Centre for Health Professions Education

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Academic 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.
Academic literacy revisited : a space for emerging postgraduate voices
(AFRICAN SUN MeDIA, 2016) Van Schalkwyk, Susan
SUMMARY : Few would challenge the notion that postgraduate studies, particularly at doctoral level, should make a contribution to the body of knowledge. Such contribution is typically the product of several years of academic endeavour characterized by a process of ‘being and becoming’ a scholar (Van Schalkwyk 2014). The doctoral journey has, however, been described as one that is fraught with uncertainty and ambiguity, and that is intricate and multi-facetted (Green 2005; Jazvac‐Martek 2009). In addition, Barnett (2009: 431) has suggested that in today’s complex and unpredictable, technology-driven world we require a “wider form of human being” than ever before. It is in this complex space that the postgraduate academic project is situated, requiring the construction of a meaningful, intellectual work such that the graduate is able to take a stand and make her voice heard. Aligned to this thinking is the tacit assumption that engagement in postgraduate studies will facilitate the acquisition of academic literacy and entry into the disciplinary discourse or community of practice within which the academic work has been undertaken. In so doing, the graduate will become recognized as a scholar in the field.
Advancing the science of health professions education through a shared understanding of terminology : a content analysis of terms for “faculty”
(Elsevier B.V., 2021-09-10) Teunissen, Pim W.; Atherle, Anique; Clelan, Jennifer J.; Holmboe, Eric; Hu. Wendy C. Y.; Durning, Steven J.; Nishigor, Hiroshi; Samaraseke, Dujeepa D.; Schuwirth, Lambert; Van Schalkwyk, Susan; Maggi, Lauren A.
Introduction: Health professions educators risk misunderstandings where terms and concepts are not clearly defined, hampering the field’s progress. This risk is especially pronounced with ambiguity in describing roles. This study explores the variety of terms used by researchers and educators to describe “faculty”, with the aim to facilitate definitional clarity, and create a shared terminology and approach to describing this term. Methods: The authors analyzed journal article abstracts to identify the specific words and phrases used to describe individuals or groups of people referred to as faculty. To identify abstracts, PubMed articles indexed with the Medical Subject Heading “faculty” published between 2007 and 2017 were retrieved. Authors iteratively extracted data and used content analysis to identify patterns and themes. Results: A total of 5,436 citations were retrieved, of which 3,354 were deemed eligible. Based on a sample of 594 abstracts (17.7%), we found 279 unique terms. The most commonly used terms accounted for approximately one-third of the sample and included faculty or faculty member/s (n = 252; 26.4%); teacher/s (n = 59; 6.2%) and medical educator/s (n = 26; 2.7%) were also well represented. Content analysis highlighted that the different descriptors authors used referred to four role types: healthcare (e.g., doctor, physician), education (e.g., educator, teacher), academia (e.g., professor), and/or relationship to the learner (e.g., mentor). Discussion: Faculty are described using a wide variety of terms, which can be linked to four role descriptions. The authors propose a template for researchers and educators who want to refer to faculty in their papers. This is important to advance the field and increase readers’ assessment of transferability.
Alienation and engagement as framework for characterizing registrars’ perceptions of their learning environment: an exploratory qualitative study
(Stellenbosch : Stellenbosch University, 2016-12) Ooko, Francis Okelo; Van Schalkwyk, Susan Camille; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY : Alienation and engagement as framework for characterizing registrars’ perceptions of their learning environment: an exploratory qualitative study. Research into students’ learning experiences in higher education has often focussed on what has been described as surface, deep or strategic approaches to learning. The approaches theory has been critiqued because it does not account for the influence of the learning environment (Webb, 1997). The concepts of alienation and engagement may be used to characterize student learning experiences in postgraduate medical training as they incorporate the influence of the learning environment and socio-cultural characteristics (Mann, 2001). The purpose of the present study was to explore the registrars’ perceptions of their learning environment through the lens of alienation and engagement. An exploratory qualitative study comprising twelve semi-structured interviews was conducted among registrars at the University of Limpopo, Faculty of Health Sciences between June and October 2015. Qualitative methods were used to analyse the results. Different degrees of alienation and/or engagement could be discerned from the registrars’ perception of their educational environment with regard to: the curriculum design and implementation; integration of theoretical and practical teaching; support from the supervisors, the university, and the teaching hospitals; and inter-professional relationships at the hospitals. This research points to a number of suggestions for future practice including that fostering closer relationships between the institutions’ administrative systems and the registrars could enhance engagement and reduce alienation.
