Centre for Health Professions Education

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Browsing Centre for Health Professions Education by Subject "Academic medical centers -- Botswana"

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    Medical students perceptions of their learning during longitudinal primary care clinical placements in a sub-Saharan medical school
    (Stellenbosch : Stellenbosch University, 2018-03) Molwantwa, Mmoloki Cornelius; Van Schalkwyk, Susan; Stellenbosch University.Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
    ENGLISH SUMMARY : Clinical placements are used as a bridge from classroom learning to real life settings (Stupans et al., 2013). Over the years, the Block Rotation Clerkship (BRC) model of clinical placements has been adopted by educational institutions and applied in different health settings such as hospitals, primary care or rural centres. However, emerging evidence in the literature supports the use of other models of placements over the BRC model to achieve clinical training outcomes (Wamsley et al., 2009; Hirsh et al., 2012). In view of this, Longitudinal Integrated Clerkships (LICs) have been shown as an acceptable alternative to the traditional block rotations (Strasser & Hirsh, 2011; Hauer et al., 2012; Hirsh et al., 2014). At the University of Botswana, an approach similar to LICs has been adopted for clinical placements. This approach involved changing clinical placements from a rotational structure to a longitudinal one in community primary care clinics. Consequently, the purpose of this study was to investigate the perceptions of second year medical students of their learning in the newly introduced longitudinal placements in primary care clinical settings. A cross sectional survey design which used the Manchester Clinical Placement Index (MCPI) tool to determine students’ perceptions of these newly introduced placements was adopted. The tool consisted of eight items that related to students’ experiences in clinical placements. Students then shared their views pertaining to the items in the tool. The tool generated quantitative and qualitative data which were analysed separately and thereafter points of alignment within the two sets of findings were identified for interpretation. This process was done using the MCPI domains as the organising framework for each item in the tool. Analysis of the quantitative data indicated that the majority of the students (more than 60%) perceived teaching of clinical tasks as optimal in the longitudinal placements at UB. Other items in the quantitative data which had majority of students perceiving them as appropriate included: leadership in terms of supervision at the placements, reception of students at placements, clinic staff supporting student learning at the placements and observations of students by staff when performing clinical tasks. In comparison to the above items, three items of organisation, facilities and feedback in the placements drew contrasting data from the students. The organisation of the placements was perceived as satisfactory by approximately half of the students (51%). There is clear evidence from the quantitative data that students were not satisfied with two items: clinic facilities as a learning environment and the feedback they received on how they performed clinical tasks. This was evidenced by less than half of the students strongly agreeing that both of these items were appropriate in the placements. Although the extrapolation was done with caution, the qualitative data from group leaders who completed the questionnaire advanced some of the reasons which could have explained the quantitative scores given by the students. According to the group leaders, the leadership was viewed as satisfactory because clinic staff who in most cases were nurses assumed responsibility over the students and allowed them to interact with patients. In terms of reception, they cited that the explanations of what was expected of the students made them feel welcome in their placement sites. In addition, the group leaders also indicated that clinic staff were supportive and possessed desirable human qualities that contributed to their learning at the placements. They also reported that the teaching they obtained on how to perform clinical tasks was delivered with clear instruction. The group leaders also added that there was sufficient observation from the different health professions in the clinics when they were performing tasks. In contrast, group leaders also advocated for an improvement in the feedback given to them while on placement. The structure, content and time were some of the factors that leaders felt presented challenges to staff when providing feedback. Primary care clinic facilities were viewed by few students as an appropriate learning environment. The group leaders revealed that the lack of space in the clinics to support academic activities as one of the reasons that could have contributed to this perception of students’. In conclusion, the findings of the study indicated that students perceived their learning experience at the placements to be beneficial, except for the feedback. Furthermore, the organization of the placement and reception of students at the placement was also perceived as adequate by majority of the students. Clinic staff at the placements, who played the role of teachers and supervisors of the students were found to be supportive to students’ clinical learning. According to the students, more could be done to improve community primary care clinics as a learning environment. In light of these results, the Faculty needs to consider steps to improving feedback given to students while on placement, and improving primary care clinics to provide an optimal learning environment for students.