44 July 2012, Vol. 4, No. 1 AJHPE
Abstracts
ORAL AND POSTER PRESENTATIONS
Patient simulations in developing clinical reasoning skills in
undergraduate paramedic learners at the Central University
of Technology
R G Campbell
Background/context: Advanced Life Support (ALS) Paramedics in South
Africa practise a form of emergency medicine in the out-of-hospital context
with limited resources and diagnostic tools. Avoidable patient care errors
in an emergency setting, specifically in diagnosis, are well described in the
literature. Effective clinical reasoning has proven to reduce diagnostic error.
ALS paramedic training has traditionally been skills- and protocol-driven
with little or no attention to clinical reasoning skills.
Aim/purpose: To demonstrate the contribution that patient simulations
make to the development of clinical reasoning in third-year learners in the
undergraduate National Diploma: Emergency Medical Care (NDip EMC)
programme at the Central University of Technology (CUT).
Methods: Third-year EMC learners were provided with an interlinking
framework of tasks and activities that highlight clinical problems and
require clinical reasoning skills to solve. Each third-year learner was
subjected to 4 simulated patient assessments followed by a case report on
each. A significant focus of the case report was a discussion on differential
diagnosis and reflection using the clinical reasoning process and evidence
for best practice. Exposure to patient simulations by learner groups from
2006 - 2011 prior to formal assessment was analysed. Results of assessed
patient simulations and reflective reports from 2006 - 2011 were analysed
for performance improvements.
Results and discussion: The preliminary results demonstrate performance
improvement among all learner groups over 4 assessed patient simulations.
Conclusion/take-home message: The anticipated outcome of this study is
to demonstrate the importance that patient simulations have in developing
clinical reasoning skills in third-year learners in the NDip EMC programme
at CUT. Since patient simulations are introduced in the programme as early
as first year, it is suggested these skills can be developed from earlier on in
the programme.
Practise on standardised patients (SPs) for practice
A C Jacobs, Y Botma, M J MacKenzie, L van Dyk
Background/context: In 2011 the School of Nursing invested in training
staff in simulation. Since then, simulations using standardised patients and
high-fidelity human simulators were implemented. The School of Nursing
views simulations as a learning opportunity and sees learning as an active
process of creating own knowledge. Outcomes, teaching and learning
opportunities, and assessments are constructively aligned.
Aim/purpose: To share our experiences of standardised patients (SPs) in
simulations.
Methods: Themes are developed in accordance with the teaching and
learning model of the School of Nursing. Because simulation is seen as a
learning opportunity, simulation with SP is aligned with the outcomes and
assessment strategies of the theme. Developing a simulation scenario for SP
occurs according to a standardised template. Second-year nursing students
completed the theme on airflow limitation in which the theory and clinical
skills were learned. The SP simulation scenario focussed on a patient with
asthma in a primary healthcare setting. Simulation footage was analysed by
the module coordinators, SP co-ordinator and educational advisor.
Results and discussion: Students enjoyed the experience but also identified
their own limitations and mistakes. They were able to plan their own
learning needs. Even fourth-year nursing students identified with the
second-year students and recognised behaviour that they exhibit in their
own practice and the need to improve.
Conclusion/take-home message: Standardised patients enhance learning
and may contribute to bridging the theory-practice gap.
Practise makes perfect: A real-life challenge for facilitation of
learning
Hanlie Pitout
Background/context: Real-life challenges as part of teaching are important
in facilitating learning. A real-life challenge that was introduced during 2011,
as part of my Fundamentals of Occupational Therapy curriculum, was for
students to create a traditional cooking area for the hospital, where patients
could practise traditional cooking, simulating patient’s home environment.
Aim/purpose: The purpose of the action research study was to evaluate
student response to a learning opportunity presented as part of a subject
where managing services is taught. Changing the way that learning is
facilitated and adapting the outcomes accordingly provided an opportunity
for growth for both the facilitator and students alike.
Methods: Students were asked to reflect at different stages during the project.
Initially they had to reflect on their understanding and expectations of the
project. They had to present their planning and progress regularly through
the process to peers and lecturers. Students' reflections on the process and
their growth throughout were recorded.
Fifth National Conference of the South African Association of Health Educationalists (SAAHE):
'From Practise to Practice’, Bloemfontein, 21 - 23 June 2012
AJHPE 2012;4(1):44-99. DOI:10.7196/AJHPE.178
45 July 2012, Vol. 4, No. 1 AJHPE
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Results and discussion: The students experienced personal and professional
growth during their participation in this real-life challenge. They had
the opportunity to apply the theory that they had learned on project
management, teamwork, planning and organising, in a real-life environment.
The end product was visible and of benefit to the hospital where the project
was executed. The hospital now has the facilities and equipment to present
traditional cooking activities.
Conclusion/take-home message: Providing a real-life challenge to students
instead of teaching a predominantly theoretical course proved to be
beneficial. Students received recognition form peers and other departments
for their knowledge and skills. They received the opportunity to practice
their project management skills and experienced the results of inadequate
planning and insufficient teamwork first-hand in a supportive environment.
Reviving the SP – authentication breathes life into the SP
H Schweickerdt-Alker
Background/context: Although simulated/standardised patients (SPs)
are used in many institutions, especially in portraying roles on given
short scenarios, the scope of how much they could mean is still not fully
understood. Often they are merely regarded as breathing manikins and
are not used to their full potential. The creation of three-dimensional (3D)
characters by implementing authenticity allows the SPs to become the
person behind the patient and to deliver a realistic true-to-life portrayal.
Aim/purpose: Describe the effect of authenticity of patient portrayal by SPs.
Methods: Through experience as an SP the importance of playing a ῾person
behind a patient’ or a 3D character, became evident. As an SP facilitator the
opportunity arose to share this knowledge with SP trainees and coach them
to understand and become 3D characters. The character traits, emotional
background, personality etc. and the subtext (meaning behind the words) of
a patient were examined and worked into the scenario as part of the patient
as a ῾whole’ human being.
Results and discussion: The SPs portrayed roles more realistically, and
their energy levels, enjoyment of the work and dedication improved. Verbal
and non-verbal communication of the SPs became more congruent. Facial
expressions became real. They became more believable characters with
more depth. This allowed the students to delve into the person behind the
patient to get to the actual root of the problem.
Conclusion/take-home message: If SPs are trained to be authentic, they
come closer to the person they are portraying as patients. This dimension
gives the students the opportunity to listen to what the SP (patient) is not
telling them – to read between the lines – and to get as much out of their
training as possible. The sessions with the SPs become a more exciting and
authentic learning process.
Clinical Skills Unit: Addressing the needs for continued
professional development (CPD) in allied health professions
S van Vuuren, M Nel
School for Allied Health Professions and Biostatistics, University of the Free
State
Background/context: The monitoring of continued professional education
in South Africa became the responsibility of the Health Professions Council
of South Africa (HPCSA). The HPCSA has implemented a compulsory
Continued Professional Development (CPD) programme to ensure that
health practitioners update their professional knowledge and skills to the
benefit of their clients/patients. A study by Phillips concludes that higher
education institutions have a responsibility towards alumni regarding CPD.
Most of these development sessions are currently the improvement of
knowledge and not necessarily skills. With the completion of the Clinical
Skills Unit (CSU) of the School for Allied Health professions (SAHP)
in 2011, one of the aims was to develop the unit as an institute for CPD
activities.
Aim/purpose: To investigate the need for an institute for CPD among
dieticians, occupational therapists and physiotherapists.
Methods: The study had a descriptive and comparative nature. Questionnaires
(N=258) were distributed to qualified dieticians, occupational therapists and
physiotherapists from the Free State and Northern Cape provinces, South
Africa. To ensure reliability, 10% of the sample was tested after 1 month.
Ethical approval was obtained to conduct the investigation.
Results and discussion: Round-one questionnaires were distributed among
respondents; 127 professionals responded. The study population was mainly
female (97.6%), with 56% from the Free State. Respondents were mostly
employed in the public sector (71.7%) and attended CPD activities in
Bloemfontein (65.9%). The majority of previous CPD activities were theory
(70.6%), but most of the respondents (85%) indicated that they would prefer
small-group learning. Respondents also expressed a need to observe experts,
especially with regards to intervention skills. The majority of respondents
agreed that the CSU can address their CPD needs. There were no significant
differences between the 3 groups of professionals.
Conclusion/take-home message: Developing the University of the Free State
CSU as a provider of CPD activities can address the needs of allied health
professionals.
An investigation into participation trends by wheelchair
basketball players at the Zimbabwe Paralympic Games: A case
study of Bulawayo
Bhekuzulu Khumalo, Ignatius Onyewandume, Sungwon Bae,
Shadreck Dube
Background/context: Physical activity and sports for participants with
functional limitations and activity restrictions are increasingly being referred
to within the framework of Adapted Physical Activity (APA) (Sherrill, 2004;
Steadward et al., 2003; Winnick, 2005), health promotion (Riley et al.,
2008), rehabilitation medicine (Roe et al., 2008), Special Olympics (Shapiro,
46 July 2012, Vol. 4, No. 1 AJHPE
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2003; Farrell et al., 2004) and Paralympics (Higgs and Vanlandewijck, 2007).
The IPC recognises 6 different disability groups: amputees, athletes with
Cerebral Palsy (CP), blind or visually impaired athletes, spinal cord injury
athletes, and athletes with an intellectual/learning disability. This research
focuses on amputees, spinal cord injury athletes and the other athletes with a
physical disability, who participate in wheelchair basketball. Disability or the
disablement process is manifested in the interaction between the individual
and his/her environment. This research was guided by the UN Accessibility
for the Disabled document, designed to guide and set standards for built
environment accessibility by the disabled.
Aim/purpose: To investigate (i) challenges faced by wheelchair users in the
use of public transport and roads; (ii) participation trends in wheelchair
basketball; and (iii) reasons for participation or non-participation in
basketball by physically disabled persons in Zimbabwe’s Bulawayo city.
Methods: Randomly selected wheelchair basketball players from 2 clubs in
Bulawayo were interviewed and group discussions carried out. Seventeen
people (9 males and 8 females) were interviewed.
Results and discussion: The results show that the barriers to participation
are a result of an unfriendly and non-adapted transport system, poverty,
lack of access to equipment and non-adapted facilities providing health and
safety risks over and above accessibility challenges.
Conclusion/take-home message: This research revealed a list of barriers to
wheelchair sports participation, opening avenues for further research in the
areas of mainstreaming and Paralympic sports participation in Zimbabwe.
The need and value of teaching knowledge and skills among
Family Medicine registrars
Marietjie de Villiers, Francois Cilliers, Nicoline Herman, Francois
Coetzee, Klaus von Pressentin, Martie van Heusden
Background/context: Postgraduate students specialising in various medical
fields (registrars) work fulltime in the health services and are usually
involved in the training of undergraduate medical students. This mostly
involves individual or small-group clinical supervision and feedback, but
some registrars are also doing formal lectures. Registrars, however, very
seldom receive any training on how to teach.
Aim/purpose: This study reports on Phase 2 of a larger research project
seeking to investigate the influence of a module on teaching and learning
on family physician trainees and its effect on their teaching practices. Phase
1 results were reported at the 2011 SAAHE Conference. In Phase 2, current
registrar perceptions of their role as medical specialists, attitudes towards
teaching, and confidence with and participation in teaching activities were
explored for groups before and after the module.
Methods: In-depth interviews were conducted with 11 purposively
selected final-year students in the MMed Family Medicine programme
at Stellenbosch University after completing the module. Two focus-
group interviews were held with a total of 7 third-year students before
commencing with the module. Interviews were digitally audio-recorded,
transcribed and thematically analysed. Ethical clearance was obtained for
the study.
Results and discussion: Both student year groups emphasised the need
for the inclusion of a module on teaching and learning in their training.
The final-year students were more confident than the third-year students
in terms of performing small-group and one-on-one teaching, as well as
doing presentations. Stress levels for presentations were similar for both
groups, but final-year students had reduced stress levels for one-on-one
teaching.
Conclusion/take-home message: Registrars-in-training expressed a clear
need to be proficient in teaching practices even at an early stage of their
studies. Although only the perceptions of respondents were ascertained,
these aligned with qualities expected of competent teachers.
A reflection on professional development of registrars
completing a module in Healthcare Practice
G J Van Zyl, J Bezuidenhout, M M Nel
Background/context: The MMed professional training and the skills
required by registrars are generic in nature. These skills were trained in the
module in Healthcare Practice (GPV 703).
Aim/purpose: This research evaluated registrars' experiences of the
module, including quality assurance, improvement of content and mode
of presentation. Module development was specifically aimed to offer each
registrar the scope to address the unique needs concerned with Ethics,
Practice Management and Patient Communication.
Methods: The study was a quantitative study enhanced by qualitative
methodologies. Guest presenters (clinicians, health sciences and other
professionals) facilitated the contextualisation and application of the
content of the module. A self-administered questionnaire included a rating
scale and open-ended questions was completed by participant registrars to
evaluate presentations.
Results and discussion: A total of 40 registrars who completed the newly
introduced module GPV703 from 2009 to 2010 participated in the study.
Informed consent was obtained before completion of the self-administered
questionnaire. Thirty-one Heads of Department (HoDs) helped with
the evaluation. Thirty-eight (95%) of the 40 registrars completed the
questionnaire. Registrars reported a total satisfactory and very good
combination mean percentage of 91% for the questions related to the
orientation session, content and applicability of the module. Thirty-one
(77.5%) of the 40 questionnaires collected, were completed by HoDs on the
insight of registrars in GPV. Registrars found the lectures on ethics to be
most valuable and an important aspect for the treatment and management
of patients.
Conclusion/take-home message: Value was added and aspects required
by registrars to develop and/or enhance their skills, knowledge and
professional behaviour with regard to Ethics, Practice Management and
Patient Communication were addressed.
47 July 2012, Vol. 4, No. 1 AJHPE
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Integration of learning in an undergraduate medical
programme at the University of the Witwatersrand
Shalote Rudo Chipamaunga
Background/context: One of the key concepts underpinning the reformed
MB BCh undergraduate programme of the University of the Witwatersrand
has been to apply the principles of integration as a strategy to enhance
learning. Integration is one of the cornerstones of current medical programme
reform in the world. Horizontal and vertical integration of content from
relevant basic sciences and pathological, humanistic and clinical disciplines
requires specific efforts. There is evidence that integration assists students
to assimilate and apply what they have learned more effectively, and thus
enhance the goal of achieving professional competence.
Aim/purpose: To outline the application of phenomenography as a unique
qualitative research approach for collection of data on student and staff
views on integration.
Methods: Individual face-to-face interviews and focus-group discussions
are being conducted to collect data from the following study samples as
they continue in the 2012 programme: cohort 1: the 2011 class of MB BCh
1; cohort 2: the 2011 class of MB BCh 2; cohort 3: the 2011 class of MB
BCh 3; cohort 4: the 2011 class of MB BCh 4; cohort 5: the 2011 class of
MB BCh 5; teachers of medical students in years 1 - 6 of the programme;
and academic staff involved in developing/reviewing the 6 years of the
reformed MB BCh programme.
Results and discussion: This is work in progress (data collection is ongoing).
Conclusion/take-home message: Determining the effectiveness of
integration requires obtaining the views of those who experience it.
Phenomenography is one of the best methods of investigating students’
experiences in education.
A document review of the MB ChB curriculum to inform
enhancement of undergraduate public health (PH), evidence-
based healthcare (EBHC), health systems and services
research (HSSR) and infection prevention and control (IPC)
teaching
Anke Rohwer,Taryn Young, Lilian Dudley, Fidele Mukinda, Neil
Cameron, Bart Willems, Shaheen Mehtar, Frederick Marais,
Angela Dramowski, Ben van Heerden
Background/context: Stellenbosch University, through a Medical
Educational Partnership Initiative grant, aims to enhance the skills of
medical professionals in HIV/AIDS and TB care in rural and underserved
communities, and to increase research capacity in this field. Strengthening
the knowledge and skills of EBHC, PH, IPC and HSSR among undergraduate
medical students is key to this initiative.
Aim/purpose: We conducted a document review of the MB ChB
curriculum at Stellenbosch University, to describe the current content of
EBHC, IPC, HSSR and PH teaching, and to inform strategies to enhance
the curriculum.
Methods: Four teams identified area-specific competencies aligned with
the CanMEDS framework. Each team reviewed all 64 theoretical and
clinical module guides and extracted learning outcomes relating to area-
specific pre-specified competencies, using standardised data extraction
forms. Learning outcomes were classified as knowledge, skill or attitude.
῾Knowledge’ outcomes were assessed based on Bloom’s taxonomy of
cognitive functioning by matching the verb contained in the learning
outcome to the appropriate level of the taxonomy.
Results and discussion: EBHC, IPC, HSSR and PH are covered to varying
degrees. Teaching is confined to specific modules and not explicitly
integrated in a stepwise fashion, progressing from lower levels of knowledge
to acquisition of skills and practical competencies throughout the
curriculum. As this study was based purely on information in the module
guides, it did not aim to comprehensively capture actual learning taking
place in various teaching contexts. To supplement data, interviews with
lecturers and tutors, and a survey with recent graduates will be undertaken.
Conclusion/take-home message: National health priorities should direct the
competencies needed by health science students. This document review is
the first part of a situational analysis which will inform the enhancement of
EBHC, PH, IPC and HSSR teaching offered at undergraduate level.
Going rural: An analysis of the first year of implementation of
an innovative medical education model
S Van Schalkwyk, J Bezuidenhout, H Conradie, M De Villiers, T Fish,
B Van Heerden
Background/context: In 2011, 8 final-year medical students from
Stellenbosch University commenced year-long clinical training at 2 sites
on the Ukwanda rural platform. Two models were adopted: a traditional
discipline-based clinical rotation programme at the regional hospital and
the longitudinal integrated model at a district hospital. While students were
required to complete the same summative assessment as their peers at the
central hospital, a number of curriculum innovations were implemented.
Aim/purpose: This benchmarking study, supported by SURMEPI was
undertaken to determine the success of the first year of implementation of
the programme to inform future refinement of the model.
Methods: The formative evaluation adopted a mixed-methods approach.
After obtaining ethical clearance, 22 in-depth interviews (with students,
preceptors and administrators) and one focus-group interview (with home-
based carers) were conducted. The transcribed recordings were analysed
using Atlas ti. Comparative analyses between the results of the rural-based
students v. students at the central hospital were undertaken.
Results and discussion: Students described their enhanced self-confidence
and improved skills. Themes less explored in the literature, such as continuity
of patient care and feeling part of a team and community, also emerged.
Students explained how the experience had influenced their thinking and
had encouraged self-study. The preceptors described their personal learning
experiences – sentiments that were echoed by the healthcare workers on
the rural platform. Also evident was how community-based activities had
48 July 2012, Vol. 4, No. 1 AJHPE
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heightened social awareness. The comparative analyses highlighted trends
which require further exploration.
Conclusion/take-home message: The findings of our study exhibit
congruence with existing literature and provide critical insights for future
iterations of innovative rural education models. The resultant learning
experiences are potentially transformative encouraging socially accountable
practices.
Generic learning skills in academically-at-risk medical
students: a development programme bridges the gap
V C Burch, G Gunston, D Shamley, C Sikakana, D Murdoch-Eaton
Background/context: A major global challenge of medical education
is widening access and enrolling students from diverse educational
backgrounds. Given the increased risk of attrition, development programmes
have been established to improve the throughput of these academically-
at-risk students. While these programmes acknowledge the importance of
generic skills development in promoting academic success, there are no
reports documenting the impact of these programmes on changes in the
students’ skills profiles.
Aim/purpose: Determine whether (i) academically-at-risk students, entering
medical school at the University of Cape Town (UCT), have a different
generic skills profile compared with conventional students; and (ii) the change
in skills profile of these students after completing a 12-month Intervention
Programme (IP).
Methods: A previously validated questionnaire was used to document
students’ self-reported practice of, and confidence in, generic skills
including information handling, managing own learning and technical,
numeracy, IT and organisational skills. The survey was self-administered
at the beginning and end of first year after completing the IP.
Results and discussion: Four hundred and thirteen first-year medical
students were enrolled in the study (99% participation) and 77 (19%)
entered the IP after failing semester 1. There was a significant difference in
the practice of, and confidence in 5/6 categories of generic skills between
the IP students and conventional students upon entry to medical school.
At the end of first year, after completing the IP, there was no significant
difference between the practice of, and confidence in 5 of the 6 categories of
generic skills between the IP students and conventional students. Sixty-two
IP students (81%) successfully completed first year.
Conclusion/take-home message: Academically-at-risk students entering
medical school at UCT lack a range of key generic learning skills. IP
participation closes the skills gap and results in a first-year completion rate
of 81%.
Do students calibrate their confidence after being informed of
their assessed competence?
T P Yeow, K C Tan, L C Lee, J Blitz
Background/context: This research was conducted at Penang Medical
College in Malaysia, among 3rd-year medical students who were learning
practical skills prior to the start of their clinical rotations.
Aim/purpose: We confirmed that self-perceived confidence in practical skills
is not an accurate reflection of competence in our student population. We
were interested to determine whether students calibrated their confidence
after receiving feedback on their assessed competence.
Methods: One hundred and fifteen third-year medical students underwent
a 13-week practical skills module. Students were invited to rate their
confidence for each skill pre- and post- module on a scale from 1 (don’t
know what this skill is) to 6 (fully expect that I am able to teach this skill to a
junior colleague). At the end of the module, their performance in a selection
of these skills was assessed by means of an OSCE. On completion of the
OSCE, students were given their performance checklists with feedback.
They then rated their confidence for the last time.
We analysed changes in pre- and post-OSCE confidence against whether
they had passed or failed the OSCE stations.
Results and discussion: Sixty-two of 115 students who completed all
confidence ratings were included for analysis. The majority of students with
high-confidence pre-OSCE maintained this, regardless of whether they
failed the OSCE or not, despite being informed of their poor performance.
In response to open-ended questions added to the final confidence rating
scale, 84% of students were unsatisfied with their performance during
OSCE while 66% believed the OSCE performance did not accurately reflect
their competence.
Conclusion/take-home message: Self-assessed confidence in practical skills
was not calibrated in response to being informed of OSCE performance.
Lack of calibration may be affected by students’ inherent character, self-
reflective skill and their confidence in the assessment process.
The effect of simulated emergency skills training and
assessments on the competence and confidence of medical
students
I Treadwell
Background/context: Medunsa’s Skills Centre came into operation in
2010. The skills teachable in simulation were listed for 6 academic years to
integrate theory and scheduled clinical practica. Sixth-year medical students
have to manage 3 simulated clinical emergencies in small groups during the
orientation period of the Family Medicine block. The skills incorporated
in these simulations include basic life support, airway suctioning, oro-
pharyngeal airway placement, endotracheal intubation, Bag-Valve-Mask
ventilation and defibrillation. The 2012 6th-year students’ emergency
training was only through apprenticeship in real-life clinical situations.
There is no evidence that these students had opportunities to practise these
49 July 2012, Vol. 4, No. 1 AJHPE
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skills during their clinical rotations or how competent and confident they
are to perform emergency skills.
Aim/purpose: To determine the effect of skills training and assessments on
the competence and confidence of senior medical students in performing
emergency skills.
Methods: A one-group pre- and post-test quasi-experimental design is
being used. A convenience sample will comprise students of 3 Family
Medicine rotations (February to June 2012). Pre-testing: (i) questionnaire
to determine participants’ exposure to the above name skills during their
training and their confidence levels in performing these skills; (ii) MCQ
test on the skills; (iii) OSCE to determine the participants’ competence.
Interventions: (a) lectures and demonstration on skills; (b) supervised
hands-on practise. Post-testing: (i) questionnaire on training experience,
MCQ and OSCE.
Results and discussion: The questionnaire responses will be summarised
by frequency counts and percentages. The percentages of ῾favourable’
outcomes before and after the teaching sessions will be compared using
the McNemar test. The mean Likert scale scores, tests scores and OSCE
results obtained before and after the teaching and practise sessions will be
compared by using the paired t-test.
Conclusion/take-home message: Research is ongoing. Results and
conclusions will be discussed at conference.
Rural longitudinal integrated clerkships: Lessons from two
programs on different continents
Ian Couper, Paul Worley, Roger Strasser
Background/context: Flinders University in Australia has had a rural
longitudinal integrated clerkship for selected medical students, the Parallel
Rural Community Curriculum, since 1997. The Northern Ontario School of
Medicine (NOSM) in Canada introduced a similar clerkship for all NOSM
students in 2007. An external evaluation of both programs was conducted,
in 2006 and 2008, respectively.
Aim: To analyse similarities and differences between these 2 programmes.
Methods: The evaluation took the form of a cross-sectional descriptive study
conducted in each school using focus-group and individual interviews,
involving students, faculty, preceptors, health service managers and
community representatives. Interviews were analysed for emerging themes
based on a grounded theory approach. Common themes were tabulated and
validated. The themes for the 2 sites were compared and contrasted to assess
similarities and differences.
Results and discussion: Interviews and focus groups were conducted with
87 people at Flinders and 39 at NOSM. All participants felt that the programs
produced confident and skilled students. The educational value of the
programs was expressed in terms of continuity of care, longitudinal exposure,
development of relationships, mentoring, teamwork, and participatory
learning. Common concerns were related to issues of standardisation,
ensuring exposure to all specialist disciplines, communication, support for
students and preceptors, isolation, dealing with personal issues, and the
process of site selection.
Conclusion/take-home message: The rural longitudinal integrated clerkship
approach to teaching the core clinical components of the undergraduate
medical curriculum has a positive impact on both students and clinicians,
as demonstrated in 2 different sites on 2 continents.
Feet of clay? No! Our model of the learning effects of
assessment seems robust
Francois Cilliers, Lambert Schuwirth, Cees van der Vleuten
Background/context: An intervention based on a validated model should
result in better outcomes than a less theoretically grounded effort. While
much research links assessment and learning, few models exist to explain
the links that are typically observed. No models have been validated or have
gained traction to inform intervention design. Using grounded theory, we
proposed a model linking assessment and pre-assessment learning. We are
in the process of validating this model.
Aim: To explore the model's generalisability in varied assessment contexts.
Methods: Cross-sectional surveys of 593 students at 3 universities were
undertaken. A purpose-made questionnaire was developed, comprising
pairs of written situational tests using the logic of the key-features
approach. The chi-square statistic was used to determine significance for
associations between assessment factors and learning effects. The frequency
of involvement of mechanism factors was calculated. As the most stringent
test of the model, we focused on the model’s 21 weakest associations. Ethical
approval was obtained.
Results: The response rate was 45.9%; 15/21 associations between
assessment factors and learning effects were significant (p<0.00625) across
institutions. The role of 7/8 assessment factors, all 8 learning effects and all
10 mechanism factors were substantiated. Three mechanism factors (agency
(25.7%), response efficacy (21.4%) and response value (14.6%)) mediated
the majority of associations.
Conclusion: Model validation is an ongoing process - these results are but
one link in a chain of evidence. The support for the weakest associations
bodes well for future studies of the model’s stronger associations. These
results bring us one step closer to a model that could meaningfully inform
assessment-based interventions.
