Ian Couper | Stellenbosch University (original) (raw)

Papers by Ian Couper

African journal of primary health care & family medicine, Mar 11, 2024

South African Family Practice, May 1, 2010

The shared consultation is a concept that differs from shared decision making and shared care. It... more The shared consultation is a concept that differs from shared decision making and shared care. It involves two or more health professionals in the consultation of a patient during the same illness episode. Commonly, the health professionals are a primary-care doctor and a clinical nurse practitioner. On the basis of clinical experience, a number of models of the relationship in such situations are described, viz the consultant, the master-servant, the teacher-pupil and the teamwork models. Issues of communication within the consultation, the patient as a person, continuity of care, and clarification of roles and responsibilities are highlighted. More investigation is required to explore this further.

South African Family Practice, Nov 1, 2012

South African Family Practice, May 1, 2013

African Journal of Emergency Medicine

Introduction: The availability of trained Medical Toxicologists in developing countries is limite... more Introduction: The availability of trained Medical Toxicologists in developing countries is limited and education in Medical Toxicology remains inadequate. The lack of toxicology services contributes to a knowledge gap in the management of poisonings. A need existed to investigate the core competencies required by toxicology graduates to effectively operate in a Poisons Information Centre. The aim of this study was to obtain consensus from an expert group of health care workers on these core competencies. This was done by making use of the Delphi technique. Methodology: The Delphi survey started with a set of carefully selected questions drawn from various sources including a literature review and exploration of existing curricula. To capture the collective opinion of experts in South Africa, Africa and also globally, three different groups were invited to participate in the study. To build and manage the questionnaire, the secure Research Electronic Data Capture (REDCap) web platform was used. Results: A total of 134 competencies were selected for the three rounds and in the end consensus was reached on 118 (88%) items. Panel members agreed that 113 (96%) of these items should be incorporated in a Medical Toxicology curriculum and five (4%) should be excluded. Discussion: All participants agreed that effective communication is an essential skill for toxicology graduates. The curriculum can address this problem by including effective pedagogy to enhance oral and written communication skills. Feedback from panellists indicated that the questionnaires were country-specific and not necessarily representative of all geographical locations. This is an example of the 'battle of curriculum design' where the context in which the curriculum will be used, will determine the content. Conclusion: The Delphi method, based on three iterative rounds and feedback from experts, was effective in reaching consensus on the learning outcomes of a Medical Toxicology curriculum. The study results will ultimately improve education in Medical Toxicology. African relevance • The Major Facilitator Superfamily (MFS) is the largest superfamily of secondary transporters currently known. • Here we expand this superfamily with nine more families, bringing the total to over 100 families. • Among these new families, three are integral membrane proteins not currently recognized as transporters. • The results reported expand the scope and significance of the MFS and reveal novel topological types within the MFS fold.

BMJ Open, 2020

ObjectivesRural doctors describe consistent pressure to provide extended care beyond the limits o... more ObjectivesRural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. This study explored the lived experience of rural doctors when they practise outside their usual scope of practice to provide medical care for people who would otherwise not have access to essential clinical services.DesignA hermeneutic phenomenological study.SettingAn international rural medicine conference.ParticipantsAll doctors attending the conference who practised medicine in rural/remote areas in a predominantly English-speaking community were eligible to participate; 27 doctors were recruited.InterventionsSemi-structured interviews were conducted. The transcripts were initially read and analysed by individual researchers before they were read aloud to the group to explore meanings more fully. Two researchers then reviewed the transcripts to develop the results section which was then rec...

Rural and Remote Health, 2005

Perspectives on Medical Education, 2020

Unfortunately information regarding the disclaimer of Paul Worley’s affiliation is missing from t... more Unfortunately information regarding the disclaimer of Paul Worley’s affiliation is missing from the original article. Please find the information here: Paul Worley is affiliated to the Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, Australia. He is the …

South African Medical Journal, 2010

Curationis, 1997

Health education is an essential ingredient of primary health care but its impact is difficult to... more Health education is an essential ingredient of primary health care but its impact is difficult to evaluate. Where evaluation does occur, the research methods often require major expenditure of manpower, time and money. In addition, despite the importance of incorporating the primary health care goal of promoting participation in health, the subjects of the research often become victims yet again, gaining no visible benefits from the process in a situation where they have many basic needs which are not met.

