Development of a best practice model for teaching and learning evidence-based health care at Stellenbosch University, South Africa

Young, Taryn (2016-03)

Thesis (PhD)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: This thesis used a mixed-methods approach to investigate how teaching and learning of Evidence-based Health Care (EBHC) could best be integrated in medical student training to enhance student EBHC knowledge, attitude and skills. An overview of systematic reviews assessing the effects of teaching EBHC showed that clinically integrated multifaceted strategies with assessment were more effective than single interventions or no interventions for enhancing knowledge, attitude and skills. Implementation of clinically integrated EBHC teaching and learning was further explored through interviews with programme coordinators from around the world. Informants were requested to provide data on the various approaches used, and on barriers and facilitators encountered with programmes aimed at teaching and learning EBHC in an integrated manner. By far the most common challenges were lack of space in the clinical setting, EBHC misconceptions, resistance of staff and lack of confidence of tutors, time, and negative role modelling. Critical success factors identified were pragmatism and nimbleness in responding to opportunities for engagement and including EBHC learning into the curriculum, patience, and a critical mass of the right teachers who have EBHC knowledge, attitudes and skills and are confident in facilitating learning. In addition, role modelling within the clinical setting and the overall institutional context were found to be important for success. The next phase involved conducting a set of studies to determine the opportunities for, and barriers to, implementing EBHC teaching and learning at Stellenbosch University’s (SU) Faculty of Medicine and Health Sciences. This included a curriculum document review, survey of recent graduates and interviews with faculty. EBHC teaching was found to be fragmented and recent graduates called for more teaching of certain EBHC competencies. Module convenors identified a number of factors that needed to be addressed: contextual factors within the faculty (e.g. recognition for teaching), health sector issues (e.g. clinical workload), access to research evidence, and issues related to educators (e.g. competing priorities) and learners (e.g. motivation). Interviewees also emphasised the importance of educators as facilitators and role models. A cross-sectional study of SU was conducted to assess SU educators’ knowledge of, attitude to and confidence in practicing and teaching EBHC as well as perceived barriers to practicing and teaching EBHC. Limitations to practicing EBHC identified included lack of time, clinical workload, limited access to internet and resources, knowledge and skills. Respondents’ called for reliable internet access, easy point-of-care access to databases and resources, increasing awareness of EBHC, building capacity to practice and facilitate learning of EBHC, and a supportive community of practice. Finally, drawing on the findings of the preceding quantitative and qualitative studies, and taking into account the context of various EBHC initiatives in the African region, an outline proposal is presented for a cluster randomised trial to evaluate alternative options for implementing a clinically integrated EBHC curriculum in an African setting.

AFRIKAANSE OPSOMMING: In hierdie tesis is ʼn gemengdemetode-benadering gebruik om ondersoek in te stel na die manier waarop die onderrig en leer van bewysgebaseerde gesondheidsorg (BGGS) die beste in die opleiding van mediese studente geïntegreer kan word om studente se kennis, houding en vaardighede met betrekking tot BGGS te bevorder. ʼn Oorsig van stelselmatige evaluerings waarin die uitkomste van die onderrig van BGGS geassesseer is, het getoon dat klinies geïntegreerde meervlakkige strategieë met assessering doeltreffender is as enkelintervensies of geen intervensie vir die bevordering van kennis, houdings en vaardighede. Die implementering van klinies geïntegreerde BGGS-onderrig en -leer is verder ondersoek in onderhoude met programkoördineerders oor die wêreld heen. Informante is versoek om data te verskaf oor die onderskeie benaderings wat gebruik word, asook oor hindernisse en fasiliteerders wat gepaard gaan met programme gemik op die geïntegreerde onderrig en leer van BGGS. Die algemeenste uitdagings was verreweg gebrek aan ruimte in die kliniese omgewing, wanopvattings oor BGGS, weerstand van personeel en gebrek aan selfvertroue van tutors, tyd en negatiewe rolmodellering. Kritieke suksesfaktore wat geïdentifiseer is, was pragmatisme en behendigheid in reaksies op geleenthede vir betrokkenheid en insluiting van BGGS in die kurrikulum, geduld en ʼn kritieke volume van die regte opvoeders wat kennis, houdings en vaardighede met betrekking tot BGGS het en leer met selfvertroue in die hand werk. Hierbenewens is rolmodellering in die kliniese omgewing en die algehele institusionele konteks as belangrik vir sukses bevind. Die volgende fase het ʼn stel studies behels om die geleenthede en hindernisse met betrekking tot die implementering van BGGS-onderrig en -leer by die Universiteit Stellenbosch (US) se Fakulteit Geneeskunde en Gesondheidswetenskappe te bepaal. Dit het ingesluit ʼn kurrikulumdokumentoorsig, ʼn opname onder nuwe graduandi en onderhoude met die fakulteit. Die bevinding was dat BGGS-onderrig gefragmenteerd plaasvind en nuwe graduandi het ʼn behoefte verwoord aan meer opleiding in sekere BGGS-vaardighede. Modulesameroepers het ʼn aantal faktore geïdentifiseer wat aandag verg: kontekstuele faktore in die fakulteit (bv. erkenning vir leer), gesondheidsektorkwessies (bv. kliniese werklading), toegang tot navorsingsbewyse, en kwessies verbonde aan opvoeders (bv. mededingende prioriteite) en studente (bv. motivering). Die ondervraagdes het ook klem gelê op die belang van opvoeders as fasiliteerders en rolmodelle. ʼn Deursneestudie van die US is uitgevoer om US-opvoeders se kennis van, houdings teenoor en vertroue in die toepassing en onderrig van BGGS asook waargenome hindernisse tot die toepassing en onderrig van BGGS te assesseer. Die geïdentifiseerde beperkings tot die toepassing van BGGS sluit in gebrek aan tyd, kliniese werklading, beperkte toegang tot die internet en hulpbronne, kennis en vaardighede. Respondente vra om betroubare internettoegang, maklike versorgingspunt-toegang tot databasisse en hulpbronne, verhoogde bewustheid van BGGS, kapasiteitsbou om BGGS toe te pas en te fasiliteer, en ʼn ondersteunende praktykgemeenskap. Op grond van die bevindings in die voorafgaande kwantitatiewe en kwalitatiewe studies, en met inagname van die konteks van verskeie BGGS-inisiatiewe in die Afrika-streek, is ʼn konsepvoorstel opgestel vir ʼn kluster- verewekansigde proef om alternatiewe opsies vir die implementering van ʼn klinies geïntegreerde BGGS-kurrikulum in ʼn Afrika-omgewing te evalueer.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98461
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