Quality assessment in undergraduate medical training: how to bridge the gap between what we do and what we should do.

INTRODUCTION: the outcome of the undergraduate medical training programme in South Africa is to produce competent medical doctors who can integrate knowledge, skills and attitudes relevant to the South African context. Training facilities have a responsibility to ensure that they perform this assessment of competence effectively and defend the results of high-stakes assessments. This study aimed to obtain qualitative data to suggest practical recommendations on best assessment practices to address the gaps between theoretical principles that inform assessment and current assessment practices. METHODS: a focus group interview was used to gather this data. The teaching and learning coordinators for five of the six modules that are offered in the clinical phase of the undergraduate medical programme participated in the focus group interview. The focus group interview proceeded as planned and took 95 minutes to complete. The responses were transcribed and recorded on a matrix. RESULTS: the lack of formal feedback to students was identified as an area of concern; feedback plays an important role to promote student learning and improve patient care. The role of teaching and learning coordinators as drivers of quality assessment were recognized and supported. All participants agreed on the outcome of the programme and the central role of the outcome in all assessments. CONCLUSION: the training of assessors and the implementation of workplace-based assessment and assessment portfolios were recommended and can also address feasibility challenges. Participants recommended decreasing summative assessments and only performing these for borderline students.

Students' voices: assessment in undergraduate clinical medicine.

INTRODUCTION: the perception exists among students that not all clinical assessments in undergraduate medical programmes are of high quality. 'Student voice' is a term used to describe how students feel about and experience their education in a safe and controlled environment. This study aimed to investigate the opinions and experiences of medical students at the University of the Free State on the quality of assessment in the clinical phase of medicine. METHODS: a cross-sectional study design was used. Quantitative data were collected with space to clarify opinions and make recommendations. The study population consisted of the clinical medical students in 2019 who had completed at least one module and one end-of-year assessment. Self-administered, anonymous questionnaires were distributed to obtain opinions and experiences regarding assessment. Questions in the questionnaire derived from an assessment framework for clinical medicine to ensure construct and content validity. RESULTS: one hundred and ninety-two (192) students completed questionnaires (84.6% response rate). Less than half of the students were of the opinion that the assessments were fair, with lack of blueprinting and incorrect level of assessment major contributors to this opinion. Two thirds believed that the assessment was aligned with outcomes, however training was not aligned with the assessment. More than 90% of students reported on the lack of feedback after assessment. Valuable suggestions from the students included ways of assessing professionalism, timing of assessments and training of assessors. CONCLUSION: majority of students were of the opinion that there is room for improvement in the quality of assessment.

Assessment practices in undergraduate clinical medicine training: What do we do and how we can improve?

BACKGROUND: Assessment should form an integral part of curriculum design in higher education and should be robust enough to ensure clinical competence. AIM: This article reports on current assessment practices and makes recommendations to improve clinical assessment in the undergraduate medical programme at the University of the Free State. METHODS: A descriptive cross-sectional study design was used. Qualitative and quantitative data were gathered by means of open- and closed-ended questions in a self-administered questionnaire, which was completed by teaching and learning coordinators in 13 disciplines. RESULTS: All disciplines in the undergraduate medical programme are represented. They used different assessment methods to assess the competencies required of entry-level healthcare professionals. Workplace-based assessment was performed by 30.1% of disciplines, while multiple-choice questions (MCQs) (76.9%) and objective structured clinical examinations (OSCEs) (53.6%) were the main methods used during formative assessment. Not all assessors were well prepared for assessment, with 38.5% never having received any formal training on assessment. Few disciplines (15.4%) made use of post-assessment moderation as a standard practice, and few disciplines always gave feedback after assessments. CONCLUSION: The current assessment practices for clinical students in the undergraduate medical programme at the University of the Free State cover the spectrum that is necessary to assess all the different competencies required. Multiple-choice questions and OSCEs, which are valid and reliable assessment methods, are used frequently. Poor feedback and moderation practices should be addressed. More formative assessments, and less emphasis on summative assessment, should be considered. Workplace-based and continuous assessments may be good ways to assess clinical competence.

A framework to benchmark the quality of clinical assessment in a South African undergraduate medical programme.