Alignment of current graduate attributes required of medical graduates of the University of Botswana to the expressed needs of users of the Botswana Health Service
(Stellenbosch : Stellenbosch University, 2018-03) Sepako, Enoch; Snyman, Stefanus; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY : Traditionally, the design of health professions curricula was often guided by traditions, values and priorities of academics. This, however, has led to a mismatch of graduates’ competencies to patient and population needs, prompting a push for curricula design that aligns the goals of professional education with the needs of society. Unsurprisingly, needs assessment for curriculum design should include societal needs (expressed by the communities served and derived from health statistics). Others are perceived needs (identified by students/graduates), observed needs (identified by experts and academics) and organisation needs (identified by invested organisations). This research aimed to determine the extent to which graduate attributes of the University of Botswana Bachelor of Medicine, Bachelor of Surgery (MBBS) programme reflect expressed societal needs. There were two research objectives: Firstly, to determine the expressed needs of users of Botswana health service regarding care received from medical doctors. Secondly, to determine how the MBBS graduate attributes are aligned with the identified expressed needs. There is substantial literature on organisational and observed needs, some data on perceived needs and societal needs derived from health statistics to inform the review of the MBBS curriculum. However, there is no documented evidence of expressed societal needs. This gap in the literature served as the rationale for this study. An interpretivist research paradigm and qualitative approach were adopted. Interviews were conducted using the Critical Incident Technique and twelve participants described their good and bad consultation experiences with medical doctors. A purposive sample was selected through village development committees and patient advocacy groups. Eleven themes were identified as expressed societal needs, which include being respectful, empowering, humble, focused, empathetic, unprejudiced, trustworthy, welcoming, humane, thorough and personal. On the contrary, a number of these identified themes do not align with the defined MBBS graduate attributes, including being focused, unprejudiced, trustworthy, welcoming and thorough. This research, even though limited in the context of this assignment, points to the importance of reconsidering the MBBS graduate attributes with a view to making changes that reflect expressed societal needs.
All in a day's work : student nurses' perceptions of their clinical learning experiences in a corporate workplace context
(Stellenbosch : University of Stellenbosch, 2009-12) Volschenk, Mariette; Van Heerden, B. B.; University of Stellenbosch. Faculty of Health Sciences. Centre for Health Science Education.
Introduction: Exposure to the clinical learning environment forms an essential part of nursing education. Individual student perceptions of this multi-dimensional context can greatly influence their clinical learning experiences. Insight into these perceptions may assist nurse educators in facilitating optimal learning outcomes. Aim: The aim of this study was to promote an awareness of the possible impact of various aspects of the clinical learning environment and nursing students’ perceptions thereof, on their learning experiences; and to generate guidelines for facilitating optimal learning outcomes. Methods: A qualitative, interpretive study, investigating nine individual second-year nursing students, was undertaken in a private hospital in South Africa. Interview transcripts were thematically analyzed. Results: Four themes and eleven sub-themes emerged, highlighting the impact of student nurses’ perceptions of the various aspects of the clinical learning environment on their learning experiences. Discussion: The impact of students’ perceptions of the clinical learning environment on their learning experiences is discussed. Recommendations are provided for measures to increase the focus on student-centered learning in the selected clinical context. Conclusion: The challenge remains to best prepare students for the complexities and dynamics of the workplace learning environment, while at the same time modifying this environment to effectively meet students’ learning needs.
Allied health professional rural education: Stellenbosch University learners’ experiences
(Health & Medical Publishing Group, 2016-10) Pillay, M.; Bester, J.; Blaauw, Renee; Harper, A.; Msindwana, A.; Muller, J.; Philips, L.
