Browsing by Author "Conradie, H."
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- ItemAcademic achievement of final-year medical students on a rural clinical platform : can we dispel the myths?(Health & Medical Publishing Group, 2015) Van Schalkwyk, S.; Kok, N.; Conradie, H.; Van Heerden, B.ENGLISH SUMMARY : Background: There is a growing body of literature relating to the establishment of rural clinical training platforms for medical students describing many positive outcomes, particularly in the case of extended placements. However, students’ fears about their academic achievement while at these sites remain a key concern. Objectives: The study set out to compare the academic achievement in end-of-rotation assessments and final examinations of final-year medical students at a rural clinical school (RCS) with those of their peers at the academic hospital complex (AHC). Methods. A cross-sectional study, comparing the marks of three successive cohorts of RCS and AHC students (2011 - 2013) using t-tests and confirmed with non-parametric rank-sum tests, was conducted. The consistency of the effect of these results across cohorts was assessed by fitting regression models with interaction terms between cohort and group, and tested for significance using F-tests. Independent t-tests were conducted to evaluate differences in the mark attained between the two groups. A p-value <0.05 was considered statistically significant. Results: Comparison of student marks attained across six of the disciplines offered at the RCS suggested there was no difference between the RCS and AHC in each of the three cohorts at baseline. A comparison of the end-of-rotation means showed that RCS students achieved significantly better results in some disciplines. A similar trend was observed for the final examination results across all seven disciplines. Conclusion: Despite small numbers, this study suggests that students who spend their final year at the RCS are not disadvantaged in terms of their academic achievement. Medical students’ concerns regarding academic achievement for those placed at rural clinical sites appear to be unfounded. Students who potentially could be placed at these sites should be made aware of this evidence.
- ItemThe contribution of South African curricula to prepare health professionals for working in rural or under-served areas in South Africa : a peer review evaluation(Health and Medical Publishing Group (HMPG), 2011) Reid, S. J.; Cakwe, M.; Chandia, J.; Couper, I. D.; Conradie, H.; Hugo, J.; Irlam, J.; Nel, J.; Mabuza, H.; Mpofu, R.Setting. The Collaboration for Health Equity through Education and Research (CHEER) was formed in 2003 to examine strategies that would increase the production of health professionals who choose to practise in rural and under-served areas in South Africa. Objectives. We aimed to identify how each faculty is preparing its students for service in rural or under-served areas. Methods. Peer reviews were conducted at all nine participating universities. A case study approach was used, with each peer review constituting its own study but following a common protocol and tools. Each research team comprised at least three reviewers from different universities, and each review was conducted over at least 3 days on site. The participating faculties were assessed on 11 themes, including faculty mission statements, resource allocation, student selection, first exposure of students to rural and under-served areas, length of exposure, practical experience, theoretical input, involvement with the community, relationship with the health service, assessment of students and research and programme evaluation. Results. With a few exceptions, most themes were assessed as inadequate or adequate with respect to the preparation of students for practice in rural or under-served areas after qualification, despite implicit intentions to the contrary at certain faculties. Conclusions. Common challenges, best practices and potential solutions have been identified through this project. Greater priority must be given to supporting rural teaching sites in terms of resources and teaching capacity, in partnership with government agencies.
- ItemDeveloping an interprofessional transition course to improve team-based HIV care for sub-Saharan Africa(BMC (part of Springer Nature), 2020-12-09) Kiguli-Malwadde, E.; Budak, J. Z.; Chilemba, E.; Semitala, F.; Von Zinkernagel, D.; Mosepele, M.; Conradie, H.; Khanyola, J.; Haruruvizhe, C.; Martin, S.; Kazembe, A.; De Villiers, M.; Reid, M. J. A.Background: With funding from the United States Health Resources Service Administration (HRSA), a consortium of health professional training institutions from Africa developed HIV-specific, interprofessional, team-based educational resources to better support trainees during the transition period between pre-service training and professional practice. Methods: Ten faculty members representing nine medical and nursing schools in sub-Saharan Africa (SSA) developed a training package of modules focused on core clinical, public health, interprofessional education (IPE), and quality improvement (QI) domains related to HIV service delivery. Curriculum development was informed by a rapid needs assessment of existing tools and future needs for HIV education across 27 SSA health professions training institutions. A total of 17 modules were developed, targeted at newly qualified health care professionals to be taught in a series of two-day workshops meant to complement existing institution specific HIV-curricula. Results: Between April and July 2019, a comprehensive case-based HIV training package was developed to support trainees in transition from pre-service training to independent professional practice. Each module, addressing different elements of interprofessional practice, was intended to be delivered in an interprofessional format. Thus far, 70 health professions training institutions in 14 countries have implemented the program; 547 educators facilitated STRIPE workshops, with a total of 5027 learners trained between September 2019 and September 2020. Conclusions: To our knowledge this is the first IPE HIV-specific curriculum explicitly focused on enhancing the quality of training provided to graduating health care professionals working in SSA. The collaborative, crossinstitutional, interprofessional approach to curriculum development provides a benchmark for how best-practice approaches to education can be disseminated in SSA.
