Centre for Health Professions Education

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An analysis of the experiences of HCWs in improving their performance in the workplace following a multi-method training intervention in a resource-limited setting
(Stellenbosch : Stellenbosch University, 2021-12) Proudfoot, Ian Graham; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY : Introduction: The educational outcomes of training initiatives are usually measured against the achievement of specific quantifiable objectives. This study sought instead to analyse the impact on changed workplace performance of a training curriculum through the personal experiences of the healthcare workers themselves. The three-week training intervention was a combination of classroom, bedside and workplace-based education, aiming to upskill a group of twenty hospital- and primary care-based clinicians in the management of advanced HIV in a rural community in Homa Bay in Western Kenya. The intention of the study was to understand more deeply what elements facilitated improved workplace performance and what challenged it. In so doing, it was hoped that lessons would be learnt to guide the further development of this and other short training curricula of this nature in similar low- and middle-income settings. Methods: Following a phenomenological line of enquiry, in-depth, semi-structured interviews were conducted fourteen months after the training intervention on a convenience sample of twelve of the twenty participants in the training course. The open-ended questions probed the factors leading to success and those challenging improvement in workplace performance, whilst opportunity was also created for free expression of other elements considered relevant. The interview data were analysed following standard interpretive, phenomenological analysis procedures, with the data finally classified into core themes, within two broad categories of factors that promoted improved performance and those that challenged it. CME - Continuing medical education MOH - Ministry of health HCW - Healthcare worker MSF - Médecins Sans Frontières MIV - Menslike immuniteitsgebreksvirus TLU - Teaching and learning unit LMIC - Low- and middle-income countries NGO - Non-governmental organisation Results: Three core areas of workplace performance were impacted positively by the training intervention, namely, clinical skills, teaching competence, and program development. Contributing to this were a number of different elements, including the classroom teaching strategies, the reference texts provided, the bedside teaching, and the engagements with a variety of colleagues in the workplace over the subsequent months. The challenges to improved performance fit into two broad categories: weaknesses in the healthcare system, and the negative influences of people, including senior colleagues, ministry of health counterparts, junior colleagues, or the patients themselves. Conclusions: Similar to the roles played by a sports coach, the role of the educator is not only to facilitate improved technical skills but also to recognise and further develop the individual agency of the players and to build resilience to thrive, even in adversity. Drawing on the established learning theories of adult learning, situated learning and social constructivism, further augmented by a wealth of empiric evidence in health education studies in low- and middle-income countries, the teaching and learning strategies were shown to contribute significantly to improved workplace performance. The individual agency of the healthcare workers, especially in teaching and program management roles in primary care was a surprise finding, pointing us, as educators, to a greater focus in the future towards not only anticipating this but also taking specific steps to harness this potential. Finally, in the face of the numerous challenges to improved workplace performance, all too frequently encountered in these rural settings, attention needs to be focused in the future on building greater resilience and capacity to manage these challenges.
Caring behaviours : the perceptions of first and fourth year nursing students
(Stellenbosch : Stellenbosch University, 2014-12) Crafford, Ilse; Archer, Elize; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professionals Education.
ENGLISH ABSTRACT: Educators across the health professions are now concerned with the teaching and assessment of professional skills. Caring behaviour is one of the attributes of professionalism in the health sciences professions and in the nursing profession it is regarded as the essence of the profession. The aim of this study is to explore the understandings and experiences of caring behaviours of first- and fourth year nursing students and how they would like to be assessed about their caring behaviours in a curriculum where it is not overtly taught. This will be investigated according to Watson’s carative factors and theoretical framework of caring, while Bloom’s Taxonomy of the affective learning domain will also be consulted. The design of the study is qualitative and explorative. A purposive sample was drawn from first-year nursing students (n=64), and fourth-year nursing students (n=41) at one nursing education institution. The sample of students (n=105) from seven (7) private training hospitals in the Western Cape participated in nine (9) focus group interviews (n=10-15). Data analysis was done by means of a framework analysis approach with a deductive strategy. Research findings from this study are extensively discussed and will be used to inform the undergraduate nursing curricula in South Africa about the profiles of caring nursing students and to make recommendations about the internalisation of caring behaviours, according to the affective learning domain.
