Doctoral Degrees (Centre for Health Professions Education)

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    The value of an e-learning bundle in the acquisition of a clinical skill : exploring the perceptions of third-year medical students at Stellenbosch University, South Africa
    (Stellenbosch : Stellenbosch University, 2022-04) Van der Walt, Lizanne; De Villiers, Marietjie R.; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
    ENGLISH SUMMARY: Introduction: The influence of e-learning and blended learning approaches (such as flipped classrooms) on the assimilation of theoretical knowledge has been studied extensively. However, health professions education requires not only the acquisition of theoretical knowledge but also the ability to integrate theoretical knowledge with clinical psychomotor skills to graduate as a clinically competent healthcare practitioner. While it is challenging to teach clinical psychomotor skills online, the cognitive component as well as practical demonstrations can be addressed in a flipped classroom scenario. This study aimed to determine how valuable students found an e-learning bundle on the administration of injections in preparation for a face-to-face contact session on the same topic. Materials and methods: Forty-one of 133 third-year medical students undergoing the Internal Medicine rotation participated in the study. They had to have completed the e-learning bundle on injections, attended the face-to-face contact session and completed an online medical e-learning evaluation questionnaire within 72 hours thereafter. Results: The students indicated that they had found the e-learning bundle to be extremely valuable in their preparation for the contact session, with a mean score of 9 out of a possible 10. The students also reported positively on the content, the relevance for their level of training and their overall enjoyment of the bundle. The students identified some barriers, namely not having enough time for preparation within a very full curriculum and experiencing technical difficulties such as slow loading and incompatible video formats. Discussion: Using an e-learning bundle in preparation for a contact session seems to be beneficial before actually practising the skills. By creating protected time for the students to complete the online learning related to clinical skills, the face-to-face contact sessions can be more focused on the actual psychomotor component, resulting in more time for deliberate practice in the Simulation and Clinical Skills Unit (SCSU). The latter has been proven to improve performance in clinical skills in real-life scenarios.
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    There’s no doubt that one learns through it all : a qualitative exploration of the value surgery trainees assign to master of medicine research
    (Stellenbosch : Stellenbosch University, 2022-04) Moxley, Karis; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
    ENGLISH SUMMARY: Background: Since 2011 The Health Professionals Council of South Africa (HPCSA) has mandated the completion of a Master of Medicine (MMed) research project for specialist registration. This has introduced several challenges for the training environment and there is concern that institutions do not adequately prepare trainees for their role as scholars. MMed research has therefore received much critical resistance and stakeholders have questioned its value as part of the specialist training curriculum. To gain a deeper understanding of the affordances, enablers, and challenges of MMed research we were interested to hear how trainees construct the meaning of value in relation to their experiences. Aim: To explore the value surgery trainees assign to their MMed research experiences. Methods: This qualitative study adopted a social constructivist epistemological perspective. We purposively sampled 9 participants who had completed their research in a single surgical division at Stellenbosch University. Data were generated via semi-structured interviews with individual participants and analysed using reflexive thematic analysis. Results and discussion: We identified four key themes: 1) resentment, relief, realisation, and prerequisite; 2) the clinician versus clinician-scientist dichotomy; 3) research exposure and leadership, and 4) “there’s no doubt one learns through it all”. MMed research is a source of trainee stress but they can recognise in hindsight research has served an important role in professional development. Through experiential and social learning, trainees develop critical appraisal skills and an improved understanding of the research process and recognise the value of scholarly competencies for evidence-based medicine. Research supervision and leadership represent key enablers in this learning process. Conclusions: Our findings suggest that MMed research offers significant educational value to specialist trainees and therefore warrants continued inclusion in the curriculum. Research supervisors play an important role in managing the research process, initiating MMed candidates into the research community, and making explicit the hidden outcomes of postgraduate research. Therefore, amongst other recommendations for health professions education, we especially recommend that future research and faculty development initiatives should focus on the professional development of MMed research supervisors.