ENGLISH SUMMARY : Background: Rural clinical training is not widely established or documented for allied health sciences (AHS) learners. This article focuses on the experiences of AHS learners from Stellenbosch University’s uKwanda Rural Clinical School. Objective: To explore learners’ practices with regard to rural clinical training in the AHS. Methods: A total of 22 documented reflections and seven educator or learner semi-structured focus group discussions, using critical conversations, were analysed with methods such as textual and thematic analysis and qualitative research software (ATLAS.ti, Germany). Results: The perception of rural clinical training was reported as an overwhelmingly positive experience. Practices positioned ‘rural’ as a catalyst for developing learners’ emerging identities as policy brokers, and as best when delivered by team participation. Professional education curricula were reported as dependant on: (i) context; (ii) educators; and (iii) how time was managed. Conclusion: Rural-based learning is a humanising experience for health science learners.
An analysis of the experiences of HCWs in improving their performance in the workplace following a multi-method training intervention in a resource-limited setting
(Stellenbosch : Stellenbosch University, 2021-12) Proudfoot, Ian Graham; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY : Introduction: The educational outcomes of training initiatives are usually measured against the achievement of specific quantifiable objectives. This study sought instead to analyse the impact on changed workplace performance of a training curriculum through the personal experiences of the healthcare workers themselves. The three-week training intervention was a combination of classroom, bedside and workplace-based education, aiming to upskill a group of twenty hospital- and primary care-based clinicians in the management of advanced HIV in a rural community in Homa Bay in Western Kenya. The intention of the study was to understand more deeply what elements facilitated improved workplace performance and what challenged it. In so doing, it was hoped that lessons would be learnt to guide the further development of this and other short training curricula of this nature in similar low- and middle-income settings. Methods: Following a phenomenological line of enquiry, in-depth, semi-structured interviews were conducted fourteen months after the training intervention on a convenience sample of twelve of the twenty participants in the training course. The open-ended questions probed the factors leading to success and those challenging improvement in workplace performance, whilst opportunity was also created for free expression of other elements considered relevant. The interview data were analysed following standard interpretive, phenomenological analysis procedures, with the data finally classified into core themes, within two broad categories of factors that promoted improved performance and those that challenged it. CME - Continuing medical education MOH - Ministry of health HCW - Healthcare worker MSF - Médecins Sans Frontières MIV - Menslike immuniteitsgebreksvirus TLU - Teaching and learning unit LMIC - Low- and middle-income countries NGO - Non-governmental organisation Results: Three core areas of workplace performance were impacted positively by the training intervention, namely, clinical skills, teaching competence, and program development. Contributing to this were a number of different elements, including the classroom teaching strategies, the reference texts provided, the bedside teaching, and the engagements with a variety of colleagues in the workplace over the subsequent months. The challenges to improved performance fit into two broad categories: weaknesses in the healthcare system, and the negative influences of people, including senior colleagues, ministry of health counterparts, junior colleagues, or the patients themselves. Conclusions: Similar to the roles played by a sports coach, the role of the educator is not only to facilitate improved technical skills but also to recognise and further develop the individual agency of the players and to build resilience to thrive, even in adversity. Drawing on the established learning theories of adult learning, situated learning and social constructivism, further augmented by a wealth of empiric evidence in health education studies in low- and middle-income countries, the teaching and learning strategies were shown to contribute significantly to improved workplace performance. The individual agency of the healthcare workers, especially in teaching and program management roles in primary care was a surprise finding, pointing us, as educators, to a greater focus in the future towards not only anticipating this but also taking specific steps to harness this potential. Finally, in the face of the numerous challenges to improved workplace performance, all too frequently encountered in these rural settings, attention needs to be focused in the future on building greater resilience and capacity to manage these challenges.
Applying 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.
Approaches, perceptions and conceptions of 3rd year physiotherapy students in a problem-based learning module
(Stellenbosch : University of Stellenbosch, 2010-12) Keiller, Lianne; Louw, A. J. N.; University of Stellenbosch. Faculty of Health Sciences. Centre for Health Sciences Education.