The role and responsibilities of higher education institutions
(HEI) regarding peer mentoring
Y Botma, S Hurter, R Kotze
Background/context: This presentation reports on the postgraduate critical
care students’ mentoring of the third-year undergraduate nursing students
during integrated work-based learning in the critical care units.
50 July 2012, Vol. 4, No. 1 AJHPE
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Aim/purpose: The purpose of the research was to describe what the higher
education institution (HEI) could do to improve this mentoring programme.
Methods: A qualitative descriptive design was used. The nominal group
technique was used to gather data from the mentors and mentees. Data
from the groups were combined and qualitatively analysed into themes.
Thereafter the themes were quantitatively ranked.
Results and discussion: The themes, ranking from the highest to the lowest,
were orientation, organisation, mentoring process, characteristics of the
mentor, and feedback to the mentor. Findings suggest that the HEI does not
always optimally support the mentoring programme. It is recommended
that more than one communication medium be used to disperse
information among role-players. HEIs should develop mentors, monitor
their interactions with mentees and give them feedback on their mentoring
skills. It is also the responsibility of the HEI to select mentors that match the
desired profile of mentors.
Conclusion/take-home message: Main tasks of the HEI are to: (i) develop
guidelines for the mentors and mentees; (ii) develop memorandum of
understanding; (iii) develop the mentors; (iv) support mentors; (v) create
and maintain open communication channels to all parties; (vi) monitor
mentoring process; and (vii) provide feedback to mentors and mentees.
St. George’s University School of Medicine (SGUSOM):
Innovative student academic support in the basic sciences
Glen Jacobs
Background/context: SGUSOM is located in the Caribbean island of
Grenada in the West Indies and the majority of the students are from the
United States. Performance on standardised measures to enter into medical
schools is lower for these students than for students attending United States
medical schools. SGUSOM students out-perform students from all other
Caribbean schools of medicine and for 2010 equalled the first-time pass
rate of 92% in the US and Canada on the United States Medical Licensing
Examination (USMLE) Step 1, a standardised examination of basic science
knowledge. An astonishing achievement.
Aim/purpose: To identify academic student support practices which may
contribute to enhance student learning and academic performance in the
basic sciences.
Methods: Comparing basic intake and outtake performance data of students
on standardised examinations.
Results and discussion: On average SGUSOM students perform equally as
well on USMLE Step 1 as students who took the basic sciences in the United
States medical schools, even though their performance on standardised
measures is lower. We have identified innovative practices at SGUSOM
that we believe contribute to enhanced performance and that have become
part of the learning culture of the university. This includes a unique
Department of Educational Services, specialised advising system, academic
enhancement program, imbedded small-group learning and review groups,
Sonic Foundry and Sakai.
Conclusion/take-home message: The philosophy at SGUSOM is that once a
student gets admitted to the university, it is a responsibility of the institution
to help them succeed without compromising standards. This is done in a
most efficient way by providing an effective student support system as well
as sufficient resources. This support should be part of the medical school
culture and not an add-on.
‘For most of S Africans, we don’t just speak’: A qualitative
investigation into collaborative heterogeneous PBL group
learning
V S Singaram, C P M van der Vleuten, D H J M Dolmans
Background/context: An enhanced interaction across the racial, ethnic and
cultural divide is particularly relevant for medical students as it prepares
them for practising medicine in a multicultural community. Collaborative
approaches such as problem-based learning (PBL) may provide the
opportunity to bring together diverse students, but their efficacy in practice
and the complications that arise due to the mixed ethnicity needs further
investigation
Aim/purpose: This study explores the key advantages and problems of
heterogeneous PBL groups from the students’ and teachers’ opinions.
Methods: Focus groups were conducted with a stratified sample of second-
year medical students and their PBL teachers. Discussions were transcribed
and analysed using Atlas-ti.
Results and discussion: Several themes describing opportunities, challenges
and recommendations emerged. These included uniting diverse students
and preparing them to work in multicultural societies. Challenges included
segregation, non-participation due to inequalities, social status, language
barriers and differing levels of academic preparedness.
Conclusion/take-home message: The presence of a multi-cultural student
population at a learning institution does not necessarily mean that there
will be positive interactions in intercultural collaborative learning activities.
Students and staff need special diversity skills training and continuous
feedback.
A dual perspective on a goal-directed mentoring programme
for a junior lecturer in the Department of Speech-Language
Pathology and Audiology
A M Wium, F Mahomed
Background/context: The benefits of mentoring in Higher Education are
well documented. In order to orientate and integrate a new staff member in
the Department of Speech-Language Pathology and Audiology a mentoring
programme was introduced. Both the mentor and the mentee were seeking
to develop professionally. The mentee, who had limited experience in Higher
Education, required support in the academic environment and in teaching
and learning. Communal goals were developed according to personal needs
and were met through a process of goal-directed mentoring.
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Aim/purpose: The aim was to develop a blueprint for a mentoring
programme to be used with junior staff in the Department of Speech-
Language Pathology and Audiology.
Methods: Specific goals were identified at the onset of the mentoring
programme. The data collected was obtained from continuous reflections
by the mentor and the mentee, peer review and self-evaluation. The process
and the outcomes of the mentoring programme were documented and
presented as a portfolio.
Results and discussion: The results are based on the experiences and
reflections of both the mentor and the mentee. Goal-directed mentoring
appears to be effective as benefits, such as personal and professional growth
and empowerment of the mentee, were identified and documented by both.
From this symbiotic relationship both parties experienced the process as
meaningful and were motivated. Future needs were identified.
Conclusion/take-home message: Goal-directed mentoring combined with
continuous reflection by both the mentor and mentee created the opportunity
for professional and personal growth. Such a mentoring process can be used
to advance the academic careers of staff.
BCMP student experiences of professionalism during clinical
rotations
M O Mapukata-Sondzaba
Background/context: Medical professionalism as a set of behaviours that
transcends personal values, beliefs and attitudes to incorporate ethical and
moral principles, is considered to be a covenant between society and the
medical practitioners. As a desired state, an understanding of the attainment
of professionalism not as an event but rather as a process obligates both the
academic and the clinical tutors to cooperate for the good of the patient.
Aim/purpose: To assess congruency between the academic and clinical
training environment with regards to professionalism by reviewing Bachelor
of Clinical Medical Practice (BCMP) student experiences of professionalism
during clinical rotations.
Methods: Following 5-week attachments in 5 purposely selected clinical
departments, 25 final-year BCMP students reflected individually on their
personal experiences of professionalism in the workplace for 3 of the
rotations. Qualitative methods were used to group emerging themes from
69 portfolios. BCMP student experiences of professionalism were analysed
from an ethical perspective, guided by HPCSA guidelines for healthcare
professionals.
Results and discussion: BCMP students reflected positively on the respect
for patients, compassion and care that they observed in paediatrics.
Professional integrity was recognised as a context-specific attribute for
admitted patients. Role modelling was experienced in emergency medicine
and in paediatrics. The lack of privacy between cubicles in the wards
was perceived as compromising privacy and confidentiality of patient
information. Inadequate communication, attitudes of staff, resources and
cultural issues were some of the attributes that compromised patient care.
Conclusion/take-home message: BCMP students demonstrated congruency
on professionalism by integrating theoretical knowledge with their
experiences during clinical training rotations. They were able to recognise
positive and negative contextual attributes of professionalism and identify
individuals who they perceived as role models.
Creating an educational environment that fosters agency and
social accountability in health professionals
Ellenore Meyer, Alwyn Louw
Background/context: Social accountability of medical schools is defined
as ῾the obligation to direct their education, research and service activities
towards addressing priority health concerns of the community, region
or nation they have a mandate to serve.’ Balancing global principles with
context specificity necessitates an understanding of the African context of
community, including the concept of Ubuntu. Medical educators play a
central part in providing relevant activities that will foster agency and social
accountability.
Purpose: Evaluating the effect of this bio-ethics module on second-year
medical students’ knowledge of, and attitudes towards, social accountability.
Method: The study evaluated an educational intervention; using a pre-
and post-intervention test design. Qualitative and quantitative data were
collected as part of a mixed-methods strategy in a survey by means of a
questionnaire. The questionnaire focused on learners’ views on community,
social accountability and Ubuntu. Qualitative data were analysed and
coded according to themes. Coding was performed through an inductive
open process. Ethical clearance was obtained. The educational intervention
entailed an in-class learning experience in small groups at the hand of
multiple case examples over 4 weeks.
Results and discussion: Eighty-five per cent of 2nd-year students in the
sample group completed questionnaires. On average, learners’ knowledge
regarding social accountability improved – the differential on the
quantitative component pre- and post-intervention was +11.2% (p=0.0033).
Qualitative data revealed a positive development of students’ views and
attitudes about their roles as health professionals having an agency and
social accountability.
Take-home message: Embedding the principle of Ubuntu in the Bio-Ethics
module has the potential to equip and inspire learners to fulfil their role as
socially accountable change agents.
Introducing basic medical isiZulu to medical students for
communication purposes – did it work?
L Molefe
Background/context: Teaching isiZulu to GEMP 1 medical students at the
University of the Witwatersrand became necessary in 2011 as problems of
communication continued between English-speaking health workers and
African language speakers.
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Aim/purpose: (i) To create a moderate background for students who do
not speak isiZulu; (ii) to increase basic communication skills in isiZulu for
those who have little to no background in the language; (iii) to straighten
communication skills among mother-tongue speakers as well; (iv) to
minimise cases where nurses become doctors’ interpreters; and (v) to
protect patient privacy.
Methods: Teaching material was created using the GEMP 1 block system;
isiZulu sentences were created using the history taking questions and
answers. Grammar and terminology from the blocks also formed part
of the lessons. The same material was placed on a website for students to
access., with video clips of a lecturer teaching isiZulu to promote correct
pronunciation. Tutorials are managed by GEMP 1 students who speak
isiZulu, with the help of a lecturer.
Results and discussion: Some students perceived that the course added to
their study load. Hence, attendance was high in the beginning but decreased
later. Mother-tongue isiZulu speakers never attended, while those with half
the background of the isiZulu speakers attended occasionally. Only those
with no background at all attended. However, the first OSCE saw an 80%
pass rate, even in the final exam. GEMP 1 students of 2012 have shown
incredible interest in the course. Their current attendance is immeasurable.
This is partly because the course was not introduced as additional work, and
also because the students understand the communication problem that this
course is attempting to address.
Conclusion/take-home message: It is hoped that more African languages
will be included in the same programme in the future. More basic isiZulu
communication teachers may also emerge from the course.
Diagnose before you prescribe: A faculty needs assessment for
a Faculty Development Programme in AHFAD
Tahra S Al-Mahdi
Background/context: Ahfad University for Women (AUW) is the pioneer
in female education and empowerment in Sudan. Ahfad Medical School
(ASM) was established in 1990 to produce the right type of graduates for
its context through an innovative community-orientated curriculum.
Due to many factors, the ASM curriculum has gradually deviated to a
more conventional form. In 2008 winds of change arrive in the shape of a
partnership with the American University of Beirut (AUB). This mandated
a university-wide move towards a more student-centred approach. Ahfad
Educational Development Centre (AEDC) was established to support
faculty in coping with new demands, through various faculty development
(FD) activities. Unexplainably, ASM faculty attendance of these activities
was consistently low.
Purpose: To identify faculty’s professional development needs (PDNs) prior
to designing a suitable FDP.
Methods: PDNs were assessed in a 1-day workshop through small-group
discussions. Consequently, a questionnaire was generated to prioritise
the different areas and capture the desired format, duration and timing of
FD activities. Both tools targeted full-time faculty (N=56 teacher). Forty-
eight members attended the workshop (85%), of whom 28 answered the
questionnaire (50%).
Results and discussion: Eight FD areas were identified: assessment,
classroom management, curriculum evaluation, instructional planning,
instructional methods, research, student support, and technology. The
different areas were prioritised from the most- to the least-needed and the
desired format (workshop), duration (1-day) and days (e.g. Saturdays) for the
FD activities. The workshop established some important recommendations
which were translated into actions during the project duration: conduction
of longitudinal workshops on assessment, implementation of a new exam
format, involvement of students in their education, regular faculty meetings
and reform of some courses.
Take-home message: Allow teachers to identify their own professional
development needs; they will be more committed to filling identified gaps.
The value of standardised video demonstrations as an
educational tool in clinical skills training
L de Bruyn, J Lombaard
Background/context: In clinical skills training, pre-clinical MB ChB students
are taught the art of managing a patient during a clinical consultation. The
nature and volume of the study matter necessitates longer teaching time
and smaller student groups. The class is therefore divided into 6 groups.
This implies that a session must be presented on 6 consecutive days by the
clinical department responsible for the particular session (e.g. Urology).
This is extremely labour-intensive and problematic for clinicians who are
also service providers in clinics and hospitals.
Aim/purpose: To determine whether standardised video demonstrations
of clinical presentations are of educational value in the Clinical Skills
course.
Methods: Video recordings were made of presentations given by the
designated clinician. The subjects included history-taking or performing
a clinical examination. These were edited and their educational value
enhanced by adding classifications, summaries and explanatory photographs
of the content presented. At the end of their Clinical Skills course, the
students (n=113) completed an anonymous questionnaire to determine
their perception of the value of these video demonstrations. The results were
analysed and presented as a percentage for this qualitative study.
Results and discussion: The majority of students (78%) responded positively
and found the presentations of clinical examinations to be of educational
value.
Conclusion/take-home message: Presentation of the components of the
clinical consultation, e.g. taking a patient’s history or performing a clinical
examination, by means of video demonstrations is perceived as a valuable
educational tool by students. This method has the advantage of replacing the
consultants’ repetitive presentations, allowing them to use their limited time
to facilitate students’ practising the physical examination and also, that each
student receives exactly the same tuition.
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Faculty development – a policy review
Ian Couper, Patricia McInerney
Background/context: As part of the development of the Guidelines for the
Scaling up of Transformative Health Professional Education, the World
Health Organization requested that a policy brief be written for the second
Core Group meeting.
Aim/purpose: To understand the issues and challenges related to faculty
development with respect to medical, nursing and midwifery education, in
order to make policy recommendations.
Methods: A review of the literature was conducted of faculty development,
specifically in relation to the teaching role of faculty members in terms of
issues, challenges, impacts and outcomes.
Results and discussion: The issues and challenges related to the development
of faculty for the teaching role are described in 7 broad areas: the multi-
dimensional roles of health professionals; attitudes towards teaching;
conflicting opportunities; the shortage of teachers; the increased demand
for physicians, nurses and midwives; developing health professionals
for a teaching role; and rewards for teaching. Assessing the impact on
outcomes of faculty development initiatives is difficult due to limited focus
in the literature on systematic evaluations of interventions using rigorous
methodologies.
Conclusion/take-home message: Faculty development does impact
positively on educational practices, and possibly on outcomes, but a
supportive faculty environment, with rewards and incentives for teaching,
requires broader institutional change. Recommendations for policy
changes are made in relation to health professional schools, government
and accrediting bodies.
Improving basic surgical skills for final-year medical students
Mohamed Labib
Background/context: The medical undergraduate curriculum at the
University of Zambia's School of Medicine is mainly knowledge-based,
with more theory than hands-on educational activities.Hospitals employing
medical graduates often express concern at the inexperience of new interns
in basic surgical skills. In self-assessment questionnaires, students reported
little clinical procedural experience.
Aim: To measure the efficacy of a basic surgical skills workshop for senior
undergraduate students, as well as retention of skills gained.
Methods: A practical skills workshop was conducted in order to set learning
goals for the final study year through simulation. Three 1-day suturing
and knot-tying workshops were held, where students were invited to
acquire the necessary knowledge and learn skills of suturing. Sixty-three
undergraduates participated in the workshops. The suturing skills of the
students were assessed before and after training using a checklist. In every
workshop, a pre- and post-training questionnaire was used to assess student
knowledge about sutures and perceptions about the workshop. Sixty-
three students attended the workshop for the first time; 31 had a second
assessment after 3 months.
Results and discussion: Teaching and assessment of technical skills in
operation theatres is difficult due to pressure on theatre time, ethical
issues and medico-legal concerns. All students completed the pre- and
post-training questionnaires; 95% who passed the assessment said that the
training improved their practical skills and theoretical knowledge. Out of 31
students who went for the second assessment, 24 (77%) passed.
Conclusion: Teaching of basic surgical skills is viable and beneficial. Basic
surgical skills should be taught to all medical students regardless of their
career aims, and such training is needed periodically.
Acknowledgment: Dr Johan Demper.
The role and position of clinical simulation as an additional
component to current undergraduate medical curricula
M J Labuschagne, M M Nel, G J van Zyl, P P C Nel
Background/context: Clinical simulation cannot replace clinical training on
real patients, but should be a required enhancement to the undergraduate
medical curriculum. The integration process was investigated and
recommendations were made.
Aim/purpose: (i) to explain the vertical integration of clinical simulation as
instructional medium in a current medical curriculum; (ii) to explain the
horizontal integration of simulation into an existing undergraduate medical
curriculum; and (iii) to describe the role of clinical simulation in the
curricula to develop leadership skills, group training and inter-professional
skills of students and to improve patient safety.
Methods: A literature review, semi-structured interviews with international
simulation experts, and focus-group interviews with lecturers of the clinical
phase of the undergraduate medical programme at the University of the
Free State were conducted, analysed and interpreted.
Results and discussion: The author aims to propose ways to integrate
clinical simulation as an essential enhancement of undergraduate medical
education and training. The integration of simulation into the curriculum,
from the first to the final year, is described as vertical integration. The
horizontal integration of theory, skills training and clinical training, will be
discussed. There should be a continuous movement between the different
components. The role of clinical simulation to develop leadership skills,
group training and inter-professional skills of students will be highlighted.
The important aspect of patient safety and how simulation can play a role in
the improvement of patient safety will be highlighted.
Conclusion/take-home message: Clinical simulation can be integrated
successfully into current medical curricula as an enhancement of
undergraduate medical education and training.
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Simulation taxonomy and conceptual framework, as proposed
by the Canadian Network for Simulation in Healthcare in a
South African context
M J Labuschagne, M M Nel, P P C Nel, G J van Zyl
Background/context: Much confusion exists in the literature regarding
simulation taxonomy and terms are used haphazardly in the literature. The
Canadian Network for Simulation in Healthcare proposed a taxonomy and
conceptual framework for simulation in healthcare in 2011.
Aim/purpose: (i) to explain the 4 levels of the framework; (ii) to standardise
the terminology, educational tools and educational experiences in clinical
simulation; and (iii) to make it applicable for the South African context.
Methods: A literature review, semi-structured interviews with international
simulation experts and focus-group interviews with lecturers of the clinical
phase of the undergraduate medical programme at the Univeresity of the
Free State were conducted, analysed and interpreted.
Results and discussion: The terminology used in clinical simulation is
currently not standardised and confusion exists in the literature, with
terms used haphazardly. The author aims to explain the taxonomy and
the conceptual framework for simulation in healthcare as proposed by
the Canadian Network for Simulation in Healthcare. The levels include
instructional medium, simulation modality, instructional methods and
presentation. The taxonomy and conceptual framework will be used to
describe and standardise the terminology, educational tools and educational
experiences in clinical simulation. The proposed framework is easy and
simple to use, and is useful for instructional design and research. The
application of aspects for the South African situation will be discussed.
Conclusion/take-home message: The standardisation of terminology,
educational tools and educational experiences in clinical simulation is
essential for descriptive purposes in research and publications.
The effect of clinical simulation on inter-professional learning
of healthcare students
I Treadwell
Background/context: An outcome for newly graduated healthcare workers
highlights the importance of teamwork and the understanding and
appreciation of the roles, responsibilities and skills of other care workers. The
majority of students are, however, not exposed to formal inter-professional
learning (IPL) events in order to form realistic expectations of each others’
roles and scope of practices.
Since studies indicate that IPL is facilitated by experiential learning, the Skills
Centre at Medunsa introduced inter-professional trauma simulations using
high-fidelity simulators and SPs. Senior medical, nursing and occupational
therapy students are scheduled to take part in these events.
Aim/purpose: To assess the effect of clinical simulation on the inter-
professional learning of healthcare students.
Methods: A quasi-experimental study will be performed in May 2012,
using a convenience sample of medical, nursing and occupational therapy
students. Pre-testing will comprise a written test and an Interdisciplinary
Education Perception Scale (IEPS) will be used to determine participants’
attitudes towards other disciplines. The simulation will include active pre-
hospital, initial in-hospital and follow-up management of a traumatised
patient by Cohort 1 participants, while observed by Cohort 2 participants.
Post-testing will be a repeat of the test and IEPS. Video recordings will be
rated by an expert panel as well as both cohorts. Focus groups will be held
on role clarification, additional needs and self-directed learning.
Results and discussion: The percentages of ῾favourable’ IEPS outcomes
before and after simulation sessions will be compared by the McNemar test.
Mean Likert scale scores before and after simulations will be compared by
the paired t-test. Agreement between student and panel assessments will be
measured by the Kappa statistic. Qualitative focus-group assessments will
be summarised descriptively. Results will be reported and discussed.
Conclusion/take-home message: To be discussed at conference.
The effect of training in characterisation on the congruence of
standardised patient (SP) portrayals
L Schweickerdt-Alker
Background/context: Although simulated/standardised patients (SPs) are
used in many institutions in South Africa, the scope of how much they
could mean is still not fully understood. Often they are given scenarios on
too short notice. Due to the lack of time for proper training regarding the
interpretation of the role, the SPs are confronted with questions that they
find difficult to answer and often their portrayals are stereotyped and/or
incongruent. In an attempt to face and rectify these challenges, the need for
character development was identified.
Aim/purpose: To assess the effect of training with regard to characterisation
(creating a three-dimensional person behind the patient) on the congruence
of SP portrayals.
Methods: A quasi-experimental study will be conducted at Medunsa.
The convenience sample will comprise ±50 sixth-year medical students,
allocated as per curriculum to the Family Medicine Blocks in April and May
2012 and the 4 least experienced SPs at the Skills Centre. Pre-testing: The
performance of 4 SPs in identical scenarios will be captured on video during
an OSCE. SP and student reflections on the congruence of SP performances
will be captured and transcribed. The characteristics of congruence will be
identified by 3 SP trainers. Intervention: Training of SPs on characterisation
with emphasis on the identified characteristics of congruence. Post-testing:
repeat of pre-testing procedures will be done during a second OSCE and the
results will be compared with the pre-testing results.
Results and discussion: The effect of training will be measured for pre- and
post-outcomes of defined characteristics of congruence. Where applicable,
the Fisher's Exact test will be used for significant changes in outcomes.
P-values <0.05 will be considered to be significant. The results will be
discussed at the conference.
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Conclusion/take-home message: To be discussed at conference.
Does increased authenticity in practise improve patient-
centred care in practice?
B Y Uys
Background/context: Simulation strategies such as using low-fidelity patient
simulators (manikins) and standardised patients (SPs) are implemented
to enhance the competency of students before encountering patients in
practice. One of the aims of using SPs is to create more authentic (more life-
like) simulated learning experiences. Such experiences should help bridge
the gap from practise (simulated) to practice (encounter with live patients)
where patient-centredness is of crucial importance.
Aim/purpose: To determine the effect of enhanced authenticity in simulated
skills training on patient-centred care rendered by nursing students.
Methods: A pre-experimental design, the post-test only design with a
comparison group, was used. The study is being conducted at the University
of Limpopo (Medunsa Campus) and the George Mokhari Hospital situated
in Ga-Rankuwa. Cohort 1 participants will be trained to administer an
intramuscular injection using a manikin while cohort 2 participants will be
trained using an SP with a strap-on device. On completion of the training,
cohorts 1 and 2 will be observed and objectively assessed in May 2012 on
their procedural skills and patient-centred care, while administering an
intramuscular injection to a patient in hospital. A comparison will be made
in the patient-centred care rendered by the cohorts.
Results and discussion: Results will be captured in data spread sheets during
analysis of observation patterns and interactions. Data will be quantified
and the entire variety of statistical analyses will be utilised.
Conclusion/take-home message: To be discussed at the conference.
The influence of podcasting on undergraduate medical
students at the Faculty of Health Sciences, Stellenbosch
University
S H Walsh, M R De Villiers
Background/context: The podcasting (or vodcasting) of lectures has been
shown to benefit students. Students mostly use them for revision and test
preparation. This mixed study correlates undergraduates’ 2011 Respiratory
Block marks with the 2012 class, as well as qualitative feedback from
students and lecturers.
Aim/purpose: To determine (i) whether undergraduate medical students
find podcasting to be a useful addition to lecture attendance; (ii) whether
the availability of podcasts influenced the Respiratory Block test scores; and
(iii) how lecturers perceived podcasting.
Methods: Lectures in the Respiratory Block of the MB ChB II course were
converted into podcasts and placed on Webstudies, where students could
view or download them. End-of-block class scores were compared with
those of the previous year. The marks of the students who downloaded
the podcasts were statistically compared with those who did not. The
opinions of the students and lecturers were obtained by means of separate
questionnaires at the end of the block.
Results and discussion: Students: 78% used the podcasts; 88% thought that
all lectures should be podcasted; 88% of students used podcasts for clarifying
concepts not fully grasped in class; the 82 podcasted lectures were viewed/
downloaded 1 737 times (an average of 21 times each); compared with 2011,
the end of block marks improved. Lecturers: 70% thought that the process
was stress-free or extremely stress-free; 80% thought the podcasts did not
influence class attendance or even translated into any improvements.
Conclusion/take-home message: Our students mostly found podcasts
beneficial for clarifying concepts that they did not grasp in class. We are
continuing to podcast the entire 2nd year’s lectures and will evaluate the
effect that this has.
The expectations of postgraduate students and supervisors:
Both sides of the coin
H Friedrich-Nel, J L MacKinnon, S Queener
Background/context: The literature on postgraduate supervision is clear
that a supervisor and a postgraduate student may not always operate from
the same platform when expectations regarding the completion of the
research project are discussed. As such, the expectations of the supervisor
may focus on engagement, interaction and formative assessment. The needs
of the student on the other hand may be completely different. The student,
in need of support may need a life-coach, friend and adviser.
Aim/purpose: The question is whether a blue print exists for ῾realistic
expectations’ from the parties, and how these expectations are
communicated.
Methods: A qualitative study exploring the opinions of faculty and students
was conducted with an American university as a case study. Students and
faculty from various schools participated voluntary in interviews according
to a structured interview schedule after approval was obtained for the
study. Responses were captured during the interview and verified with the
interviewee at the conclusion of the interview. Data were investigated for
common themes that emerged, and grouped.
Results and discussion: Fifteen students and 23 faculty members
participated in the study. Although the responses from students and
supervisors varied, the majority of the student responses indicated that the
supervisor has to provide guidance and/or support throughout the research
process, establishing a helpful/supportive relationship. The supervisor on
the other hand is open about expectations, namely that the student needs
to work hard, learn, accept constructive criticism, be committed during the
research process, do their best, and successfully accomplish the degree.
Conclusion/take-home message: Given the challenges that we face in South
Africa with postgraduate student completion and the preparedness of
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supervisors, it is of value to translate the results obtained in the study to the
South African context. The paper will communicate these results and reflect
critically on the local context.