Evaluation of a pilot "registrar-as-teacher" faculty development program at Stellenbosch University
(Stellenbosch : Stellenboch University, 2014-12) Smit, Elizabeth Johanna; Archer, Elize; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH ABSTRACT: A. Background - Registrars play a significant role as teachers for undergraduate medical students and junior doctors in the clinical setting. (Jack et al. 2010; Busari & Scherpbier 2004). Many however teach ineffectively as registrars are rarely taught how to teach (Morrison et al. 2002, Busari et al. 2002; Thomas et al. 2002). This has prompted a number of universities to implement “Registrar-as-Teacher” training programs as part of faculty development (FD) initiatives (Leslie et al. 2014; Post et al. 2009, Hill et al. 2009). Although available evidence has demonstrated a positive impact of these programs on the teaching performance of registrars, large differences exist in the interventions, curricula content and participant characteristics. Few studies identified a conceptual framework that informed the design. Most studies focused on a quantitative approach to evaluate outcome; ignoring contextual factors that may shape the successful implementation of new knowledge and skills gained. At Tygerberg Hospital, education is a key performance area of registrar’s staff performance management agreement but no formal training program for registrars as teachers exists. The Centre for Health Professions Education at Stellenbosch University thus piloted a half-day workshop for newly appointed registrars from various disciplines with the aim to develop the clinical supervision skills of registrars as clinical educators. B. Research Design and Methodology - The overall aim of this study was to evaluate the outcome of a pilot “Registrar-as-Teacher” workshop at the University of Stellenbosch. The specific objectives included: - To evaluate registrar perceived relevance of workshop content - To evaluate registrar self-evaluation of teaching practices - To identify factors affecting the teaching practices of registrars - To observe and evaluate registrar teaching practices in the clinical setting - To increase the “Registrar-as-Teacher” workshop effectiveness A two-phased mixed method design was used, using semi-structured interviews and observation of registrars. Phase one comprised of semi-structured interviews to elicit both numerical and text-based data. Phase two included observer ratings to further explore the application of knowledge, skills and attitudes gained. The “Registrar-as-Teacher” program content was informed by the teaching roles described by Harden and Crosby (2000). As educational strategy, Knowles’ adult learning theory (1980) was applied. The study was conducted at Tygerberg Hospital, a Stellenbosch University Faculty of Health Sciences affiliated teaching hospital in Cape Town, South Africa. The study population included newly appointed registrars (year 1 and 2) from the Departments of Internal Medicine, Paediatrics, Obstetrics and Gynaecology, Surgery, and Orthopaedics. An inductive approach was used to analyze the qualitative data. Demographic, registrar self- evaluations and workshop evaluation data was analyzed using descriptive statistics. This study was approved by the Health Research Ethics Committee of Stellenbosch University (protocol number S13/10/177). C. Results - Seven of the fifteen registrars attending the pilot workshop agreed to take part in phase 1 of the study; five from the Department of Paediatrics and Child Health, and one from Surgery and Obstetrics & Gynaecology respectively. Five agreed to take part in phase 2 of the study; all from the Department of Paediatrics and Child Health. Participants reported satisfaction with the program and experienced the workshop as a positive learning experience (Kirkpatrick level 1). Participants self-reported positive changes in attitudes, including motivation, self-confidence, enthusiasm, and conceptions of teaching. Knowledge and skills were gained, as self-reported and observed. Individual benefits such as increased self-awareness of teaching ability and increased awareness of student needs were reported (Kirkpatrick level 2). Participants self-reported behavior changes in their teaching practices. Participants, bar one, demonstrated appropriate educational practices and teaching skills (Kirkpatrick level 3). Participants in our study reported their expanded conceptions of the roles of a teacher as one of the most useful aspects of the workshop. Role modelling was singled out as the most useful session. Participants generally had a positive view on their contribution to student learning. They saw it as a formative influence on how students view the profession and discipline. Unique aspects of registrar teaching were highlighted as being more informal in nature, more practice orientated; and working in a closer relationship with students; thus complementary to the consultant teaching role. Participants recognized that they are still developing their clinical teaching skills. Most participants rely on observed teaching methods or borrow from their own experiences as students. Participants based their self-assessment of being a good teacher on their personal views that mirrored their conceptions of a good teacher; seldom asking for or receiving feedback on their teaching skills to shape their own learning or performance as clinical teachers. Most participants in our study asked for regular or follow up training where they could reflect on their development and also receive feedback on progress made. Few participants felt comfortable to give feedback to students or to use the ‘one-minute preceptor’ compared to other aspects of clinical teaching. Our FD program’s session on teaching in the clinical