Aim: The aim of this study was to investigate the approaches, conceptions and perceptions toward learning of undergraduate Physiotherapy students in a PBL module in order to inform curriculum development and enhance facilitation of learning at the Stellenbosch University Division of Physiotherapy. Methodology: A mixed-method, descriptive study was conducted during 2010. Physiotherapy students currently in their 3rd year of the course, completed the Revised Two-factor Study Process Questionnaire (R-SPQ-2F) at the commencement of the academic year and again at the end of the first semester. The aim of this questionnaire is to determine the deep and surface approach toward learning of participants. Students also completed a perception of learning questionnaire and participated in focus group discussions to evaluate their perceptions and conceptions of learning in the module. Results of the three data instruments were analysed statistically, descriptively and phenomenographically, respectively. Results: There was a 100% response rate to the R-SPQ-2F and perception questionnaires, with only 6 out of 16 participants responding to invitations for focus group interviews. There were a statistically significant greater number of students who adopted a deep approach toward learning at the commencement of the academic year. An increase in those with a deep approach and a decrease in those with a surface approach toward learning were seen at the end of the first semester. This shift was however not significant. Students showed a trend toward an increase in their intrinsic interest in the learning material as the module progressed. Clinical reasoning and internalizing information were seen as two of the advantages of the instructional approach. Conversely, the disadvantages of the module included the perception that the instructional approach used is time consuming and concerns regarding quality and accuracy of learning material. The presence of dysfunctional group dynamics also plays a role in students perceptions of disadvantages in APT. Students conceived the module to have an effect on their approach toward learning and both personal and professional skills. Conclusion: The Applied Physiotherapy 373 module had no significant effect on students‟ approach toward learning. The results of this study however are not conclusive on why and how this lack of significant effect is present. Further research is needed to determine the long-term changes in approach toward learning and the possible determinants of these changes. This should be done in conjunction with implementation of quality assurance mechanisms for learning material, introduction of multi-media into PBL sessions and earlier preparation of students for the change in learning environment.
Assessment of professional behaviour in occupational therapy education: investigating assessors’ understanding of constructs and expectations of levels of competence.
(Stellenbosch : Stellenbosch University, 2012-03) Snyman, Margaretha Alberta; Cilliers, F.; Beukes, S.; Stellenbosch University. Faculty of Health Sciences. Centre for Health Sciences Education.
ENGLISH ABSTRACT: The development of professional behaviour is one of the core components of occupational therapy education. The assessment of professional behaviour poses a problem as the constructs and expectations are not clearly defined; this results in compromised inter-rater reliability. The purpose of the study was to investigate assessors’ understanding of the constructs and the expectations deployed during the assessment of professional behaviour of third and fourth year occupational therapy students during clinical practice. A case study design was used in the qualitative study. Clinical supervisors were involved in: (1) a focus group interview to scrutinise the usefulness of the current assessment instrument and (2) a participatory discussion to determine their understanding of the constructs of professional behaviour and the level of expectations to be set for third and fourth year students respectively. This study confirms that the development of effective assessment of professional behaviour entails a number of pivotal steps that include developing a shared definition of the constructs thereof and the expectations at different levels of undergraduate training, the refinement of the assessment instrument and training of assessors in the use of this assessment instrument.
Attitudes and perceptions of first year students towards interprofessional education in the Faculty of Community and Health Sciences at the University of the Western Cape
(Stellenbosch : Stellenbosch University, 2012-12) Filies, Gerard C.; De Villiers, M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.; Thesis (MPhil)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: The setting for this study was the University of the Western Cape, Faculty of Community and Health Sciences, first year undergraduate students. All students who participated in the compulsory interprofessional programme were from the following disciplines: Occupational Therapy; Physiotherapy; Psychology; Social Work; Natural Medicine; Dietetics; Human Ecology; Sports Sciences and Nursing. The objectives of this study were to measure the attitudes and perceptions of first year students who participated in an undergraduate interprofessional programme. The attitudes and perceptions were further measured in relation to the specific lecturers involved, the age of the students, their gender, race, background as well their specific discipline. This was primarily a quantitative study incorporating two qualitative questions in which 657 students were issued with a questionnaire designed to determine their attitudes and perceptions towards interprofessional education. A sample size of 264 students resulted in 95% confidence intervals with a maximum precision of 5%. The questionnaire was adapted, with permission, from Cameron; Rennie; DiProspero; Langlois & Wagner (2009). MS Excel was used to capture the data and STATISTICA version 9 (StatSoft Inc. (2009) STATISTICA (data analysis software system), www.statsoft.com.) was used to analyze the data from the questionnaires. Descriptive statistics was used to describe the main features of the sample of this study and summary statistics was further used to summarize the findings of this study in order to communicate the bulk of the information as simple as possible. Two open-ended questions were included at the end of the questionnaire and this was used to triangulate the data. The Kruskal-Wallace test was used to measure the results, whereby a p-value of <0.05 indicated statistical significance. Of all the factors used to measure the attitudes and perceptions of students, the following three were significant: Gender; Race and Discipline. No other factors impact on the attitudes and perceptions of students towards interprofessional education. Student attitudes and perceptions towards interprofessional education were found to be very positive. The findings revealed that the most significant factor in the study was the lack of understanding of various disciplines participating in the programme and their understanding of the relevance of the teaching approach (interprofessional) as well as their specific role in the health care team. This clearly illustrated the need to recommend to the co-ordinating unit of the programme that this be defined more clearly for the students and specifically the Sports Sciences students.
