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Volunteer, community-based student-run clinics for the underserved : can they be used to attain 21st century medical education goals?

Gordon, Chivaugn (2016-03)

Thesis (MPhil)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: Background: Community-based education has increasingly become emphasised as an important aspect of health professions education. Not only does it provide opportunities for student-centred learning; it also facilitates the attainment of graduate attributes desired of health care professionals in the 21st century. Further, it can influence career choices and thus retain doctors in primary care, where the greatest practitioner deficit is. South Africa has committed to training community-based, primary care generalists who can attend to the country’s greatest healthcare needs. Consequently, Health Science Faculties aim to include community-based teaching and learning opportunities in their curricula. At the University of Cape Town, this has proved a challenge due to the limited number of sites available for student placements. However, there are several voluntary community-based student-run clinics co-ordinated by the Students Health and Welfare Centres Organisation (SHAWCO), which could offer students community-based teaching and learning experiences. Objectives: To investigate students’ perceptions of the benefits of SHAWCO clinic attendance to their learning and personal development, in order to determine these clinics’ suitability for inclusion into the undergraduate curriculum as community-based teaching and learning sites. The research questions that guided this research were: Does attending volunteer SHAWCO clinics in under-serviced communities impact on student learning; the development of graduate attributes; and/ or students’ development as individuals? Based on these findings, do SHAWCO clinics offer the same opportunities described for community-based education, and if so, could they be used as a formalised platform for community-based education at the University of Cape Town? Subsidiary questions 1.How, if at all, do students think SHAWCO clinic involvement benefits their learning? 2.How do students learn at these clinics? 3.Does SHAWCO clinic involvement facilitate the development of desired graduateattributes? 4. How, if at all, does SHAWCO involvement impact on students’ personal development? 5. Based on students’ experiences of the SHAWCO environment, do SHAWCO clinics offer the same opportunities as standard CBE, and if so, could they be formalised into the UCT undergraduate medical curriculum? Methods: This was a descriptive case study using semi-structured focus group interviews for data collection. Ethical clearance for the study was obtained from The Universities of Cape Town and Stellenbosch. Seven focus groups were held with medical students; one with SHAWCO Steering Committee members in any year of study; three with preclinical students (years one and two); and three with clinical students (years four and five). A total of 49 students were interviewed. Interviews were analysed inductively using thematic content analysis. Results: SHAWCO clinic involvement did offer the same opportunities as standard community-based education, but the fact that SHAWCO is student-run conferred many additional qualities to this experience. Involvement in SHAWCO complimented and enhanced the curriculum but also took students far beyond curricular bounds, which allowed for the development of many graduate attributes, in addition to personal growth and professional identity development. The voluntary nature of SHAWCO attendance for both students and supervising clinicians was central to its success, as it created an enabling learning environment, where teachers were enthusiastic and patient. Other facets of the SHAWCO learning experience included peer-assisted learning and mentorship, early patient contact, accountability and emotional engagement. Conclusions: While SHAWCO clinics provide an ideal community-based teaching and learning opportunity, they should not be formalised into the curriculum to any great extent, as doing so would rob SHAWCO of the very essence that makes it so beneficial. However, one compulsory visit in students’ first year of study during a period when many become disillusioned due to dry academic bookwork is suggested, after which time students could return if they so choose. Offering senior students, who are responsible for the majority of teaching, voluntary input on effective clinical teaching and mentorship methods could potentially enhance the educational value of the SHAWCO learning experience.