Rural and Remote Health, 2021

Introduction: Clinical courage occurs when rural doctors push themselves to the limits of their s... more Introduction: Clinical courage occurs when rural doctors push themselves to the limits of their scope of practice to provide the medical care needed by patients in their community. This mental strength to venture, persevere and act out of concern for one's patient, despite a lack of formally recognised expertise, becomes necessary for doctors who work in relative professional isolation. Previous research by the authors suggested that the clinical courage of rural doctors relies on the relationships around them. This article explores in more depth how relationships with others can impact on clinical courage. Methods: At an international rural medicine conference in 2017, doctors who practised rural/remote medicine were invited to participate in the study. Twenty-seven semistructured interviews were conducted exploring experiences of clinical courage. Initial analysis of the material, using a hermeneutic phenomenological frame, sought to understand the meaning of clinical courage. In the original analysis, an emic question arose: 'How do interpersonal relationships impact on clinical courage'. The material was re-analysed to explore this question, using Wenger's community of practice as a theoretical framework. Results: This study found that clinical courage was affected by the relationships rural doctors had with their communities and patients, with each other, with the local members of their healthcare team and with other colleagues and health leaders outside their immediate community of practice. Conclusion: As a collective, rural doctors can learn, use and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion rural doctors' way of working.

South African Family Practice, Aug 1, 2006

Background The primary healthcare system was adopted as the vehicle of healthcare delivery and a ... more Background The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team, particularly nurses. A successful collaboration at this level brings benefit to everyone involved, particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork, thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics, but their workload, staff shortages and transport often interfere with these visits. As a form of private-public partnership, local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported, including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time. Methods A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors, clinic nurses, district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers, lengths of the visits, remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes. Results The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills, patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints, such as a shortage of medicines and equipment, which reduce the success of these visits. Conclusion The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level.

Sexual Medicine, Sep 17, 2022

IntroductionDoctors experience barriers in consultations that compromise engaging with patients o... more IntroductionDoctors experience barriers in consultations that compromise engaging with patients on sensitive topics and impede history taking for sexual dysfunction.AimThe aim of the study was to identify barriers to and facilitators of sexual history taking that primary care doctors experience during consultations involving patients with chronic illnesses.MethodsThis qualitative study formed part of a grounded theory study and represents individual interviews with 20 primary care doctors working in the rural North West Province, South Africa. The doctors were interviewed on the barriers and facilitators of sexual history taking they experienced during 151 recorded consultations with patients at risk of sexual dysfunction. Interviews were transcribed and line-by-line verbatim coding was done. A thematic analysis was performed using MaxQDA 2018 software for qualitative research. The study complied with COREQ requirements.OutcomeDoctors’ reflections on sexual history taking.ResultsThree themes identifying barriers to sexual history taking emerged, namely personal and health system limitations, presuppositions and assumptions, and socio-cultural barriers. The fourth theme that emerged was the patient-doctor relationship as a facilitator of sexual history taking. Doctors experienced personal limitations such as a lack of training and not thinking about taking a history for sexual dysfunction. Consultations were compromised by too many competing priorities and socio-cultural differences between doctors and patients. The doctors believed that the patients had to take the responsibility to initiate the discussion on sexual challenges. Competencies mentioned that could improve the patient-doctor relationship to promote sexual history taking, include rapport building and cultural sensitivity.Clinical implicationsDoctors do not provide holistic patient care at primary health care settings if they do not screen for sexual dysfunction.Strength and limitationsThe strength in this study is that recall bias was limited as interviews took place in a real-world setting, which was the context of clinical care. As this is a qualitative study, results will apply to primary care in rural settings in South Africa.ConclusionDoctors need a socio-cognitive paradigm shift in terms of knowledge and awareness of sexual dysfunction in patients with chronic illness.Pretorius D, Mlambo MG, Couper ID. “We Are Not Truly Friendly Faces”: Primary Health Care Doctors’ Reflections on Sexual History Taking in North West Province. Sex Med 2022;10:100565.