Best practices for teaching healthcare workers about infection prevention and control : a systematic review
(Stellenbosch : Stellenbosch University, 2016-03) Aucamp, Magdalena C.; Van Schalkwyk, Susan; Mehtar, Shaheen; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH ABSTRACT: Background: Education and training of healthcare workers (HCWs) in the theory and practice of infection prevention and control (IPC) is widely regarded as a pivotal measure to reduce the risk of healthcare-associated infection (HAI). Although IPC programmes in healthcare facilities devote much time and effort to teach HCWs about IPC, the education methods may not always be effective to establish immediate and long-term changes in IPC practices. Aim of the study: The aim of the study is to determine which teaching strategies have been used with success to teach HCWs about IPC and to recommend a set of best practices for effective IPC education and training. Method: The researcher conducted a systematic review of primary studies on IPC education interventions published from 1990 to 2013. A total of 76 studies were eventually selected from sources identified by means of an extensive electronic literature search in several databases. Data was extracted and then analysed using a combination of qualitative and quantitative methods. Finally the data was synthesized and the limitations in the methodology acknowledged. Results: The interventions mostly employed a combination of two or more teaching methods and made a conscious attempt to actively engage students in the learning process. There was a strong focus on behaviour change and reinforcement of learning to ensure long-term compliance with IPC standards. Assessment of learning and e-learning was left mostly underutilized and unexplored. No new or useful insights could be obtained from interventions done in resource-poor healthcare facilities. Limitations: Only interventions published in English were reviewed. Most of the interventions were done in resource-rich settings and in urban tertiary education facilities. Conclusion: IPC education strategies require careful consideration, perhaps in equal measure to the subject matter that is being taught, to facilitate effective learning that will result in a change in behaviour and practice in the long term. The systematic review revealed that the approach to IPC education and training needs to be holistic: Apart from the teaching content, consideration must be given to the context within which the teaching will provided, as well as teaching methods that will actively engage HCWs in the learning process and stimulate behaviour change. There should be continuous reinforcement of learning by various means. These considerations and more are included in a set of recommended best practices for in-service education and training in IPC. Recommendations are made for future research projects.
Building 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, Marietjie
Background. 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.
Caring behaviours : the perceptions of first and fourth year nursing students
(Stellenbosch : Stellenbosch University, 2014-12) Crafford, Ilse; Archer, Elize; Blitz, Julia; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professionals Education.
ENGLISH ABSTRACT: Educators across the health professions are now concerned with the teaching and assessment of professional skills. Caring behaviour is one of the attributes of professionalism in the health sciences professions and in the nursing profession it is regarded as the essence of the profession. The aim of this study is to explore the understandings and experiences of caring behaviours of first- and fourth year nursing students and how they would like to be assessed about their caring behaviours in a curriculum where it is not overtly taught. This will be investigated according to Watson’s carative factors and theoretical framework of caring, while Bloom’s Taxonomy of the affective learning domain will also be consulted. The design of the study is qualitative and explorative. A purposive sample was drawn from first-year nursing students (n=64), and fourth-year nursing students (n=41) at one nursing education institution. The sample of students (n=105) from seven (7) private training hospitals in the Western Cape participated in nine (9) focus group interviews (n=10-15). Data analysis was done by means of a framework analysis approach with a deductive strategy. Research findings from this study are extensively discussed and will be used to inform the undergraduate nursing curricula in South Africa about the profiles of caring nursing students and to make recommendations about the internalisation of caring behaviours, according to the affective learning domain.
