Sociocultural factors affecting first-year medical students' adjustment to a PBL program at an African medical school.

BACKGROUND: Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students' experiences during the first semester of an undergraduate problem-based learning medical program at an African medical school. METHOD: We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. RESULTS: Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. CONCLUSIONS: Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self-direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research-informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem-based learning process.

Design of a Learning Development Program to Support First-Year Undergraduate Medical Students in the Transition to a PBL Curriculum.

While the evaluation of learning development interventions needs to be considered carefully and included at the curriculum design stage, there is limited literature on the actual design of interventions, especially on how these designs evolve and improve over time. This paper describes the evolution of a learning development program intended to support first-year medical students adjusting to a problem-based learning curriculum. We used a design-based research approach, articulating our theoretical grounding and incorporating students' voices to develop an "optimal" intervention for the specific challenges in our context. We describe lessons learned around four aspects: students' growth and development, teachers' professional growth and development, program design principles, and the emergent components of a learning development program. Overall, our students describe the Learning Success Program as adding value by enabling the adoption of a repertoire of skills and strategies for learning management. Additionally, the incremental nature of design-based research allowed for the development of a context-specific program that considers students' voices through needs assessment and feedback on the program offerings. It has also provided an opportunity for the professional development of teachers through feedback from classroom practice, reflection, and the literature. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01790-3.

Enhancing learning in longitudinal clinical placements in community primary care clinics: undergraduate medical students' voices.

Longitudinal clinical placements are increasingly adopted by medical training institutions. However, there seems to be little evidence regarding their implementation in primary care settings in the developing world. This paper explored medical students' perceptions of their learning experiences in longitudinal placements in primary care clinics. The Manchester clinical placement index (MCPI) survey was offered to second-year medical students at the University of Botswana to determine perceptions of their 16 weeks clinical placement in primary care clinics. The MCPI provided data on eight aspects of clinical placements which were analysed to gain insight into students learning experiences while on placement. The eight items in the tool were grouped into four themes, namely, teaching and learning, learning environment, relationships and organisation of placements. Students cited the feedback they received whilst on placement and the learning environment in primary care clinics as aspects of clinical placements which could be improved to enhance their learning experience. For an enriched learning experience in primary care settings in a developing world context, there are critical aspects to be considered. Based on the students' perspective we suggest an approach of how learning in such placements could be enhanced.

Using a virtue ethics lens to develop a socially accountable community placement programme for medical students.

BACKGROUND: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in medicine, and what are the virtues that are likely to promote and sustain them? METHODS: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre's virtue ethics theory as the conceptual framework. RESULTS: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals' virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. CONCLUSION: This study found that MacIntyre's virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice.

Community-based education programs in Africa: faculty experience within the Medical Education Partnership Initiative (MEPI) network.

PURPOSE: This paper examines the various models, challenges, and evaluative efforts of community-based education (CBE) programs at Medical Education Partnership Initiative (MEPI) schools and makes recommendations to strengthen those programs in the African context. METHODS: Data were gathered from 12 MEPI schools through self-completion of a standardized questionnaire on goals, activities, challenges, and evaluation of CBE programs over the study period, from November to December 2013. Data were analyzed manually through the collation of inputs from the schools included in the survey. RESULTS: CBE programs are a major component of the curricula of the surveyed schools. CBE experiences are used in sensitizing students to community health problems, attracting them to rural primary health care practice, and preparing them to perform effectively within health systems. All schools reported a number of challenges in meeting the demands of increased student enrollment. Planned strategies used to tackle these challenges include motivating faculty, deploying students across expanded centers, and adopting innovations. In most cases, evaluation of CBE was limited to assessment of student performance and program processes. CONCLUSIONS: Although the CBE programs have similar goals, their strategies for achieving these goals vary. To identify approaches that successfully address the challenges, particularly with increasing enrollment, medical schools need to develop structured models and tools for evaluating the processes, outcomes, and impacts of CBE programs. Such efforts should be accompanied by training faculty and embracing technology, improving curricula, and using global/regional networking opportunities.