- ItemThe effect of undergraduate students on district health services delivery in the Western Cape Province, South Africa(Health and Medical Publishing Group, 2018) Reid, S.; Conradie, H.; Daniels-Felix, D.Background. The quality of care, attitudes of staff and long-term recruitment of practitioners have been shown internationally to improve health services as a result of a health facility accepting students for teaching. This study aimed to develop further insight regarding the impact of undergraduate student involvement on district health services in South Africa to understand the issues in a resource-constrained environment. Objectives. To describe the effect of the placement of undergraduate students on service delivery, and to understand the health service and academic factors that influence this effect. Methods. A descriptive study, using qualitative methods, was undertaken in two rural sites where undergraduate health science students had been recently introduced. Potential respondents were identified to be interviewed on the basis of their positions in the health services, their degree of involvement with students and their knowledge of the health system. Results. Sixteen participants were interviewed, and described the effect of undergraduate students on service delivery in terms of a balance between the burden and benefit. Three pivotal issues, which could tip the balance in favour of one or the other, included the length of time of student rotations, seniority of the students and number of students allocated to a particular site. Overall, it would appear that the balance was marginally in favour of the benefit of student service delivery. Conclusion. Undergraduate students can add value to service delivery under certain conditions, but further research is needed to quantify this effect.
- ItemInfluences on the choice of health professionals to practise in rural areas(Health and Medical Publishing Group (HMPG), 2007-11) Couper, I. D.; Hugo, J. F. M.; Conradie, H.; Mfenyana, K.Background: Training health care professionals (HCPs) to work in rural areas is a challenge for educationalists. This study aimed to understand how HCPs choose to work in rural areas and how education influences this. Methods. Qualitative individual interviews were conducted with 15 HCPs working in rural areas in SA. Results. Themes identified included personal, facilitating, contextual, staying and reinforcing factors. Personal attributes of the HCPs, namely rural origin and/or their value system, determine consideration of rural practice. The decision to 'go rural' is facilitated by exposure to rural practice during training, an understanding of rural needs and exposure to rural role models. Once practising in a rural area, the context and nature of work and the environment influence the decision to remain, supported by the role of family and friends, ongoing training and development, and the style of health service management. Personal motivation is reinforced by a positive relationship with the community, and by being an advocate and role model for the local community. Educational factors were often felt to work against the decision to practise in rural areas. Discussion. The results show the complexity of the interaction between a large number of factors working together to make HCPs choose to go and stay in rural areas. Factors other than educational ones seem more important. A comprehensive approach is needed to attract and retain HCPs in rural areas. Issues for educationalists to address include helping rural-origin students to connect with their own values and communities.
- ItemA medical audit of the management of cryptococcal meningitis in HIV-positive patients in the Cape Winelands (East) district, Western Cape(Medica l& Pharmaceutical Publications (Pty )Ltd -- MedPharm Publications, 2012-08) Von Pressentin, K. B.; Conradie, H.; Mash, B.Background: Cryptococcal meningitis (CM) has become the most common type of community-acquired meningitis. CM has a poor outcome if the initial in-hospital treatment does not adhere to standard guidelines. The aim of this audit was to improve the quality of the care of human immunodeficiency virus (HIV) positive patients with CM in the Cape Winelands District. Method: Following an initial audit in 2008, the researchers and a new audit team introduced interventions, and planned a second audit cycle. The folders of 25 HIV-positive adults (admitted to three district hospitals, one regional hospital, and one tuberculosis hospital) were audited. Results: Spinal manometry was performed more consistently in the regional hospital, than in the district hospitals. Reasons for failing to reach the 14-day amphotericin B target were in-patient deaths, drug stock problems, and renal impairment. The renal monitoring of amphotericin B treatment was suboptimal. The quality of care at district hospitals appeared to be comparable to that found at the regional hospital. The in-patient referral for antiretroviral treatment (ART) counselling was better in the district hospital setting. However, both levels of care had difficulty in achieving the four-week target between the onset of amphotericin B and onset of ART. Conclusion: Deficiencies in the quality of care remained. Between the prior and current audit cycles, there was no consistent improvement in care at the regional hospital. An integrated care pathway document has been developed, and adopted as policy in the Cape Winelands district. Its impact on the quality of care will be evaluated by a dedicated audit team in the future.
- ItemWe have to flap our wings or fall to the ground : the experiences of medical students on a longitudinal integrated clinical model(Health & Medical Publishing Group, 2015) Voss, M.; Coetzee, J. F.; Conradie, H.; Van Schalkwyk, S. C.Background. In 2011, Stellenbosch University introduced a district hospital-based longitudinal integrated model for final-year students as part of its rural clinical school. The present study is an analysis of students’ experiences during the first 3 years of the programme. Methods. All 13 students who started the programme between 2011 and 2013 were interviewed. Thematic networks linking recurrent issues were developed and transcripts were analysed against this framework using ATLAS.ti. Results. Two major themes emerged. These were ‘preparation for being a doctor’ and ‘academic/exam preparation’. Students were overwhelmingly positive about the working atmosphere and their preparation for clinical practice and felt that their learning had been facilitated by the flexibility of the programme and the requirement to take responsibility. This contrasted with their academic (‘book’) learning, which was characterised by uncertainty about expectations, particularly regarding exams and parity with learning at the central teaching hospital. The flexibility of the integrated approach was seen as a problematic lack of structure when it came to academic learning. Negative academic emotions were compounded by some frustration about administrative issues early in the programme. Conclusions. The district hospital-based longitudinal integrated model has great potential as a teaching platform for final-year students; however, students remain concerned about academic learning. Potential strategies to reduce student anxiety include more opportunities for dialogue between rural students and specialist teaching platforms, clearly communicated expectations – both about what the students can expect from the programme and about what is expected from them – and administrative excellence.