Browsing by Author "Archer, Elize"
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- ItemApplying empathic communication skills in clinical practice : medical students' experiences(AOSIS, 2021-02) Archer, Elize; Meyer, Ilse S.Background: Studies have demonstrated that empathic communication improves patient outcomes and helps doctors to deliver accurate symptom reports and diagnoses. These benefits emphasise the need for medical students to apply empathic communication skills during their interactions with patients. Focussed empathic communication skill workshops were introduced into the undergraduate medical students’ training at the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. This study aimed to explore students’ perceptions of applying these empathic communication skills during their clinical practice. We were interested in determining the factors that might influence the development of empathic communication skills. The findings could help curriculum developers to optimise these workshops for inclusion in a formal medical curriculum. Methods: This study followed a qualitative, descriptive enquiry, exploring the perceptions of medical students through focus-group discussions. The students (N = 18) were selected using convenience sampling techniques. Recordings were transcribed, and the data were thematically analysed. Results: The two main themes identified relate to the students and the clinical learning environment. The students valued the knowledge and skills they acquired. However, feelings of emotional vulnerability, a lack of language proficiency and inadequate role modelling were highlighted as challenges when applying empathic communication during clinical practice. Conclusion: The students reported positively on the workshops as these improved both their patient and personal interactions. However, for students to develop these skills further for clinical practice, they need more intentional and supervised opportunities to practise, reflect and receive constructive feedback. These learning opportunities could help medical schools deliver graduates who can competently communicate with their patients in an empathic manner.
- ItemClinical educators' self-reported personal and professional development after completing a short course in undergraduate clinical supervision at Stellenbosch University(Health & Medical Publishing Group, 2013-05) Schmutz, Anna Maria; Gardner-Lubbe, Sugnet; Archer, ElizeBackground. In 2007, a Supervision Course in Undergraduate Clinical Supervision was developed at the Faculty of Medicine and Health Sciences at Stellenbosch University in South Africa. The target group was inter-professional clinical educators that are involved in student education on the clinical platform. Although the course participants were professionals and specialists in their own fields, the majority of clinical educators have very little or no knowledge of adult education. The Supervision Course aims to develop clinical supervision skills of clinical educators by exposing these supervisors to basic principles of education and specifically clinical teaching, resulting in quality education for undergraduate students. The aim of this study was to determine the impact of this short course on the personal and professional growth of the clinical educator. Methods. A qualitative study was performed, including an open-ended questionnaire that provided opportunity for the clinical educators to elaborate freely on their strengths, weaknesses and areas of desired improvement before and after the Supervision Course, and a semi-structured individual interview after the Supervision Course. The questionnaire data were categorised according to strengths, weaknesses and areas of desired improvement. An inductive approach was used to analyse the qualitative data. Key themes that emerged from the interviews were identified and grouped together in categories. Results. The results are summarised in table format to identify themes with supporting quotes. Conclusion. Although a small sample, this study demonstrates the personal and professional growth reported by attendees of a clinical supervision short course.
- ItemDeveloping higher education curriculum in the health sciences context(AFRICAN SUN MeDIA, 2016) Louw, Alwyn; Archer, ElizeENGLISH SUMMARY : Introduction: How did it happen that Professor Eli Bitzer – the educationist – ended up being involved in health professions education? Was it a matter of a trans-disciplinary approach followed by two faculties, or was it because of specific expertise needed at a specific time of development at one faculty? The answer is most probably – both. In this chapter we will attempt to demonstrate how expertise in one field of science can very successfully be transferred to another field. We will also explore the links between the field of Education where Eli Bitzer comes from, and the field of Health Sciences from which perspective this chapter is written. We do not intend to report on each and every intervention Eli Bitzer had with students, neither do we claim to be the experts in writing about someone as respected as he is. We have only focused on writing about the period between 2006 and 2016, when both of us had the privilege of working closely with him as a colleague. While the main purpose of this chapter is to describe the role Eli Bitzer played in health professions education, the second part of our chapter will pay tribute to him as a teacher, supervisor and colleague. This chapter further highlights his personal characteristics, as perceived by the health sciences community, his involvement in the establishment of an educational centre, his role in the development of a curriculum for the MPhil in Health Sciences and his contribution to postgraduate students as lecturer, mentor and supervisor.