setting and the ‘one-minute preceptor’ thus worked less well. This speaks to how to increase the effectiveness of future workshops. Even though all participants enjoyed teaching students, reported barriers to effective teaching were many. Participants often felt frustrated and overwhelmed by their teaching task. Limited time with competing responsibilities such as huge service demands and administrative duties impacted negatively on participants’ ability to teach students. Participants mostly felt unsupported and undervalued as teachers by their various departments, with little guidance on the expected student teaching content, process or learning outcomes. Although the expectation to teach is clearly communicated by the various departments, there is no training, supervision structure, formative feedback, or appreciation of their teaching performance. This lack of orientation and communication was further highlighted by participants pointing to the explanation of the MBChB undergraduate curriculum structure as the second most useful component of the course after role modelling. D. Conclusion and Recommendations - Our study confirmed the important role of registrars as teachers in the clinical setting. Apart from sharing theoretical and on-the-job knowledge, registrars teach practical skills and act as role models for the profession. Participants perceived the pilot “Registrar-as-Teacher” workshop content as relevant and the workshop shaped their teaching conceptions and practices. But workplace barriers like limited time with competing responsibilities impacted negatively on participants’ ability to teach students. A reported lack of guidance and support from the respective departments further undermined their ability to develop as clinical teachers. Future “Registrar-as-Teacher” FD initiatives at Stellenbosch University should thus provide registrars with optimal approaches and best teaching practices for busy clinical settings; enabling them to merge teaching with work. Strengthening FD requires the adoption of a broader conceptual framework that does not just focus on the individual participant, but link FD to the development of the department or institution as a whole (Swanwick & McKimm 2012). Workplace communities that include departmental faculty members should be involved in FD programs; allowing for ongoing learning and professional development of registrars as clinical teachers (O’Sullivan & Irby 2011; Steinert et al. 2010; Webster-Wright 2009; Hunter et al. 2008; Thorndyke et al. 2006). This requires a longitudinal strategy. Our “Registrar-as-Teacher” FD program should thus move away from the one-time workshop and instead create multiple learning events with opportunities for application and reflection.
Exploring the factors that impact on the non-attendance of physiotherapy clinical educators at faculty development training programmes at Stellenbosch University : a descriptive study
(Stellenbosch : Stellenbosch University, 2017-12) Solomon, Petula A.; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY: Physiotherapy students are placed at various clinical sites over their third and fourth year of study as part of their undergraduate training at Stellenbosch University, Division of Physiotherapy. A physiotherapy supervisor is employed by the university to specifically meet with the student to facilitate their clinical reasoning, while on the clinical placement. It is also the clinical supervisor who completes the final summative assessment regarding the student’s competency at the end of the placement. However, the physiotherapy clinicians who are employed by the Department of Health work at these clinical facilities and monitor the daily progress of the students. The Division of Physiotherapy at Stellenbosch University hosts three annual workshops where topics related to clinical education are presented, to the various clinical educators that work with the physiotherapy students. These workshops provide an opportunity for discussion and promoting collaboration amongst the clinical educators. The researcher embarked on an evaluation of this faculty development programme by conducting interviews with six physiotherapy clinicians (N=6) who had not attended these workshops over the years of 2015 and 2016. A descriptive phenomenological qualitative research study was undertaken. The aim of this study was to gain a better understanding of the physiotherapy clinicians’ barriers to attending faculty development programmes. Also, to elicit possible recommendations on how future faculty development programmes could be made more accessible to them. Two themes emerged from the data, namely practical barriers and poor relationships. The participants suggested that the practical barriers were related to the demands of service delivery and the logistics. The second theme related to poor relationships which was underpinned by concerns regarding poor communication and perceived tension. Therefore, valuable insights were gained from the nonattending physiotherapy clinicians. This research suggests that these participants did not feel part of the community of clinical educators. Faculty developers are encouraged to explore the development of multidisciplinary work-based programmes and investigate broadening the role of the clinical supervisor to include a formal educational support role, for physiotherapy clinicians. Furthermore, this research suggests that faculty developers should take into account the logistical arrangements, review the marketing strategies, and focus on collaboration, if they endeavor to build a community of practice amongst their clinical educators. Future research could evaluate the effect of incorporating informal engagement opportunities as part of existing faculty development programmes.