BACKGROUND: The outcome of the undergraduate medical programme is to produce clinically competent health care providers relevant for the South African context. Educational institutions find it hard to ensure the quality of assessments where competency must be assessed. This study aimed to compile an assessment framework that can be used to benchmark current assessment practices in the clinical phase of the undergraduate medical programme where competency must be certified. METHODS: In this observational, descriptive study, qualitative data were gathered using the steps described by the World Health Organization for rapid reviews. Literature was searched, screened and selected before data were analysed and a framework was constructed. RESULTS: Twenty-five official documents were included in the study. The framework addressed the three components of quality assessment, namely, accreditation, assessment and quality assurance. Assessors should attend to the principles of assessment, namely, validity, reliability, fairness, feasibility, educational effect and acceptability, but realise that no assessment meets all these criteria. The first step to ensure quality assessment is to identify a clear outcome. Assessment should be planned and aligned with this outcome. CONCLUSION: It is clear that clinical assessment is multidimensional and that no assessment is perfect. Programme accreditation, assessment practices and psychometrics can assist to improve the quality of assessment but cannot judge clinical competence. Using experienced assessors with a variety of assessment methods on a continuous basis is the proposed way to assess clinical competence. An assessment framework can assist to improve assessment, but it cannot guarantee quality assessment.

Assessment practices in undergraduate clinical medicine training: what do we do and how we can improve?

Background: Assessment should form an integral part of curriculum design in higher education and should be robust enough to ensure clinical competence. Aim: This article reports on current assessment practices and makes recommendations to improve clinical assessment in the undergraduate medical programme at the University of the Free State. Methods: A descriptive cross-sectional study design was used. Qualitative and quantitative data were gathered by means of open- and closed-ended questions in a self-administered questionnaire, which was completed by teaching and learning coordinators in 13 disciplines. Results: All disciplines in the undergraduate medical programme are represented. They used different assessment methods to assess the competencies required of entry-level healthcare professionals. Workplace-based assessment was performed by 30.1% of disciplines, while multiple-choice questions (MCQs) (76.9%) and objective structured clinical examinations (OSCEs) (53.6%) were the main methods used during formative assessment. Not all assessors were well prepared for assessment, with 38.5% never having received any formal training on assessment. Few disciplines (15.4%) made use of post-assessment moderation as a standard practice, and few disciplines always gave feedback after assessments. Conclusion: The current assessment practices for clinical students in the undergraduate medical programme at the University of the Free State cover the spectrum that is necessary to assess all the different competencies required. Multiple-choice questions and OSCEs, which are valid and reliable assessment methods, are used frequently. Poor feedback and moderation practices should be addressed. More formative assessments, and less emphasis on summative assessment, should be considered. Workplace-based and continuous assessments may be good ways to assess clinical competence

Students' Perspectives of a Community-Based Medical Education Programme in a Rural District Hospital.

BACKGROUND: The adoption of community-based medical education (CoBME) into the undergraduate medical curriculum is in line with the SPICE model for medical curriculum proposed by Harden and colleagues. Students are the consumers of medical education and are, thus, the ideal evaluators of the efficacy of their own course and learning environment. To evaluate the quality of the CoBME programme in Botshabelo District Hospital (BDH), this study investigated student's perceptions of their experience during their CoBME training at BDH. In addition, suggestions on how to enrich students' experience during the CoBME posting were obtained from the participants. METHODS: This research was designed as a qualitative (ethnographic) study that used a structured questionnaire, to obtain written statements from 120 fourth-year undergraduate medical students describing their experience during their CoBME training at BDH. The structured questionnaire in the form of an evaluation form was self-administered, consisted of only open-ended questions grouped into 4 main sections and was distributed manually (hard copy) to the participants. RESULTS: Of the 120 questionnaires distributed, 84 were returned, giving a response rate of 70.0%. When asked to indicate what they liked or disliked about their CoBME training, 'Good educators/staff' and the 'Poor attitude of some doctors' were the themes that scored highly (25.1% and 19.4%) in the 'likes' and 'dislikes' category, respectively. Some of the major challenges faced during the CoBME training at BDH included: exposure to new learning environment (14.2%), clinical practice context (12.6%), and language barrier (7.2%). Participants stated that they gained knowledge of how to perform certain clinical procedures and acquired core clinical skills in the areas of formulating management and managing some medical emergencies during their training at BDH. Increasing the duration of training (25.6% coverage) was suggested as a major way to enrich students' experience during the training at BDH. CONCLUSION: Findings by this study reveal that CoBME is a valuable pedagogical tool to enhance learning in undergraduate medical education and that more work is required to improve the quality of CoBME training in BDH. We believe that the findings by this study will inform future planning of CoBME training programmes in BDH.

Self-managing individual wellness for the health professional: A somatology perspective.