- ItemEmpathy : an essential tool in any doctor’s skillset(Health & Medical Publishing Group, 2019) Archer, Elize; Turner, RoseanneNo abstract available
- ItemEngaging patient-centredness in an undergraduate medical curriculum(Stellenbosch : Stellenbosch University, 2016-12) Archer, Elize; Bitzer, Eli; Van Heerden, Ben; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.ENGLISH SUMMARY : There is ample evidence that medical students’ empathy with their patients and their inclination towards patient-centeredness decline from the time they enter medical school until they complete their medical education. Patient-centeredness , an approach that puts the patient at the center of the consultation, thus focusing on patients instead of on their disease, has been identified by most medical schools worldwide as a desired core competence of their graduates. It thus seems vital that medical schools foster patient-centered values and behaviour in their graduates. However, there seems to be a focus on the biomedical aspects of patients in the practice and theory of teaching and learning in undergraduate medical curricula; therefore, students tend to become cynical and soon tend to focus on the disease of their patients. The expectation that doctors should be patient-centered has thus caused medical curriculum planners worldwide to pay attention to aspects such as communication skills training, the inclusion of subjects from the humanities and placements of students in longitudinal clerkships. Relevant literature reports that despite some of these initiatives, undergraduate medical students often still display a lack of patient- centeredness by the time they graduate. This state of affairs is reason for concern and it was thus deemed important to explore the possible factors that enable or inhibit the teaching and learning of patient-centeredness in undergraduate medical curricula. The aim of this study was therefore to gain a better understanding of the factors that influence the learning of patient- centeredness in at least one undergraduate medical programme. An explorative programmatic case study design, rooted in an interpretive knowledge paradigm, was considered most appropriate for the study in which final-year medical students and their lecturers participated. Observations of clinical teaching activities were also conducted and curriculum documents of the undergraduate medical (MB, ChB) curriculum at Stellenbosch University were analyzed. Themes of meaning were deduced from the data by employing components of an integrated behaviour model (IM). The findings of the study revealed that the following factors play a role in students’ learning about patient-centeredness : background characteristics of students and their lecturers, attitudinal factors, acquired skills and knowledge, subjective norms (the hidden curriculum), student self-efficacy, assessment of learning, and the environment or context within which patient- centeredness is taught and learnt. Two factors that have proved to have a highly significant effect on the learning of patient-centeredness are subjective norms and assessment. Subjective norms refer to the clinical learning environment where the students are exposed to role models, as well as opportunities to practice patient-centeredness on real patients. The latter is highly important in the process by which students develop self-efficacy, especially if followed by opportunities for feedback from a clinician teacher as well as opportunities for reflection on such feedback in order to discover new meanings and learn new practices. Assessment is recognized as an important factor that drives student learning, and the lack of assessment of patient-centeredness in many departments renders a message strongly favouring the biomedical component of patient care. The study provides new insights into the teaching and learning of patient-centeredness in an undergraduate medical curriculum by suggesting an adapted version of Fischbein’s IM and an improved understanding of enablers and disablers in the teaching and learning of patient-centeredness . This study further points to a need for a jointly planned and well-coordinated approach to the formal, informal and hidden curriculum spaces within one MB, ChB programme with well-trained clinician teachers/faculty members who understand the importance and application of patient-centeredness in modern medical practice.
- ItemFresh simulation options in critical care nursing education(Health and Medical Publishing Group (HMPG), 2010-12) Archer, ElizeMany forms of simulation, as a teaching strategy, have been used successfully over the last few decades. Some of the advantages thereof in health sciences education are that it is a learner-centered training modality that presents with no risks to patients and allows for facilitated repetition of learning until all students have achieved the required level of proficiency. Simulation may reduce time spent by students in clinical areas to master the necessary skills and it is therefore perceived as an efficient use of limited resources. Utilising the Clinical Skills Centre (CSC) for teaching of procedures may therefore facilitate the reduction in time allocated to the clinical areas. Critical care (CC)-trained nurses are expected to have the expertise to perform a variety of practical procedures on patients, but even more importantly, they should be able to integrate information about a patient in order to provide holistic and effective care. The practical component of the CC nursing programme at the specific university consists of two parts: the completion of practical procedures and case presentations. Some of the challenges associated with the teaching and assessment of these two components are important and will be discussed in this article.