International journal of child health and human development, 2011

IntroductionThe focus of rural medical education is often on the expected outcomes, in terms of a... more IntroductionThe focus of rural medical education is often on the expected outcomes, in terms of addressing the human resource challenges faced by rural communities, by giving students an orientation to and understanding of rural health care (1-5). While it is often recognised that many additional skills can be learnt in rural areas, an asset-based approach which focuses on what rural placements can offer medical training as a whole is seldom adopted.It is for this reason that rural communities have seldom been considered as useful avenues to facilitate medical education, instead of simply as alternative geographical and demographic settings. Although there are some good examples of rural based medical education providing an innovative form of learning that is not offered in urban sites (6-8), the focus is more often on strategies that will improve access to health care.This paper describes a clinical rotation introduced into the programme for final year medical students in the Faculty of Health Sciences of the University of the Witwatersrand (Wits), Johannesburg, South Africa. This rotation has been vital in achieving major goals of the overall degree programme, which has a commitment to integration, theoretically at least, at the same time as exposing students to primary care and rural practice.The programmeThe Wits Faculty of Health Sciences launched a new curriculum for medical students, the Graduate Entry Medical Programme (GEMP), in 2003. As part of the development of this curriculum, it was agreed that the new programme should maintain its international standards of excellence, while preparing students for the health care needs of all South Africa's citizens. Core competencies agreed upon included providing comprehensive patient care in a plurality of health and social contexts, developing and delivering appropriate care beyond the immediate consultation, and professional cultural and social competencies. The graduating doctor is expected to have an appreciation of the strengths and contributions of other members of the health care team, the organisation of primary care and community health services, referral systems linking primary secondary and tertiary care and the associated human resource needs in the main health care settings in South Africa, as well as the common clinical conditions presenting to primary, secondary and tertiary care settings.As one contribution towards achieving these aims, the faculty supported a proposal from the Division of Rural Health for the development of a new rotation for final year medical students (GEMP 4) to spend six weeks of their training based in primary health care settings. As a consequence, the Integrated Primary Care (IPC) block became one of the seven compulsory rotations in final year.A planning committee (the IPC team) was formed in 2004 comprising of representatives of each of seven disciplines identified as relevant to and which were interested to be involved in the rotation, namely Paediatrics, Family Medicine, Internal Medicine, Obstetrics and Gynaecology, Psychiatry, Public Health and Surgery. Under the leadership of the Chair of Rural Health this integrated planning team worked over an 18 month period to develop an operational framework for the IPC block, identifying objectives, key learning areas and assessment activities. A feature of the block, it was agreed, would be to integrate the three critical areas of student development, community engagement and service delivery. The IPC team decided the overarching aim of the block would be to provide an opportunity for students -to experience and to practise integrated primary care medicine that is responsive to patients, their families and communities". The IPC block was launched in January 2006, as the new curriculum rolled out for the final year students. The GEMP 4 class is divided into groups of about 30 students, each of which completes seven rotations of six weeks, one of which is the IPC block. …

South African Family Practice, Aug 1, 2006

Research Square (Research Square), Apr 15, 2020

Background There is a global trend towards providing training for health professions students out... more Background There is a global trend towards providing training for health professions students outside of tertiary academic complexes. In many countries, this shift places pressure on available sites and the resources at their disposal, specifically within the public health sector. Introducing an educational remit into a complex health system is challenging, requiring commitment from a range of stakeholders, including national authorities. To facilitate the effective implementation of distributed training, we developed a guiding framework through an extensive, national consultative process with a view to informing both practice and policy. Methods We adopted a participatory action research approach over a four year period across three phases, which included seven local, provincial and national consultative workshops, reflective work sessions by the research team, and expert reviews. Approximately 240 people participated in these activities. Engagement with the national department of health and health professions council further informed the development of the Framework. Results Each successive 'feedback loop' contributed to the development of the Framework which comprised a set of guiding principles, as well as the components essential to the effective implementation of distributed training. Analysis further pointed to the centrality of relationships, while emphasising the importance of involving all sectors relevant to the training of health professionals. A tool to facilitate the implementation of the Framework was also developed, incorporating a set of 'Simple Rules for Effective distributed health professions training'. A national consensus statement was adopted. Conclusions In this project, we drew on the thinking and practices of key stakeholders to enable a synthesis between their embodied and inscribed knowledge, and the prevailing literature, this with a view to further enaction as the knowledge generators become knowledge users. The Framework and its subsequent implementation has not only assisted us to apply the evidence to our educational practice, but also to begin to influence policy at a national level. Background As the body of knowledge around health professions education (HPE) research continues to grow,