‘Fit for Purpose’: Graduates of a new Emergency Medicine
programme
Heike Geduld, Leana Wen, Lee Wallis, Vanessa Burch
Background/context: The first Emergency Medicine (EM) training
programme in Africa started in Cape Town in 2004 as a joint division
between the University of Cape Town (UCT) and Stellenbosch University
(SUN). Upon graduation, many of the junior Faculty were quickly drafted
into roles as managers, teachers and mentors, to support the developing
academic programme and provincial healthcare service delivery needs.
Aim: The aim of the study was to evaluate self-assessed competencies
including medical expert, scholar and manager of graduates of the EM
program. Faculty development needs were also be identified, in order
to develop an appropriate development plan for faculty and inform the
postgraduate EM training curriculum.
Methods: This descriptive study formed part of a larger formal programme
evaluation process. The study population included the 30 graduates of the
first 4 years of the EM training (2004 - 2007). Participants were asked to
complete a questionnaire and a structured interview by a single researcher
not connected to the program. Participants were surveyed regarding
their perceptions of training, evolving career plans and self-identified
competencies and deficiencies for fulfilling their current jobs. Participation
was voluntary and responses were recorded anonymously.
Results and discussion: Twenty-seven of 30 (90%) participants were
sampled; 14 (52%) were in academic posts, 4 (15%) were in non-academic
clinical posts and 9 (33%) had temporary posts; 21 (72%) were still in
Cape Town. Participants felt that their training had provided them with
appropriate clinical and procedural skills, but management, research and
teaching skills were lacking. Formal management training was cited as
necessary. Lack of clear career prospects and progression was concerning.
Conclusion: While the EM training programme provides excellent
clinical knowledge and skills training, there are deficiencies in academic,
management and leadership competencies. Potential solutions identified
include graduated responsibilities during training, fellowships and formal
faculty development programs.
The impact of training in pattern recognition on the ability of
diagnostic radiographers to interpret images accurately
Lynne Hazell
Background/context: Diagnostic radiographers in South Africa could
provide an interpretation of an image to a recognised practitioner in the
clinical situation within their scope of practice. In many South African
departments there is a shortage of radiologists resulting in delayed or no
reports to referring doctors. In order to meet the needs of the country,
South African radiographers need to become multi-skilled radiographers.
Empowering radiographers with pattern-recognition skills could address
the problem in many South African departments
Aim/purpose: To assess the ability of qualified diagnostic radiographers in a
Gauteng Government Hospital to apply pattern recognition and interpret a
radiograph after training in musculoskeletal pattern recognition.
Methods: The study employs a pre-/post-test model and an intervention
training of radiographers in musculoskeletal pattern recognition. Nine
radiographers volunteered to participate. The radiographers identified
whether an image was normal or abnormal and then provided a comment
on the abnormal images. After the pre-test, training in the application of
pattern recognition for the musculoskeletal system was provided.
Results and discussion: Accuracy of the image interpretation demonstrated
a significant improvement in the post-test. The participants identified
normal and abnormal images accurately. The comments on the images also
showed a significant change from the number of incorrect comments on
the images to partially or completely correct comments in line with the
reference standard.
Conclusion/take-home message: The intervention – training in pattern
recognition of the musculoskeletal system to enable image interpretation –
appears to have been successful. To empower the diagnostic radiographers
in these hospitals with the skills to provide image interpretation, a training
programme would need to be developed.
Sustainability of a Postgraduate Diploma in Transfusion
Medicine: Results from semi-structured interviews and a
Delphi survey
Vernon J Louw, Marietjie M Nel, John F Hay
Background/context: Quality education in transfusion medicine is key to
delivering a safe and cost-effective blood service. A number of factors affect
the long-term viability and sustainability of such a programme, particularly
in a poorly resourced context with a limited number of clinicians trained
in this field.
Aim/purpose: To determine and test the criteria that are key to programme
sustainability when developing a model for the academic development and
implementation of a Postgraduate Diploma in Transfusion Medicine.
Methods: Qualitative and semi-quantitative approaches were followed to
determine and test the criteria considered to be important in programme
sustainability. A literature survey was conducted, followed by semi-
structured interviews with national and international transfusion medicine
experts, and a Delphi survey.
Results and discussion: Fifty-five criteria were identified from the semi-
structured interviews. Consensus was reached on 41 criteria and stability
was reachedc on a further 13. Elements essential to programme sustainability
were identified and ranked in order of importance.
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Conclusion/take-home message: Literature on programme sustainability
in the field of transfusion medicine is virtually non-existent. This study
identified a number of elements essential to the long-term viability of such
a programme. This should prove useful to any institution developing a
postgraduate training course in transfusion medicine.
Feedback of examiners as learning opportunities for
supervisors and postgraduate students
M M Nel, G J Van Zyl
Background/context: The requirements that theses and dissertations in the
Health Professions Education programme should meet, are that they should
demonstrate the candidate’s familiarity with the relevant literature, their
research skills, and their ability to write a proper report on their research. A
thesis should, in addition, make an original and significant contribution to
the subject field. As far as research is concerned, the candidate should prove
that they are fully conversant with the research methods and techniques of
their specific subject field and that they have mastered and are able to use
the research methods and techniques of the particular subject field. As far
as the report is concerned, they should be able to document the research
problem and objective, the research setup or design, method, results and
conclusions in a proper scientific (systematic and logical) manner. The work
should bear evidence of the candidate’s analytical skills, critical stance and
substantive insight.
Aim/purpose: To analyse the feedback in 115 reports of examiners.
Methods: Quantitative and qualitative approaches were used. An empirical,
non-experimental research design was followed in this descriptive study.
Results: The findings of the study are reported on by means of a description
and a discussion. The findings are used to make recommendations
on postgraduate education as far as the selection of a research theme,
problem statement, literature review, research methodology, analysis and
interpretation of results and documentation of the report, etc.
Conclusion: The role that defined criteria and clear recommendations can
play was of utmost importance. With this study an attempt was made to
emphasise feedback of examiners as learning opportunities for supervisors
and postgraduate students.
Narrative inquiry in identity construction research: What do
we do with these stories?
Lakshini McNamee
Background/context: In the human and social sciences, narrative methods
are widespread in identity construction and professional development
research. However, there is a noticeable lack of narrative research into the
development of medical practitioners. Empirical strategies for analysing
personal narratives are scarce in medical education. Even in studies that
have reportedly generated suitable qualitative data, analyses are limited
to thematic approaches, and structural analysis of narrative form remains
neglected. This progress report describes an ongoing study using narrative
inquiry to examine the learning processes and identity construction of
newly qualified doctors (NQDs).
Aim/purpose: To gain a better understanding of the school-to-work
transition and internship experiences of NQDs.
Methods: Autobiographical reflections of NQDs (generated by a previous
study) were examined using socio-linguistic methods, using a socio-cultural
theoretical framing of ῾situated learning’ in ῾communities of practice’. A
modified Labovian classification of clauses was applied to storied events.
Close attention was paid to language, discourses and narrative form (telling
of narrative rather than referential aspects alone). Inferences were made
regarding participants’ self-categorisation and positionality in relation to
various social groups encountered in practice.
Results and discussion: Identity construction of NQDs is not fixed, and as
newcomers their identities were in a state of flux. They experienced various
degrees of angst due to unfamiliar systems, burdensome responsibility and
their sense of how others perceived them. Individuals aligned themselves
with other interns and healthcare professionals according to perceived
strengths. Learning opportunities afforded by different environments varied
considerably, however, participants demonstrated intentionality, judging
their own situations, negotiating their individual progress and choosing
trustworthy sources of assistance or guidance.
Conclusion/take-home message: Early career learning viewed from a social
practice perspective offers a meaningful way to study identity construction
of NQDs. The professional development of medical practitioners is a
complex process where identity construction is implicated along with the
development of knowledgeable skill. Relational aspects of persons play an
important role in determining practice.
Evaluation of a web-based module on evidence-based
medicine (EBM) for Family Medicine specialist in training at
Stellenbosch University
Anke Rohwer, Taryn Young, Susan van Schalkwyk
Background/context: Practising evidence-based medicine (EBM) using
current best evidence in making healthcare decisions typically involves 5
steps: phrasing answerable questions, searching for relevant studies, critically
appraising it for validity and usefulness, applying results, and auditing
the process. Acquiring basic knowledge and skills of EBM is essential for
successful implementation and subsequent improvement in healthcare
quality. Enhancing EBM knowledge and skills at postgraduate level is a key
strategy of Stellenbosch University’s (SU) Medical Educational Partnership
Initiative grant which aims to enhance skills of medical professionals in
rural and underserved communities. SU’s Family Medicine Division offers a
12-week online EBM module to specialists in training during their first year
which could be expanded to other specialists in training.
Aim/purpose: To formatively evaluate the EBM module to inform further
enhancement of delivery and content.
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Methods: A mixed-methods approach was adopted. This consisted of a
document review comparing learning outcomes to EBM competencies;
semi-structured interviews with tutors; and a survey of the students. Ethics
approval was obtained.
Results and discussion: The module content addressed 4 of the 5 main
EBM competencies, although learning outcomes were poorly defined. Most
students had a positive attitude towards EBM and the module, however
some felt they needed more support from tutors. Interviews highlighted
the need for more advanced technologies to support learning, to respond
to questions and address difficult concepts in real time. The importance of
EBM teaching to specialists in training was also emphasised.
Conclusion/take-home message: Results show that the content of the EBM
module is adequate in addressing 4 of the 5 main EBM competencies. There
is a need to incorporate modern technologies like social media, screencasts,
blogs and more interactive sessions to create a more authentic learning
environment. Similar modules are needed for other specialists in training.
‘Teaching Teamwork’
Alan Barnard
Background/context: The teachers of palliative medicine at the University of
Cape Town (UCT) work in a team of 3 palliative care trained professionals:
a nurse, a doctor and a social worker. An element of the teaching is the
importance of interdisciplinary teamwork. This is both taught in a didactic
session (small-group lecture and a subsequent tutorial). The teamwork is
also modelled by the teachers in the classroom and at the bedside (with
clinical ward staff ) during the clinical pharmacology ward round. The
teachers and the students have never had the opportunity formally to
comment on this aspect of the teaching, and this evaluative research is an
attempt to address this gap.
Purpose: To understand the experience of the teachers and students in
the fourth-year palliative medicine programme at UCT in respect of the
interdisciplinary team approach to palliative medicine, so as to improve
teaching and learning in this important field.
Results: A qualitative analysis of interviews with the teachers in this
programme and the reflective commentaries of the students will be
presented to illustrate the experience of teamwork teaching and learning in
this programme.
Impact: The results are expected to be valuable to all health professional
educators who are concerned about team functioning in the graduates
of their programmes, and the functioning of teaching teams within the
programmes.
A ‘toolkit’ for the promotion of undergraduate research:
When students talk to students
G I Van Schalkwyk, H Botha, J Bezuidenhout, J Blitz, S C De Vries
Background/context: Conducting research as an undergraduate medical
student has been shown to encourage later research interest among these
students, and to also develop their critical reasoning and information
literacy skills. At our institution, despite there being opportunities within
the curriculum for medical students to complete research projects, few avail
themselves of the opportunity to carry the process through from obtaining
ethical clearance to eventually disseminating results via presentation or
publication.
Aim/purpose: Led by 2 final-year medical students who had completed a
number of research projects as part of their studies, we sought to develop
an instrument that would encourage and guide undergraduate health
sciences students in conducting research. Our ultimate aim is to increase
undergraduate research output at Stellenbosch University’s Faculty of
Health Sciences.
Methods: The process of developing the artefact which has become known as
the ̔ toolkit’ was initiated by the 2 students who are also the primary authors.
Drawing on their experiences, which included first author publications,
they sought to specifically address those aspects of the research process
that they had found to be challenging or of value. A number of experienced
researchers acted as supervisors on the project.
Results and discussion: The toolkit, which is presented in a student-friendly
format, comprises 3 documents. The first offers general guidelines on
planning, designing and implementing a research project. This is followed
by a discussion of quantitative and qualitative research methodologies
respectively. In each case the importance of sharing one’s findings with
peers is encouraged. Twenty students attended a Saturday seminar during
which the toolkit was explained and distributed – a marked increase in
the number of students expressing interest in undergraduate research over
previous years.
Conclusion/take-home message: Encouraging research at undergraduate
level has the potential to enhance the student’s learning experience.
Facilitating such participation with innovative, student-driven interventions
provides an important catalyst.
Perceptions among University of Johannesburg Emergency
Medical Care students towards mandatory physical training
Andrew Makkink, Phoenix Bean
Background/context: Physical fitness plays an integral part in the
performance of emergency service duties by both male and female
emergency service personnel. The duties of emergency service personnel
often comprise heavy aerobic content and muscular strength components
that are best performed by practitioners who are in good physical condition.
The University of Johannesburg’s Department of Emergency Medical
Care acknowledges the need for improved physical condition among
emergency service personnel, and has addressed this need by implementing
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a mandatory physical training programme for all students enrolled in the
Bachelor of Emergency Medical Care (BEMC) programme.
Aim/purpose: The aim of this study was to analyse the perceptions of
EMC students towards the mandatory physical fitness programme and its
facilitation on the Bachelor of Emergency Medical Care programme.
Methods: A 26-question survey was conducted and the responses of 66
(63%) participants were quantitatively analysed.
Results and discussion: The results suggest that the students generally enjoy
participating in the training sessions. There is, however, a need for improved
structuring and better objective setting, to assist students in reaching
expected outcomes of the program. The majority of the students felt that
the programme had benefited them physically and had motivated them to
improve their own health, physical condition and lifestyle choices.
Conclusion/take-home message: The mandatory training programme is
an essential and indispensable component of the BEMC course, that has
a significant impact on the students lifestyles, their own health and their
physical condition. It should be considered crucial for improving and
maintaining adequate physical condition in prospective emergency service
personnel of South Africa.
Is drama meaningful in healthcare education?
Margaret Hugo, Louise Schweickerdt-Alker
Background/context: MB ChB III students choose from a group of at least
10 selective courses which do not teach them about medicine per se. They
attend the course throughout the year, and receive a mark at the end as
proof that they have learnt something other than just becoming a medical
practitioner. At Medunsa, Drama has been offered since 2009; 20 - 25
students attend the course annually. The program: learning about oneself,
visualisation, the voice, movement, connecting with an audience, writing
plays, rehearsing, performing, and working with stage make-up, props,
lighting and music. Students perform in the children’s wards and in front
of their peers. A ῾test’ at the end of the year is written in groups, where they
discuss the following: value of the course, development of communication
skills and use of the acquired skills with patients. They voice experiences in
discussion groups, throughout the year.
Aim: The ongoing question of the lecturers is: what value can a creative
course have in the teaching and learning of medical students?
Methods: A qualitative analytic method was employed.
Results: Lively discussions mostly result in positive feedback, although
negative feedback is appreciated and encouraged. Personal issues are faced,
growth take place and confidence is gained. The students get to know their
own unique abilities, learn to trust themselves and to appreciate their own
unique way of communicating. Their energy levels increase. They learn
sensitivity and trust in teamwork. Empathy is enhanced and the holistic
concept increased. Inner creative abilities are developed which help with
effective problem solving.
Conclusion: Creative courses facilitate students to look at and experience
themselves, as well as patients and patients’ life worlds differently. Personal
growth is essential in developing a professional attitude, which in the end
prepares them to render effective, comprehensive clinical care.
From colour-blind to rainbow-brained: Using Whole Brain
Learning (WBL) principles in physiotherapy education
A Human, P H du Toit
Background/context: Institutional changes in higher education call for
innovative ideas in teaching practices. The scholarship of teaching and
learning requires scholarly enquiry into student learning to inform the
practice of teaching. Learning style flexibility in teaching practice can bridge
the gap between the individual learner (and their preferences) and the design
and delivery of the facilitation of learning. As a facilitator of learning (FOL)
I wanted to engage in critical discourse regarding my teaching practices by
implementing innovative ideas in my class room based on the principles of
WBL.
Aim/purpose: This study aimed to determine the effect of facilitating
Whole Brain Learning (WBL) on the teaching practice of the FOL in the
Department of Physiotherapy, Medunsa.
Methods: A participatory action research method was applied in an
attempt to transform facilitation of learning in the second-year module on
paediatrics/child health. Triangulation of qualitative and quantitative data
collected from questionnaires, peer-review, and reflections were performed.
Results and discussion: Despite differences in learning style preference
between the FOL and the second-year physiotherapy students, I was able to
accommodate and challenge my learners on various levels. My professional
development in my teaching practice within the context of the 7 roles of
the educator as observed and experienced by my second-year physiotherapy
students is explained. Evidence is presented that WBL principles assist in
improving facilitation of learning on multiple levels and seems to increase
the students’ satisfaction and creates an environment conducive to learning.
Conclusion/take-home message: As FOL we must be flexible in our teaching
and learning styles in order to accommodate and challenge all students in
class so that they can maximise their human potential. This participatory
research project formed a foundation for further research and reflective
practice in our department and institution.
Perceptions of preceptors regarding expected competencies
of final-year midwifery students of Mulago School of Nursing
and Midwifery, Uganda
Margaret Milly Kabanga, Fikile Mtshali, Sarah Kiguli
Background/context: Midwifery training at Mulago School of Nursing and
Midwifery (MTSNM) was traditional, teacher centred until curriculum
was changed and implemented competence-based training (CBT) model.
However, there are complaints by qualified midwives (Preceptors) who
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supervise and mentor students during clinical placement, regarding
expected competencies of final-year midwifery students.
Aim/purpose: This study was designed to explore and document perceptions
of preceptors regarding expected competencies of final-year midwifery
students of MTSNM. The study findings would provide a basis for quality
improvement in midwifery training in Uganda.
Methods: A cross-sectional descriptive study was conducted at Mulago
Hospital, a clinical placement site for midwifery students. Qualitative
data collection methods were employed. Seven focus-group discussions
(FGDs) were conducted with 33 preceptors, purposively selected from
clinical placement areas including labour wards, postnatal clinics and
family planning clinics. An interview guide was used to conduct FGDs. Two
investigators worked independently to review and analyse transcripts for
contents and emerging themes.
Results and discussion: Students are expected to have knowledge in family
planning methods, and antenatal, delivery and postnatal care. Desired skills
include examination of patients during antenatal, delivery/postnatal period,
communication/interpersonal skills, decision-making, management of
procedural skills including delivering babies, inserting contraceptive
devices and intravenous lines. Students are expected to portray attitudes
such as professionalism and ethical practice. Gaps identified were mainly
professionalism, communication and interpersonal skills. Causes of
competencies included inadequate mentorship and supervision of students
by preceptors.
Conclusion/take-home message: Preceptors of midwifery students should
be empowered with CBT knowledge to enable them to effectively provide
mentorship and support to midwifery students of MTNSM.
Implementation of OSCEs in assessment of postgraduate
students in the Department of Obstetrics and Gynaecology,
Makerere University College of Health Sciences
Mike N Kagawa, John Tumbo, Elsie Kiguli, Sarah Kiguli
Background/context: The department of Obstetrics and Gynaecology
(O&G) has been in existence for over 30 years and offers a 3-year fulltime
course leading to the award of a Master of Medicine (O&G) of Makerere
University. Several methods have been used to assess clinical skills of
postgraduate students. In an effort to improve assessment, OSCEs were
introduced about 5 years ago.
Aim/purpose: To evaluate the implementation of OSCEs from 2008 to 2011.
Methods: Through a descriptive cross-sectional study, observation of the
OSCE process, key informant interviews with the Head of Department
(HoD) and course coordinators, desk review of external examiners’
comments and a retrospective evaluation of students’ OSCE scores, was
performed.
Results and discussion: OSCE formulation was done by a committee of
the HoD, course coordinators and senior faculty. There were 5 - 7 OSCE
stations of 15 minutes each. There was, however, no OSCE blue-print and
the examiners were not trained. The venue was spacious but with little
auditory/visual privacy. Real patients and models, as opposed to simulated
patients, were used. Most students scored above the university pass mark
of 60%. The average score of the students ranged from 48.6±9.5 to 84.8±6.5
for year 2, and 54±7.6 to 84.0±7.6 for year 3. There was no feedback given
to the students.
Conclusion/take-home message: The OSCEs were generally well conducted
with adequate preparation and good students’ performance according
to the pass mark. There is need to develop an OSCE blue-print and train
examiners, organise feedback to students and improve on privacy between
the candidates.
‘We are becoming doctors!’: The social context of problem-
based learning for developing professional identity
Dianne Manning
Background/context: The concept of a community of practice as a social
learning environment offers a useful framework with which to interrogate
student engagement with the intended learning. The medical programme of
the University of the Witwatersrand uses problem-based learning (PBL) as
a vehicle for integrating knowledge and introducing an approach to clinical
reasoning. Interaction with the small-group facilitator and meaningful
participation in PBL tutorials thus provides students with access to
discipline-based discourse and opportunities for developing professional
identities.
Aim: To understand the role of the PBL facilitator as an agent and role model
in students’ construction of meaning and development of professional
insights.
Methods: A mixed-methods cohort study design was used. Fourth-
year medical students were invited to complete an anonymous self-
administered questionnaire and to participate in semi- structured focus-
group discussions. Questionnaire data, consisting of responses to 7-point
Likert scale items, were analysed using descriptive statistics. Focus-group
discussions were audio-recorded, transcribed and analysed qualitatively
for emergent themes. Data from the questionnaires and interviews were
triangulated.
Results and discussion: The results clearly indicated the importance of the
specific social context of the PBL group interaction for effective engagement
with the medical discourse. The role of the facilitator was identified as the
most important factor for guiding students in developing professional ways
of thinking. The PBL tutorial thus provides a valuable opportunity for
students to start creating professional identities as medical practitioners and
developing personal trajectories into the practice.
Take-home message: PBL facilitators in a medical programme need not be
subject experts in the tutorial content, but should preferably be medically
qualified. Where human resources are limited, facilitators from different
backgrounds should be assisted in developing ways of thinking which are
appropriately aligned with the clinical reasoning process.
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Understanding the role of a supervisor during the Integrated
Primary Care (IPC) rotation for final-year medical students
P N Mnqapu, L Du Toit, N Sondzaba, I Couper
Background/context: As part of medical training, final-year medical students
complete a 6-week integrated primary care (IPC) rotation in urban or rural
sites. The purpose of the IPC rotation is to familiarise medical students with
primary healthcare and to develop and enhance students’ clinical skills.
During the rotation students are allocated to a local supervisor at the site.
Aim/purpose: The aim was to understand the role of the supervisor from
both the supervisors and the students’ perspectives, and to assess how
supervisors see their role in terms of their responsibilities to students,
comparing these with student expectations.
Methods: Data used was obtained from IPC rotation student post-placement
questionnaires in 2011 and from 2011 supervisors questionnaire. The aim
of the supervisors’ questionnaire was to establish their understanding of
their role. Data from both were entered in Excel and analysed for common
themes.
Results and discussion: The study has identified common characteristics
of what the student and supervisor perceive the role of the supervisor to
be, such as being a role model and truly being willing to teach. Dedication
to patient care and a good work ethic were furthermore identified as key
characteristics. Both identified common traits of mentors, and classified a
mentor and a role model as the same thing.
Conclusion/take-home message: The results showed that there is an overlap
in understanding what the role of the supervisor is among both students and
supervisors. Assessment of rational prescribing skills in the written exit-
examination at the Medical School of the University of the Witwatersrand.
Assessment of rational prescribing skills in the written exit-
examination at the Medical School of the University of the
Witwatersrand
Shirra Moch, Devika Naidoo, Lionel Green-Thompson
Background/context: Prescribing medicines is the primary intervention
that doctors offer to influence their patients’ health; however concerns have
been expressed about the extent to which graduates are prepared by medical
schools to assume prescribing responsibility.
Aim/purpose: To analyse the exit-level written assessment component of
final-year students in the Graduate Entry Medical Programme (GEMP) at
the University of the Witwatersrand, Johannesburg with respect to fitness-
for-purpose (validity) to test rational prescribing skills.
Methods: Permission to conduct the study was obtained from the
Human Ethics Research Committee (Medical) of the University of the
Witwatersrand, Clearance Number M080949. Examination questions
were selected via an adjudicative process to determine a prescribing mark.
Question items were then analysed according to Bloom’s Revised and the
SOLO Taxonomies. The theoretical framework of constructive alignment
was used to interrogate fitness-for-purpose and the knowledge structures of
the skills were explored using a Bernsteinian lens.
Results and discussion: A comparison of ῾A-Type’ (single best answer)
multiple choice questions (MCQs) with ῾R-Type’ (extended matching)
MCQs paradoxically highlighted students’ greater proficiency in the R-Type
questions (p<0.0001). Both Bloom’s and SOLO taxonomies indicated that
students scored well on questions which tested recall and application of
knowledge, but struggled with questions involving evaluation. Questions
were poorly distributed according to Harries’ delineation of prescribing
skills to be tested. Examination marks showed that 83.6% of students
were competent to prescribe according to the graduating standards of the
University.
Conclusion/take-home message: Despite high examination scores, this
study illustrates a lack of constructive alignment between assessment
requirements, curriculum delivery and course objectives. Curricular
components including problem-based learning and horizontal integration
constrained epistemic access to the structure of rational prescribing
knowledge and the exit-level written assessment does not sufficiently test
rational prescribing skills.
Peer-tutoring in a language code-switching lecture as strategy
for educators in multilingual classes
Sandra du Plessis
Background/context: Educators have the responsibility to prepare students
for the future, and to be successful in their task with multilingual students,
they have to incorporate certain teaching approaches and strategies, as
well as modifications, in their presentations. One of the challenges is to
use language creatively in the multilingual classroom, and language code-
switching (the switching from one language to another) may be one method
of experimenting with language. Educators who cannot language code-
switch themselves, may employ peer-tutoring. Peer-tutoring is a promising
strategy in multilingual classes in Higher Education, by which individualised
help may be provided to students in a large groups. Through peer-tutoring
the home language (L1) of the students may be a resource in an English-only
environment where educators are not proficient in the students’ L1.
Aim/purpose: The aim was to evaluate the effectiveness of peer-tutoring as
teaching strategy during language code-switching in a multilingual first-
year classroom.
Methods: A descriptive design within the quantitative framework was
selected. A questionnaire was designed as data collection instrument and
was completed by first-year students after peer-tutoring in a language code-
switching lecture.
Results and discussion: In the results the linguistic profile of the students
is presented to illustrate the complexity of the situation. In addition an
evaluation of the peer-tutoring strategy reveals that the majority of the
students experienced peer-tutoring positively and provides some directions
for future implementation. Other linguistic support needs are also identified
by the students.
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Conclusion/take-home message: By reinforcing students’ conceptual base
in their L1, a foundation may be provided for long-term growth in English
skills. Language code-switching is currently recognised as a teaching
strategy in multilingual classrooms. It is suggested that L1 can support
especially first-year students in Higher Education to understand curriculum
content and new concepts.
