Review of Final-Year Medical Students' Rural Attachment at District Hospitals in KwaZulu-Natal: Student Perspectives

Objectives: This study aimed to investigate the views of students involved in rural community-based medical attachments during their final year at medical school. The programme has been in existence for some time; but no formal evaluation thereof has yet taken place. This paper describes the first two phases of what is described as a quality improvement project: namely to describe the problem state and to discuss possible activities to improve the programme.Design; setting and subjects: The study adopted a mixture of quantitative and qualitative type research. Data were collected by means of a self-administered questionnaire which students at Nelson R Mandela Medical School; University of KwaZulu-Natal; completed at the end of their Family Medicine rotation. Consent was obtained from the participants and ethical approval granted by the University of KwaZulu-Natal Humanities and Social Science Ethics Committee.Results: Students were generally positive about their rural attachment experience. The majority (86) believed that their skills adequately prepared them to enter the community. Allocation of a supervisor and rostering were found to be of great importance. Academic activities provided adequate learning opportunities. The majority (76) of students who used hospital accommodation found it to be satisfactory; although it was an area that needed attention. Technological support was lacking. Fewer than 50of students had access to such facilities.Conclusion: Students' responses were generally positive about the rural attachment experience; but logistical and technological support issues; as well as that of accommodation; need to be addressed if the programme is to flourish. Community-based education in a rural district hospital can provide unique learning opportunities for students if the opportunities are identified and the programme is well managed

A Qualitative Exploratory Study: Using Medical Students' Experiences to Review the Role of a Rural Clinical Attachment in KwaZulu-Natal

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