The Collaboration for Health Equity through Education and Research (CHEER) was formed in 2003 to ... more The Collaboration for Health Equity through Education and Research (CHEER) was formed in 2003 to examine strategies that would increase the production of health professional graduates who choose to practise in rural and under-served areas in South Africa. It consists of an academic from each of nine universities in South Africa with a health science faculty, who is involved in communitybased education, service-learning or rural health, or similar activities that prepare students for rural and under-served areas. Literature reviews, 1,2 a qualitative study 3 and a case-control quantitative study 4 have been completed, around the same research question. An integral component has been peer reviews at each university in the collaboration, to identify in more detail how each faculty is preparing its students for service in rural or under-served areas. All nine participating institutions have held a review to date, and this article reports on the outcomes. Each university has a different approach and operates in a unique context. The reviews therefore amount to a series of case studies, each complete in itself. We report the insights, learning and recommendations arising from each peer review around common themes and assess these in terms of proposed best practices for South Africa.

African Journal of Primary Health Care & Family Medicine, Apr 23, 2022

Background: Sexual history taking seldom occurs during a chronic care consultation and this resea... more Background: Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction. Aim: This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations. Setting: The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas. Methods: One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data. Results: Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time. Conclusion: Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care.

PLOS Global Public Health

We sought to evaluate the impact of transitioning a multi-country HIV training program from in-pe... more We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% a...

Frontiers in Public Health

African journal of primary health care & family medicine, Mar 11, 2024

South African Family Practice, May 1, 2010

The shared consultation is a concept that differs from shared decision making and shared care. It... more The shared consultation is a concept that differs from shared decision making and shared care. It involves two or more health professionals in the consultation of a patient during the same illness episode. Commonly, the health professionals are a primary-care doctor and a clinical nurse practitioner. On the basis of clinical experience, a number of models of the relationship in such situations are described, viz the consultant, the master-servant, the teacher-pupil and the teamwork models. Issues of communication within the consultation, the patient as a person, continuity of care, and clarification of roles and responsibilities are highlighted. More investigation is required to explore this further.

South African Family Practice, Nov 1, 2012

South African Family Practice, May 1, 2013

African Journal of Emergency Medicine

Introduction: The availability of trained Medical Toxicologists in developing countries is limite... more Introduction: The availability of trained Medical Toxicologists in developing countries is limited and education in Medical Toxicology remains inadequate. The lack of toxicology services contributes to a knowledge gap in the management of poisonings. A need existed to investigate the core competencies required by toxicology graduates to effectively operate in a Poisons Information Centre. The aim of this study was to obtain consensus from an expert group of health care workers on these core competencies. This was done by making use of the Delphi technique. Methodology: The Delphi survey started with a set of carefully selected questions drawn from various sources including a literature review and exploration of existing curricula. To capture the collective opinion of experts in South Africa, Africa and also globally, three different groups were invited to participate in the study. To build and manage the questionnaire, the secure Research Electronic Data Capture (REDCap) web platform was used. Results: A total of 134 competencies were selected for the three rounds and in the end consensus was reached on 118 (88%) items. Panel members agreed that 113 (96%) of these items should be incorporated in a Medical Toxicology curriculum and five (4%) should be excluded. Discussion: All participants agreed that effective communication is an essential skill for toxicology graduates. The curriculum can address this problem by including effective pedagogy to enhance oral and written communication skills. Feedback from panellists indicated that the questionnaires were country-specific and not necessarily representative of all geographical locations. This is an example of the 'battle of curriculum design' where the context in which the curriculum will be used, will determine the content. Conclusion: The Delphi method, based on three iterative rounds and feedback from experts, was effective in reaching consensus on the learning outcomes of a Medical Toxicology curriculum. The study results will ultimately improve education in Medical Toxicology. African relevance • The Major Facilitator Superfamily (MFS) is the largest superfamily of secondary transporters currently known. • Here we expand this superfamily with nine more families, bringing the total to over 100 families. • Among these new families, three are integral membrane proteins not currently recognized as transporters. • The results reported expand the scope and significance of the MFS and reveal novel topological types within the MFS fold.