The autopsy as a teaching tool in forensic medicine for
undergraduate students: A University of Pretoria experience
L du Toit-Prinsloo, V Tredoux, G Saayman
Background/context: The use of the autopsy in teaching medical students
has strong historical precedent. As large numbers of unnatural deaths in
South Africa require medico-legal investigation by medical practitioners,
it is important that undergraduate medical students receive some training
and exposure to the field of forensic medicine. The scope and nature of such
training remains a topic of uncertainty and discussion, while the possible
vicarious effects of – and the attitude of students to – this activity requires
careful consideration.
Aim/purpose: To assess the attitudes of senior medical students towards
the autopsy as a training tool in the medical curriculum at the School of
Medicine, University of Pretoria.
Methods: MB ChB V students attend daily forensic autopsy at the Pretoria
Medico-Legal Laboratory, for a continuous period of 2 weeks. Students were
requested to comment on their experience, voluntarily and anonymously,
regarding the general impression and rating of the rotation and to comment
on strengths, weaknesses, opportunities and threats which may have been
experienced.
Results and discussion: Of the approximately 220 students who were
enrolled in MB ChB v. 95% of students provided feedback. The overall
experience appears to have been a very positive one, with an 8.2/10
overall rating for the block. However, 64 students indicated that they felt
psychologically unprepared for the block and that they experienced it as
emotionally traumatising, with some students stating that they experienced
nightmares due to the exposure.
Conclusion/take-home message: Exposure of students to forensic autopsies
may be a valuable training modality, but more research is needed as to the
possible vicarious effects and the emotional support which students may
require, before and after such exposure.
Early exposure to physiology: Challenges faced by health
science students and their teachers
Susan B Higgins-Opitz, Mark A Tufts, Lihle Qulu, Sabiha Essack
Background/context: Health Science students at the University of KwaZulu-
Natal perform better in their professional as compared with their physiology
modules. Pass rates of physiology modules, particularly in the first-year
basic physiology module taught in the first semester when students are still
adapting to University, have steadily declined. Our data has also shown a
strong correlation between these students’ performance in their first class
test and their final performance.
Aim/purpose: To devise a strategy identify struggling students early i.e.
before they write the first class test, so that appropriate interventions can be
made to prevent them failing the module.
Methods: Using a short questionnaire, students’ attendance of tutorials,
financing of their studies, and their perceived relevance of physiology to their
future professions were probed. Following the first class test, failing students
were invited to complete a second questionnaire in which attendance of
teaching sessions, perceived reasons for their poor performance, and their
plans for improvement in subsequent evaluations were explored. Student
results and demographics were obtained from the module records.
Results and discussion: One hundred and eighty students completed the first
questionnaire, which represented 83% of the class. 73% of the respondents
were first-year students and therefore had not been risk assessed, while 44%
(n=77) of students failed test 1, which mirrored the failure rate of the entire
class (46%). The questionnaire results indicated that most students were
positive about physiology and recognised its relevance. Almost 50% (36/77)
of failing students completed the second questionnaire, 28 of whom were
first-time students. Analysis of their responses revealed that the majority of
students (>60%) who eventually passed the module (n=8), had plans that
specifically addressed their problems.
Conclusion/take-home message: Based on these findings, we have embarked
on a more interactive strategy centred on e-learning and earlier monitoring
of struggling students.
Primum non nocere: The preparation of University of the
Witwatersrand medical students in Pharmacology – a student
perspective
P Keene, S Moch, D Manning
Background/context: Medical education literature reflects a global
concern about the pharmacology education of medical students and its
ability to produce junior doctors who have the knowledge and skills to
prescribe drugs safely and appropriately. Formal pharmacology teaching
in the University of the Witwatersrand MB BCh degree takes place in
the 3rd and 4th years, consisting primarily of lectures within a system-
based, integrated curriculum. A PBL case each week contextualises
appropriate pharmacological management. Assessment is integrated and no
subminimum is required.
Aim/purpose: To determine: (i) whether senior students are confident in
their pharmacology knowledge acquired in the formal phase; (ii) attitudes
to learning pharmacology and the factors contributing to this.
Methods: This study was conducted by 5th-year MB BCh students in
the compulsory research component of the curriculum. An anonymous
questionnaire was administered to 5th- and 6th-year students, consisting
of 29 fixed-response items, (28 graded by a 5-point Likert scale), and 5
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open-ended questions. Results were respectively analysed in Excel and
thematically.
Results and discussion: While satisfied with the quality of the course as
delivered, they indicated that their knowledge was insufficient both for
the senior years of their course and for practice once qualified. The lack
of a subminimum and consequent strategic failure to learn the subject
contributed strongly to this. The lack of alignment of the curriculum
to clinical experience and insufficient contextual learning were also
problematic.
Conclusion/take-home message: Assessment drives learning – this course
needs to be assessed more extensively and requires a subminimum in order
to ensure that students gain sufficient knowledge.
Enhancement of registrar competence through professional
development in completing a module in Healthcare Practice
J Bezuidenhout, M M Nel, G J Van Zyl
Background/context: A need for professional development in the training
of registrars was identified by the School of Medicine, University of the Free
State, in 2007. Registrars have not always been trained in aspects outside
their specific clinical disciplines as required for professionals.
Aim/purpose: This part of the research focused on responses from registrars
regarding the orientation session, content and applicability of the module in
Healthcare Practice (GPV703). Module development was specifically aimed
with a view to offer each registrar the scope to address the unique needs
in as far as Ethics, Practice Management and Patient Communication are
concerned.
Methods: The study was a quantitative study enhanced by qualitative
methodologies. A self-administered questionnaire was completed by
registrars evaluating the presentations made. The questionnaire included a
rating scale and open-ended questions.
Results and discussion: A total of 40 registrars completed the newly
introduced module GPV703 from 2009 to 2010 and participated in the
study. Informed consent was obtained before completion of the self-
administered questionnaire. Thirty-eight (95%) of the 40 registrars
completed the questionnaire. Registrars showed a total satisfactory and very
good combination mean percentage of 91% for the questions related to the
orientation session, content and applicability of the content of the module.
Thirty-one (77.5%) of the 40 questionnaires collected, were completed by
HoDs on the insight of registrars in GPV and it was found that registrars
showed significant improvement in content and applicability. Registrars
found the lectures on ethics to be most valuable as an important aspect in
the treatment and management of patients.
Conclusion/take-home message: Value was added and aspects required
by registrars to develop and/or enhance their skills, knowledge and
professional behaviour with regard to Ethics, Practice Management and
Patient Communication were addressed. Strive towards excellence in
Medical Education.
Health Professions Education (HPE): faculty needs assessment
at the University of Zimbabwe, College of Health Sciences
M M Chidzonga
Background/context: Faculty development has assumed great significance
in meeting the diverse roles and responsibilities of health professions
educator. HPE training facilities are desirable.
Purpose: No facility designed to train/guide HPE issues exists at UZCHS.
This study was designed to assess the faculty HPE needs so as to guide the
establishment of a facility that offers relevant services.
Methods: A cross sectional survey using a self-administered questionnaire
was used: socio-demographics, teaching experience, academic grade,
education/experience/training in HPE issues, willingness to participate
in and time to be allocated to HPE activities and the format they should
take, the use and role of technology were assessed. Perceived knowledge/
importance of HPE issues was assessed using a 7-point Likert scale.
Results/discussion: The departmental response rate was 96% (22/23); overall
response rate was 37% (74/201); 54% of the respondents were male, 34% in
the age group 36 - 50 years; 54% were in the lecturer grade with less than 10
years teaching experience , relatively young and inexperienced. This should
make training more acceptable and more useful before they are entrenched
in their own ways. Curriculum development and finding relevant tools and
aids were identified as important and faculty had least knowledge; regular
seminars and online courses were the preferred formats for educational
activities. Power point presentations, 96% (71/74), most commonly used and
the least used was web-based courses (10%) (7/74); 99% (73/74) indicated
willingness to participate in HPE activities; 36% (27/74) preferred 2 hours
per week; 58% (43/74) suggested the activities be compulsory.
Conclusion: The junior/young faculty with limited knowledge of HPE issues
is appreciative of their importance willingness to train. The proposed HPE
unit will be driven by the identified faculty needs.
Perspectives of South African general surgeons regarding
their postgraduate training
M M de Beer, H Pienaar
Background/context: One of the most critical stages in the professional
life of new surgeons is residency training, and the objective of a surgical
residency programme is to ensure that newly trained surgeons are
competent to deliver the relevant skilled services to their patients. Because
of the fact that the curriculum has not been revised for a number of years,
the need arises to consider adapting the curriculum to changing needs and
circumstances.
Aim/purpose: The aim of the study is to determine communal strong and
weak points in the training of general surgeons in South Africa, as well as
to provide guidelines for the possible improvement of the current system.
Methods: The population group comprised of all qualified general surgeons
in the country. Data collection was done by means of a questionnaire sent to
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the population group via e-mail. The number of responses was statistically
adequate, and analysis of the data was done to extract the main themes.
Results and discussion: The 4 main areas of questioning in the survey were:
theoretical knowledge, research training, operative technique training, and
practice-related needs. The discussion will cover all the main categories, and
elaborate on each of them in detail.
Conclusion/take-home message: A discrepancy exists in the need of
practising general surgeons in South-Africa, and the training that is being
provided. By examining the shortcomings, as well as the strong points of
the current training programme, a more applicable curriculum can be
established in the future.
Improving facilitation of problem-based learning through
monitoring, feedback and professional development
M Alperstein
Background/context: A primary healthcare-led curriculum, with problem-
based learning (PBL) as a philosophy and teaching methodology, was
implemented in the University of Cape Town's MB ChB programme in
2002. A small core of PBL facilitators has remained constant, but there has
been a rapid turnover of many facilitators annually. Quality of facilitation
across PBL groups has been highlighted in the literature. A PBL monitoring
project arose from concerns of course convenors regarding quality of PBL
facilitation. For the Education Development Unit (EDU), it was to ascertain
the aspects of training that needed more attention to promote improved
quality of facilitation in PBL.
Aim/purpose: This evaluative paper aims to demonstrate shifts in facilitation
following monitoring, feedback and further professional development.
Methods: The EDU facilitated the development of a monitoring tool and
coordinated a standardised monitoring project in 2009 and 2011 across the
first 3 years of the programme. In 2009 and 2011, 4 experienced facilitators
were recruited and trained to use the monitoring tool developed in 2009.
Data were collected by the 4 facilitators by observing 32 out of 60 PBL
facilitators in 2009, and 25 facilitators in 2011. Observations were recorded
on the monitoring tool. Quantitative and qualitative data were captured
electronically and analysed for results.
Results and discussion: Aspects identified as needing improvement in 2009
were focused on in PBL training in 2010. All facilitators monitored were given
individual feedback on their strengths and areas needing improvement. The
2011 results showed improvement in all aspects monitored. Some aspects,
while showing improvement since 2009, still need further development.
These findings will be reported on in the presentation
Conclusion/take-home message: The quality of PBL facilitation could be
improved by means of individual monitoring and ongoing professional
development.
Initial outcomes of the Dundee Ready Educational
Environment Measure (DREEM) among final-year Clinical
Associate students at the University of the Witwatersrand
Lilo du Toit, Abigail Dreyer, Mpumi Mnqapu, Ian Couper, Audrey Gibbs
Background/context: The Bachelor of Clinical Medical Practice (BCMP) is
a 3-year degree programme leading to qualification as a Clinical Associate.
The aim is to produce a mid-level healthcare worker that will work under
supervision of the doctor in the team of clinicians in district hospitals. Most
of the training takes place in district hospital sites. The ongoing development
of the curriculum and of training sites is key in the implementation of the
programme. Continuous monitoring and evaluation is necessary to improve
quality.
Aim/purpose: To assess the perception of the educational programme and
training environment among the first cohort of Clinical Associate students,
during their final year at the University of the Witwatersrand (2011).
Methods: The Dundee Ready Educational Environment Measure (DREEM)
is a standardised tool used to evaluate students’ perceptions of their
educational environment. DREEM questionnaires were completed by 22
of the 25 final-year Clinical Associate students during 2011. This data was
analysed using Excel to explore initial trends in perceptions.
Results and discussion: The DREEM is a useful tool for evaluating the
perceptions of health professional students. Results from the first round
of data collection explore issues for the implementation of Clinical
Associate training in different educational environments. Collecting such
data longitudinally would be invaluable in improving the educational
environment, and therefore the learning of Clinical Associate students.
Conclusion/take-home message: A number of interesting issues emerge
for consideration at management level. It is envisioned that the DREEM
questionnaire will be used for at least 3 years to track and monitor
perceptions among students of the learning environment for the BCMP
degree.
Reflecting on the quality of teaching and learning in the
Internal Medicine module
J M M Koning
Background/context: Obtaining student feedback is one of the ways in
which the quality of a module can be measured. Alternatives to the current
module evaluation form of the fifth-year Internal Medicine module are
being explored.
Aim/purpose: (i) To evaluate the quality of teaching and learning that takes
place in the fifth-year Internal Medicine module using a modified Student
Course Experience Questionnaire (SCEQ); (ii) To critically reflect on the
findings in this pilot study and use them to implement changes.
Methods: An Action Research strategy was used in this study. The SCEQ,
which was developed by Oxford University, was modified by Dr Saretha
Brussouw for use at the UFS. This 32-question questionnaire was filled out
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by the fifth-year students at the end of their rotation at Internal Medicine.
The data from 7 different scales was analysed.
Results and discussion: 112 students completed the questionnaire (40
English and 71 Afrikaans). The scores for the Satisfaction, Generic Skills and
Motivation scales were high. 70% of the students reported that they were
satisfied, but there was a significant difference between the Afrikaans and
the English students. The Teaching and Appropriate workload scales had the
lowest scores. Almost 20% of the students thought the outcomes were not
clear. A large number said that they did not know what was expected from
them. 40% said that the workload was inappropriate. Significant differences
were found between the 2 language groups in the scales measuring Generic
skills, Motivation and Satisfaction.
Conclusion/take-home message: The modified SCEQ is a helpful tool to
assess quality of teaching and learning. However, due to the lack of space
for explanatory free text, the reasons for negative findings and differences
between language groups could not be elucidated. A document which
clearly states the expectations was included in the 2012 Module Guide. A
programme is underway to ensure that the outcomes are better described.
Nurses’ experience of the transition from student to
professional practitioner in a public hospital in Lesotho
A M Makhakhe, M Williams, E Bornman
Background/context: Newly qualified professional nurses in Lesotho
experience a non-caring environment, marginalisation, negative attitude
and lack of support, resulting in questioning their choice of profession.
Aim/purpose: The aim of this study was to identify the experiences of
newly qualified nurses and to develop guidelines to support them in their
transition from student to professional practitioners.
Methods: An explorative, descriptive, contextual, qualitative research
design was chosen. The sample consisted of newly qualified professional
nurses who worked in a public hospital in Lesotho for a period of one year
or less at the time of the study. Data collection took place by means of semi-
structured individual interviews with 10 newly qualified professional nurses
and a focus-group interview with 8 newly qualified professional nurses.
Results and discussion: Content analysis of the data in the qualitative
tradition was independently done by 2 coders who identified 4 themes and
10 sub-themes. The identified themes included culture shock, competence,
vision for the future, competence and support from management
with subthemes of emotional reactions, limited resources, knowledge,
attitudes and skills. These newly qualified professional nurses felt they
were sufficiently prepared with knowledge and skills, but a restrictive
clinical environment resulted in feelings of despondency, an attitude of
blaming and not applying their capabilities. They viewed themselves as
change agents for the future though. Guidelines to ease the transition
from student nurse to professional practitioner were developed to
address professional expectations and to enhance collaboration between
the training institutions, the hospital, the Ministry of Health and Social
Welfare and the newly qualified nurses.
Conclusion/take-home message: Clear guidelines and orientation
programmes are needed with specific attention to welcoming, addressing
expectations, code of conduct, monitoring and mentoring to ease the
transition period from student to professional practice in future.
Service learning in Pharmacy: Instilling professionalism
through sequential institutionalisation of an undergraduate
service-learning programme
M B Akleker, A Bheekie, N Butler
Background/context: At UWC School of Pharmacy, Service learning in
Pharmacy (SLIP) was introduced as a pharmacotherapy initiative (2002)
directed to final-year pharmacy students. SLIP had a strong service bias and
competency component, training students for the roles they would fulfil
as pharmacy interns. An independent evaluation of SLIP found that while
the course enabled students to be technically competent and prepared for
internship, values-based professionalism was lacking.
Aim: To produce pharmacy graduates who are technically competent and
socially able. Course expansion to the third and second years was aimed at
exploring critical issues that underpin values-based professional practice;
including social injustice, cultural competency and poverty.
Methods: SLIP 4, targeted toward final-year students, boasts technical
competency as a core focus area. A series of 3 rotational blocks (1 week
each) allows service activities. SLIP 3, directed to third-year students, entails
students examining issues around social injustice and cultural barriers in
the context of medicine use. The course comprises a single exposure to a
PHC clinic and informal settlement. Students are assessed by way of a group
project to fulfil a community need. SLIP 2, directed to second-year students,
focuses on developing professional communication skills.
Results and discussion: The outcomes from SLIP 3 service projects include
various community-targeted endeavours, such as drug awareness campaigns
at schools, sustainable feeding schemes by way of community driven
vegetable gardens, and educational initiatives such as the establishment
of learning centres in informal settlements. Students report that these
exposures are ῾eye-opening,’ and that the experience would mould their
future professional practice. Early exposure to professional interface (SLIP 2)
supports the development of inter-professional communication skills.
Conclusion: Learning opportunities that nurture technical and social and
cultural competencies are more likely to produce graduates capable of
addressing social injustices.
Community service learning for MB ChB students, Medunsa
Debbie Barnard
Background/context: MB ChB I - IV students learn about interacting with
the community, identifying health needs and reacting to it, learning at the
same time from that interaction, while simultaneously rendering a service to
the community. Successful training takes collaboration and the community
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is a highly effective collaborative partner in the training and education of
Medunsa’s medical students.
Method: By taking the MB ChB I - IV students to the clinics and into
the community for facilitated interaction with the community itself, new
knowledge/meaning surfaces with each contact period, which enriches the
overall learning experience of the students.
Results: This results in learning about the community and its needs while
simultaneously rendering a service to the community.
Conclusion: Service to the public/community is the core of the medical
profession. Medical students at the University of Limpopo, Medunsa are
trained to be committed to rendering humanistic care, improving the health
of the community and serving the public (AAMC, 1998). They are taught to
have insight into the needs of the community beyond the individual patient
in order to serve the community needs, and to address community concerns
and involve community partners in addressing these needs. Healthcare is
approached as a partnership with the client, where the patients are involved
in their own wellness and healing process.
Take-home message: Medical students should receive learning experiences
outside of the classroom, clinic room and hospital room, in order to
become integral parts of the communities in which they will practise
medicine.
How does the community benefit from community-based
education?
P Diab, P Flack
Background/context: Community-based education (CBE) has become
a primary teaching and learning platform in all health sciences globally.
There is a significant body of literature that explores the pedagogy and in
particular the benefits of CBE to students. However there is little evidence
in the literature from the perspective of the other role players in CBE,
particularly the community partners.
Aim/purpose: The aim of the study was to explore how community-based
education is perceived by the various stakeholders, in the provinces of
Limpopo, KwaZulu-Natal and Western Cape. This paper reports on the
benefit to the community and what challenges need to be addressed in order
for this to be an effective partnership.
Methods: Data was collected at multiple established training sites, through
focus-group interviews with participants identified through purposeful
sampling. An open–ended interview guide was used and interviews were
conducted in the vernacular, audio-taped, transcribed verbatim and then
where necessary translated into English. Data analysis was aided with
the use of Nvivo. Ethical clearance was obtained from the participating
universities’ ethical boards as well as the Provincial Departments of Health
and participating healthcare institutions.
Results and discussion: Benefits ranged from reducing work load in the
healthcare facilities, promoting more holistic patient care and clinician-
patient interactions to the reciprocal nature of such learning where students
could enhance the knowledge of local practitioners as well as gain practical
training during their interactions. The tension between service delivery and
teaching is an aspect that needed to be addressed in order to balance the
needs of the patients, the students and the supervisors.
Conclusion/take-home message: In order for CBE to be beneficial to
the community partner, the programme needs to be well structured, the
students and community well prepared and student activities more aligned
to community needs. Recommendations from this research will be valuable
in evaluating existing CBE programmes.
Integration of service learning (SL) into the 2nd-year BSc
Physiotherapy paediatric and child health module
A Human
Background/context: Service learning (SL) links the classroom curriculum
(theory) with a community need and then collaborate with community
members in improving service delivery (Lorenzo et al., 2006). Medunsa’s
community engagement and SL initiatives include Missionary of Charity
(MOC) in Klipgat, a children’s home close to the Medunsa campus, run
by the sisters of Mother Teresa (Roman Catholic Church). This home
serves Klipgat and the surrounding communities by caring for mainly
children with physical disabilities and mental disorders, AIDS orphans, and
abandoned children.
Aim/purpose: The aim of the study was to determine the effect of SL as
an integral part of the 2nd-year BSc Physiotherapy paediatric curriculum.
Physiotherapy students can be given the opportunity to apply theory in a
practical setting (experiential learning) and gain a deeper understanding
through reflection.
Methods: An action research approach has been applied in order to guide
the curriculum and assessment of the BSc second-year Physiotherapy
students. A structured SL initiative was implemented, with the outcomes
of some of the paediatrics modules aligned with the services delivered to
MOC. As part of the experiential learning students were divided into groups
and had to implement certain physiotherapeutic assessment and treatment
principles, write it in the form of a case study, and do a reflection on their
active learning experience.
Results and discussion: Students were introduced to the principles of
experiential and active learning as well as reflective practice. Reflections
of students indicated that this real-life challenge was an overall positive
experience despite their initial fear and uncertainty.
Conclusion/take-home message: Implementing and integrating SL at the
second-year level seem to have a positive impact on student learning and
assists in establishing community service delivery. Integration of SL at
junior levels can assist in developing graduates that can become facilitators
of change within their communities.
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The utilisation of video as primary content delivery medium
for staff development of health professions educators
Nico Baird, Marietjie M Nel and Sonet B Kruger
Background/context: We are living in a digital age, and even today with
so many tasks being performed by computers, people are still the driving
force in every organisation. Staff development can be seen as a continuous
process. The development can begin at anytime but if successful will end
at retirement or beyond. It encompasses the process in which staff engages
to prepare themselves, continuously update themselves, and the constant
revision and reflection of their own performance in their daily endeavours.
Aim/purpose: The study forms part of a master’s degree in the Health
Professions Education programme with the view to determine the value of
the use of online video as primary medium for content delivery for staff
development of health professions educators.
Methods: A quantitative study was done with minimal qualitative feedback
included in the questionnaire. A course was created with 3 sections. Content
was delivered to the participants. After the completion of the course
sections, the Health Professions Educators complete a short survey, which
consisted of multiple choice questions and minimal open-ended questions.
Results and discussion: Findings indicated the value of online video as
primary content delivery medium and will be made available as part of the
presentation.
Conclusion/take-home message: Staff development opportunities can be
improved and expanded through an innovative educational approach.
The impact of podcasting on students and student learning
Gegory Doyle
Background/context: In South Africa the use of technology in teaching
and learning does not compare with that in first world countries and new
technologies often take longer to implement. The use of podcasting in
institutions of higher learning in South Africa is minimal. This study took
place at the University of Cape Town (UCT) and explores the impact of
this technology among medical students. Podcasting is a technological
intervention where lectures are audio recorded which in turn are downloaded
by students via a web interface, often to a mobile device. In general podcasts
have been found to be useful to students involved in distance learning. Yet
there is little evidence on the impact of podcasting at a contact university.
Aim/purpose: This presentation investigates undergraduate student
engagement with podcasts and looks at the issue raised most often by
lectures – lecture attendance. The fear is that if lectures are podcasted
students would no longer attend lectures.
Methods: Educators involved in teaching second-year medical students
agreed to have their lectures recorded over a period of 5 months. Students
were asked to complete a survey prior to the pilot to determine any pre-
conceived ideas and implicit knowledge they had about podcasting. Also
they completed a post-survey which focused on how they used the podcasts
and how useful they found them. In addition a log file which automatically
kept track when a podcast was downloaded was kept.
Results and discussion: The information provided via the surveys and log
file was used to determine how the students viewed, used and interacted
with the podcasts.
Conclusion/take-home message: Lecture attendance was not affected. Not
all students were interested in the podcasts; it does not cater for all learning
styles. Podcasting made no noticeable difference to class performance, but
anecdotal evidence exists that it made a difference to individual students.
The usability and benefits of an electronic learning
management system in learning clinical skills at Medunsa
H Havenga
Background/context: Blackboard, an electronic learning management
system, was introduced in 2011 and became fully operational in 2012. In the
Skills Centre the system is being used as repository for learning material and
assessment tools as well as for communication and as tool for monitoring
and tracking of student activity on the system. It is essential to be aware
of how latest technology can be used to enhance learning and therefore
vital to monitor not only the students’ perceptions on the usability of the
system and their actual activity profiles but also to determine the value of
the system for their learning experiences in clinical skills learning.
Aim/purpose: To assess the perceived usability, as well as use and benefits, of
the electronic learning management system in learning clinical skills.
Methods: The sample comprises 4th-year medical students (Cohort 1)
and 3rd-year nursing students (Cohort 2). Prior to each practise session
a pre-test is done on relevant learning material. An online survey will be
completed at the end of the block to gather data on the usability of the
learning management system (ease of access, communication, suitability
and quality of teaching material); the value for learning; the usefulness of
the tools; transferability of material to clinical practice (Cohort 2 only) and
recommendations for using web-based learning tools as learning aids.
A descriptive analysis of the outcomes will be done. A logical regression
will be performed with student performance (pass or fail) as the dependent
variable and with selected relevant questions in the survey as predictor
variables. A correlation between students’ performance and their activity
profiles and perceptions will be done.
Results and discussion: Results will be discussed at the conference.
Conclusion/take-home message: Conclusions to be discussed at conference.
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Alternative teaching method for anaesthesiology residency of
third-year students
C L Odendaal, A Hugo, B J S Diedericks
Background/context: The Department of Anaesthesiology investigates
alternative teaching methods for a 2-week residency of third-year medical
students.
Aim/purpose: Sixteen basic anaesthetic subjects are presented the Blackboard
e-learning platform. Two groups (8 students) rotate alternatively 2-weekly
in (i) theatres for practical demonstration of anaesthesia theory and (ii)
Visimed Computer Unit for student centred self-study of anaesthetic theory
on Blackboard. Formative and summative assessments (from ~600 subject-
specific multiple choice questions) as well as written peer-evaluation
assignments form the computer-based learning. The lecturer follows all
computer-based learning closely and assesses peer-evaluations to verify the
peer-learning process. All computer-based learning generates marks and
form part of a portfolio that further includes a log book with 20 confirmed
clinical tasks that must be completed and confirmed by an anaesthetist’s
signature and proof of 3 attended anaesthetic cases logged on a theatre chart.
Methods: An anonymous questionnaire to evaluate the programme is
completed by students at the end of residency. Continuous analysis of the
questionnaire and outcomes of the programme help to plan interventions
and strengthen residency programme.
Results and discussion: Results are reported from one group of 105
third-year students that completed the first rotation of the programme.
