Centre for Health Professions Education

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Browsing Centre for Health Professions Education by browse.metadata.advisor "Cilliers, Francois"

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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.
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    Volunteer, community-based student-run clinics for the underserved : can they be used to attain 21st century medical education goals?
    (Stellenbosch : Stellenbosch University, 2016-03) Gordon, Chivaugn; Cilliers, Francois; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Sciences Education.
    ENGLISH ABSTRACT: Background: Community-based education has increasingly become emphasised as an important aspect of health professions education. Not only does it provide opportunities for student-centred learning; it also facilitates the attainment of graduate attributes desired of health care professionals in the 21st century. Further, it can influence career choices and thus retain doctors in primary care, where the greatest practitioner deficit is. South Africa has committed to training community-based, primary care generalists who can attend to the country’s greatest healthcare needs. Consequently, Health Science Faculties aim to include community-based teaching and learning opportunities in their curricula. At the University of Cape Town, this has proved a challenge due to the limited number of sites available for student placements. However, there are several voluntary community-based student-run clinics co-ordinated by the Students Health and Welfare Centres Organisation (SHAWCO), which could offer students community-based teaching and learning experiences. Objectives: To investigate students’ perceptions of the benefits of SHAWCO clinic attendance to their learning and personal development, in order to determine these clinics’ suitability for inclusion into the undergraduate curriculum as community-based teaching and learning sites. The research questions that guided this research were: Does attending volunteer SHAWCO clinics in under-serviced communities impact on student learning; the development of graduate attributes; and/ or students’ development as individuals? Based on these findings, do SHAWCO clinics offer the same opportunities described for community-based education, and if so, could they be used as a formalised platform for community-based education at the University of Cape Town? Subsidiary questions 1.How, if at all, do students think SHAWCO clinic involvement benefits their learning? 2.How do students learn at these clinics? 3.Does SHAWCO clinic involvement facilitate the development of desired graduateattributes? 4. How, if at all, does SHAWCO involvement impact on students’ personal development? 5. Based on students’ experiences of the SHAWCO environment, do SHAWCO clinics offer the same opportunities as standard CBE, and if so, could they be formalised into the UCT undergraduate medical curriculum? Methods: This was a descriptive case study using semi-structured focus group interviews for data collection. Ethical clearance for the study was obtained from The Universities of Cape Town and Stellenbosch. Seven focus groups were held with medical students; one with SHAWCO Steering Committee members in any year of study; three with preclinical students (years one and two); and three with clinical students (years four and five). A total of 49 students were interviewed. Interviews were analysed inductively using thematic content analysis. Results: SHAWCO clinic involvement did offer the same opportunities as standard community-based education, but the fact that SHAWCO is student-run conferred many additional qualities to this experience. Involvement in SHAWCO complimented and enhanced the curriculum but also took students far beyond curricular bounds, which allowed for the development of many graduate attributes, in addition to personal growth and professional identity development. The voluntary nature of SHAWCO attendance for both students and supervising clinicians was central to its success, as it created an enabling learning environment, where teachers were enthusiastic and patient. Other facets of the SHAWCO learning experience included peer-assisted learning and mentorship, early patient contact, accountability and emotional engagement. Conclusions: While SHAWCO clinics provide an ideal community-based teaching and learning opportunity, they should not be formalised into the curriculum to any great extent, as doing so would rob SHAWCO of the very essence that makes it so beneficial. However, one compulsory visit in students’ first year of study during a period when many become disillusioned due to dry academic bookwork is suggested, after which time students could return if they so choose. Offering senior students, who are responsible for the majority of teaching, voluntary input on effective clinical teaching and mentorship methods could potentially enhance the educational value of the SHAWCO learning experience.