had to engage with a hospital's compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42); a written group report (n = 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139). Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator; health advocate; scholar; communicator; manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students; who also acted as catalysts for transforming practice.Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning

Medical Student Participation in Community-based Experiential Learning: Reflections From First Exposure to Making the Diagnosis

Background: Fifth-year medical students from the University of Pretoria participated in a four-week rotation in the primary care clinics of a large metropolitan centre. An academic service-learning (ASL) approach was introduced into this rotation to improve the integration of theoretical learning and clinical practice through relevant community service and structured reflection.Methods: Students wrote semi-structured reflective journals as a means to gaining greater insight into their learning experiences. These reflections were analysed qualitatively with a view to improving the community-based curriculum.Results: Four major themes were identified: expectations and the reality of primary care; service and learning; becoming a doctor; and making a difference.Conclusion: While students gained a deeper insight into their development as clinicians; using an ASL approach also assisted the faculty in making an informed educational diagnosis of the curriculum

Management of District Hospitals - Suggested elements for improvement

It is not difficult to find examples of district hospitals that are not functioning well. Health workers and administrators are quick to point out faults and failures. The media takes delight in highlighting them. How; though; can the management of district hospitals be improved? Many solutions have been offered to address this problem. However; programmes undertaken in different provinces and regions have not made much difference

Management of District Hospitals: Exploring Success

Interviews were conducted with senior staff (or former staff); hospital management members and district management members of 4 hospitals in 2 very different rural districts; one in KwaZuluNatal and one in North West province. These hospitals were chosen because they were thought to be functioning relatively well. The purpose was to understand some of the factors contributing to their relative success; in order to share lessons learnt with other institutions