- ItemHuman resources for nephrology in South Africa : a mixed-methods study(Public Library of Science, 2020-02-13) Hassen, Muhammed; Archer, Elize; Pellizzon, Adriano; Chikte, Usuf M. E.; Davids, Mogamat RazeenIntroduction: The global nephrology workforce is shrinking and, in many countries, is unable to meet healthcare needs. Accurate data pertaining to human resources in nephrology in South Africa is lacking. This data is critical for the planning and delivery of renal services and the training of nephrologists in South Africa to meet the challenge of the growing burden of chronic kidney disease. Methods: A cross-sectional study of adult and paediatric nephrologists currently delivering nephrology services in South Africa was conducted. Participants were identified using various data sources, including the register of the Health Professions Council of South Africa. This cohort of doctors was described in terms of their demographics and distribution. A survey was then conducted among these nephrologists to collect additional information on their training, scope of practice, job satisfaction, challenges and future plans. Finally, two focus group interviews were conducted to probe themes identified from the survey data. Results: A total of 120 adult nephrologists and 22 paediatric nephrologists were identified (an overall density of 2.5 per million population). There is a male predominance (66%) and the median age is 45 years. The bulk of the workforce (128 nephrologists, 92%) is distributed in three of the nine South African provinces, and two provinces have no nephrologist at all. The survey was completed by 57% of the nephrologists. Most reported positive attitudes to their chosen profession; however, 35 nephrologists (43%) reported an excessive workload, 9 (11%) were planning emigration and 15 (19%) were planning early retirement. A higher frequency of dissatisfaction regarding remuneration (39% vs. 15%) and unsatisfactory work conditions (35% vs. 13%) was observed amongst nephrologists working in the public sector compared to the private sector. A total of 13 nephrologists participated in the focus group interviews. The themes which were identified included that of a rewarding profession, an overall shortage of nephrologists, poor career planning, a need for changes to nephrologists’ training, excessive workloads with inadequate remuneration, and challenging work environments. Conclusion: There are insufficient numbers of nephrologists in South Africa, with a markedly uneven distribution amongst the provinces and healthcare sectors. Qualitative data indicate that South African nephrologists are faced with the challenges of a high workload, obstructive policies and unsatisfactory remuneration. In the public sector, a chronic lack of nephrologist posts and other resources are additional challenges. A substantial proportion of the workforce is contemplating emigration.
- ItemImproving undergraduate clinical supervision in a South African context(Health & Medical Publishing Group, 2011-12) Archer, ElizeObjectives: The Faculty of Health Sciences, Stellenbosch University, has undergraduate programmes for several disciplines; these programmes need clinical supervisors to teach their students in the clinical settings. The faculty does not have the resources to present different clinical supervision courses for each discipline; therefore a short course with an interprofessional focus was designed. Design: A qualitative study was done to determine the strengths and weaknesses of the course in order to re-curriculate as deemed necessary. Semi-structured individual interviews were held with 10 (n=18) course participants as well as the tutors involved in the development of the course. Ethical approval was obtained. Participation was voluntary and anonymity was guaranteed. The recorded and transcribed data were analysed. Setting: The health professionals acting as supervisors may be the experts in their fields, but they do not always have the necessary teaching skills. The Centre for Health Sciences Education (CHSE) at the faculty has developed a generic short course in undergraduate clinical supervision to address the above issue. Results and conclusion: The data were used to inform restructuring of the short course for the following year. The impact of this short course on clinical supervisors was that their interaction with students in the clinical setting improved. There was unanimous support for extending the short course to all clinical supervisors. The lecturers involved in developing the course were positive about the interprofessional cooperation among colleagues and students. They emphasised that the Faculty of Health Sciences has an obligation to provide opportunities for clinical supervisors to improve their skills to supervise students.
- ItemInfluence of confidence and experience on the competency of junior medical students in performing basic procedural skills(African Journal of Health Professions Education, 2011-06) De Villiers, Adele; Archer, Elize; Southern African FAIMER Regional Institute (SAFRI) Poster Day, Cape Town, March 2011; SA Association of Health Educationalists (SAAHE) Conference, Johannesburg, July 2010ENGLISH ABSTRACT: Studies, mostly done with final-year medical students and doctors, show that the confidence level with which a clinical skill is performed is not a reliable benchmark of actual clinical competence. This inaccurate selfevaluation of proficiency has far-reaching implications, e.g. the inability to identify learning deficiencies and consequently to manage learning – both essential components of self-directed learning programmes.
