Centre for Health Professions Education

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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.
Consequences, conditions and caveats : a qualitative exploration of the influence of undergraduate health professions students at distributed clinical training sites
(BMC (part of Springer Nature), 2018-12-19) Van Schalkwyk, Susan; Blitz, Julia; Couper, Ian; De Villiers, Marietjie; Lourens, Guin; Muller, Jana; Van Heerden, Ben
Background: Traditionally, the clinical training of health professionals has been located in central academic hospitals. This is changing. As academic institutions explore ways to produce a health workforce that meets the needs of both the health system and the communities it serves, the placement of students in these communities is becoming increasingly common. While there is a growing literature on the student experience at such distributed sites, we know less about how the presence of students influences the site itself. We therefore set out to elicit insights from key role-players at a number of distributed health service-based training sites about the contribution that students make and the influence their presence has on that site. Methods: This interpretivist study analysed qualitative data generated during twenty-four semi-structured interviews with facility managers, clinical supervisors and other clinicians working at eight distributed sites. A sampling grid was used to select sites that proportionally represented location, level of care and mix of health professions students. Transcribed data were subjected to thematic analysis. Following an iterative process, initial analyses and code lists were discussed and compared between team members after which the data were coded systematically across the entire data set. Results: The clustering and categorising of codes led to the generation of three over-arching themes: influence on the facility (culturally and materially); on patient care and community (contribution to service; improved patient outcomes); and on supervisors (enriched work experience, attitude towards teaching role). A subsequent stratified analysis of emergent events identified some consequences of taking clinical training to distributed sites. These consequences occurred when certain conditions were present. Further critical reflection pointed to a set of caveats that modulated the nature of these conditions, emphasising the complexity inherent in this context. Conclusions: The move towards training health professions students at distributed sites potentially offers many affordances for the facilities where the training takes places, for those responsible for student supervision, and for the patients and communities that these facilities serve. In establishing and maintaining relationships with the facilities, academic institutions will need to be mindful of the conditions and caveats that can influence these affordances.
Designing faculty development : lessons learnt from a qualitative interpretivist study exploring students’ expectations and experiences of clinical teaching
(BMC (part of Springer Nature), 2019) Blitz, Julia; De Villiers, Marietjie; Van Schalkwyk, Susan
Background: Clinical teaching plays a crucial role in the transition of medical students into the world of professional practice. Faculty development initiatives contribute to strengthening clinicians’ approach to teaching. In order to inform the design of such initiatives, we thought that it would be useful to discover how senior medical students’ experience of clinical teaching may impact on how learning during clinical training might be strengthened. Methods: This qualitative study was conducted using convenience sampling of medical students in the final two months of study before qualifying. Three semi-structured focus group discussions were held with a total of 23 students. Transcripts were analysed from an interpretivist stance, looking for underlying meanings. The resultant themes revealed a tension between the students’ expectations and experience of clinical teaching. We returned to our data looking for how students had responded to these tensions. Results: Students saw clinical rotations as having the potential for them to apply their knowledge and test their procedural abilities in the environment where their professional practice and identity will develop. They expected engagement in the clinical workplace. However, their descriptions were of tensions between prior expectations and actual experiences in the environment. They appreciated that learning required them to move out of their “comfort zone”, but seemed to persist in the idea of being recipients of teaching rather than becoming directors of their own learning. Students seem to need help in participating in the clinical setting, understanding how this participation will construct the knowledge and skills required as they join the workplace. Students did not have a strong sense of agency to negotiate participation in the clinical workplace. Conclusions: There is the potential for clinicians to assist students in adapting their way of learning from the largely structured classroom based learning of theoretical knowledge, to the more experiential informal workplacebased learning of practice. This suggests that faculty developers could broaden their menu of offerings to clinicians by intentionally incorporating ways not only of offering students affordances in the clinical learning environment, but also of attending to the development of students’ agentic capability to engage with those affordances offered.