The enthusiasm by which the students approached the programme was
significant. Problems were minimal; the most important issue was limited
time to achieve proper clinical experience. Portfolio marks were excellent.
Conclusion/take-home message: Accommodating a 2-week residency needed
an alternative approach due to time, staff and theatre space constraints in
the Department of Anaesthesiology. The residency relies on student-centred
computer-based learning to master anaesthetic theory and a structured
exposure to clinical work. The first results and impressions are positive,
indicating that the residency is realistic and effective in achieving outcomes as
set in the MB ChB programme at the University of the Free State.
Turning an OSCE into a VOSCE
J Lombaard, L de Bruyn
Background/context: The objective structured clinical examination
(OSCE) is a performance-based assessment tool which is used to evaluate
the medical students’ clinical competency in taking a history, performing
a physical examination and simple procedures. The OSCE consists of
stations through which students rotate and are assessed by lecturers using
standardised checklists. It is a widely recognised assessment tool, but does
have disadvantages.
Aim/purpose: The aim of this study is to determine whether a videotaped
OSCE (VOSCE) can be used as an alternative assessment method and has
advantages over a traditional OSCE.
Methods: A sample group of 41 pre-clinical students were assessed in this
qualitative explanatory study. During their semester 4 OSCE these students
had to perform the procedure of venapuncture. They were evaluated by
lecturers using standardised checklists. These students were again evaluated
during their semester 5 module OSCE performing the same procedure.
This time however it was a VOSCE. The students were asked to complete a
questionnaire anonymously regarding the VOSCE station.
Results and discussion: During the semester 4 OSCE, 6 different lecturers
assessed these students and their average scores for the station fluctuated
between 58% and 85%. The average score of the 41 students was 65%. In the
VOSCE the station was assessed by one lecturer who watched all the video
recordings. The average score for the station was 70.2%.The majority of
Afrikaans students preferred the traditional OSCE station, but the majority
of the English group preferred the VOSCE station. The whole group,
however, wanted a CD copy of their assessment for learning purposes.
Conclusion/take-home message: A VOSCE has advantages over the
traditional OSCE regarding reliability and saving resources e.g. number
of examiners. Students’ performance was not influenced negatively by the
VOSCE station.
Tutoring scientific subject matter in students’ mother tongue
A Louw, M De Villiers, M van Heusden
Background: Teaching in a country with different academic languages
offered special challenges to institutions that cater for these languages. The
languages English and Afrikaans are both used as languages of instruction
at Stellenbosch University. However, at the Faculty of Health Sciences,
Chemistry for Health Sciences for entry-level students is only offered in
English. This could cause understanding and interpreting problems, because
some students studied Chemistry only in Afrikaans in the preceding years.
Faculty put an intervention into place where all the Afrikaans and other
African language speaking students could voluntary attend small tutor
groups facilitated by senior students. The primary purpose of the groups
was to create a safe space for students to communicate about chemistry in
their mother tongue.
Aim: To determine the impact formally structured chemistry tutor groups
in the students’ mother tongue, have on their knowledge, skills and attitude
towards the module.
Methods: A mixed method research approach was used to generate data in
an effort to determine the effectiveness of the intervention. Focus groups
and individual interviews with students and tutors, were used for qualitative
data collection. Data from a questionnaire as well as summative results were
also collected and analysed for triangulation purposes.
Results and discussion: Participating students performed very well.
Although the objectives of the small group were aimed at translating
content of the course into the mother tongue language of the participants,
it also offered other benefits. These benefits included the development of
essential generic skills e.g. group work, effective communication and peer
learning of these students.
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Conclusion: Providing space where students can communicate in their
mother tongue about specific subject matters, assist in enhancing learning
of that subject, as well as enhancing the development of critical generic skills
that students need to function at an optimal level at university.
Aligning clinical assessment practices with the Prosthetic
Dentistry curriculum
R D Maart
Background/context: Removable Prosthetic Dentistry is a fourth-year
module of the undergraduate dentistry programme which consists of a
large clinical component. Clinical tests were introduced and implemented
as an additional clinical assessment method. The intention of introducing
the clinical tests was an attempt to ensure that students were assessed fairly,
that their theoretical knowledge and the ability to apply it clinically were
properly assessed, and to provide feedback.
Aim/purpose: To compare the relationship between the students’
performance in the clinical tests and daily clinical grades with their
theoretical performance in this module. The second part of the study
explored the academic staff s’ perceptions of the clinical test as clinical
assessment tool.
Methods: This was a case study design with a mixed methods approach.
Record reviews of the results of students who completed this module in one
year were used, and included 110 students. The data analysis was done with
the assistance of a statistician. Three full-time lecturers within the Prosthetic
department were interviewed. The analytical abstraction method was used
to assist with the qualitative data analysis; first the basic level of analysis was
done in the narrative form, followed by second higher level of data analysis.
Results and discussion: There appeared to be hardly any relationship
between the students’ clinical daily grade assessment marks and their theory
marks. It appeared that there is a better correlation of the clinical test mark
and the theory mark, than clinical daily mark and the theory mark. This
finding related well with the lecturers’ views that the clinical tests were more
reliable as a clinical assessment tool than the daily clinical mark.
Conclusion/take-home message: The clinical test as an assessment tool is
well accepted by the supervisors and they agreed that it is more reliable and
accurate than the clinical daily grade assessment method.
Learning approaches used by students in the Department of
Emergency Medical Care at the University of Johannesburg
Colin Mosca, Andrew Makkink, Christopher Stein
Background/context: The relevance of identifying different learning
approaches used by students lies in how these impact the way that the learner
engages with the learning material, and how this in turn impacts the overall
learning experience. The main distinction lies in that the surface approach
is generally relied upon when the aim of learning is to ῾momentarily’
perform well in assessments as opposed to the deep approach, where the
aim of learning lies in the understanding and interpretation of the learning
material. Understanding the approach used by learners can provide
important information on learner adaptation to the learning content and
environment, and the learning strategies adopted in each of the specific
years of academic study.
Aim/purpose: The aim of this study was to examine learning approaches
used by students in a 4-year professional degree programme in Emergency
Medical Care.
Methods: The research was conducted using the Biggs R-SPQ-2F
questionnaire which was voluntarily completed by registered students of
BEMC degree programme. A Likert scale method was used to facilitate the
interpretation of the results of the survey.
Results and discussion: Data analysis demonstrated that the majority of
students in the BEMC programme use a Deep approach to learning. Of
the Deep learners, year-one learners were mostly intrinsically motivated
to adopt a Deep approach, while years 2 to 4 were mostly extrinsically
motivated to adopt a Deep learning approach. Of the learners that scored as
having a Surface learning approach, none were found to be Surface motive
learners, meaning that the Surface learners were extrinsically motivated to
adopt a Surface learning approach.
Conclusion/take-home message: Although there is no significant difference
between learning approaches between years, further research is needed
to determine whether or not approaches change during the course of a
student’s studies.
Does the gender of examiners determine the academic
performance of medical students?
D J H Niehaus, E Jordaan, L Koen
Background/context: Final-year medical students in the Department of
Psychiatry at the University of Stellenbosch perform oral exit examinations.
We had previously reported that the gender combination (female-female) of
the examiners predicted (p=0.029) poorer student outcomes, but the sample
size was insufficient to determine whether specific characteristics of these
combinations could account for this finding and we therefore now report
on a much larger sample.
Methods: The class and examination marks (from all disciplines) of 685
final-year medical students (2008 - 2011) were analysed. Odds ratio
calculations were done based on thresholds identified by Bland-Altman
statistical analysis. Group status was determined by the gender distribution
of examiners and the additional variables evaluated included the examiner’
age, first language, experience in examination and area of expertise.
Results: The majority of examiner pairs was male-female (62.9%), followed
by male-male (25.0%) and female-female (12.1%). The mean mark in
the psychiatry oral exit examination was 62.3% (SD 9.1) and the overall
examination mark was 62.8% (SD 8.8). Twelve students failed psychiatry
during the period of observation. The examiner’s gender was a predictor
(p=0.015) for the psychiatry oral exit examination marks.
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Conclusion: This study suggests that the choice of examiners in oral exit
examinations in psychiatry requires careful consideration in order to ensure
a fair assessment of student abilities.
Developing clinical reasoning: reasons for progression and
non-progression
T C Postma
Background/context: Third-year dental students engage with case-based
pre-clinical clinical reasoning training at the School of Dentistry, University
of Pretoria. They are assessed using a standardised case-based progress test,
which is repeated in the subsequent clinical study years. Action research
shows that some students demonstrate progress in clinical reasoning
skills over time while others don’t. The reasons for this phenomenon are
unknown.
Aim/purpose: This study explores students’ perspectives on the reasons for
progression and non-progression in developing clinical reasoning skills.
Methods: Two focus groups (8 students each), more or less representative in
terms of race, and gender were purposively selected. Individuals in Group
1 achieved at least 9% or more improvement in clinical reasoning scores
after one year while individuals in Group 2 achieved little or no progression.
The dicotomy between the groups was based on improvement in clinical
reasoning decisions over time and not on actual academic performance.
The the focus groups were voice-recorded, transcribed and qualitatively
analysed. The university’s Health Sciences Ethics Committee provided
ethical clearance.
Results and discussion: Students that had shown progression expressed
appreciation for the case-based training. They were focussed on the main
outcome of comprehensive patient care and provided constructive criticism
to improve the system. Students who had not shown progression expressed
less appreciation for the case-based training. Although they provided
constructive criticism, they tended to be self-centred in their discussions,
complaining about the feedback and a lack of structure, and displayed self-
handicapping behaviours such as poor time management. Some were not
aware of available learning opportunities.
Conclusion/take-home message: The students who had demonstrated
progress in clinical reasoning skills seem to be able to reflect and learn
independently. Those who did not demonstrate progress may need more
structure and intensive feedback, as well as formative feedback about
behavioural aspects such as time management and professionalism.
A board game for medical microbiology and infectious
diseases: Do academic members of staff think it can work?
M C Struwig, A A Beylefeld, G Joubert
Background/context: Innovative teaching and learning strategies have
become part of medical training, and educational games are increasingly
used to enhance the process of mastering subject content. Students in the
Faculty of Health Sciences, University of the Free State, experience medical
microbiology as an exceptional challenge because of unfamiliar terminology
and the extensive volume of work. Consequently, many students believe
that medical microbiology could be a major contributor to failing an
academic year. A board game, Med Micro Fun With Facts (MMFWF),
based on Trivial PursuitTM principles, was developed to stimulate second-
year medical students’ interest in microbiology, and to expose them to the
subject content of an Infections module in an informal way involving active
group dynamics.
Aim/purpose: When a novel approach to teaching and learning is
considered, evaluation of the instrument or process should not be limited
to the students for whom it is intended. Therefore, the purpose of this
descriptive study was to corroborate students’ positive experiences of the
MMFWF game, by having it evaluated by academic members of staff.
Methods: Members of staff participated in direct observation of the play
process. The nominal group technique was used to identify their perception
of the game as a learning tool. Feedback was analysed to investigate the
potential viability of the innovation, and comments were interpreted in
terms of the criteria of the diffusion of innovation theory.
Results and discussion: The game itself and the play process generated
positive feedback from staff members. Measured against the criteria of
diffusion of innovation theory, the game meets the requirements for an
innovation to be accepted. Its relative advantage, observability, compatibility,
level of complexity, and trialability has been confirmed by the participants’
feedback.
Conclusion/take-home message: Supplementary to formal lectures,
MMFWF has the potential to enhance students’ learning experiences in
medical microbiology.
How can I help the students visiting my practice to learn
more?
M van Rooyen
Background/context: Each 4th-year medical student from the University of
Pretoria visit a primary care practitioner (PCP) for 2 weeks. They submit a
reflective photo-story report on their experiences and their personal and
academic growth after the visit. To identify whether the objectives of the
visit have been met and to describe the experiences of students, the reflective
reports are qualitatively analysed. A second purpose of the analysis is to
propose strategies that can be implemented by the PCPs to optimise the
learning experience of the students in their practices.
Aim/purpose: Using a qualitative analysis of 4th-year medical students’
photo-story reflections to propose strategies for physicians hosting these
students in their practices, to optimise learning opportunities.
Methods: A qualitative approach to analyse the narratives of the photo-story
reports was used. Main and sub-themes were identified in terms of the topics
reflected upon. Quotes from the narratives were selected to support the
themes. Each quote was scrutinised for evidence of learning taking place.
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Results and discussion: The main themes were identified as: the impact
the visit had on the student, the emotions they experienced, working with
the physician, interacting with patients and the clinical care of patients.
Conditions where learning generally happened were identified as when
students felt comfortable, confident or happy and inspired, they actively
participated, they were challenged, they could see the advantage of learning
and they received feedback.
Conclusion/take-home message: Strategies that practitioners can use to
optimise the learning experience of students in their practice are proposed.
Strategies include active participation, reflection, creating a positive
environment, challenging experiences, active learning plans and quality
time with patients.
The State of Educational Research at the Faculty of Health
Sciences, Stellenbosch University
Juanita Bezuidenhout, Ben van Heerden, Marietjie de Villiers
Background/context: Since its inception in 2006, the Centre for Health
Sciences Education (CHSE) has committed itself to the promotion and
support of Health Sciences Education research in the Faculty of Health
Sciences (FHS) at Stellenbosch University. It played a pivotal role in
initiating research, and collaborating with researchers in other disciplines
within the faculty, the university, nationally and internationally. Therefore
in April 2011 a Research Unit for Health Sciences Education was established
within the CHSE.
Aim/purpose: To establish a research framework for educational research
in the FHS by firstly determining the educational research that is currently
performed within the FHS.
Methods: A document analysis was performed to collect information
regarding existing projects. All projects were classified according to
programme; research focus; location of research and discipline/division/
departments involved.
Results and discussion: There are 106 educational research projects, mostly
at undergraduate level, of which 50% are in the MB ChB programme.
More than 50% of projects focus on teaching and learning design or
evaluation, while very few focus on assessment. All 5 undergraduate
programmes are represented in educational research with only 9 medical
disciplines focusing on postgraduate education. Although most projects
are within the FHS, a number of projects are situated in communities and
also national and international collaborations. Only 20% of projects are
classified as clarification research; the rest as justification or description
research.
Conclusion/take-home message: Educational research appears healthy in
the FHS, but it is essential to establish macro-projects with comparative,
collaborative and/or longitudinal aspects. These would reinforce the
results and interdisciplinary cooperation, lead to better use of current
capacity and promote trans-professional and interdisciplinary cooperation.
Research projects which are explanatory in nature must be developed.
Recommendations are made on how to achieve these aims.
From undergraduate research report to publication
G Joubert, M C Struwig
Background/context: During their second and third years of study in the
5-year undergraduate medical programme at the University of the Free
State, students plan, perform and report on a research project in small
groups of 3 - 5 students, under the guidance of a clinical study leader.
Aim/purpose: We report the experiences of the module leader, Faculty
medical writer, and study leaders in taking undergraduate student research
reports to publication.
Methods: In this descriptive study with both quantitative and qualitative
elements, the approximately 300 projects completed in the decade since
their introduction were reviewed for suitability for publication. The research
reports that have already been submitted for publication were reviewed in
terms of publication success and comments received by reviewers.
Results and discussion: Approximately a third of the student projects are
considered publishable. The main reason for not pursuing publication
in the remainder is small sample sizes or low response rates. Forty-three
student projects have been submitted for publication and have all been
published. The methodology of the student projects is generally sound, as
their protocol is evaluated as part of the research methodology module,
and is reviewed by the institutional ethics committee. Analysis is done or
verified by biostatisticians. What is often lacking in the student reports is
an understanding of the topic. As a reviewer has stated: ῾The Introduction
is rather inappropriate and does not give an adequate picture of the topic’.
Similarly, students often lack insight into the meaning of their results, and
struggle to write a thorough Discussion.
Conclusion/take-home message: Undergraduate student research reports
can be published successfully, if one acknowledges the limited knowledge and
insight of pre-clinical students into the specific field. The Introduction and
Discussion sections thus generally need to be rewritten, which circumvents
problems regarding inadvertent plagiarism and incorrect referencing.
Health professions students’ beliefs of and learning strategies
for acquiring Xhosa
Philip Lewis, M R De Villiers
Background/context: In keeping with evidence that communication in
a patient’s mother tongue improves quality of care and patient outcomes,
the Faculty of Health Sciences at Stellenbosch University (SUFHS) has
embarked on an extensive initiative to implement Xhosa training in the
clinical consultation in all 5 of its undergraduate courses. Other than
anecdotal evidence, it would appear that little is really known about the
preconceived ideas students from different language backgrounds have
about Xhosa language learning and in particular, their (i) beliefs, and (ii)
the language learning and communication strategies they employ to master
the language.
Aim and objectives: The objectives of this study are to gain insight into the
nature and identity of SUFHS students’ language learning beliefs and the
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strategies they employ learning Xhosa; determine whether students from
different language backgrounds reflect similar Xhosa language learning
beliefs and language learning and communication strategies; and identifying
factors that will enhance effective Xhosa language teaching and learning.
Methods: A survey comprising of a 31-Likert scale closed answer options
followed by open question options was conducted with 48 students from
the divisions Speech-Language and Hearing Therapy and Human Nutrition
in the faculty. Statements used in the survey were divided into the following
categories, i.e., aptitude, motivation, the nature of language learning,
communication strategies and difficulty of language.
Results: The study is currently in progress and it is anticipated that the
preliminary findings of this ongoing study will be available from April 2012.
These results will be reported in this presentation. We plan to use the results
to further compare with other undergraduate programmes envisaged to
begin learning Xhosa from July 2012; as well as findings of a post-course
survey which will be conducted in October 2012 to determine whether
students leaning strategies and beliefs reflected in the pre-questionnaire
remain prevalent.
Conclusion: We hope that the findings from this study will provide useful
insight into students’ Xhosa language learning beliefs and trends which
will be used to focus, guide and improve Xhosa teaching and learning
interventions at SUFHS.
A novel method of data collection
Alma Snyman, Francois Cilliers
Background/context: The use of group methods to collect data can pose
a number of problems. This is especially true when engaging with a
group of participants who work together within a specific department or
hierarchy. The lack of anonymity is one of the most inhibiting problems
in such situations and one that motivates us to search for new methods of
facilitating participation. Participlan is a method of facilitation originally
used to facilitate meetings, group discussions and workshops in the business
world. This method of facilitation uses visual mapping to stimulate group
participation and the free flow of ideas in a non-threatening environment.
Aim/purpose: To introduce the Participlan method and share the experience
of this novel data collection method with colleagues who want to engage
with groups during the data collection process.
Methods: The experience of the presenter will be used to illustrate the
possibilities and results of using this novel method of data collection to
engage with a group of Health Sciences Educators.
Results and discussion: The Participlan method was recently used with great
effect to create a positive, non-threatening and engaging process of data
collection in a research project focused on the assessment of professional
behaviour in Health Sciences Education. In addition to the issue of
anonymity being addressed, equal participation by all group members were
also facilitated and a concise visual record of data was generated during the
sessions.
Conclusion/take-home message: There are existing methods of group
facilitation that offer possibilities in terms of reliable data collection
for research purposes. It is possible to guarantee anonymity during a
participatory group session for data collection. Participlan is an example of
a novel, valuable method of data collection.
Acute Shortage of Faculty at School of Medicine of the Catholic
University of Health and Allied Health Sciences, Tanzania
Mange Manyama, Stephen Mshana, Steve Justus, Ralf Graves and Fikile
Mtshali
Background: The number of medical schools and student intake in Tanzania
has increased 3-fold in the last decade in response to the growing population
and health needs. However, there has not been a corresponding increase in
the number of faculty, resulting in a critical shortage at these institutions.
Aim/purpose: This study was conducted to determine the extent and nature
of the faculty shortage at the school of medicine, Catholic University of
Health and Allied Sciences (CUHAS). Results from this study will aid the
school in planning future interventions to address the shortage.
Methods: A cross-sectional descriptive survey approach was used to gather
information from department heads and university records on the number
of faculty and students at CUHAS.
Results and discussion: At the time of this study, the school of medicine
had a total of 86 faculty and 700 undergraduate students and residents.
Of the entire faculty, 40 (46.5%) work as full time and 46 (53.5%) as part
time. The department of surgery had a higher number of faculty while
the psychiatry and ophthalmology departments had the lowest. Over 50%
of departments had shortages of 30% or more of the required number
according to departments requirements/wishes. The extent of the shortage
was determined based on department requirements/wishes since there is no
existing policy for specifying the faculty required per department. The World
Federation for Medical Education (WFME) recommends that the teacher-
student ratio should be relevant to the various curricular components and
the appropriate number of faculty should be determined by departments
implementing the curriculum.
Conclusion/take-home message: The shortage of faculty is likely to
compromise the quality of teaching and therefore the competence of future
health professionals. Various interventions are recommended including
establishment of a residents-as-teachers programme and faculty development
programs to help meet the shortage and groom faculty for leadership roles in
finding solutions to improve health professions education in Tanzania.
The impact of brief quality improvement projects (QIPs) by
medical students
Claire van Deventer, Ian Couper, Nontsikelelo Sondzaba
Background/context: Since 2006 final-year medical students do QIs as part
of their primary care block in Gauteng and North West province.
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Aim/purpose: To report on the QI reports done in the North West province
between 2006 and 2008.
Methods: The triggers, methods and outcomes of the projects are reported.
Results and discussion: Mother and child projects comprised 30% of
the Qi’s, followed by health education (25%), Emergency room, chronic
illness and observation (all 13%) and administrative issues (6%). Most
of the methods used were questionnaires followed by training sessions
and posters or information brochures. The outcomes were mainly short-
term knowledge improvement and some systems improvement, e.g. well-
organised emergency rooms.
Conclusion/take-home message: Even very short projects can have an
influence on clinic staff and patient care as well as helping students to learn
particular skills.
Support of HSS-TA in the implementation of National
Continuing Education Strategy for the MOHSW
R M Mpemi, S H Phafol, M Theko
Background/context: Lesotho, like many African countries, faces challenges
of shortage of Human Resources for Health (HRH) due to migration to
other countries. This has led to a grave decline in key health indicators. In an
effort to retain the scarce HRH, the MOHSW with assistance from its Health
Development Partners (HDPs) has developed a 5-year national Continuing
Education Strategy (CES). The Health Systems Strengthening Technical
Assistance (HSS-TA) plays a key role in facilitating the implementation of
this strategy. HSS-TA is an MCC/MCA funded project, that focuses on 4
main areas of health reform processes: (i) Developing Human Resources
Capacities and Competences (HRCD); (ii) Supporting the Ministry’s
process of decentralisation of health services; (iii) Developing the Health
Management Information System (HMIS); and (iv) Strengthening the
Ministry’s ability to coordinate and oversee health research activities. The
poster will focus on the first area – HRCD.
Aim/purpose: To illustrate the support and achievements of HSS-TA in the
implementation of the MOHSW national CES, 2010 - 2015.
Methods: Desk review of documents from inception of the project to date,
stakeholders’ interviews and observations.
Results and discussion: Training activities are coordinated by the HR
Directorate of the MOHSW and HDP support one training plan. As of
31 March 2012, 1 212 participants from different cadres of HRH were
trained on different health-related topics and a draft Competence-Based
Curriculum for Nursing Assistants is available.
Conclusion/take-home message: There are a variety of ways in which HRH
could be retained and providing continuing in-service training has proved
to be one of the best mechanisms. Retaining HRH needs a concerted effort
from both the Ministries of Health and HDP.
Service learning in Pharmacy: Student reflections on changes
in the health service
A Bheekie
Background/context: Service learning is institutionalised in undergraduate
pharmacy training at the University of the Western Cape (UWC).
Strengthened partnerships between UWC School of Pharmacy and the
Department of Health, Western Cape initiated service learning across several
tiers of the healthcare system. Student objectives were to contextualise
learning during service provision.
Aim/purpose: The aim of this investigation was to assess student reflective
reports of practice patterns within the health services, that they would
consider changing.
Methods: Final-year pharmacy students engaged in routine service activities
under the direct supervision of pharmacy service staff for a week, for 3
academic terms. After the session, students offered feedback to the service
facilitator, and actively engaged in a guided reflection session on campus
with an academic facilitator. The reflective report typically focused on a
practice theme that they had experienced or observed during the service
session. Students were exposed to different healthcare sites for each service
learning week. After the 3rd service learning week (2011), students gained
profound insight into the public health service sector. The theme for the
reflective report focused on identifying a practice pattern that students felt
they would like to change and indicated how that change could be achieved.
Results and discussion: Preliminary qualitative analyses of the reports
indicated that students would consider changes in several service aspects.
Among others improving staff language proficiency and inculcating a
positive attitude, promoting greater engagement on medication therapy
management were emerging themes. Service and reflection prompt students
towards personal and professional transformation.
Conclusion: Reflection contextualises learning and sensitises students to
dissonance between theory and the health service. Pharmacy students can
emerge as change agents towards quality service delivery.
Enhancing the inter-professional interface through early
exposure of undergraduate pharmacy students to the
healthcare environment
N Butler, A Bheekie
Background/context: Senior undergraduate pharmacy students at the
University of the Western Cape (UWC) undertake extensive experiential
learning within a structured and institutionalised service-learning
programme.
Aim: To extend the experiential learning component to entry-level
pharmacy students within the context of a module on Primary Healthcare
(PHC) and Development.
Methods: Students, within the first month of their first term of pharmacy
studies, initiate, arrange and undertake a visit to a PHC clinic. This
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telephonic communication is structured and supervised by a staff member;
students complete a tracking sheet containing details of the interaction. A
prior assignment served to develop specific interview skills. During the visit
they compile information by observation and interviews with both staff
members and patients, to critically assess the facility in terms of adherence
to PHC principles. A current innovation (2012) entails including a reflection
session after the visit, intended to introduce students to reflective thinking
and to allow a sharing of experiences around their first inter-professional
encounter and the impact of the visit on their communication skills and
self-identification as a potential healthcare provider.
Results and discussion: Pre-exposure data collection on expectations
showed an overwhelmingly positive towards the visit as a potential learning
experience; nervousness was the dominant emotion expressed. The
strategies of prior development of interview skills and structured, guided
and supervised telephone communication both served to overcome their
apprehension and enhance their confidence, communication skills and
professional identity.
Conclusion: Student development in terms of both embedding knowledge
and enhancing professionalism is nurtured through early exposure to
experiential learning. This serves to support the notion that it is possible to
use an alternative approach to extended classroom-based instruction prior
to practice exposure.
Challenges in caring for post-stroke clients in low socio-
economic settings: A community health nursing experience
Rosemary Duduzile Mbatha-Ndaba
Background/context: Community health nursing students conduct part of
their clinical practice in communities. They go on home visits to work with
clients of different health needs. Home visiting to clients who are cared for at
home post stroke, has unravelled a number of challenges to students, faculty
and home-based care workers. The country (Botswana) has prioritised
Community Home-Based Care as a strategy to address the overburdened
inpatient care services resulting in the need for additional health manpower
to attend to varied health needs of clients cared for at home.
Aim/purpose: This presentation discusses various constraints, repeatedly
reported by students, during home visits, in the endeavour to improve the
care of a client who has had a stroke, maximise body function, and prevent
complications.