- ItemThe influence of context on the teaching and learning of undergraduate nursing students: A scoping review(2020-10) Meyer, Rhoda; Van Schalkwyk, Susan; Archer, ElizeBACKGROUND. The role that context plays in the teaching and learning space has been well documented.OBJECTIVES. To synthesise perspectives from previous studies related to the influence of context on teaching and learning among undergraduate nursing students.METHODS. This study was guided by the stages for review proposed by Arksey and O'Malley. Six databases were searched, generating 1 164 articles. Based on the eligibility criteria, the articles were screened through several processes, resulting in 55 articles being included in the final review.RESULTS. Five themes were identified, including the organisational space, the nature of interactions in the healthcare team, the role of the nurse manager, the role of the educator and the academic institution-hospital engagement.CONCLUSION. While there are many studies of the role of context in teaching and learning, this review highlights the interconnectedness of the various factors within the learning context, providing a framework that can inform decision-making when seeking to enhance teaching and learning in nursing education.
- ItemMeasuring empathy in a group of South African undergraduate medical students using the student version of the Jefferson Scale of Empathy(AOSIS, 2019) Archer, Elize; Turner, RoseanneBackground: Patient-centred care is a model of care that demands healthcare providers change their focus from the disease to the patient and his or her perceived physical and psycho-social needs. This model requires healthcare workers to listen actively and to have effective communication skills and well-developed levels of empathy. Aim: The aim of this study was to determine the suitability of the Jefferson Scale for Empathy (JSE-S) as a valid test for empathy in third-year medical students at a South African university and also to determine the baseline level of empathy in this same group of students. Setting: The study took place at a medical school in the Western Cape, South Africa. This medical degree (MB ChB) is a 6-year programme. Students are first exposed to patients within their second year of training, but it is during their third-year that they start their clinical rotations. We wanted to test whether our empathy training would give students the necessary skills and enable them to establish good empathic communication habits in order to prevent a fall in empathy during this vulnerable period. Methods: This article explores the suitability of the student version of the JSE-S as a valid test for empathy, within the South African medical school context. We briefly discuss the psychometrics and the scores against what is already known in countries like ours, specifically, developing nations where cultural and language differences exist in the student populations. Furthermore, we explore whether the JSE-S is a valid scale for pre- and post-intervention measurement of medical student empathy within our context and discuss the limitations of self-assessment. We also report on baseline levels of empathy in third-year medical students. Results: Two hundred and six third-year medical students (69% females) completed the JSE-S prior to the intervention. Females and students aged 25 years and older had significantly higher scores than males and those 22 years old or less. The mean JSE was 109.98 (SD = 12.54), which is lower than most internationally reported scores. The Cronbach’s alpha coefficient was 0.81, indicating scale reliability and consistency, but graded item response testing highlighted variance in three reverse-scored questions. Conclusion: The JSE-S is an appropriate and valid scale for measuring levels of empathy in undergraduate medical students in South Africa. However, language may need to be clarified in the negatively phrased items.
- ItemPatient-centred care: The patients’ perspective – A mixed-methods pilot study(2020-10-09) Turner, Roseanne E; Archer, ElizeBackground: Patient centredness is a broad concept, a moral philosophy. Patient-centred care can be viewed as the actions of patient-centredness. One of the most pertinent actions that a healthcare practitioner can utilise to deliver patient-centred care is empathic communication. Whilst many medical programmes include empathetic communication skills as part of their curricula, the recipients of this care are not asked about the relevance of this teaching. Aim: We attempted to determine whether the Western constructs of empathy were relevant in our context and also establish whether there were any parts of the medical interview which participants felt were especially important to be communicated to in their home language. Setting: Two urban communities within the City of Cape Town, Western Cape Province, South Africa. Methods: This was a mixed-methods pilot study using an explanatory sequential design. Participants who would typically make use of public health care facilities and whose first language was Afrikaans or isiXhosa were conveniently sampled. A subgroup of participants was invited to take part in a follow-up focus group discussion to add clarity to the survey responses. Results and conclusion: Western constructs for empathy appeared to be relevant within our multicultural context. Patients wanted to communicate with their doctors and understand the cause of their problems as well as the management plan. Finally, whilst the numbers in this pilot study were too small to be generalisable, it was evident that patient-centred care was not perceived to be implemented in some public healthcare facilities attended by the participants, which resulted in them feeling unseen and disrespected.