How do non-attenders of faculty development offerings perceive their development as educators?
(Stellenbosch : Stellenbosch University, 2019-12) Madzimbamuto, Farai Daniel; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY : Background: Faculty Development, as a means of addressing the educational needs of health professionals entering undergraduate and postgraduate teaching, has been undergoing continuous change of definition and expanding its scope of activities. The research literature has tended to focus on those that participate or attend faculty development activities. The Department of Health Professions Education at the University of Zimbabwe College of Health Sciences has been offering faculty development activities for seven years. There are members of faculty who have not attended all or most of these. From the literature, those who attend in other countries, describe the same constraints to participation as non-attenders, and yet still manage to attend. In higher education, faculty are recruited for their content expertise and have to develop pedagogic expertise, and faculty development activities assist in this process. The aim of this study is to explore how faculty who do not attend perceive their development and identity as educators. Methodology: This was a phenomenological study attempting to present, record, understand and be interpretive of the experience of faculty developing into teachers and educators. Non-attenders were defined as those who, in the last five years, have attended one or less faculty development offerings of the Department of Health Professions Education. Attendance registers were used to identify participants and purposive sampling was used to achieve a sample balanced for clinical and non-clinical roles, full and part-time, gender and years since appointment to the university. An interview schedule was used, with all the interviews recorded, transcribed, and member-checked before analysis commenced. Transcendental phenomenological analysis was used. Each subject’s own words, phrases, sentences and narratives related to the research question were extracted. These ‘moments of meaning’ were then arranged in clusters and themes before being combined and subjected to interpretation. Results and Discussion: Six faculty members were interviewed, and each transcript generated between 41-65 ‘moments of meaning’, from which duplications and redundancies were removed. The themes that emerged were related to becoming a teacher, professional identity and perception of personal development. In becoming a teacher, there was a diversity of pathways into teaching, participants had mainly been identified as academic or bright and encouraged to join or participate in the academic activities of their discipline on completion of postgraduate training. Health professionals usually come into higher education with an identity as a clinician already formed, and they must negotiate developing or adding a new one as an educator. The departments and professional association provided a network for the source and dissemination of information about teaching, learning and education research. This networking played was a key enabler of informal learning. Conclusion: The non-attenders were largely independent and organise their own learning opportunities, goals and objectives. Their drive and motivation can help other faculty, particularly in being able to articulate their learning needs, so that FD can be more purposive and needs directed.
The perceptions of basic science lecturers at Sefako Makgatho Health Sciences University on their need for health professions educator development
(Stellenbosch : Stellenbosch University, 2018-03) Govender, Melvin Megandran; Blitz, Julia; Van der Merwe, Charmaine; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY : Faculty development is an institutional imperative that aims to ensure that health professions educators are adequately equipped as educators in their profession. Institutions have thus developed and implemented faculty development programs to answer to this imperative. However, significant barriers exist that hinder teacher’s participation in these initiatives. Evidence shows that the identification and introduction of means to overcome these barriers would increase their participation. Thus the aim of this study is to explore the perceptions of the basic and preclinical science teachers at the Sefako Makgatho Health Sciences University on their need for health professions educator development in order to identify barriers that are preventing them from participating in current faculty development initiatives. The study design was interpretivist within a qualitative methodological framework. The study targeted the 102 basic and preclinical science teachers at the Sefako Makgatho Health Sciences University. Data collection was completed in two phases. Phase one adopted a self-administered questionnaire sent to all 102 prospective participants. In phase two, the responses to the questionnaire were analysed and used to purposively sample 13 participants for interviews. A response rate of 43% was recorded for the questionnaire. The second phase findings revealed that teachers perceived a need for health professions educator development. However, the barriers of; misconceptions and beliefs with regards to funding, institutional support and their conceptions of teaching; perceived absence of an institutional faculty development plan; an institutional focus on research; and a lack of time and scheduling issues, are hindering their participation. Thus these identified barriers need to be overcome in order to increase their participation in future faculty development initiatives.