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    Clinical teaching on an expanding training platform : designing a fit-for-purpose faculty development framework for emerging clinical teachers in a resource-constrained environment
    (Stellenbosch : Stellenbosch University, 2018-12) Blitz, Julia; Van Schalkwyk, Susan Camille; De Villiers, Marietjie René; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
    ENGLISH SUMMARY: The research presented in this dissertation was catalysed by a preliminary phase of research which described the journey undertaken by specialist clinicians as they took on the role of clinical teacher. This gave rise to the question of how other clinicians might be assisted on a similar journey, particularly in the context of an under-resourced environment and an expanding clinical training platform. Training in the clinical environment forms a crucial part of medical curricula. Particularly in the later years of the curriculum, it is the component in which students may develop their identity as doctor. Clinicians involved in this phase play a crucial role in the training of medical students. Medical schools are needing to expand their clinical training platforms in order to provide opportunities for greater numbers of students, as well as to offer clinical training that covers the full spectrum of healthcare. In this expansion, medical schools have an obligation to maintain the quality of teaching in the clinical context. Faculty development is a means to strengthen such clinical teaching. In a resource-constrained environment, it is incumbent upon us to consider how best to design faculty development offerings for these emerging clinical teachers. This research was approached from an interpretivist stance, therefore qualitative methods were used. Based on Kern’s six step approach to curriculum development, the targeted needs of emerging clinical teachers were identified by using four different data sets to develop an understanding of current clinical teaching and strategies used to strengthen it. Senior medical students, clinical teachers and staff responsible for faculty development were interviewed and clinical teaching episodes were recorded. Each data set was analysed individually and thereafter all four sets of findings were synthesized and presented as the situational analysis. The findings informed the development of a fit-for-purpose faculty development framework for emerging clinical teachers. The outcome of the study is a fit-for-purpose faculty development framework that is based on four constituent elements. The first is that faculty development be situated within the network of clinical practice, involving not only individuals, but also their clinical practice community and their academic discipline. The second addresses clinical teaching as supervision; the offering of affordances. The third emphasises clinical learning as student engagement, with an essential interplay between the offering of affordances, and the development and exercising of student agency for engagement. The fourth is to tailor-make faculty development offerings that are informed by students’ evaluations of clinical teaching effectiveness. Learning in the workplace needs to be mirrored by teaching in the workplace. This fit-forpurpose framework is offered as a means to assist those responsible for faculty development to meaningfully assist clinicians on the journey to becoming confident clinical teachers.
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    Exploring health sciences students’ experiences of feedback in a problem based learning tutorial : a case study in an African Medical School
    (Stellenbosch : Stellenbosch University, 2018-03) Mubuuke, Aloysius Gonzaga; Louw, Alwyn Jacobus Nicolas; Van Schalkwyk, Susan; Stellenbosch University.Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
    ENGLISH SUMMARY : Problem Based Learning (PBL) has been widely adopted by medical educators across the globe since its inception at McMaster Medical School in Canada. It is a student-centered instructional approach in which learners collaboratively solve problems and reflect on their learning experiences. PBL involves designing tasks as triggers for learning, and setting them in a context that may be relevant in the real world. Students work in small groups also known as tutorial groups supported by tutors, with the emphasis being student centered rather than teacher centered. This enables students to take charge of their own learning, conduct research, integrate theory and practice, and also apply knowledge and skills while developing solutions to a presented learning task. In such a setting, students construct their own knowledge and regulate their own learning activities in order to achieve the intended learning outcomes. Tutor feedback is an important aspect of the PBL tutorial process. This feedback is aimed at identifying students’ strengths as well as learning gaps on a number of outcomes. These may include: knowledge, team work, communication skills, interpersonal skills, life-long and leadership skills among others. This study highlights the experiences and perceptions of health sciences students regarding tutor feedback in a PBL setting. Learning in a PBL tutorial group setting is not only a cognitive process, but also influenced by socio-contextual factors. Therefore, this study has utilized both psychological as well as socio-cultural theory to understand and explain the students’ experiences and perceptions of tutor feedback. It is envisaged that findings from the study will perhaps contribute to not only knowledge on the subject of feedback, but also to general teaching practice in health sciences education within Africa and beyond. Therefore, the over-arching objective of the study was to explore students’ experiences and responses to tutor feedback as well as factors that influence those responses in a PBL tutorial setting in an African context. It was an exploratory qualitative study using a case study approach. The study involved third year undergraduate health sciences students from Makerere University, College of Health Sciences that had attended PBL tutorials. The