Methods: This is a clinical experience while working with community
health nursing students in the communities.
Results and discussion: Constraints which students cannot do anything
about create anxiety and frustration when evaluating the plan and efficacy
of care rendered against the time spent with the client. Some of these clients
have been in the same state of health for several years.
Conclusion: It concludes that from the planning process, faculty need to
be involved in guiding and supporting the student as he/she implements
and evaluates the care. The long-envisaged multidisciplinary home-based
care team is overdue. This may necessitate an increase in the numbers of
healthcare professionals and/or creating a cadre which can be ῾stretched’
to render several care activities which are currently inadequately offered.
The development of inter-professional learning sites at
community-oriented primary care (COPC) health posts by
multi-professional teams
M van Rooyen, R Jansen, A Reinbrech-Schutte
Background/context: In 2011, the re-engineering of primary healthcare
(PHC) was promulgated by the Minister of Health. This innovation involves
moving the focus of intervention from institutions (clinics and hospitals)
to the community. UP Health Sciences, with collaborators, is setting up
health posts in a model. Nine such sites are being established. L-CAS is a
medical-education-through-experiential-service-learning initiative that
was implemented in the UP School of Medicine. The programme faces
logistical challenges, like limited space and resources at the clinics that are
threatening to impact negatively on it.
Aim/purpose: The adaptation of L-CAS by supporting the development of
learning sites at the COPC health posts, in answer to the posed challenge by
the minister, and other logistical difficulties.
Methods: A participatory action research project was initiated to evaluate,
review and adopt the L-CAS program. This project includes questionnaires,
focus groups and a workshop.
Results and discussion: After the initial round of evaluations a number
of proposed changes were identified including the development of inter-
professional learning, creating a more diverse learning platform, exploring
partnerships with students from other faculties working in the same
communities, and continue the research. One of the challenges faced
by implementing these proposed changes in the COPC sites, is limited
space. Through the community engagement division of the University,
a partnership was formed between the Faculties of Health Sciences and
Construction Engineering to build physical structures at the sites. These
structures could provide an academic meeting place, academic resources,
consultation rooms, office space and safe parking facilities.
Conclusion/take-home message: Exposing students through service learning
to address the needs of the community, based on the COPC health post model.
Medical students will receive exposure through the medical-education-
through-experiential-service-learning initiative and construction economics
students will receive exposure through the construction-education-through-
physical-construction-service-learning.
Connecting the dots: eLearning during Public Health fieldwork
Paula Barnard-Ashton, Dianne Manning
University of the Witwatersrand
Background/context: The 4th-year occupational therapy students attend
a 3-week rural community fieldwork placement for Public Health. The
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placements are typically under-resourced, and the students are ῾virtually
cut-off ’ from accessing learning materi¨als and online library resources.
Connectivity during this placement could be facilitated through supplying
students with pre-paid data on a tablet-computing device.
Purpose: This study investigated the relationship between use of tablet
computing for learning during rural fieldwork and the self-reported
perceived knowledge gain of the students.
Methods: Post ethical clearance, a pre- and post-test survey design was
used. The students completed an initial survey of their perceived knowledge
(on a 5-point Likert scale) for each of the 16 rural fieldwork learning
objectives (RO’s), as well as 32 other-setting fieldwork objectives (OO’s).
The survey was re-administered after their 4th fieldwork rotation. Students
were assigned to groups by the department. Seven students on rotation 1
and 2 did not take the devices with them on their rural placement (control).
The 13 students on rotation 3 and 4 took a minimum of 1 device/ pair,
on their rural placement (experimental). The data was organised into 4
clusters: Control Group’s Rural Objectives (CGRO); Control Group’s Other
Objectives (CGOO); Experimental Group’s Rural Objectives (EGRO);
Experimental Group’s Other Objectives (EGOO).
Results and discussion: T-test analysis of the pre- and post-test data for
each cluster showed significant difference in all clusters with a highly
significant difference for the EGRO’s (p=0.000145). A greater difference in
the perceived knowledge gain was found in the Likert scale of the EGROs
(average gain of 0.9), compared with the other clusters (EGOO=0.4;
CGRO=0.5; CGOO=0.4). A one-way ANOVA showed this to be significant
(p=0.046).
Take-home message: There is self-reported perceived benefit to students
having connectivity and access to online resources during rural fieldwork
place
Technology in Emergency Medicine teaching in South Africa:
Are we ready for 2.0?
Heike Geduld
Background: Enthusiasm for web 2.0 and technology usage in medical
education is high. In the field of Emergency Medicine there is a move to
an increasing and diverse amount of electronic resources. However in
postgraduate education students are generally on the wrong side of the
῾digital divide’ and their focus is primarily on shop-floor learning.
Aim: The aim of the study was to survey technology literacy among the
staff and students in the Division of Emergency Medicine at the University
of Cape Town/Stellenbosch University, to determine levels of access to
technology, confidence with standard software and tools, and the current
usage of technology in teaching and learning.
Methods: A Google-form electronic survey was sent to 62 participants
(42 registrars, and 20 faculty members). The survey included open-ended
questions on attitudes towards technology for learning. Participants had to
rate their confidence with search engines, word processing, presentation
and referencing software. Participation in the study was voluntary. All
responses were anonymous.
Results and discussion: Forty-eight of 62 (77%) responses were received:
30/42 (71%) registrars and 18/20 (90%) faculty. Two (4%) had no access
to a computer and the internet at home. 39/48 (81%) respondents were
able to access the internet at work, mostly (21; 44%) using smartphones.
Confidence was high with using word-processing programs (45; 94%),
presentation software (46; 96%), social-networking sites (37; 77%) and
search engines (36; 75%). More people read online journals (38; 81%)
compared with printed journals (15; 32%). Respondents were generally
positive but emphasised the need for local content. Technology should
῾complement not replace’ traditional learning.
Conclusion: Technology may provide a means for students to access up-
to-date clinical information and an always accessible teaching platform,
however mature learners are not necessarily as familiar with or confident in
using technology. Training is essential before instituting technology-based
interventions.
A needs analysis/situational analysis for professional
development distance learning courses for doctors in rural
areas of Sudan
Shahd Osman
Background/context: The Continuous Professional Development Centre
(CPDC) in Khartoum aims to assist all health professionals in Sudan to use
continuous professional development (CPD) more effectively. However, in
rural areas difficulties of accessibility, finance and manpower are limitations.
Aim/purpose: The study aims to identify the distance learning (DL) courses
needed for doctors in rural areas, and assess the technologies needed to
implement and support DL.
Methods: A descriptive pilot study was used. Qualitative data was collected
using in-depth interviews with instructors’ representative of courses
provided by the CPDC and its technical support department. A focus-
group discussion with doctors was held in Al Gezira; and a questionnaire
was developed and then completed by a stratified sample of forty doctors
working in rural areas of Al Gezira province.
Results and discussion: In-depth interviews with CPDC members
indicated the need for a material production unit with technical support
and instructional designers and a need for co-facilitators in rural areas.
The results of the questionnaire indicated electricity was available for more
than 12 hours/day for (85%) of participants. Computers were available for
(92.5%); and internet connectivity good or excellent for (72.5%). Nearby
technical support was available for only (57.5%). Courses which participants
considered of greatest need included: basic life support (85%), trauma life
support (75%), advanced life support (62.5%), severely ill child (62.5%) and
patient at risk (62.5%). Computer skills were important for the professional
development of (80%), but only (40%) felt very competent with their skills.
Other courses that were suggested the CPDC could offer were ultrasound,
and ῾when to refer’ course.
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Conclusion/take-home message: Though CPDC has reasonable equipment
to start DL, technical support must be addressed. Courses delivered should
target the rural doctors’ needs. Courses aimed at improving computer skills
may be offered to ensure benefit from DL.
The use of automated integrated management of childhood
illness guideline in Primary Healthcare in the Western Cape
in South Africa
Hilary Rhode, Bob Mash
Background/context: The IMCI guidelines provide a standardised integrated
approach to delivering quality care for children under 5 years of age. Nurses
in South Africa are currently using a paper-based guideline. The automated
guideline in the format of a convertible personalised computer tablet aims
to improve training in IMCI and the quality of clinical decision making in
primary care. The automated guideline has been designed to systematically
navigate through the IMCI algorithm reducing errors and making it more
effective. This study evaluated the use of automated guidelines in improving
the training of nurses and use of the IMCI guidelines in primary care
settings in the Western Cape.
Aim/purpose: The purpose of this research is to evaluate the use of automated
guidelines in improving the training of Clinical Nurse Practitioners (CNPs)
in the use of integrated management of childhood illness guidelines in
Primary Healthcare setting in the Western Cape.
Methods: A sample size of 30 Professional Registered Nurses was selected
from a population of 100 nurses who attended the 1-year Postgraduate
Diploma in Clinical Nursing Science at Stellenbosch University. Descriptive
study design compared cohorts of CNP’s who used and did not use the
automated guidelines during training and subsequent practice. The study
was conducted in rural and urban primary healthcare centres in the Western
Cape.
Results and discussion: Results compare the CNP’s knowledge of the IMCI
guidelines at the end of the IMCI training course in those using and not
using the automated version; the CNP’s adherence to the IMCI guidelines
in practice following the IMCI training course when using and not using
the automated version and the experience of those CNP’s who use the
automated guidelines.
Conclusion/take-home message: The use of automated guidelines shows
the potential for improving adherence to IMCI guidelines in the Western
Cape.
Evidence regarding information communication technology
used by generation Y students in Health Sciences Education
L J Van der Merwe, G J Van Zyl, M M Nel, G Joubert
Background/context: Challenges in Health Sciences Education include
effectively engaging the current cohort of so-called Generation Y students
(born 1981 - 2000), who are said to display typical characteristics due to
sharing a common place in history. This includes the impact of information
technology and a uniquely South African educational context.
Aim/purpose: The aim of this study was to formulate an educational
approach for the generation profile of undergraduate students at the Faculty
of Health Sciences, UFS, by discovering whether common perceptions
describing Generation Y are accurate and how differences in perceptions
impact on the teaching-learning environment.
Methods: A mixed-methods research design was used. In phase one,
concurrent triangulation, quantitative and qualitative data were gathered
simultaneously in a questionnaire survey for undergraduate students and
academic staff members respectively. In phase 2, sequential explanatory
design, a focus-group interview held with academic staff members yielded
qualitative data, followed by incorporation of a literature survey and the
results of the questionnaire survey and focus-group interview in order to
formulate the educational approach as indicated in the aim of the study.
Results and discussion: Results indicated that there was agreement
between undergraduate students and academic staff members with many
of the positive characteristics attributed to Generation Y, e.g. confidence,
but differences existed regarding perceived weaknesses, e.g. an attitude
of entitlement. Their values and behaviour, communication and learning
styles, skills and needs, and environment and shaping events revealed an
information-communication technology connected cohort with poor
interpersonal communication abilities desiring structured guidance and
role-modelling. This distinctive profile necessitates a bespoke educational
approach.
Conclusion/take-home message: The focus for effective educational practices
by well-equipped lecturers should be on the involvement of students by
means of teaching-learning approaches that are appropriate and balanced,
as well as theoretically sound, within a suitable, relevant environment.
Podcasting lectures for second-year medical students at the
Faculty of Health Sciences, Stellenbosch University
S H Walsh, M R De Villiers
Background/context: The podcasting of lectures has been shown to benefit
students. Students mostly use them for revision and test preparation.
Lectures in the Respiratory Block of the MB ChB II course were converted
into podcasts and placed on Webstudies, where students could view or
download them as a measure to improve the success rate of the class.
Aim/purpose: The aim of this study was to determine whether undergraduate
medical students find podcasting a useful addition to lecture attendance.
Further objectives included whether the availability of podcasts influenced
the Respiratory Block test scores; and lecturers’ experience of podcasting.
Methods: Questionnaires were sent to the students and lecturers at the end
of the block. End-of-block class scores were compared with those of the
previous year. The marks of the students who downloaded the podcasts were
statistically compared with those who did not. A focus-group interview was
held with the students who assisted with the podcasting in the class.
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Results and discussion: The 82 podcasted lectures were downloaded and
viewed 1 737 times (an average of 21 times each). 78% of the students used
the podcasts and 88% thought that all lectures should be podcasted. 88% of
students used podcasts for clarifying concepts not fully grasped in class. The
focus group identified benefits and challenges and ways to deal with it. 70%
of the lecturers thought that the process was stress free or extremely stress
free and 80% thought the podcasts did not influence class attendance or
even showed an improvement. The test marks of the class improved.
Conclusion/take-home message: Our students mostly found podcasts
beneficial for clarifying concepts they did not grasp in class. The feedback
provided useful pointers for change, including clarification around
copyright issues and that we will be continuing to podcast the entire second
year’s lectures.
Training needs on violence against women in a medical
curriculum at the University of Ibadan, Nigeria
O I Fawole
Background/context: Medical practitioners are in an ideal position to
be able to mitigate the impact of violence on the health of women. They
manage women with various health conditions and are thereby able to
educate, screen and treat victims.
Aim/purpose: To determine final-year medical students’ knowledge and
skills in managing VAW victims and describe extent to which VAW was
taught by faculty in the College of Medicine, University of Ibadan, Nigeria.
Methods: Quantitative data was collected from 109 students using semi-
structured self-administered questionnaire. Qualitative data was collected
by review of documents and modules and interview with one key informant
faculty each from 6 departments in the College, namely: Family Medicine,
Paediatrics, Obstetrics and Gynaecology, Accidents and Trauma, Dentistry
and Public Health.
Results and discussion: Response rate was 85.1%. Mean age was 25.2±3.1
years. Sixty-five (59.6%) were males. Physical, sexual, psychological
and economic violence was known by 73.8%, 72.6%, 54.8% and 44.0%,
respectively. Majority (77.4%) felt it was part of their duty to ask patients
about abuse. Less than half (46.4% or 39) had ever received training on
VAW, most of which were formal lectures (83.3%). Students with previous
training were more likely to be knowledgeable (OR 1.64; 95% CI 0.61 - 4.42)
and skilled (1.27; 0.53 - 3.05). Males had better knowledge and skills than
females (OR 2.44; 0.89 - 6.65 and 1.27; 0.53 - 3.05 respectively). The review
of curriculum documents revealed that the topic had not been included
for teaching. Key informants admitted to not having a formal teaching
programme, although Public health, Family Medicine and Obstetrics and
Gynaecology stated they occasionally mentioned it at teachings.
Conclusion/take-home message: While most students were willing to ask
patients about abuse, they lacked fundamental knowledge and skills to do
so. The present teachings should be enhanced to improve knowledge and
management skills. Faculty agreed to review the curriculum.
Point-of-care ultrasound in Madagascar: What should be core
knowledge? Work in progress
Rabenandrasana Hajasoa Alain, Juanita Bezuidenhout
Background/context: Although use of point-of-care diagnostic ultrasound
(DUS) is an increasingly valuable diagnostic tool to the general practitioners
(GPs), providing adequate DUS training in Madagascar is difficult due to
the lack of standardisation. Detailed international training guidelines for
those who are using or wish to use this imaging technique are underutilised.
Purpose: The purpose of this study is to determine the required content for
undergraduate clinical ultrasound and training in Madagascar.
Methods: Questionnaires based on the WHO: Technical Report Series,
1998 and the Joint Review Committee on Education in Diagnostic Medical
Sonography (USA) guidelines and addressing content, were distributed
randomly to GPs (n=41) and all faculty (n=11) at University Hospital of
Toamasina, Madagascar. The data were collected and were entered on
SurveyMonkey® and analysed.
Results: Completed questionnaires were received from 38 GPs and 9 faculty
members (90% response rate). They agreed that ultrasound instruction
should start with second-year medical students (43% GPs and 36% faculty).
Based on their priority rankings, DUS instruction should focus on: physics
that underlie ultrasound (92% GPs, 89% faculty) and diseases relevant to
Madagascar (79% GPs; 89% faculty). Based on these results, ultrasound
training was initiated in 2011. Student evaluation was obtained at the start
of in 2012. Based on these results, concomitant video and/or tele-medicine
should be used to supplement lectures.
Conclusions: These findings indicated that it is possible to adapt
international guidelines for use in Madagascar. Concomitant video and or
tele-medicine in addition lectures will be valuable. US educational materials
can therefore also serve to advance e-learning, reaching a larger number of
health practitioners, resulting in creating a virtual learning environment.
Reflections of graduating medical students: A qualitative
study
Lionel Green-Thompson, Patricia Mcinerney, Dianne Manning,
Ntsiki Mapukata-Sondzaba, Shalote Chipamaunga, Tlangelani
Maswanganyi
Background/context: The 6-year medical programme at the University of
the Witwatersrand admits students into the programme through 2 routes
– school entrants and graduate entrants. Graduates join the school entrants
in the third year of study for a transformed curriculum called the Graduate
Entry Medical Programme (GEMP). In years 1 and 2 of the GEMP, the
curriculum is structured into system-based blocks. Problem-based learning
is applied in these 2 years. The curriculum adopts a biopsychosocial
approach to healthcare, which is implemented through spiral teaching and
learning in 4 main themes – basic and clinical sciences, patient-doctor,
community-doctor and personal and professional development. In 2010
this programme produced its fifth cohort of graduates.
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Methods: We undertook a qualitative, descriptive and contextual study
to explore the graduating students’ perceptions of the programme.
Interviews were conducted with a total of 35 participants who volunteered
to participate in the study. The majority of the participants interviewed
participated in focus-group discussions. The interviews were transcribed
verbatim and analysed using Tesch’s 8 steps. Ethics approval for the study
was obtained from the Human Research Ethics Committee of the University
of the Witwatersrand.
Findings: Six themes were identified – 2 separate programmes, problem-
based learning and Garmins (navigation system), see patients for real,
being seen as doctors, assessment: of mice and MCQ’s, a cry for support
and personal growth and pride. Participants were vocal in their reflections
of experiences encountered during the programme and made several
insightful suggestions for curriculum transformation. The findings suggest
that graduates are exiting the programme confident and ready to begin their
internships.
Conclusion: Qualitative methods provide a valuable tool for the evaluation
of programmes. Participants felt adequately prepared by the programme
for their internship. Concerns were raised about variability in learning
opportunities as well as assessment.
A survey of the conditions treated by 3rd- and 4th-year
physiotherapy students at the University of Cape Town during
placement in general hospitals
Lunelle Pienaar
Background/context: Clinical practice is the mainstay of training of
physiotherapy students. The HPCSA requires that students spend at least
1 000 hours in the clinical arena. What is unclear is how students spend their
time while in the hospitals.
Aim/purpose: This study aims to document the most common conditions
treated, the intervention techniques used, and the time spent on
administration and patient treatment respectively.
Methods: Students were asked to complete an on-line questionnaire
regarding their practice. As this was initially planned as a simple audit, no
ethical approval was sought.
Results and discussion: Seventeen students who completed the survey
were included in the study. One hundred and ninety new patients were
recorded; most common conditions were respiratory (75) and orthopaedic
(38). The 4th-year students treated more respiratory conditions (30%)
compared with 3rd years (13%). Third-year students had more orthopaedic
conditions (13%) compared with 4th years (10%). Third-year students
included technique of gait re-education (51%) in treatment whereas 4th
years included chest physiotherapy (43%). Third-year students spent more
time on 219 treatments (37.1, SD 13.2). Fourth-year students spent less time
(28.7, SD 19.0) on their 460 treatments (t=5.8, p>0.001) and significantly
more time writing up patient records (15.2, SD 12.2) than 3rd years (10.0,
SD 6.5) (t=6.0, p<0.001).
Conclusion/take-home message: Further work is needed to explore the
influence of conditions students encounter in clinical practice and the
application of practical skills.
Problem-based learning at UKZN – pedagogy, people and
paradigms
T E Sommerville
Background/context: Some forty-odd years after problem-based learning
(PBL) was introduced to higher education, its strengths and weaknesses and
its widespread application have been documented. Most evidence emanates
from first world settings, in quantitative terms, making comparisons with
traditional teaching methods.
Aim/purpose: Ten years after PBL’s introduction in UKZN’s medical school,
I examined the form of PBL pedagogy practised in a diverse, multi-racial,
multi-cultural, multi-lingual, multi-educational, developing-world setting,
through the eyes of students, staff members and institution.
Methods: Qualitative study using interviews with 19 students and 6
staff members, analysed using Nvivo and compared with institutional
statements, using Bernstein’s theory of classification and framing as an
analytical framework.
Results and discussion: Faculty documents reflected a conventional type
of PBL: student-centred, self-directed, collaborative learning in response
to a ῾problem’. Interviews, in contrast, revealed a picture of a strongly
classified and framed pedagogy. The boundary between everyday and
medical knowledge was significant (in slightly different ways) for both
students and staff, who had differing views of inter- and intra-disciplinary
boundaries. Seven different conceptions of ῾integration’ were voiced. Local
perceptions of PBL differ from the theoretical view of a weakly classified and
framed pedagogy. The everyday-medical boundary is delineated chiefly by
differences in discourse, rather than by the language of pedagogy. Differing
perceptions of inter- and intra-disciplinary boundaries can be related to
curriculum and faculty structures. The range of conceptions of ῾integration’
probably relates to conceptions of the knowledge structure of medicine. The
field has been regarded as akin to the natural sciences – in Bernstein’s terms,
a hierarchical knowledge structure.
Conclusion/take-home message: Medicine is largely a horizontal knowledge
structure, comprising a number of distinct regions with minimal overlap.
This leads to dissonant perceptions of ῾integration’. The pedagogy applied
should strive actively to assimilate disparate areas of knowledge.
Breaking bad news: public health electives for medical
students
Liz Wolvaardt, David Cameron, Vanessa Burch
Background/context: The HPCSA has decided to include public health in
the medical curriculum. This headline intention is difficult to implement:
lack of clarity of content; lack of interest by students and an overloaded
79 July 2012, Vol. 4, No. 1 AJHPE
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curriculum remain challenges. At our University one opportunity is the
one-month elective in the third year.
Purpose: As students self-design their elective, few design one in public
health as students cannot choose what they do not know. Students also
lack the social capital to identify meaningful learning opportunities in the
community. Simultaneously medical schools should demonstrate social
accountability that considers the priority health concerns of the community
for education, research and service. This elective could address the goals of
learning and social accountability.
Methods: Post ethical clearance, an action research study used a voluntary
10-item online student-needs survey to inform the development of an
inner-city elective. The elective was marketed and a review of actual choices
conducted.
Results and discussion: 106 students participated and 25 (28.1%) showed
interest with another 44 interested but needing details. The majority (n=66)
preferred to do an elective that would deepen their knowledge of something
already in their curriculum. Proximity to home (n=38) and public transport
access (n=18) were unimportant. Open-ended responses revealed 3 themes
that influence elective choice: institutional factors that support learning; the
setting and opportunity to practice. Two named public health topics as an
interest. The bad news is that no students enrolled for this elective. The 230
elective forms showed that 33.5% (n=77) of students divided their electives
into 2 or more activities. Possibly this group includes those who expressed
interest, so a one-month elective (irrespective of the number of activities
included) is inappropriate.
Take-home message: It seems like public health electives should be
like miniskirts. Long enough to cover the topic but short enough to be
interesting.
Computer-based simulation as e-learning tool
M J Labuschagne, M M Nel, G J van Zyl, P P C Nel
Background/context: Computer-based simulation and game play are new
emerging e-learning tools. The use of computer-based simulation can be an
e-learning tool that can be utilised to add a new dimension to e-learning.
Computer-based simulation can be used to assess higher order skills.
Aim/purpose: (i) List e-learning tools; (ii) Describe the tools for the different
e-learning categories; (iii) Explain the uses, advantages, disadvantages and
assessment possibilities for computer-based simulation and game play.
Methods: A literature review, semi-structured interviews with international
simulation experts and focus-group interviews with lecturers of the clinical
phase of the undergraduate medical programme at the UFS were conducted,
analysed and interpreted.
Results and discussion: The author will give as background, some of the
e-learning tools that are available to develop online lectures and activities.
The aspects that will be discussed include: content/course or learning
management system (CMS/LMS); synchronous collaboration applications;
computer tools/applications (including asynchronous collaboration
applications); game play or game simulation software. The tools for the
different categories will be discussed and the author will elaborate especially
on computer-based simulation options, the uses, advantages and limitations
and the options that are available for developing flat screen simulation to use
in simulation centres and online.
Conclusion/take-home message: Computer-based simulation and
simulation games can be useful tools to be added to the e-learning toolbox.
Computer-based simulation and virtual games can be used to assess higher
order skills.
Developing an e-Learning platform to complement Xhosa
and Afrikaans language teaching and learning: a Stellenbosch
University Faculty of Health Sciences initiative
Philip Lewis, Leandra Khoury, M R De Villiers
Background/context: Communication problems experienced between
healthcare professionals and patients are well documented and perceived
as a major barrier to quality healthcare. Stellenbosch University Faculty of
Health Sciences (SUFHS) has embarked on a range of innovative roll-out
initiatives to empower students with the necessary Xhosa communication
skills to improve patient quality care. This presentation demonstrates a
novel e-learning platform, specifically designed to complement formal
lectures and to enhance students’ Xhosa language skills.
Aims: This project aims to develop and design a range of task-based activities
and interactive assessment procedures to assist students in learning Xhosa
for use in the clinical consultation, and prepare them for their simulated
OSCE’s. The implementation is informed by a study investigating students’
perceptions and application of the e-learning platform for Xhosa.
Methods: The presentation describes the application of the Xhosa
e-learning platform design as well as the development of the course material
consisting of various interactive text-to-speech language learning activities
and assessment procedures. The e-learning course is designed to be hosted
on Blackboard, which is SUFHS’s Learning Management System (LMS),
and will be in the format of a Sharable Content Object Reference Model
(SCORM) module.
Results: Currently 20 students from the division of Human Nutrition are
appraising the effectiveness and application of the e-learning material.
These findings will be made available from October 2012, and will lend
itself to further analyses to improve the application of future e-learning-
related developments as well as further ways to support and reinforce future
students’ Xhosa communication skills.
Take-home message: South Africa is faced with huge language barrier
challenges in the healthcare sector. The SUFHS e-learning course is not only
designed to complement Xhosa lectures to improve language proficiency
but also to prepare students in clinical communication contexts. We trust
that by developing this novel e-learning course material we will be able to
greatly enhance the learning of an African language for health professionals
in order to improve patient care in our health services.
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Fostering lecturer-student engagement using the social
network (Facebook) in an undergraduate Radiography course
S Mdletshe
Background/context: Engagement with the students in higher education
(HE) is critical to their success with their studies. In Radiography engagement
is more critical because the students spend half of their academic time in
the clinical environment for work integrated learning (WIL). This implies
that they only have direct access to the lecturer during half the academic
time which negatively impacts on effective student engagement. Effective
engagement is enhanced by communication with the students.
Aim/purpose: This presentation reports on an intervention to address
the challenge of student engagement based on the use of Facebook (FB)
as a communication tool with the third-year radiography students at the
University of Johannesburg (UJ). The presentation focuses on the experience
of the author in using this tool and how it impacted on student engagement.
Methods: The author noted the lack of communication with the students
and the negative impact this had on engagement. In response to this, the
author decided to use FB as a communication tool with the students by
creating a FB page and called it ῾Radiography Thirdyr Diagnostic.’