Changes in attitudes, behaviour and practices following an educational intervention for midwives using reflective writing journals
(Stellenbosch : Stellenbosch University, 2019-12) Ray, Sunanda; Jacobs, Cecilia; Van Schalkwyk, Susan; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY: Introduction: Inclusion of transformative learning techniques into the education of midwives and other health professionals, creates opportunities for improving health outcomes. Women in public and private sector health facilities in Southern Africa have experienced abusive behaviour and neglect from midwives. Negative birth experiences may deter women from seeking institutional care during labour, and lead to poor obstetric outcomes such as delayed progress in labour, higher risk of instrumental and surgical interventions and postnatal depression. Complex relationships between midwives and women in labour give rise to dissonance between the midwives’ sense of identity and pride as professionals, and their apparently disrespectful behaviour in their workplace, leading to possible negative outcomes. The aim of the research study was to explore from the midwives’ perspective the influence of an educational intervention in changing the attitudes, behaviour and practices of a group of midwives in Zimbabwe, as evidenced by entries in their reflective writing journals augmented by facilitated group dialogue. Methods: The qualitative research study comprised two facets: firstly, a document analysis of eighteen reflective journals written by the midwives and secondly, member-checking of the thematic analysis of the journal entries during follow-up discussions and a one-day participative workshop held a year later. Data were analysed using a phenomenology approach, which looks at how individuals make sense of social phenomena in their lived experiences. Transformative learning theory was used as a conceptual framework to explore the learning journey of the midwives. The a priori analysis identified patterns of changes within the pre-determined domains of attitudes, behaviours and practices. The comments and insights of the midwives during the member-checking process contributed further data for analysis. Findings: Overall the midwives reported gains in professional pride and stronger identification as patient advocates. Their stories in their reflective writing journals gave several examples of treating women in labour with empathy and compassion. Categories were constructed within the three domains of attitudes, behaviours and practices. Some of these categories aligned directly with the ten phases of transformative learning theory, such as self-examination of prior experience, building of competence and self-confidence into new roles and relationships. Other categories related to improving communications and teamwork, providing role-models of good behaviour and demonstrating competence in management of complex cases. Changes in practices were specific to this context and relate to changes in practices related to involvement of birth companions and encouragement to use different positions in labour and delivery. Discussion: This study demonstrated that participatory approaches to training on respectful maternity care may lead to changed attitudes, behaviour and practices in this context. The beneficiaries of these changes will be the midwives, as well as the women they look after in maternal health, their colleagues and the health system at large. The midwives have shown that even in adverse circumstances, they are able to share a common vision for the quality of service they want to provide and to progress with improving health outcomes. Sustainability and reproducibility to achieve the same results depends on continued investment in the participatory methodology to train midwives in respectful maternity care, with skilled facilitation of the reflective writing and dialogic approach. Pre-service and in-service training for midwives and medical students in maternal health could benefit from these new approaches, using reflective writing journals and dialogue as part of their educational methods and curricula. Conclusion: Promoting Respectful Maternity Care as part of the educational process opens the door to more empathy and compassion in healthcare, with better health outcomes and more rewarding relationships with their patients. This study shows that innovative educational initiatives have the potential to significantly change the way midwives work together, how they can continue to learn from reflecting on their experiences and to develop life-long learning skills.