health sciences students who participated in the study were drawn from five disciplines namely: Medicine, Radiography, Nursing, Pharmacy and Dentistry. The tutorial groups thus consisted of students from these disciplines. Some of the tutors were also involved in the study to provide more understanding of the student experiences. Purposive-convenience sampling was used to select participants into the study. Multiple data collection methods used, included: in-depth individual interviews with students and tutors, focus group discussions with students, document reviews and observations of the tutorial process and the feedback process. Participant responses from the interviews and focus groups were audio recorded and transcribed. The observations were guided by a checklist. For analysis of the transcriptions, thematic analysis was used in which raw data was coded. The developed codes were further related resulting into categories and subsequently into themes and clusters. The analysis was iterative in nature in which data was constantly compared. The findings from the student interviews and focus group discussions were grouped into five clusters, each cluster having a number of themes. The first cluster related to the focus and nature of tutor feedback received by students during PBL tutorials. The themes from this cluster reflected that tutor feedback seemed to be limited in scope to address all the intended PBL outcomes. This observation was also reflected in the interview responses with the tutors. The second cluster was about factors influencing students’ responses to tutor feedback. It was found out that both cognitive and socio-contextual factors influenced students’ responses to tutor feedback. The themes in yet another cluster related to the ways in which students utilized tutor feedback in their learning. It was found out that students used feedback to activate their prior knowledge, reflect upon their own performance and also to engage in self-regulated learning processes. The last cluster and related themes spoke to the students’ experiences of the feedback delivery process. The responses from the student interviews and focus group discussions were supported by key findings from the tutorial observations, document reviews and information from the tutors. An interpretation of these findings was guided by a framework developed from the Activity Theory. Overall, the key outcome of this study was the development of a structured feedback tool for PBL tutors.
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    An investigation into the exit level assessment of the clinical competence of medical graduates for the Sub-Saharan African context
    (Stellenbosch : Stellenbosch University, 2017-12) Tan, Christina Phoay Lay; Van Schalkwyk, Susan; Cilliers, Francois; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
    ENGLISH SUMMARY : Assessment plays a major role in the process of medical education and is an essential component of any medical curriculum. In order to allow judgements to be made on the competence of students, the quality of assessment methods needs to be assured. As exit-level assessments are used for licensing and certification purposes, they are regarded as “high-stakes” in nature, with significant implications for the student, the curriculum, the institution and the public. This study investigated how valid exit-level assessment practices are in determining the clinical competence of medical graduates for selected health-related issues, with the focus on selected medical schools in Sub-Saharan Africa where there are resource constraints and a high burden of disease. It was warranted in light of the paucity of published information about assessment practices and factors that could influence the decisions that are made in exit level assessment in Sub-Saharan Africa The study was conducted within a qualitative interpretive paradigm. A range of data-gathering methods were utilised. The research design selected was multiple case studies, with the unit of analysis the exit-level assessment practices of undergraduate medical curricula. Three medical schools in Sub-Saharan Africa were purposively selected, and as a proxy for the entire curriculum, the clinical disciplines of Obstetrics & Gynaecology and Paediatrics were specifically chosen. Data sources included document analysis, the observation of exit level assessments, and individual and group interviews with faculty involved in exit level assessments. The audio-recorded interviews were transcribed and inductive thematic analysis was carried out. Data from documents were mapped on Excel spreadsheets and an observation schedule was used to collect data during observation of actual clinical assessments. Two analytical tools, Miller’s ‘pyramid’ (1990) and Disability Adjusted Life Years (DALYs), were then used for deductive analysis of data obtained from documents and observations. There were a number of findings of note. A selection of assessment methods were used at the three study sites. Although assessment question content was appropriate and focussed on relevant contextual health-related issues, the evidence gathered through current assessment practices is insufficient to allow accurate judgements to be made about the clinical competence of the students. DALYs as an analytical tool has the potential to contribute to a process of blueprinting, but its limitations in its use with the non-disease based curriculum have been highlighted. Examiners were key players involved in exit-level assessment and have considerable influence on assessment practices. However, their lack of understanding of the basic concept of assessment suggests a need for faculty development to raise the level of assessment literacy. The context within which assessment occurs and institutional cultures also influences assessment practices. This study has provided insights into exit level assessment practices taking place in a resource-constrained context such as Sub-Saharan Africa. It is envisaged that this research will add to the body of knowledge and that it will inform assessment practices going forward, as well as potentially informing curriculum design.