Browsing by Author "De Villiers, Marietjie"
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- ItemBuilding a research agenda in health professions education at a Faculty of Medicine and Health Sciences : current research profile and future considerations(Health & Medical Publishing Group, 2014-10) Bezuidenhout, Juanita; Van Schalkwyk, Susan; Van Heerden, Ben; De Villiers, MarietjieBackground. To generate evidence in and for health professions education (HPE) that can enable reform and establish new relevance, a comprehensive HPE research foundation is required. Gaps identified in the sub-Saharan Africa (SSA) HPE literature should be addressed, while a need for more clarificatory and collaborative research to strengthen evidence has been expressed. Relatively few HPE centres exist in SSA. At Stellenbosch University’s Faculty of Medicine and Health Sciences (FMHS) the Centre for HPE was established in 2006, followed by an HPE Research Unit in 2011. Objectives. To determine and analyse the current status of educational research in the FMHS, thereby contributing to conversations around an HPE research agenda for Africa. Methods. A database of all HPE-related research was compiled, followed by a desktop analysis of all documents pertaining to current educational research projects in the FMHS in 2012, categorising projects according to: general information; sites where research was conducted; research focus; and research purpose. All data were recorded in an Excel spreadsheet and a descriptive analysis was performed. Results. There were 106 projects, mostly aimed at undergraduate programmes. More than half focused on teaching and learning, while a few focused on assessment. A number of projects were community-based or involved national and/or international collaborations. Only 20% of projects were classified as clarification research. Discussion. Educational research appears healthy in the FMHS, but more clarificatory and macro-projects are required. The profile of research is similar to the SSA profile. A research strategy relevant and feasible in our context has to be established with a shift to areas beyond our professional/ institutional boundaries, posing HPE questions of relevance to South Africa and the African continent.
- ItemConsequences, 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, BenBackground: 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.
- ItemDecentralised training for medical students : a scoping review(BioMed Central, 2017-11-09) De Villiers, Marietjie; Van Schalkwyk, Susan; Blitz, Julia; Couper, Ian; Moodley, Kalavani; Talib, Zohray; Young, TarynBackground: Increasingly, medical students are trained at sites away from the tertiary academic health centre. A growing body of literature identifies the benefits of decentralised clinical training for students, the health services and the community. A scoping review was done to identify approaches to decentralised training, how these have been implemented and what the outcomes of these approaches have been in an effort to provide a knowledge base towards developing a model for decentralised training for undergraduate medical students in lower and middle-income countries (LMICs). Methods: Using a comprehensive search strategy, the following databases were searched, namely EBSCO Host, ERIC, HRH Global Resources, Index Medicus, MEDLINE and WHO Repository, generating 3383 references. The review team identified 288 key additional records from other sources. Using prespecified eligibility criteria, the publications were screened through several rounds. Variables for the data-charting process were developed, and the data were entered into a custom-made online Smartsheet database. The data were analysed qualitatively and quantitatively. Results: One hundred and five articles were included. Terminology most commonly used to describe decentralised training included ‘rural’, ‘community based’ and ‘longitudinal rural’. The publications largely originated from Australia, the United States of America (USA), Canada and South Africa. Fifty-five percent described decentralised training rotations for periods of more than six months. Thematic analysis of the literature on practice in decentralised medical training identified four themes, each with a number of subthemes. These themes were student learning, the training environment, the role of the community, and leadership and governance. Conclusions: Evident from our findings are the multiplicity and interconnectedness of factors that characterise approaches to decentralised training. The student experience is nested within a particular context that is framed by the leadership and governance that direct it, and the site and the community in which the training is happening. Each decentralised site is seen to have its own dynamic that may foreground certain elements, responding differently to enabling student learning and influencing the student experience. The insights that have been established through this review have relevance in informing the further expansion of decentralised clinical training, including in LMIC contexts.
- ItemDesigning 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, SusanBackground: 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.
- ItemImplications 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, SusanIntroduction : 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.