BACKGROUND: Health professionals play a vital role in the stability and sustainability of any healthcare system. However, the well-documented long working hours, lack of wellness support structures, regular occurrence of burnout and low retention rates are concerning. AIM: The aim of this research study was to understand how a group of therapists self-manage their own individual wellness, to provide insight on how other health professionals, working in a demanding environment, could potentially address their individual wellness more effectively. SETTING: The research was conducted in a private room at the place of participant employment, in two metropolitans in Gauteng, South Africa. METHOD: Qualitative, explorative, descriptive and contextual designs were used within the paradigm of constructivism. Purposive sampling was used to select participants. Data were collected through in-depth interviews, field notes and reflective practices, and analysed through open coding. RESULTS: This study revealed disequilibrium between the theoretical knowledge and practical realities of therapists, and indicated that these therapists experience various personal obstacles that hinder the self-management of their individual wellness. CONCLUSIONS: Somatology therapists use various personal strategies that allow them to better self-manage their individual wellness. Individual wellness seems to be a personal phenomenon, indicating the need to self-reflect on personal perceptions of wellness, individual wellness obstacles and individual wellness strategies to effectively self-manage individual wellness.

Self-managing individual wellness for the health professional: a somatology perspective

Background: Health professionals play a vital role in the stability and sustainability of any healthcare system. However, the well-documented long working hours, lack of wellness support structures, regular occurrence of burnout and low retention rates are concerning. Aim: The aim of this research study was to understand how a group of therapists self-manage their own individual wellness, to provide insight on how other health professionals, working in a demanding environment, could potentially address their individual wellness more effectively. Setting: The research was conducted in a private room at the place of participant employment, in two metropolitans in Gauteng, South Africa. Method: Qualitative, explorative, descriptive and contextual designs were used within the paradigm of constructivism. Purposive sampling was used to select participants. Data were collected through in-depth interviews, field notes and reflective practices, and analysed through open coding. Results: This study revealed disequilibrium between the theoretical knowledge and practical realities of therapists, and indicated that these therapists experience various personal obstacles that hinder the self-management of their individual wellness. Conclusions: Somatology therapists use various personal strategies that allow them to better self-manage their individual wellness. Individual wellness seems to be a personal phenomenon, indicating the need to self-reflect on personal perceptions of wellness, individual wellness obstacles and individual wellness strategies to effectively self-manage individual wellness

The physician-scientists: rare species in Africa.

There is paucity of physician-scientists in Africa, resulting in overt dependence of clinical practice on research findings from advanced "first world" countries. Physician-scientists include individuals with a medical degree alone or combined with other advanced degrees (e.g. MD/MBChB and PhD) with a career path in biomedical/ translational and patient-oriented/evaluative science research. The paucity of clinically trained research scientists in Africa could result in dire consequences as exemplified in the recent Ebola virus epidemic in West Africa, where shortage of skilled clinical scientists, played a major role in disease progression and mortality. Here we contextualise the role of physician-scientist in health care management, highlight factors limiting the training of physician-scientist in Africa and proffer implementable recommendations to address these factors.

Medico-legal documentation of rape or sexual assault: are community-service doctors equipped for the task?

Background: Following upon two-year internship, community-service doctors make mistakes when they deal with evidence of medico-legal examinations in various settings. These mistakes result in alleged perpetrators being released by courts. This study investigated undergraduate clinical forensic medicine training, based on experiences and opinions of community-service doctors. This article focuses on incidents of alleged rape cases only.Methods: The study was a quantitative retrospective cohort study that made use of a questionnaire with an adapted Likert scale. An electronic survey tool was employed to target 150 community-service doctors throughout South Africa. Percentages are used to display results.Results: A response rate of 59.3% was achieved. Although 80% of the participants reported that they had undergraduate training on how to manage alleged rape or sexual assault cases, only 11.4% of the participants had hands-on exposure to an alleged rape case during their undergraduate training. In addition, the majority of the participants (77.1%) never had undergraduate training on how to complete the J88 form. These findings indicate that clinical forensic training in the undergraduate medical programme does not adequately prepare community-service doctors to meet the challenges of clinical forensic practice. The current curriculum should be adapted to address these shortcomings.Conclusions: Perpetrators cannot be convicted if evidence collected cannot stand up in court. Proper training of undergraduate medical students prior to their community-service posting will ensure that medico-legal documentation is completed correctly, leading to the presentation of credible evidence in a court of law in order to ensure successful conviction of alleged perpetrators