Results and discussion: The use of this tool showed enhanced communication
between the students and the lecturer, which positively affected student-
lecturer engagement.
Conclusion/take-home message: Student-lecturer engagement can be
greatly enhanced by using the various platforms of currently available social
networking tools.
What academic advisors need to provide better student
support – lessons from a Malaysian medical school
C P L Tan, J Bezuidenhout, J J Blitz
Background/context: Academic support programmes have an important
role in addressing the needs of students experiencing difficulties. A quality
assurance exercise by the national accreditation body highlighted that
academic staff involved in non-academic counselling had no prior training.
Aim/purpose: The purpose of this study was to investigate the current
practice(s) of academic advisors in a Malaysian medical school in order to
determine their needs and to make recommendations for a faculty training
programme.
Methods: Focus-group discussions (FGDs) involving 10 academic advisors
were conducted using a semi-structured interview schedule.
Results and discussion: Study participants demonstrated some instinctive
understanding of their role (especially as role models in their professional
development) although they did not have clear guidelines. They strongly
expressed a need for training in counselling skills and better administrative
support. There was some reluctance to undertake the task of academic
advising as there were no perceived rewards or incentives.
Conclusion/take-home message: The training of academic advisors
needs to be addressed in faculty development programmes. Strong
institutional administrative support is important with efficient channels of
communication to academic advisors on student performance and other
relevant information. Teaching activities need due institutional recognition
and reward.
A pilot study on the validity and reliability of an assessment
using R-Type MCQs
Lunelle Pienaar, Gregory Doyle
Background/context: The Faculty of Health Sciences at the University
of Cape Town uses a problem-based learning medical curriculum which
focuses on developing problem solving abilities rather than recalling facts.
It is therefore best that the assessment instruments should focus on problem
solving. More R-type MCQs asking students to solve problems based on
information provided in a clinical case-based scenario have been included.
R-type MCQ or extended matching items (EMIs) have approximately 8
options and 2 or more items. The extensive list of options reduces chance of
guessing and recognition of correct answers. Literature sees this as a better
alternative to A-Type MCQs where the limited number of options (usually
4 or 5) encourage guessing. Application of theory and problem solving can
be tested in the same EMI as it allows greater range higher order reasoning
to be tested.
Aim/purpose: To determine whether using EMIs rather than A-type MCQs
will result in a more reliable and valid assessment instrument based on the
difficulty and discrimination.
Methods: One of the fifth-year medical papers was analysed. The 193
students answered a paper containing 5 EMI sets with 34 items and 16 best
of 4 A-Type MCQs The item difficulty and discrimination for the EMIs and
A-type MCQs were determined.
Results/discussion: The EMIs’ mean discrimination and difficulty was 0.2
and 78% respectively. Whereas the A-type MCQs mean difficulty was 70%
and the discrimination the same, 0.2.
Conclusion/take-home message: The small sample of test items made it
difficult to demonstrate validity and reliability. A larger study with more
items needs to be conducted to determine which MCQ type results in a
more valid and reliable assessment.
Do you know your brain dominance status? A participatory
action research project in the School of Healthcare Sciences,
University of Limpopo, Medunsa Campus
A Human, H Pitout, A M Wium
Background/context: Multi-disciplinary teamwork is considered best
practice and is essential for the efficacy of service delivery. The 3 disciplines
of physiotherapy (PT), occupational therapy (OT) and speech-language
pathology and audiology (SLPA) are therefore expected to work together as
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team during service delivery. The intention of this research was to enhance
collaboration between these 3 professions by using the Herman Brain
Dominance Instrument (HBDI) to determine the learning preferences of
each discipline in an effort to create a better understanding of each other.
Aim/purpose: A collaborative action research project was conducted by
3 facilitators of learning (FOL) to compare the brain dominance profiles
and learning style preferences within and between these disciplines. In each
discipline, the brain dominance of second-year students and the FOL was
determined to improve teaching and learning practices as well as collegial
collaboration.
Methods: Within a participatory action research approach the brain
dominance and learning preferences of second-year students (n=82) from
the various departments were determined as baseline data by using the
Hermann Brain Dominance Instrument (HBDI) (Herrmann, 1996). The
data was quantitatively analysed. The findings informed changes to be made
to the teaching practices and collaboration of the respective FOL.
Results and discussion: Similar brain profiles and learning preferences were
noted across the 3 disciplines as the majority preferred learning primarily in
the B Quadrant (Sequential/Organised), and secondary in the A Quadrant
(analytical/intellectual), which is predominantly left brain. The results
obtained enhanced teaching and learning practices and contributed towards
the professional development of the FOL.
Conclusion/take-home message: The knowledge accrued contributed
towards improved communication, collaboration and understanding
on various levels (individual, departmental and School). It is therefore
recommended that similar studies be conducted at other tertiary institutions
in South Africa.
An educational approach for the generation profile of
undergraduate students in the Faculty of Health Sciences,
University of the Free State
L J Van der Merwe, G J Van Zyl, M M Nel, G Joubert
Background/context: Challenges in Health Sciences Education include
effectively engaging the current cohort of so-called Generation Y students
(born 1981 - 2000), who are said to display typical characteristics due to
sharing a common place in history. This includes the impact of information
technology and a uniquely South African educational context.
Aim/purpose: The aim of this study was to formulate an educational
approach for the generation profile of undergraduate students at the Faculty
of Health Sciences, UFS, by discovering whether common perceptions
describing Generation Y are accurate and how differences in perceptions
impact on the teaching-learning environment.
Methods: A mixed-methods research design was used. In phase one,
concurrent triangulation, quantitative and qualitative data were gathered
simultaneously in a questionnaire survey for undergraduate students and
academic staff members respectively. In phase 2, sequential explanatory
design, a focus-group interview held with academic staff members yielded
qualitative data, followed by incorporation of a literature survey and the
results of the questionnaire survey and focus-group interview in order to
formulate the educational approach as indicated in the aim of the study.
Results and discussion: Results indicated that there was agreement
between undergraduate students and academic staff members with many
of the positive characteristics attributed to Generation Y, e.g. confidence,
but differences existed regarding perceived weaknesses, e.g. an attitude
of entitlement. Their values and behaviour, communication and learning
styles, skills and needs, and environment and shaping events revealed an
information-communication technology connected cohort with poor
interpersonal communication abilities desiring structured guidance and
role-modelling. This distinctive profile necessitates a bespoke educational
approach.
Conclusion/take-home message: The focus for effective educational practices
by well-equipped lecturers should be on the involvement of students by
means of teaching-learning approaches that are appropriate and balanced,
as well as theoretically sound, within a suitable, relevant environment.
The usefulness of a tool to assess reflection skills in service-
learning in the Department of Speech-Language Pathology
and Audiology, Medunsa
A M Wium, S Du Plessis
Background/context: Service-learning is a credit-bearing educational
experience which requires students to reflect on the service activity in order
to develop a deeper understanding of course content and relate these to the
scope of practice within the discipline, as well as to develop a sense of social/
civic responsibility. Reflection following a clinical learning experience
helps to organise the students’ thoughts, provides them with a permanent
record of their experiences, allows them to talk about their experiences to
each other, and share their thoughts and feelings. Second-year students in
the Department Speech Language Pathology and Audiology are engaged
in service learning at a rural site on a weekly basis and reflect on their
experiences. The researchers had a need to assess reflection skills to monitor
the students’ personal and professional growth and therefore developed an
assessment tool to this purpose.
Aim/purpose: The aim was to determine the usefulness of a tool to assess
students’ reflection skills in the Department Speech-Language Pathology
and Audiology, Medunsa.
Methods: The data was obtained retrospectively from the reflection diaries
of the students. These reflections were analysed and scored with a matrix.
Scores were compared over the course of the academic year to measure
change.
Results and discussion: The assessment tool proved to be useful in
documenting change in reflection skills over time. The reflections portrayed
an increased sense of social responsibility, problem solving and insight.
Conclusion/take-home message: Guided reflection conducted on a
regular basis is key to the service-learning experience and contributes to
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professional and personal growth. Reflection is an integral part of effective
practice and meaningful service delivery.
Infection prevention and control practices in SA revealed
through teaching and assessment strategies
M Theron
Background/context: The National Infection Prevention and Control (IPC)
Policy & Strategy for Healthcare Facilities was introduced in 2007. Research
conducted by the Department of Health in 2011 showed that there are only
253 IPC practitioners in South Africa, not all of them trained. Policy states
that there should be one practitioner for every 200 occupied beds. This
shortage of trained IPC practitioners in the country led to the development
of a theory and practice integrated IPC Short Learning Program. Training
programmes could also lead to the identification of shortcomings in IPC
practices.
Aim/purpose: To highlight the shortcomings of IPC practices through
reflection on a Short Learning Programme.
Methods: The IPC Short Learning Program, based on unit standards
(NQF level 7) was presented during 7 contact sessions. Facilitation of
the programme comprised teaching and assessment strategies such as
group work, class activities, reflection reports and assignments. Narrative
information and records were obtained from the participants’ written
learner activities, reflection reports and conversations in class. The main
shortcomings of IPC in practice were identified and the needs of the
candidates were revealed.
Results and discussion: IPC was viewed as an additional task, added to the
daily work load of most of the candidates. Policies, Protocols and Hospital
acquired infection statistics were not available. IPC teams and committees
were absent at most Healthcare Facilities.
The learning experience and quality assurance projects of the candidates
improved IPC practices in their healthcare settings.
Conclusion/take-home message: The Short Learning Program equipped IPC
practitioners with the knowledge and skills needed to provide high quality
care through appropriate implementation, evaluation and improvement of
IPC practices in Healthcare Facilities.
Teaching medical students quality improvement in health
Claire van Deventer, Nontsikelelo Sondzaba
Background/context: 6th-year medical students involved in a 6 week
integrated primary care block are expected to do a facility audit and based
on that or other observed problems initiate a quality improvement (QI)
project.
Aim/purpose: To assess the QI reports of 6th-year students from 2005
- 2010. Methods: An observational study of QI reports done by students.
Project reports assessed and compared to site marks, indicators of learning
assessed and individual and group marks compared.
Results and discussion: Of 274 projects undertaken, 223 (81.4%) were
available for evaluation. Geographical placements and QI themes were
categorised. Management issues were most frequently identified as being
problematic followed by chronic illnesses. Understanding and applying the
principles of QI was partially achieved and gaps were identified for future
projects. The most common intervention was training of personnel and
design and distribution of posters or pamphlets.
Conclusion/take-home message: Most QI projects were well thought out
and relevant to the chosen setting. In the majority of cases, a great deal of
effort and creativity went into the process and skills other than clinical skills
were employed such as writing, presentation of data in graphs and tables.
Integration of theory and practice was achieved only partially.
Emergency Medical Care student opinions of a reflective
journal
Andrew Makkink
Background: Students in the first year of study of a 4-year Bachelor’s
degree in Emergency Medical Care at the University of Johannesburg are
required to complete a reflective journal in which they reflect on a number
of various situations and skills that they have been exposed to within the
clinical learning environment. Information of student opinions of this tool
may provide important strategies at improving the format and structure of
the reflective journal, and potentially also the reflection process.
Aim/purpose: The aim of this study was to examine student opinions of the
reflective journal and to assess a number of areas related to its relevance
within the learning environment.
Methods: A questionnaire containing open-ended questions, forced-binary
and Likert-type scales was developed wherein students registered in their
first year of study were able to assess various aspects of the reflective journal.
Data was captured and analysed using Microsoft Excel and reported on
descriptively.
Results and discussion: Most students understood what the purpose of a
reflective journal was and assigned a positive value to the reflective journal.
Interestingly, many students did not regularly make entries into their journal
as was expected with most leaving their entries to the last minute. There
were a number of interesting trends observed when analysing whether
students would prefer an online or written format for the journal. Although
students are often observed discussing cases, most students did not read
other students’ journals, nor allow others to read their own.
Conclusion/take-home message: The reflective journal has an important
place in the Work-Integrated Learning (WIL) environment. The challenge
is to use it to encourage reflective thinking in our students by ensuring their
active involvement in developing their skills as reflective practitioners.
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Illuminative evaluation of the final-year prosthodontic
component of the Oral Health Science curriculum
P D Moipolai
Background/context: A hybrid problem-based learning curriculum was
introduced in the early 2000s in the School of Oral Health Sciences, and
since its inception no evaluation of the innovation had been done. It was
felt necessary to undertake such a project to adjudicate the worth of the
reform. This was to determine whether goals were being achieved and that
the programme remained relevant and did what it set itself to do.
Aim/purpose: The aim of the study was to use a qualitative evaluation
approach to assess the impact of curriculum change at classroom level
and to evaluate how a department had reformed its teaching and learning
strategies. Additionally, it was to evaluate how this curriculum operated in
its own terms. This approach was employed to illustrate how an evaluation
strategy was used to assess classroom practices following institutional
curriculum reform.
Methods: Illuminative evaluation as a research method in the qualitative
paradigm was utilised. From July through October 2007 small-group
teaching involving problem-based learning, led by 2 faculty from the
department of prosthodontics were observed. Six 2-hour long small-group
sessions, were observed. In-depth follow-up interviews with students and
faculty were conducted. The plan, as outlined in the instructional system,
was held up against the reality through observations in the classroom.
Results and discussion: By and large the findings illustrated that much of
what was planned was realised, with the more experienced staff member
teaching more or less to the plan. However, from the themes that were
inductively derived from analysis of the data, it was clear that integration
of content knowledge and critical thinking necessary to assist in the
comprehensive management of dental patients was not as robust as would
be expected from the students at this level during their training.
Conclusion/take-home message: This finding illustrates the importance
of using qualitative evaluation approaches as a mechanism to assess
curriculum change efforts.
Development of a specific approach to facilitate knowledge
in augmentative and alternative communication across two
learning contexts
A M Wium, M Mophosho
Background/context: HPCSA exit level outcomes specified by the HPCSA,
requires that students in speech-language pathology and audiology are
competent to provide services to clients who require augmentative and
alternative communication (AAC). Such clients present with severe
communication problems and their assessment and intervention, as well as
management is complex. To ensure high quality teaching and learning 2
facilitators of learning at 2 universities collaborated to develop a specific
teaching approach for AAC. Such an approach accommodates all learning
preferences and therefore consists of multiple teaching methods, of which
assessment (as teaching method) is one.
Aim/purpose: To determine the outcomes of a specific approach that
facilitates learning of final-year students in AAC.
Methods: The students at both campuses received similar learning
experiences, learning material and assessments. In both instances the
process of facilitating learning was evaluated by both students and a peer
to increase the validity of the findings. The results obtained from assessing
the students were compared and factors were identified which could have
affected the results.
Results and discussion: The results obtained showed that learning was
facilitated by using a multi-method approach but that the specific context
had to be taken into account.
Conclusion/take-home message: A ῾one-size-fits-all’ assures effective
learning and teaching but that this approach is not necessarily the best
option to ensure quality in teaching. Specific factors need to be considered,
especially for students in a semi-rural context.
Peer teaching at the University of Zimbabwe: Understanding
the learning needs
Chiratidzo E Ndhlovu, Jose Frantz
Background/context: At the University of Zimbabwe (UZ), clinical skills
training occurs during the 3rd year of a 5-year undergraduate medical
curriculum. The clinicians providing the bedside training are ῾content
experts’ but most are not trained medical educators. Given the declining
senior clinician numbers, it is proposed that interns and Masters in Medicine
(MMed) students be formalised as clinical teacher assistants (CTAs).
Purpose: To determine the experiences of the third-year medical students
and the learning needs of interns and MMed students.
Methods: A mixed qualitative and quantitative design using 2 focus-group
discussions (FGD) and self-administered questionnaires was employed. The
target sample was 60 interns and 32 MMed students. 12 participants were
purposively selected per FGD. All data were entered into Microsoft Excel.
The qualitative data were analysed using the broader themes of strengths,
weaknesses, opportunities and threats. The quantitative data was analysed
using Stata 10 (Stata Corp LP). Ethics clearance was obtained from the
institutional review board.
Results and discussion: The response rate was 21(35%) interns and 7 MMeds
(22%). Nine (75%) medical students and 8 (67%) interns turned for the FGD.
From the FGD, using ῾real’ patients was a strength; weaknesses included
the classes being too large and students feeling ῾ignored’ by their trainers.
10 (48%) interns perceived themselves as <5% of their time teaching. Both
groups (100%) reported ῾high or some confidence’ in teaching the medical
students. Clinical load was a major barrier to teaching. Only one of the
MMeds and none of the interns felt they ῾belonged’ to UZ.
Take-home message: There is urgent need to address the sense of ῾not
belonging’ to the training institutions as well as balancing teaching and
service delivery if clinical skills training by peers is to be introduced.
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Students’ perception of their readiness for the clinical area
B Masava, T Munangatire, C N Nyoni, M M Shawa
Background/context: Paray School of Nursing in Thaba Tseka, Lesotho
was established in 1977. The school then offered the Certificate in Nursing
Assistant which was a 1-year programme. The institution operated with
one permanent faculty member and part-time teachers from within Paray
Hospital. Over the years the institution has grown, it had its first intake of
the Diploma in General Nursing in 2009. However, the institution is facing
challenges in the training of future nurses for Lesotho. The current enrolment
is 97 against a staff faculty of 6 nurse educators and 2 clinical instructors.
These staff members are responsible for the 2 programmes being offered by
the institution. Notably there is over burdening of the Nurse educators who
can teach up to 6 courses per semester. This compromises the quality of pre-
clinical training of students. The school does not have fully equipped clinical
skills laboratory, that may aid the learning of vital nursing skills necessary in
the clinical area. In addition to these challenges, the clinical area where the
students are mostly attached has several noted shortcomings, namely; lack
of variety of both patients and departments, unavailability of material to use
in nursing care and poor supervision as majority of staff in the hospital are
Nursing Assistants who profess difficulty in supervising a student for senior
position. These challenges then prompted the researchers to then determine
the perception of the students regarding their preclinical preparation and
whether they perceive themselves to be ready for clinical placement in spite
of all challenges they are meeting.
Aim/purpose: To improve preclinical training of nursing students.
Methods: Self-administered questionnaires in English or Sesotho to be
given to 30 second-year students. Questionnaire will be analysed utilising
descriptive statistics, in determining frequency among variables. Data is to
be presented in graphs and tables.
Results and discussion: In progress.
Conclusion/take-home message: In progress.
Improving Objective Structured Clinical Examinations
(OSCE) practice in Kampala International University (KIU)
A O Ogah, E M Kiguli
Background/context: Kampala International University (KIU) Medical
School was established in 2007, and adopted the OSCE as a form of clinical
assessment in 2010. Since then, there has been effort to improve the quality
of the examinations to meet with international standards.
Aim: To describe OSCE practices and examination outcomes at KIU
teaching hospital and to assess faculty knowledge on conducting OSCEs.
Methods: Both quantitative and qualitative methods were used. The study
was conducted in 5 clinical departments (Internal medicine, Paediatrics,
Obstetrics and Gynaecology, Surgery and Psychiatry). Thirty examiners
and 17 graduating medical students at the July 2011 exit examination were
involved. The examiners’ knowledge was assessed using a self-administered
semi-structured questionnaire. The OSCE setup and process was observed
using a checklist. Five key informant interviews were conducted with Heads
of Departments.
Results and discussion: Examiner response rate was 86.7%. Surgery declined
to conduct OSCE. Only 16 (61.5%) examiners could correctly write OSCE in
full. Fourteen (53.8%) had heard about OSCE only from the faculty. Twenty-
four (92.3%) had never heard of blueprinting nor of standard setting. OSCE
was highly accepted but 23 (88.5%) examiners believed that OSCE alone was
not sufficient for clinical assessment at the exit examination. Prior organisation
was fairly done. Examinations were delayed for 2 hours and information
sharing was common. There was neither a blueprint nor standard setting.
The manned and unmanned stations ratio: >1:1. The differences in the mean
marks and pass-rate between the manned (62.2%, 100%) and unmanned
(45.8%, 35.3%) stations were significant (t-test and p<0.005).
Conclusion: Faculty knowledge and practice of OSCE were poor. Examiners’
scores probably overrated the students’ performance. There is need to set up
an OSCE committee to conduct OSCE training workshops, encourage all
departments to participate and develop guideline for the faculty.
Developing clinical reasoning: Pre-clinical case-studies or
lectures? – student feedback
T C Postma
Background/context: Pre-clinical case-based training was introduced as a
teaching method for third-year dental students at the School of Dentistry,
University of Pretoria in 2009. The aim of the case-based training is to
develop the students’ clinical reasoning skills as part of a Comprehensive
Patient Management (CPM) module. The module stretches over 3 years and
the skills that are acquired pre-clinically are applied in the subsequent 2
clinical years. Prior to 2009 the pre-clinical course was lecture-based.
Aim/purpose: This study explores differences in course feedback between
students who received pre-clinical case-based training (CBT) and those
who received lecture-based instruction (LBI).
Methods: A standardised student feedback questionnaire was administered
(100% response rate) at the end of the fourth and fifth study years (2009 -
2011). Students were asked to rate the course relevance, training alignment
with course outcomes, assessment’s contribution to learning, faculty
competence, knowledge integration, their own clinical reasoning ability,
and the extent of the gap between the pre-clinical- and clinical years, using
a visual analogue scale. T-tests were used to compare the feedback of the
CBT and LBI groups.
Results and discussion: Fourth-year students who received CBT (n=99)
rated the relevance of the course, training alignment with course outcomes,
assessment’s contribution to learning, faculty competence, and the
knowledge integration between subjects in the same study year significantly
(p<0.05) higher compared with those who received LBI (n=51). The CBT
group also perceived the jump to the first clinical year to be significantly
(p<0.05) smaller compared with the LBI group. Fifth-year students in the
CBT group (n=43) gave similar feedback. The fifth-year LBI group (n=95)
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scored the course organisation, knowledge integration between subjects of
different study years, and their self-perceived treatment planning ability
significantly (p<0.05) lower compared with the CBT group.
Conclusion/take-home message: According to student feedback, pre-
clinical case-based training is more effective to prepare students for the
clinical setting compared with a lecture-based approach.
Student support initiatives in the Department of Internal
Medicine
J M M Koning
Background/context: The undergraduate students often perceive the fifth-
year Internal Medicine module as extremely difficult to pass. Over the last
few years 3 challenges were identified which contribute to this perception,
namely a negative attitude towards the module, underlying emotional
challenges and surface learning among the students. Utilising the process
of transformative reflection, a variety of student support initiatives has been
introduced by the Department to try to change these perceptions.
Aim/purpose: To identify the different initiatives undertaken in the
undergraduate Internal Medicine module.
Methods: An audit of all student support initiatives in the undergraduate
programme of the Department of Internal Medicine was undertaken in
2011. The results of the audit will be described.
Results and discussion: A departmental education committee drives these
initiatives. All departmental staff, and those of Departments of Cardiology,
Neurology and Dermatology, give their input at an annual strategic planning
meeting, which focuses on teaching and learning. The Internal Medicine
module has a year group tutoring system in which the tutor has weekly
meetings with the students. Students’ photographs are taken and circulated
to encourage staff to know the students. Extensive feed-back is sought from
students and taken into consideration when planning any changes. Students
with attitude or emotional problems are seen by the year group tutors. These
students are referred to Kovsie counselling or a private psychologist. Since
2011 Internal Medicine is also part of the University’s NATP programme.
Conclusion/take-home message: Having a structured student support
programme in a clinical department is extremely beneficial. As a result of
these initiatives the general attitude of students towards Internal Medicine
has improved. The support rendered contributed to the academic success of
a number of students who had been identified with emotional challenges.
From January 2012 the support programme was expanded to include
workshops on stress management, self-esteem and time management.
The UFS School of Medicine transport project
Anne-Marie Nel, Scarpa Schoeman
Background/context: The clinical training component of the University of
the Free State’s medical curriculum is presented at 5 different hospitals in
the greater Bloemfontein area. Previously, our underprivileged students and
many international students, who do not have access to private transport,
had to rely on the costly and often dangerous public transport system (taxi's)
in Bloemfontein to commute between these hospitals. This placed enormous
pressure on the students’ time, monetary resources and most probably their
academic performance.
Aim/purpose: This need and challenge was recognised by the medical
school and a plan was made to address the issue and provide assisstance to
the students. A business plan was developed and, with gracious corporate
sponsorship, the School of Medicine Transport project was implemented in
April 2011.
The main aim of the project is to support the underprivileged medical
students’ academic performance and study efforts by removing a logistical
hurdle and enable them to focus more on their studies and be successful. By
providing daily and regular dedicated transport for them, they do not have
to stress about making use of expensive, untimely and unsafe taxi’s.
Methods: The students buy semester tickets, currently at a cost of R1 350
per semester, to make use of the service. This money, together with the
sponsorship money, is used towards covering the operational costs. Regular
trips each day are carried out by 2 dedicated drivers, committed to ensuring
that the students arrive safely and on time at their different destinations.
Results and discussion: The appreciation of the students benefitting from
this project cannot be expressed in words. It is clear from the student’s day-
to-day testimonies that the project is certainly having its desired impact and
effect on their educational experience. The satisfaction of their thankfulness
and overwhelmed gratitude is definitely worthwhile.
Conclusion/take-home message: Coming together is a beginning; keeping
together is progress; working together is success.
Training needs assessment for a group of medical educators at
Al Neelain University, Sudan
Sara L Brair
Background/context: Quality of teaching practice is an important
determinant of graduating doctor competency. In order to achieve this,
special emphasis has to be put on the educational development of teachers.
Al Neelain University does not offer Medical Education courses to teachers;
therefore, there is a need to offer such courses and to train teachers in order
to improve the quality of education being offered to undergraduate and
postgraduate students.
Aim: Al Neelain University decided to start a programme of regular training
in medical education to all staff working in the institution. The aim of the
study was to find out needs and priorities of medical educators at Al Neelain
University regarding such a medical education training programme.
Methods: Medical educators had to rate a predetermined list of medical
education topics so as to start their training programme according to the
topics most important to their educational practice.
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A questionnaire containing a list of all medical education topics was
circulated among full time academic staff. Answers were rated on a 5-point
Likert scale of importance. The mean results were calculated for each topic
and topics were arranged in a descending order of importance.
Results: Response rate was 77.50%. Analysis of the questionnaire showed
that among the ῾most important’ topics was student-teacher relationship
with a mean value of 4.45. Among the ῾important’ topics was microteaching
with a mean value of 4.22. ῾Moderately important’ topics were philosophies
of learning and concept learning with a weighted mean of 3.36. Among
topics rated as ῾of little importance’ was qualitative research with a weighted
mean of 2.59. No topics were rated as ῾not important’.
Conclusion: The study showed that among ῾most important’ topics is
student-teacher relationship, therefore it was recommended to start the
training programme with this topic.
Improving health professions education in sub-Saharan
Africa: What are the needs?
Elsie Kiguli-Malwadde, Francis Omaswa, Fitz Mullan, Seble Frehywot
Background/context: The US Government through the Presidents
emergency plan for AIDS Relief (PEPFAR), Health Research and Systems
Management (HRSA) and National Institute of Health (NIH) awarded
grants to 13 African institutions in 12 countries. The aim is to increase
numbers and quality of Healthcare Workers and retain them where they are
most needed, strengthening medical education system infrastructure and
improving locally relevant research capacity in Africa.