Residents-as-teachers : needs assessment of residents teaching skills in a clinical setting using direct observation of teaching
(Stellenbosch : Stellenbosch University, 2020-03) Ayodele, Olugbenga Edward; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY : Background: Residents teach undergraduate medical students and other health care workers in clinical settings. Despite this pivotal teaching role, the majority of residents have not received formal training in education, and may be adopting ineffective teaching strategies. Some institutions have established residents-as-teachers (RaT) programmes with the aim of improving the teaching competency of residents. However, many of these programmes were put in place without a context-specific needs assessment to identify the existing strengths and deficiencies in the residents’ teaching skills. RaT programmes are rare in sub-Saharan Africa, and do not appear to exist in Nigeria. Successful planning and implementation of such a program will involve judicious commitment of scarce human and material resources, which makes a needs assessment imperative. Aim and Objectives: The aim of the study was to do a needs assessment of residents’ skills in teaching in the clinical setting. The specific objectives were to determine: residents’ self-perceived and true learning needs for facilitating learning in the clinical setting; residents’ self-perceived important topics that could be included in a RaT curriculum; and residents’ preferred methods of instruction for a RaT programme. Methodology: This cross-sectional observational, quantitative inquiry was conducted at Ladoke Akintola University of Technology (LTH), Ogbomoso, Nigeria. Thirty nine (78%) out of a total population of 50 residents voluntarily agreed to participate in the study. The 39 residents were subsequently divided into two groups on the basis of their willingness to have their clinical teaching sessions observed – those who were willing to be observed (Group A, n=20) and those not willing to be observed (Group B, n=19). Sixty two (85%) out of a total population of 73 medical students in Years 5 and 6 rotating through Internal Medicine, Surgery, Paediatrics and Obstetrics & Gynaecology at the hospital agreed to participate in the study. The study instruments consisted of a self-administered questionnaire completed by all residents, and the 24-item, 7-domain Maastricht Clinical Teaching Questionnaire (MCTQ) [rated on a 5-point Likert scale] completed by the residents, the medical students (recipients of the clinical teaching), and the researcher (who acted as an unobtrusive observer) after the teaching sessions. The residents’ self-perceived learning needs were determined by the teaching actions the fewest residents agreed or strongly agreed that they used during the course of their teaching. The residents’ true learning needs from the students’ and researcher’s perspective were the teaching actions least experienced by the students, and the teaching actions least observed by the researcher respectively during the course of teaching. Discrete data were summarized as percentages, and quantitative data as means (standard deviation [SD]). Differences in discrete and continuous variables were analysed using chi square and student’s t test respectively. All p values ≤ 0.05 were considered to be statistically significant. Results: Most residents had never had formal training in teaching, the vast majority indicated that skill development in teaching is very important, and all expressed the desire to be trained in developing their teaching skills. The residents’ self-perceived learning needs based on a self-administered questionnaire were formulation of learning goals (‘exploration’), and guidance given to students to bolster students’ independence (domain of ‘scaffolding’). The residents’ true learning needs based on MCTQ items least observed were demonstration of different tasks (‘modelling’), providing guidance and feedback (‘coaching’), encouraging students to think through their performance, voicing out their strengths and weaknesses (‘reflection’), and formulation of learning goals (‘exploration’). The leading topics perceived by residents to be important for a RaT course were communication skills, leadership, teaching of procedural skills, and bedside teaching; and their preferred methods of instruction were interactive sessions with teachers, and working in small groups with a facilitator. Conclusion: Findings from this study therefore provide important baseline information on the strengths and weaknesses of our residents in facilitating learning in the clinical setting. This needs assessment of residents’ teaching skills will serve to inform the design of a tailor-made RaT course for LAUTECH residents.
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.
What academic advisors need to provide better student support : lessons from a Malaysian medical school
(Stellenbosch : Stellenbosch University, 2011-12) Tan, Christina P. L.; Blitz, Julia; Ping Wong, Li; Ting Tong, Wen; Bezuidenhout, Juanita; Stellenbosch University. Faculty of Health Sciences. Dept. of Centre for Health Sciences Education.
ENGLISH ABSTRACT: Background: Academic support programmes have an important part to play in addressing the needs of students experiencing difficulties. A quality assurance exercise by the national accreditation body highlighted the fact that academic staff involved in non-academic counselling had no prior training. Aim: The aim of this study was to evaluate the academic advisor programme in a Malaysian medical school from the academic advisors’ perspective in order to determine their understanding of their role, their experiences and needs. Method: Focus group discussions (FGDs) involving 10 academic advisors were conducted using a semi-structured interview schedule. Results: 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. Conclusions: 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.

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