AFRIKAANSE OPSOMMING: gtergrond: Gemeenskapsgebaseerde onderrig word toenemend beklemtoon as ’n belangrike aspek van gesondheidsberoepe-onderrig. Dit voorsien nie net geleenthede vir student-gesentreerde leer nie, maar fasiliteer ook die bereiking van gewenste eienskappe van graduandi vir gesondheidssorgdeskundiges in die 21ste eeu. Dit kan ook loopbaankeuses beïnvloed en dus geneeskundiges in primêre sorg behou, waar die grootste tekort aan praktisyns tans bestaan. Suid-Afrika is daartoe verbind om gemeenskapsgebaseerde, primêre-sorg algemeniste op te lei wat die land se grootste gesondheidsorgbehoeftes kan aanspreek. Gevolglik mik fakulteite van gesondheidswetenskappe om gemeenskapsgebaseerde leer- en onderriggeleenthedeby hul kurrikula in te sluit. By die Universiteit van Kaapstad was hierdie mikpunt ’n uitdaging te danke aandie beperkte aantal beskikbare plasings vir studente. Daar is egter ’n aantal vrywillige, gemeenskapsgebaseerde klinieke wat deur studente gelei en deur die Students Health and Welfare Centres Organisation (SHAWCO) gekoördineer word wat moontlik vir studente gemeenskapsgebaseerde leer- en onderriggeleenthede kan bied. Doelwitte: Om studente se persepsies te ondersoek van die voordele aan hul leer en persoonlike ontwikkeling van SHAWCO kliniek-bywoning, sodat die geskiktheid van hierdie klinieke vir insluiting in die voorgraadse kurrikulum as gemeenskapsgebaseerde leer- en onderrigplasings bepaal kan word. Die navorsingsvrae wat die studie gerig het is: Impakteer die bywoning van SHAWCO-klinieke in ondervoorsiene gemeenskappe op studenteleer; op die ontwikkeling van eienskappe van graduandi en / of studente se ontwikkeling as individue? Gebaseer op hierdie bevindinge, bied SHAWCO-klinieke dieselfde geleenthede wat vir gemeenskapsgebaseerde-onderrigbeskryf is en, indien wel, kan hulle as ’n geformaliseerde platform vir gemeenskapsgebaseerde-onderrig by die Universiteit van Kaapstad gebruik word? Spesifieke vrae: 1. Hoe, indien enigsins, dink studente bevoordeel betrokkenheid by SHAWCO-klinieke hul leer? 2. Hoe leer studente by hierdie klinieke? 3. Fasiliteer SHAWCO-kliniek betrokkenheid die ontwikkeling van gewenste eienskappe van graduandi? 4. Hoe, indien enigsins, impak SHAWCO betrokkenheid op studente se persoonlike ontwikkeling? 5. Gebaseer op studente se ervarings van die SHAWCO omgewing, bied SHAWCO klinieke diselfde geleenthede as gewone gemeenskapsgebaseerde-onderrig, en indien wel, kan dit in die Universiteit van Kaapstad se voorgraadse mediese kurrikulum geformaliseer word? Metodes: Hierdie was ’n beskrywende gevallestudie wat semi-gestruktureerde fokusgroeponderhoude vir data-insamelings ingespan het. Etiese klaring vir die studie is van die Universiteite van Kaapstad en Stellenbosch verkry. Sewe fokusgroepe is met mediese studente gevoer; een met lede van die SHAWCO-bestuursskomitee in enige studiejaar; drie met prekliniese studente (eerste- en tweedejaar) en drie met kliniese studente (vierde- en vyfdejaar). ’n Totaal van 49 studente is ondervra. Onderhoude is induktief ontleed met behulp van tematiese inhoudsanalise. Resultate: SHAWCO-kliniekbetrokkenheid het dieselfde geleenthede as gewone gemeenskapsgebaseerde-onderrig gebied, maar die feit dat SHAWCO deur studente gelei is verleen vele addisionele eienskappe aan die ervaring. Betrokkenheid by SHAWCO komplimenteer en brei op die kurrikulum uit, maar het studente ook ver buite die perke van die kurikkulum geneem, wat die ontwikkeling van verskeie eienskappe van graduanditoegelaat het benewens persoonlike groei en die ontwikkeling van professionele identiteit. Die vrywillige aard van SHAWCO bywoning vir beide studente en toesighouende klinici was sentraal tot die sukses daarvan, omdat dit ’n bemagtigende-leeromgewing geskep het, waar dosente entoesiasties en geduldig was. Ander fasette van die SHAWCO-leerervaring het eweknie-ondersteunde leer en -mentorskap, vroeë pasiënt-kontak, aanspreeklikheid en emosionele betrokkenheid. Gevolgtrekkings: Terwyl SHAWCO klinieke ’n ideale gemeenskapsgebaseerde-leer- en onderriggeleentheid bied, moet dit nie in die kurrikulum tot enige groot mate geformaliseer word nie – om dit te doen sou SHAWCO van die wese wat dit so voordelig maak, beroof. Daar word egter voorgestel dat eerstejaarstudente een verpligte besoek onderneem, dié in ’n jaar waar baie studente ontnugter raak as gevolg van droë akademiese boekwerk. Na so ’n besoek sou studente kon terugkeer sou hulle dit verkies. Die opvoedkundige waarde van die SHAWCO-leerervaring kan potensieël verbeter word deur senior studente (wie vir die meerderheid van die onderrig verantwoordelik is) vrywillige insette oor effektiewe kliniese onderrig en mentorskap metodes te bied.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98371
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