Clinical associate students’ perceptions of factors influencing their developing professional identity
(Stellenbosch : Stellenbosch University, 2019-04) Mgobozi, Aviwe Palesa; Couper, Ian; McNamee, Lakshini; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH SUMMARY : The Carnegie Foundation for the Advancement of Teaching and the Lancet Commission called for educational reforms to improve the preparation of 21st century healthcare professionals through strengthening of professional identity in medical education. The factors influencing professional identity amongst nurses and doctors emerge as role modelling, patient encounters, clinical experience, and professional practice. However, factors influencing professional identity within the clinical associate profession have not been described. The study explores clinical associate students’ perceptions of factors that influence their developing professional identity. The research question is positioned within the phenomenological research paradigm. The research inquiry used a qualitative descriptive interpretivist approach. The study was conducted at the University of Witwatersrand in Johannesburg. The population for the study were all undergraduate clinical associate students enrolled at the University of Witwatersrand in 2018. A non-probability convenience sampling technique was utilised. Sampling were done from first-year and the final-year group of students. Three focus group discussions were held per year of study. The focus group discussions were guided by the researcher utilising semi-structured interview questions. Focus group discussions were audio recorded. Ethics approval was received from Stellenbosch University and the University of Witwatersrand. Three themes emerged from the results, namely, individual factors, training related factors, and perceptions of identity. The focus on professional identity aims to provide formal educational opportunities to enhance factors that positively influence student professional identities and dispel negative factors. Strengthening professional identities produces healthcare professionals who embody the professional qualities, values and dispositions required in an effective profession. The study reveals clinical associate students’ perceptions of factors that influence their professional identity. The information suggests a need to increase marketing and advocacy of the profession, improve student selection into the programme, include inter-professional education and faculty development, and utilise clinical associate role models at clinical learning facilities.
Clinical learning environment and supervision : student Nurses experiences within private health care settings in the Western Cape
(Stellenbosch : Stellenbosch University, 2014-04) Borrageiro, Filomena; Archer, Elize; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
ENGLISH ABSTRACT: Background - Student nurses indicated that the clinical environment was not conducive to learning because they were part of the ward staff ratio and clinical supervision was inadequate. Upon observations by the researcher and feedback from student nurses’ a study was planned to identify the clinical experiences and supervision. The study itself was conducted within private health care settings in the Western Cape Province of South Africa. Objectives - The objective of this study was to determine the experiences of student nurses of the clinical learning environment. To also identify the support and clinical supervision that the student nurses received from ward staff, clinical facilitators and lecturers. Methods and analysis - The CLES+T is a reliable and valid evaluation scale for the gathering of information on the clinical learning environment and supervision of student nurses. The CLES+T evaluation scale was completed by 234 student nurses within the selected sites. A quantitative, descriptive cross-sectional survey was conducted by making use of the CLES+T evaluation scale. The CLES+T evaluation scale is subdivided into three main sections with additional sub-sections: (1) the Learning environment, (2) the Supervisory relationship and (3) the Role of the nurse teacher (lecturer). Results - The clinical learning environment was experienced as mostly positive by the student nurses; however the format and type of clinical accompaniment and supervision students received varied. Conclusion - This study gave valuable insights into the status of the clinical learning environment, the clinical accompaniment and supervision of student nurses which can be useful to the nursing school in order to enhance existing nursing programmes.
Clinical occupational therapists' experience of their role as clinical educators during the fieldwork experience of occupational therapy students
(Stellenbosch : Stellenbosch University, 2012-03) Emslie, Brenda; Louw, A. J. N.; Bester, Juanita; Stellenbosch University. Faculty of Health Sciences. Centre for Health Sciences Education.
ENGLISH ABSTRACT: Fieldwork is an essential part of the occupational therapy student’s education, and optimal learning is dependent on effective facilitation by a clinical Occupational Therapist. This study explored the lived experience of the clinical Occupational Therapists in their role as clinical educators by means of a phenomenological inquiry. Ten semi-structured interviews were conducted with clinical Occupational Therapists involved in clinical education. The data was analysed by using thematic content analysis, and was discussed according to the Lived Experience of a Clinical Educator Model. The results indicated that the clinical OTs’ sense of self, which revealed strong humanistic values, acted as the core element influencing the way in which they related to others and were able to juggle many roles in order to perform their role as clinical educator. It furthermore influenced the ways in which they managed balance and harmony in the workplace, as well as the process of growth and development. Incongruence during the performance of their roles as clinical educators was mainly caused by insufficient collaboration between the clinical educators and the university, the prescriptive nature of the fieldwork curriculum, workload pressures, the students’ attitudes and their lack of knowledge, as well as insufficient training of new clinical educators. The results may be helpful in fostering a collaborative relationship between the university and the clinical Occupational Therapists, as well as renewed attention to growth and development, all of which will benefit the students’ education.
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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