Family medicine rotation in Botswana: experiences of fifth-year medical students in decentralized rural training sites.

Introduction: globally, medical students have been exposed to decentralized training in rural settings. The experiences of these students regarding this kind of training have been reported in various settings. However, such students´ experiences have rarely been reported from sub-Saharan Africa. The purpose of this study was to explore fifth-year medical students´ experiences of a Family Medicine Rotation (FMR) at the University of Botswana and their recommendations for improvement. Methods: an exploratory qualitative study using a Focus Group Discussion (FGD) was done to collect data from the fifth-year medical students who underwent family medicine rotation at the University of Botswana. Participants´ responses were audio-recorded and later transcribed. Thematic analysis was used to analyze the data collected. Results: the overall experience of the medical students during FMR was positive. Negative experiences included issues with accommodation, logistic support onsite, inconsistency of learning activities between teaching sites, as well as limited supervision attributed to staff shortage. Emerging themes from the data included: diverse FMR rotations experiences, inconsistency of activities and different learnings between FMR training sites, challenges, and barriers to learning during FMR, enablers to learning during FMR, and recommendations for improvement. Conclusion: FMR was regarded as a positive experience by fifth years for medical students. However, improvement was needed especially with the inconsistency of learning activities between sites. Accommodation, logistic support, and recruitment of more staff were also needed for the improvement of medical students´ FMR experience.

The integration of mental health care act in primary care: an audit of the use of mental health care act forms for patients´ admission and the effect of continuing medical education on health professionals´ performance of usage, based on Letsholathebe II Memorial Hospital´s experience, in Maun, Botswana.

INTRODUCTION: despite the adoption of mental disorders act in 1972, the use of required mental health care act (MHCA) forms during admission of patients with mental illnesses remained below the legal expectation in the Maun District Hospital. This study audited Letsholathebe II Memorial Hospital (LIIMH) professionals´ usage of MHCA forms. METHODS: this was a quasi-experimental study that audited files of patients admitted with mental illnesses, before, three and six months after a continuing medical education (CME). Cochran Q, McNemar symmetry Chi-square were used for comparison of performance. RESULTS: of the 239 eligible files, we accessed 235 (98.3%). About two in ten (n=36/235, 15.3%) MHCA forms were not used in combination with required forms. The quasi-majority of MHCA forms set used, aligned with involuntary admission (n=134/137, 97.8%). Required admission MHCA forms significantly increased from nil before continuing medical education (CME-0), to 64.6% (n=51/79) at CME-3 and 77% (n=59/77) at CME-6 (p<0.001). However, there was no statistical difference between the last two periods (64.6% vs 77%, p=0.164). Voluntary admission remained below 13% (n=10/79). Only six types of MHCA forms were used during this study. CONCLUSION: there was no adequate use of required MHCA forms at LIIMH before CME. Thereafter, the proportion of adequate use increased from period CME-0 to the periods CME-3 and CME-6. However, there was no difference in proportion between the last two periods. We recommend an effective and regular CME twice a year for health professionals on selected MHCA forms.