- ItemQuality of life in patients on chronic dialysis in South Africa : a comparative mixed methods study(BioMed Central, 2017-01-05) Tannor, Elliot K.; Archer, Elize; Kapembwa, Kenneth; Van Schalkwyk, Susan C.; Davids, M. RazeenBackground: The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. Dialysis should not only be aimed at prolonging lives but also improve quality of life (QOL). Using mixed methods, we investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD). Methods: We conducted a cross-sectional study at Tygerberg Hospital in Cape Town, South Africa. All the PD patients were being treated with continuous ambulatory peritoneal dialysis. The KDQOL-SF 1.3 questionnaire was used for the quantitative phase of the study. Thereafter, focus-group interviews were conducted by an experienced facilitator in groups of HD and PD patients. Electronic recordings were transcribed verbatim and analysed manually to identify emerging themes. Results: A total of 106 patients completed questionnaires and 36 of them participated in the focus group interviews. There was no difference between PD and HD patients in the overall KDQOL-SF scores. PD patients scored lower with regard to symptoms (P = 0.005), energy/fatigue (P = 0.025) and sleep (P = 0.023) but scored higher for work status (P = 0.005) and dialysis staff encouragement (P = 0.019) than those on HD. Symptoms and complications were verbalised more in the PD patients, with fear of peritonitis keeping some housebound. PD patients were more limited by their treatment modality which impacted on body image, sexual function and social interaction but there were less dietary and occupational limitations. Patients on each modality acknowledged the support received from family and dialysis staff but highlighted the lack of support from government. PD patients had little opportunity for interaction with one another and therefore enjoyed less support from fellow patients. Conclusions: PD patients experienced a heavier symptom burden and greater limitations related to their dialysis modality, especially with regards to social functioning. The mixed-methods approach helped to identify several issues affecting quality of life which are amenable to intervention.
- ItemUsing simulation for achieving competency in the practical procedures of a Critical care nursing programme(Stellenbosch : Stellenbosch University, 2008-12) Archer, Elize; Bitzer, E. M.; Stellenbosch University. Faculty of Education. Dept. of Curriculum Studies.Background to the study: The Critical Care nursing programme at the Faculty of Health Sciences (Stellenbosch University) is a one-year programme. The practical component consists of practical procedures and case presentations. Students have limited time available in the clinical areas to reach competency in the practical skills. Students tend to use the majority of the clinical teaching time available to reach competency in these practical procedures, rather than discussing the patient and learning the skills to integrate and understand the patient’s condition and treatment, which they can acquire by doing case presentations. The end result of this misuse of clinical contact time is that some of the students, by the end of their programme, still have difficulty to integrate a patient’s diagnosis and treatment regime, although they have managed to complete the expected practical procedures. Summary of the work: A case study design was used. I wanted to investigate whether one could make use of simulation and the Clinical Skills Centre (CSC) to complete the majority of the practical procedures so that more time would be available in the clinical areas for the students to do case presentations. The study focuses on describing how the tutors and students involved experienced the use of simulation, as well as how it impacted on the available teaching time in the clinical areas. Conclusions and recommendations: Some of the most important issues that were highlighted in the study and needs to be mentioned are the following: · The students highly valued supervision by a Critical Care tutor when practising their skills in the CSC. · Students indicated that they valued the opportunity to practise some of the more risky procedures in simulation, because it presents no risk to patients. · Case presentations seem important to be added to the CSC’s practical sessions in order to attempt making the practical simulated scenarios even more realistic. · The teaching at the bedside in the clinical areas used to be done somewhat ad hoc. With the teaching in the CSC now being much more structured, this necessitates the teaching at the bedside to be revisited and to be structured to a certain extent. Summary of the results: The information obtained from the Critical Care tutors and the students indicated that these two groups were largely in agreement that simulation seems to be valuable and can effectively be used in a Critical Care nursing programme.