Results/Findings: The grants are unique in that the schools identified
their needs and addressed them accordingly. Some emergent themes were
identified. Most school projects are focussed on Curriculum development,
faculty development and improving the learning environment through
skills laboratories and ELearning. The greatest numbers of efforts are aimed
at undergraduate training. In the area of curriculum development, schools
are reviewing the competencies for their graduates and also the methods of
delivery. This is aimed at producing graduates that can meet the needs of
their communities. Many schools are focussing on training teachers mainly
in the basic sciences subjects where there is a great need. All schools are
embracing the use of technology in teaching so as to improve access to the
internet and educational resources.
Schools are also establishing research support centres to help improve
research. These are aiming at training faculty and students in research
methods and ethics, mentoring young faculty and students in conducting
research.
Conclusion: The aim of all this is to try to combat the human resource crisis
which though global is worst in sub-Saharan Africa. The Health Workforce
is an important integral part of health systems strengthening. It is hoped
that strengthening the component of training will lead to improvement of
population health.
Expert tutors’ role in capacitating educators in health training
institutions in Lesotho
M C Earle, R M Marck-Katumba, J E Chikuse, M M Tlapu, N E Mabitle, S
H Phafoli
Background/context: The Ministry of Health and Social Welfare (MOHSW)
of Lesotho is faced with a challenge of shortages human resources
and inadequate continuous professional development of educators
in health training institutions. The MOHSW with assistance from its
health development partners developed a 5-year National Continuing
Education Strategy to address these challenges. The Millennium Challenge
Corporation/Millennium Challenge Account (MCC/MCA) contracted
the National Institute of Health and Welfare, Finland (THL), functioning
in Lesotho as Health Systems Strengthening Technical Assistance Project
(HSS-TA Project), to recruit 6 expert tutors. The role of the expert tutors is
to capacitate the National Health Training College and the Christian Health
Association of Lesotho Training Institutions. The main terms of reference
for the expert tutors are: curriculum development, training programme
development and implementation, training programme management,
quality assurance in training, and monitoring and evaluation.
Aim/purpose: To illustrate the role of the expert tutors in capacitating
educators in health training institutions in Lesotho.
Methods: The needs were identified through focus-group discussions and
individual interviews, self-administered questionnaires, as well as review of
documents and observation.
Results and discussion: Areas identified for capacitating were: Curriculum
development, Teaching skills, Quality assurance, Assessment and
measurement, Mentorship and preceptorship. Induction of tutors, Research,
Management structures, Strategic planning, Clinical laboratories and
Student support. Workshops and mentoring activities were conducted.
Educators at the training institutions were also exposed to conferences,
symposiums and special educational capacity building events.
Conclusion/take-home message: It is evident that a pool of experts can
contribute positively to maximise the quality of human resources for
health. Recommendation is made for countries with scarce resources to
have a pool of experts to be used nationally for capacity building in health
education.
Factors influencing recruitment and retention of faculty at
Catholic University of Health and Allied Sciences (CUHAS) –
Bugando, Mwanza, Tanzania
Stephen E Mshana1, Mange Manyama1, Steve Justus1, Ralf Graves2, Enoch
Kwizera3
1. Catholic University of Health and Allied Sciences-Bugando, Mwanza,
Tanzania; 2. FAIMER, Philadelphia, USA; 3. Walter Sisulu University,
Mthatha, South Africa.
Background/context: Attracting and retaining faculty is essential for success
of any higher learning institution. This has become a major challenge for
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higher educational institutions, especially in the newer Medical Institutions
in Tanzania.
Aim: This study was conducted to determine factors favouring recruitment
and retention of faculty at CUHAS – Bugando.
Methods: Using standardised self-administered questionnaires developed
after focus-group discussion; a cross-sectional survey was conducted.
Respondents were asked to rank each factor that might influence recruitment
and retention on a 4-point Likert scale of: ῾very important’, ῾important’,
῾less important’ or ῾does not apply’. Data were analysed using SPSS.
Results and discussion: Of the 55 questionnaires distributed, 42 (76%)
were returned and analysed. The ranks of faculty surveyed were Tutorial
assistants (16) Assistant lecturers (3), Lecturers (16), Senior lecturers (5) and
Associate Professors (2). Opportunity for professional growth, support from
colleagues for creative ideas, opportunities for promotion, financial support
for scholarly activities and staff collegiality were the top 5 factors which made
faculty take up CUHAS positions; and the same factors were cited as very
important or important determinants of respondents remaining at CUHAS.
The most important factor for the faculty to accept a CUHAS position and
remain at CUHAS was the opportunity for professional growth. Salary was
the most important factor for recruitment and retention in only 7.1% of the
faculty surveyed.
Conclusion: The majority of academic staff surveyed were junior and their
opportunity for professional growth was the most important factor cited
by them in favouring recruitment and retention at CUHAS. The University
should focus on providing such opportunities to create a favourable
environment to attract and retain more academic faculty. Further study
in relation to other academic ranks is warranted to generate additional
recommendations for the owners of these Universities in Tanzania.
Stress in medical students in a problem-based learning
curriculum
S S Naidoo, J M Van Wyk, K Moodley, S Higgins-Opitz
Background/context: An unintended consequence of any educational
programme is the development of maladaptive stress in students. Many
studies have shown that this can impact on students’ health and their
academic outcomes.
Aim: This cross-sectional study was conducted to explore the prevalence of
stress in a diverse cohort of final-year medical students in a problem-based
curriculum.
Methods: A qualitative study was conducted among 94 students representing
66% of the final-year medical cohort in 2008. Semi-structured interviews
were conducted. Data was thematically analysed.
Results and discussion: Seventy eight per cent (n=73) of the participants
experienced stress during the programme. Of these 49 (67%) were female
and 24 (33%) were males. Differences were identified between the different
racial groups of students. Participants identified the following as the main
sources of stress: academic-related issues, time management, language
difficulties and financial problems.
Individual lifestyle adaptations, family support and religious structures and
study groups were reported strategies used by students to cope with stress.
Conclusion/take-home message: Maladaptive stress is a serious problem in
medical students. Curriculum designers need to take cognizance of this and
take appropriate action to minimise this. All students (including seniors)
need guidance and support to manage their time and workload effectively.
Factors influencing nursing students’ absenteeism from
scheduled learning events
K Kgasi, M Randa
Background/context: Student absenteeism creates a negative classroom
environment that makes students attending class uncomfortable and
the lecturer irritable. It also disturbs the dynamic teaching-learning
environment and adversely affects the overall well-being of classes.
Absenteeism is seen as a waste of educational resources, time and human
potential. It causes repetition of teaching, wasting lecturers’ and students’
time. Student absenteeism in undergraduate studies is a concern as it results
in inefficient or inadequate learning and poor academic performance in
certain instances.
Aim/purpose: To explore the factors resulting in absenteeism among
undergraduate nursing students.
Methods: A qualitative, descriptive explorative research design will be
conducted at the University of Limpopo, Medunsa campus. The focus
groups will be held in May 2012. Voice recording and field notes will be
made during the interviews. The voice recordings will be transcribed and
exported to a qualitative data analysis package. Content analysis will be
done to conclude valid inferences from the data. Coding of qualitative
data, content analysis and development of themes will be done. The factors
influencing undergraduate nursing students’ class attendance will be
determined.
Results and discussion: The data will be presented in the form of graphs,
tables and statements. Recommendations will be made to improve class
attendance.
Conclusion/take-home message: Conclusions to be discussed at conference.
Using impulse reviewer training sites to engage students in
basic research
S Smith, M Barkhuizen, P D Theron, D J Joubert, I Seale, L Jones
Background/context: One option to expand student understanding of basic
research is by mentoring and training students as reviewers for the journal
IMPULSE. IMPULSE is an international, online neuroscience journal
for undergraduate publications. Submissions are reviewed by students
88 July 2012, Vol. 4, No. 1 AJHPE
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worldwide under faculty guidance, and articles are immediately published
online, as they are accepted.
Aim/purpose: As the Faculty Advisor of a Review Training Site with
IMPULSE, many of the concepts of basic research can be introduced
through the experience of reviewing primary submissions to the journal.
The online journal has been publishing undergraduate neuroscience
articles since 2003. Currently, the international team of reviewers comprises
students that have come from over 65 universities and 10 countries (one in
SA – the first site outside US). Most reviewers are affiliated with Reviewer
Training Sites, where they receive formal training on reviewing. However,
the particulars of that training vary from site to site.
Methods: Dr Stephanie Smith (MB ChB), lecturer at the Department of Basic
Medical Sciences, UFS (SA), was introduced to IMPULSE in October 2010.
Dr Smith acts as Faculty Advisor for a Review Team consisting of Marizna
Barkhuizen (Associate Editor), PD Theron, Daniël J Joubert and Inge Seale
(current 4th-year medical students). These students have completed an
undergraduate research project as part of their curriculum. Dr Smith meets
with the review team to discuss their comments on submissions as they
arrive. The Associate Editor compiles the final comments of the team, sends
it to the Editor-in-Chief, who merges all the comments from the different
teams into the final review, again, under the guidance of a Faculty Advisor.
This process assures both maximal involvements of as many reviewers
as wish to participate as well as professional quality. This final review,
commented on by as many as 50 reviewers world-wide, is then sent back to
the corresponding author.
Conclusion/take-home message: Faculties are encouraged to consider ways
they might enhance the research experience of their undergraduates by
hosting a Reviewer Training Site at their institution.
Evaluation of a workshop to teach techniques for large-group
teaching
L P Green-Thompson, P McInerney
Background/context: The South African higher education environment is
characterised by teaching in large groups of lectures. This is particularly
significant in the health sciences environment where there is a growing
pressure to increase the numbers of students trained for these scarce skill
professions.
A 2-hour workshop was conducted by the authors using many of the
techniques described in the literature as encouraging active learning. These
included buzz groups in pairs, feedback during presentation, automated
responses (clickers) and minute papers.
Aim/purpose: To describe the process used in this faculty development
workshop on large-group teaching and comment on the evaluation of this
workshop.
Methods: An evaluation of the workshop was conducted using the minute
paper (a recognised technique to enhance active learning). Participants were
asked to list what they had learnt and what they would use in their ensuing
lecturing practice. A second evaluation will be conducted as a second part
to this process.
Results and discussion: All 30 participants completed a minute paper and
had a positive response to the workshop. The participants commented
positively on the use of the minute paper as the means of evaluation. The
learning by the faculty attending the workshop covered a range of areas –
new ways of engaging students (20%), active learning techniques (43%),
different theories of learning (10%), effective use of power point (30%) and
use of clickers (17%).
The workshop evaluation has demonstrated that faculty members need
training at different levels for large-group teaching. Many respondents
commented that seeing active learning techniques in action was important.
Conclusion/take-home message: When conducting Faculty Development
activities, it is important that the theory being taught is also experienced
by the participants.
WORKSHOPS AND SYMPOSIA
Teaching and learning a clinical skill
Dason Evans
Objectives: This workshop aims to explore how educational theory can
inform teaching within medical education. By the end of this interactive
workshop, participants will: (i) understand the key choices required in
planning clinical skills teaching; (ii) review the major factors affecting
student learning; (iii) apply these factors affecting learning in order to
critique traditional and more modern approaches to teaching a clinical skill.
Methods: This interactive workshop will have 2 main components. Firstly,
participants will teach a simple skill in small groups (no prior knowledge
required) and observers within each group will be asked to deconstruct the
main choices that were made in doing so. From this the participants will
identify some of the key principles to consider when planning and delivering
clinical skills training, and these will be related to the literature. These
are likely to include aspects from the competency model (Purnell, 1998),
level of skill (Simpson, 1972); instructor behaviour including scaffolding,
just in time information (van Merrienboer and de Croock, 2002), timing
of feedback etc; and training design choices including Part task vs Whole
task training, overtraining, spacing and duration (Patrick, 2002) The second
half of this workshop will ask the participants to identify the key factors
affecting student learning through a snowballing exercise. We will use this
framework to critique 4 models for clinical skills teaching and learning –
the 4-stage/ACLS approach (Peyton, 1998), Cagne’s instruction events
(O’Connor, 2002), the Evans-Brown approach (Evans and Brown, in press)
and the Michels’ framework (Michels et al., 2012).
Outcomes: This workshop will be of interest to those with some experience of
teaching clinical skills who would like to know more about how educational
theory may validate and help them improve their practice. It will also be
relevant to those involved in clinical skills curriculum design and in staff
development around clinical skills.
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Transforming your ‘working’ environment into a place of
‘learning: How to do the job and learn/teach
D Murdoch-Eaton
Working in a busy clinical environment with the immediacy of pressing
and urgent tasks can leave health professionals with a feeling that they
never have time to ῾learn’ on the job. Contributing to this frustration (and
perceived workloads) are the needs of students, also wanting help, guidance
and teaching in the clinical environment. This workshop will look at how to
facilitate your working environment to become a more effective ῾learning’
environment, utilising the expertise and experiences of the workshop
participants together with development of contextually workable ideas
integrating workplace learning with adult learning theories and principles.
Using adult learning theories to plan assessment
David Taylor
When students learn they follow a clear sequence of 4 learning domains,
recall, elaboration, organisation and reflection. One of the difficult aspects
of designing assessment is working out which learning domains we are
testing with each type of question or activity. Another is ensuring that we
are not only testing recall. The final problem is determining how to give
meaningful and useful feedback to the students following or during the
assessment. Based on a simple plan of adult learning we will work in pairs
or small groups to either develop or improve our assessment strategies, to
meet each of these objectives.
Abuse: Acknowledgement and action in the medical
curriculum
Theme: Ethics
Veronica Mitchell
Background/context: Abuse exists in the South African health system. It
occurs in diverse forms at health-care facilities and students frequently
confront examples in their clinical contacts. When they witness
unprofessional behaviours they face dilemmas, often not knowing how to
respond. At the University of Cape Town, the Department of Obstetrics and
Gynaecology has created spaces in the curriculum opening opportunities to
explore these difficult issues.
Aim: This workshop aims to empower participants to initiate conversations
about the reality of human rights violations in the clinical teaching
platforms. By sharing our experiences in using interactive tutorials, we plan
to raise awareness on these challenging matters and to promote change.
This workshop will allow participants to learn how these issues have been
successfully addressed in a medical student environment. It will provide the
attendees with techniques and skills to introduce similar methods in their
own environments.
Methods: At the workshop we will use a participatory methodology to
initiate a collective dialogue among educators. The methods and the results
from our facilitated student workshops will be explored by attendees so
that techniques may be successfully employed in their own situations.
Existing literature underpinning abuse causes and an innovative reflective
framework will be shared.
Results: The learning outcomes will be tabled and the students’ feedback
after the teaching sessions will be presented so that participants can judge
their usefulness and applicability to their circumstances.
Discussion: Moving from silence to dialogue on issues concerning abuse
requires innovative approaches and trusting relationships. By collaboratively
exploring the realities of practice into which students are immersed,
transformative practices can be promoted.
Take-home message: Abuse is a difficult topic to address in a training
curriculum. Innovative methods have contributed towards developing
students’ awareness and ability to respond in a sensitive and appropriate
fashion to abuse in the workplace.
Student support ... What a challenge ... ?
Theme: Selection/Support/Retention
Aziza Bawoodien
Background/context: Student support forms an integral part of
endeavouring to optimise student success and throughput. Stellenbosch
University has a multi-, trans- and interdisciplinary approach to student
support. The core team consists of an educationalist, family physician, and
clinical and educational psychologist. We also utilise the services of speech
and language therapists, psychiatrists and university social and financial
services. Much experience has been derived from working with students
and the interventions implemented, with many successes and some failures.
Aim/purpose: To generate discussion between participants. Best practice
methodologies utilised by peer faculties could be determined, and the
development of a network of student supporters could be fostered.
Methods: A workshop by means of case studies, hold with fellow student
supporters to create and stimulate group discussions. The case studies will
be representative of the different modalities of support or interventions
utilised. All attempts at maintaining confidentiality of the cases under
discussion will be ensured by removing all characteristics that could
serve as identifiers of the cases. Attempts will also be made to minimalise
marginalisation or stereotyping of characters based on language, religion
or cultural groups unless specific reference has a pertinent influence on the
discussion of the case.
Results and discussion: The discussions generated may identify evidence-
based pedagogical and psychological theories and practice, on which
student supporters can build to enhance own practice and to develop
further research in this field.
Conclusion/take-home message: It is the moral obligation of institutions to
enable students selected into programmes in the Health Sciences to succeed
and progress back into society to fulfil societal commitments and service
delivery.
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The design, implementation and evaluation of the New
Academic Tutorial Programme in the School of Medicine
at the University of the Free State with a view to improve
throughput rates and student retention
M Jama, M Koning, L Damons
Background/context: Student retention has been and is still a challenge
for universities internationally and nationally. In an effort to improve
throughput rates and student retention, the School of Medicine at the
University of the Free State (UFS) has, in collaboration with the Centre
for Teaching and Learning (CTL), among other strategies designed and
implemented a New Academic Tutorial Programme (NATP). This is a
structured programme designed to increase mastery of content in ῾high-
risk’ modules. The programme was first implemented in the Pre-Clinical
Phase of the MB ChB Programme in 2007 and extended to the Clinical
Phase in the Department of Internal Medicine since 2011.
Purpose: The purpose of the symposium is to describe and discuss how the
NATP has been customised and how it has contributed in improving the
throughput rates and student retention in the UFS School of Medicine.
Type of workshop/symposium: Presentation and discussion of the NATP
by the 3 authors.
Intended outcomes: (i) explain the design, implementation and evaluation
of the NATP; (ii) elucidate how the NATP has contributed towards the
academic performance of students; and (iii) share the views of the tutors
who have been involved in the NATP.
Healthcare students’ inter-professional learning in a Skills
Centre
I Treadwell
Background/context: An outcome for newly graduated healthcare workers
highlights the importance of teamwork and the understanding and
appreciation of the roles, responsibilities and skills of other care workers. The
majority of students are however not exposed to formal inter-professional
learning (IPL) events in order to form realistic expectations of each others’
roles and scope of practices. Since studies indicate that IPL is facilitated
by experiential learning, the Skills Centre at Medunsa introduced inter-
professional trauma simulations using high-fidelity simulators and SPs.
Senior medical, nursing and occupational therapy students are scheduled
to take part in these events.
Aim/purpose: At the end of the workshop participants should be able to
develop events for IPL learning in their respective institutions.
Structure: (1) Share with participants our experience in: (i) simulated
management of a traumatised patient in the pre-hospital, initial in-hospital
and outpatient phases by an inter-professional team of undergraduate
students; (ii) effect of IPL on students’ attitudes towards and perceptions of
roles and responsibilities of a profession other than their own. (2) Individual
identification by participants of feasible opportunities in their own institutions.
(3) Facilitation of small groups in the development of a (i) tool to prepare
for selected IPL events, based on a template comprising the scenario and
sequence of events, pre-requisite skills and knowledge, expected outcomes,
problem identification, equipment, SP training, moulage, preparation of
students, management of problems based on the model of clinical judgment;
(ii) mark scheme for technical and non-technical skills.
Constructing high quality Multiple Choice Questions (MCQs)
Scarpa Schoeman
Background/context: Although the use of MCQs is a popular and cost-
effective method of assessment in healthcare education, the quality of the
questions can sometimes be problematic. This adds more variables to the
eventual outcome of the assessment and increases the inherent difficulty
of the assessment. To maximise the advantages and reduce the technical
disadvantages the National Board of Medical Examiners (NMBE) have
written a manual on the lessons they as a body have learned in the last 20
years of running large scale MCQ licensing exams for medical students in
the USA. The valuable tips and pitfalls they highlight in their manual will
form the basis for this workshop.
Aim/purpose: The aim of this workshop is to facilitate participants in the
writing of high quality MCQs, based on the 2003 NMBE manual. This will
be done by explaining which types of MCQs are the most appropriate to use
in assessing clinical knowledge of medical (or other healthcare) students.
Apart from some general guidelines on writing good MCQs, the presenter
will focus on how to write MCQ that will assess clinical application of
medical knowledge in particular.
Methods: During the first component of the workshop, the basic concepts
and principles of writing high quality MCQs will be shared (summarising
the NMBE manual). In the second component the participants will have
the opportunity to build new or modify their MCQs under the guidance
of the presenter. Participants are requested to bring a charged laptop to
the workshop with the idea to work on their own MCQs electronically.
The presenter will provide examples and templates for the different MCQ
formats.
Diagnostic reasoning – how can we help?
Janet Grant
This workshop will look at the nature of clinical problems and the challenges
of making a diagnosis. The importance of the content, organisation and
accessibility of information in the clinician’s memory will be stressed.
Common errors will be reviewed.
Participants will be invited to complete the Diagnostic Thinking Inventory
to analyse their own thinking, as well as undertaking a variety of teaching
and learning exercises that can be used to help students and trainees to
improve their own clinical reasoning and diagnostic processes.
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Social accountability: Crafting the southern African definition
L P Green-Thompson
Centre for Health Science Education, University of the Witwatersrand
Background/context: A global consensus on the social accountability
of medical schools was achieved at the end of 2010. There is a growing
international trend towards the development of health professions education
which are responsive to the needs of the society’s in which the education
occurs. The author is embarking on postgraduate studies in the area of
social accountability; in particular, looking at the nature of the professional
who a society identifies as socially accountable. The workshop will assist in
defining the role players/stakeholders in the local health environment.
Purpose: The aim of this workshop will be to examine what social
accountability means in the Southern African context. Establishing and re-
enforcing networks to reflect on the characteristics of a socially accountable
health professional.
Type of workshop: Interactive with small-group discussion.
Intended outcomes: At the end of this workshop, participants will have (i)
developed a common understanding of social accountability; (ii) reflected
on the characteristics of the individual health professional and the features
of their practice which make them socially accountable.
Now that I believe in simulation, where do I start (without
excessive costs)?
Bosseau Murray
This workshop will present methods to introduce cost-effective simulation
based on a Needs Analysis, i.e. identifying weak areas in the present
curriculum? What do the trainees not ῾get’? Many concepts of simulation
focus on videotaping a crisis event with a full human, robotic simulator, and
then debriefing (reflecting with) the participants, using the videotape. Such
a system typically requires a financial investment in a full human simulator
(US$25 000 – 250 000), plus a high fidelity simulation facility (US$ millions).
However, there are alternatives based on an understanding of (a) the very
broad range of simulators (e.g. part task trainers and flat-screen simulators
starting at US$100s - 1 000s) and (b) the ῾Strategies to Use Simulators’ (see
introductory Plenary Abstract).
Description of the workshop: The workshop participants will be introduced
to various cheaper simulator alternatives (including home-grown
equipment, flat-screen simulators, and commercial lung simulators.) The
participants will also be given an outline of the elements of a simulation
session. The participants will then split up into smaller groups. Each group
will plan and develop (under guidance) a training session appropriate for a
specific level of trainee, based on an identified need. The simulators selected
for each group will include: a homemade simulated lung using endotracheal
tubes and anaesthesia reservoir bags (cost US$25); a flat-screen simulator
programme (AneSoft) to practise drugs and dosages needed during crisis
($100); a simple resuscitation mannequin with an electrocardiogram (ECG)
and pulse oximeter simulator producing vital signs (many bio-medical
departments have ECG and pulse oximeter simulators to test equipment,
and most healthcare training institutions already own resuscitation
mannequins).After reconvening, the various newly developed scenarios
will be discussed and further developed. An open question-and-answer
period will encourage further specific discussion. Examples of successful
(published) scenarios will be given, as well as inter-professional education
(IPE).
Conclusion: Based on the needs of the trainees, there are multiple innovative
and cost-effective ways to start using simulation to gain experience with this
teaching modality.
Using experiential learning in your teaching practice – a
practical workshop
J Brown
Experiential learning is a popular way of teaching and learning in medical
education; it is particularly helpful to skills and professionalism learning,
and can be applied to any topic that requires students to try out new
behaviours or skills in small groups and receive feedback on performance.
This workshop will provide participants with an opportunity to take part in
an experiential-learning group and try out facilitation skills in a practical
way. By the end of the workshop participants will: (i) have explored a
working model of a roleplay session including the importance of feedback;
(ii) have taken part in a roleplay session as either a learner, facilitator or
simulated patient; and (iii) have reflected on the use of experiential learning
as part of the teaching repertoire.
Teaching teachers to teach large groups
L P Green-Thompson, P McInerney
Background/context: There are increasing numbers of students being taught
in health science faculties across the country. While many institutions have
espoused small-group learning as ideal, there are many situations in which
teaching a large group of students can be both effective and appropriate.
Purpose: The aim of this workshop will be to explore the techniques of active
learning which may be employed in a large-group teaching environment.
Type of workshop/symposium: Skills workshop, in a large venue, which will
encourage the participation of all those attending.
Intended outcomes: At the end of this workshop, participants will be able to
(i) reflect on their own learning styles and link these to dominant theories
of adult education; (ii) reflect on the use of lectures as a means of learning
knowledge; (iii) evaluate a range of active teaching strategies and situations
in which these may be applied; and (iv) use an automated response system.
Abstracts
92 July 2012, Vol. 4, No. 1 AJHPE
Engaging with the challenges of small-group learning
Lorna Olckers, Lindiwe Dlamini
Background/context: The education of health science students has
undergone significant change. In keeping with the principles of the Primary
Healthcare Approach, graduates must be able to work effectively in dynamic
diverse multi-professional teams. In order to facilitate this type of learning,
teaching methodologies have shifted from didactic to student-centred
small-group techniques. Small-group facilitators therefore need to be able
to work with both ῾task’ and ῾process’ and understand how groups function
including group processes, phases and dynamics. They also need to be able
to balance the needs of individual group members against those of the
student group itself. This can be extremely challenging.
Purpose: The purpose of this workshop will be to explore and further develop
understanding and experience in small-group facilitation techniques.
Type of workshop/symposium: This workshop will be experiential and
participant-centred. Educational and group theory will be used to explore
small-group learning techniques including ῾task’ and ῾process’, group
dynamics and processes. Participants will be asked to draw on their own
experiences.
Intended outcomes: Small-group learning is about more than achieving
outcomes. This workshop will explore this complex but exciting process and
assist educators with techniques in small-group facilitation.
Clinical skills teaching in a medical environment
Lin De Bruyn
Clinical Skills Unit, School of Medicine, University of the Free State
Background/context: Clinical skills facilities where preclinical medical/
nursing students are taught to manage patients. Activities include teaching
and practising procedures, taking a patient’s history, examination of patients.
Problems encountered are related to: numbers of students, assessment,
῾patients’ on whom to practise skills related to managing a patient, selection
and procurement of manikins, care of manikins and equipment etc.
Purpose: To identify and discuss mutual challenges and possible solutions/
strategies to resolve the problems related to clinical skills teaching.
Type of workshop/symposium: Open round-table discussion of matters
submitted by attendees, lead by representatives from the various clinical
skills teaching facilities.
Intended outcomes: To be able to use the information gathered to the
advantage each clinical skills facility.