Doctoral Degrees (Centre for Health Professions Education)

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Browsing Doctoral Degrees (Centre for Health Professions Education) by Subject "Medicine -- Study and teaching"

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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.
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    Engaging 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.