Implications for faculty development for emerging clinical teachers at distributed sites : a qualitative interpretivist study
(James Cook University, 2018) Blitz, Julia; De Villiers, Marietjie; Van Schalkwyk, Susan
Introduction : Medical faculties have the responsibility to graduate competent health professionals and a consequent obligation to assure the quality and effectiveness of their students’ clinical teaching. Many institutions are responding to rural workforce needs by extending clinical training from the traditional academic teaching hospital to include rural and remote sites distributed away from the central training institution. It is incumbent upon medical schools to consider how this might impact on the faculty development of these clinicians as teachers. The research reported here sought to develop an understanding of how clinicians working at distant resource-constrained and new training sites view their early experiences of having been delegated the task of clinical teaching. This was with a view to informing the development of initiatives that could strengthen their role as teachers. Methods: Qualitative research using an interpretive approach was used to reach an understanding of the views and subjective experiences of clinicians taking on the role of clinical teaching. Participants were emerging clinical teachers at distant peri-urban, rural and remote sites in South Africa. They were deemed to be emerging by virtue of either having recently taken on the role of clinical teacher, or working at sites newly used for clinical teaching. In-depth interviews were conducted with all nine clinicians meeting these criteria. The interviews were coded inductively looking for underlying meanings, which were then grouped into categories. Results: The findings clustered into three inter-related themes: relationships, responsibilities and resources. The clinicians take pleasure in developing learning relationships that enable students to have a good experience by participating actively in the clinical environment, value what students bring from the medical school in terms of clinical advances and different perspectives, and in the contribution that they feel they are making to creating a more appropriately trained future healthcare workforce. However, they yearn for a closer relationship with the medical school, which they think could acknowledge the contributions they make, while also offering opportunities for them to become more effective clinical teachers. They also feel that they have a role to play in both curriculum re-alignment and student evaluation. These clinicians felt that the medical school has a responsibility to let them know if they are doing ‘the right thing’ as clinical teachers. Interestingly, these participants see trusted clinical colleagues and mentors as a resource when needing advice or mentorship concerning clinical teaching. Conclusion: This study adds to an understanding around designing faculty development initiatives that meet the needs of clinicians at distant sites that take on the role of clinical teaching. There remains the need to impart particular strategies to support the learning of particular kinds of knowledge that is commonly dealt with in faculty development. However, there may be an additional need for faculty developers to embrace what is known about rural doctor social learning systems by overtly designing for incorporation of the foundational three Rs: relationships, responsibilities and resources.
PIQUE-ing an interest in curriculum renewal
(Health & Medical Publishing Group, 2014-03) Blitz, Julia; Kok, Norma; Van Heerden, Ben; Van Schalkwyk, Susan
Background. The primary aim of undergraduate medical training at South African medical schools is to prepare the graduates adequately for internship. If we are to attain this objective, it is crucial to evaluate the ability of our graduates to cope with the demands of internship. Objective. To determine the extent to which first-year interns from Stellenbosch University (SU) considered that their undergraduate education prepared them for internship. Methods. The Preparedness for Internship Questionnaire (PIQUE) is based on Hill’s Preparation for Hospital Practice Questionnaire, with additional questions covering core competencies and exit outcomes that SU has determined for its medical curriculum. Participants were asked to respond to a series of statements preceded by ‘My undergraduate medical training prepared me to … ’, and also two open-ended questions. SU’s MB ChB graduates of 2011 (N=153) were invited to participate in the online survey. Results. Although the response rate was only 37%, graduates generally thought they had been well prepared for most mainstream clinical activities. However, there were areas in which respondents considered they could have been better prepared, specifically pharmacology, medicolegal work, minor surgery and the non-clinical roles that interns encounter. Conclusion. PIQUE appears to be a useful tool that can assist with curriculum renewal by highlighting areas that graduates feel they could be better prepared for. This challenges us to identify how curricula and teaching can be adjusted accordingly.

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