- ItemPrevalence of substance use amongst people living with human immunodeficiency virus who attend primary healthcare services in Mthatha, South Africa(AOSIS, 2020) Kaswa, Ramprakash; De Villiers, MarietjieBackground: About 13.3% of the South African population use some kind of substance during their lifetime. The incidence of substance use disorders is twice the global average. The use of various substances amongst people living with human immunodeficiency virus (PLWH) has increased tremendously in recent years. The growing culture of substance use amongst PLWH is a serious threat adding to the human immunodeficiency virus (HIV) epidemic and is likely to compromise the continuity of HIV care. Methods: A cross-sectional descriptive survey recruited adult PLWH who attended primary healthcare (PHC) services in Mthatha between 15 March and 15 April 2018. The Alcohol, Smoking and Substance Involvement Screening Test questionnaire (ASSIST), a tool validated by the World Health Organization, was used for data collection. Results: Out of a total 347 participants, 53% reported lifetime substance use and 32% admitted current use of a substance. Alcohol was the most common substance reported, followed by tobacco and cannabis. The majority of participants were female (75.2%), unemployed (70.8%), had secondary school-level education (85.2%) and a per capita household income below the national food poverty line (75%). The mean age of the participants was 37.9 years (standard deviation [SD] ± 10.33); this was marginally higher for male (39.9 years; SD ± 10.92) than female (37.2 years; SD ± 10.06) participants. Conclusion: This study has shown that there is a high prevalence of lifetime and current alcohol abuse amongst PLWH who make use of PHC services in the Mthatha area of South Africa. Of particular concern are the strong pointers towards younger people and males.
- ItemThe SARS-CoV-2 pandemic : an urgent need to relook at the training of the African health workforce(Health & Medical Publishing Group, 2020) Reid, Michael; Suleman, Fatima; De Villiers, MarietjieAs of 11 March 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had infected over 120 000 people in more than 90 countries, of whom 4 369 had died.  As recent modelling analysis highlights, the evolving impact of SARS-CoV-2 will be as a large outbreak in sub-Saharan Africa (SSA) that may rapidly overwhelm existing health services. To avoid the worst of outcomes, African health systems must act quickly and decisively. Investing in health professions education will be essential to both containing and managing the pandemic and any other new infections in the future. Here we describe how a transnational HIV training project, implemented by the African Forum for Research and Education in Health (AFREhealth) and the University of California, San Francisco (UCSF), offers a template for how we can deploy African-bred approaches to address this emerging threat.
- ItemTeaching medical students in a new rural longitudinal clerkship : opportunities and constraints(Levy Library Press, 2018) De Villiers, Marietjie; Conradie, Hoffie; Van Schalkwyk, SusanBackground: Medical schools in Africa are responding to the call to increase numbers of medical graduates by up-scaling decentralized clinical training. One approach to decentralized clinical training is the longitudinal integrated clerkship (LIC), where students benefit from continuity of setting and supervision. The ability of family physician supervisors to take responsibility for the clinical training of medical students over a longer period than the usual, in addition to managing their extensive role on the district health platform, is central to the success of such training. Objective: This study investigated the teaching experiences of family physicians as clinical supervisors in a newly introduced LIC model in a rural sub-district in the Western Cape, South Africa. Method: Nine semi-structured interviews were conducted with six family physicians as part of the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) five-year longitudinal study. Code lists were developed inductively using Atlas.ti v7, they were compared, integrated, and categories were identified. Emerging common themes were developed. Findings: Three overarching themes emerged from the data, each containing subthemes. The rural platform was seen to be an enabling learning space for the LIC students. The family physicians’ experienced their new teaching role in the LIC as empowering, but also challenging. Lack of time for teaching and the unstructured nature of the work emerged as constraints. Despite being uncertain about the new LIC model, the family physicians felt that it was easier to manage than anticipated. Conclusion: The centrality of the rural context framed the teaching experiences of the family physicians in the new LIC, forming the pivot around which constraints and opportunities for teaching arose. The African family physician is well positioned to make an important contribution to the upscaling of decentralized medical training, but would need to be supported by academic institutions and health service managers in their teaching role.