BMJ Open, 2020

ObjectivesRural doctors describe consistent pressure to provide extended care beyond the limits o... more ObjectivesRural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. This study explored the lived experience of rural doctors when they practise outside their usual scope of practice to provide medical care for people who would otherwise not have access to essential clinical services.DesignA hermeneutic phenomenological study.SettingAn international rural medicine conference.ParticipantsAll doctors attending the conference who practised medicine in rural/remote areas in a predominantly English-speaking community were eligible to participate; 27 doctors were recruited.InterventionsSemi-structured interviews were conducted. The transcripts were initially read and analysed by individual researchers before they were read aloud to the group to explore meanings more fully. Two researchers then reviewed the transcripts to develop the results section which was then rec...

Rural and Remote Health, 2005

Perspectives on Medical Education, 2020

Unfortunately information regarding the disclaimer of Paul Worley’s affiliation is missing from t... more Unfortunately information regarding the disclaimer of Paul Worley’s affiliation is missing from the original article. Please find the information here: Paul Worley is affiliated to the Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, Australia. He is the …

South African Medical Journal, 2010

Curationis, 1997

Health education is an essential ingredient of primary health care but its impact is difficult to... more Health education is an essential ingredient of primary health care but its impact is difficult to evaluate. Where evaluation does occur, the research methods often require major expenditure of manpower, time and money. In addition, despite the importance of incorporating the primary health care goal of promoting participation in health, the subjects of the research often become victims yet again, gaining no visible benefits from the process in a situation where they have many basic needs which are not met.

Rural and Remote Health, 2021

Introduction: Clinical courage occurs when rural doctors push themselves to the limits of their s... more Introduction: Clinical courage occurs when rural doctors push themselves to the limits of their scope of practice to provide the medical care needed by patients in their community. This mental strength to venture, persevere and act out of concern for one's patient, despite a lack of formally recognised expertise, becomes necessary for doctors who work in relative professional isolation. Previous research by the authors suggested that the clinical courage of rural doctors relies on the relationships around them. This article explores in more depth how relationships with others can impact on clinical courage. Methods: At an international rural medicine conference in 2017, doctors who practised rural/remote medicine were invited to participate in the study. Twenty-seven semistructured interviews were conducted exploring experiences of clinical courage. Initial analysis of the material, using a hermeneutic phenomenological frame, sought to understand the meaning of clinical courage. In the original analysis, an emic question arose: 'How do interpersonal relationships impact on clinical courage'. The material was re-analysed to explore this question, using Wenger's community of practice as a theoretical framework. Results: This study found that clinical courage was affected by the relationships rural doctors had with their communities and patients, with each other, with the local members of their healthcare team and with other colleagues and health leaders outside their immediate community of practice. Conclusion: As a collective, rural doctors can learn, use and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion rural doctors' way of working.

South African Family Practice, Aug 1, 2006

Background The primary healthcare system was adopted as the vehicle of healthcare delivery and a ... more Background The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team, particularly nurses. A successful collaboration at this level brings benefit to everyone involved, particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork, thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics, but their workload, staff shortages and transport often interfere with these visits. As a form of private-public partnership, local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported, including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time. Methods A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors, clinic nurses, district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers, lengths of the visits, remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes. Results The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills, patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints, such as a shortage of medicines and equipment, which reduce the success of these visits. Conclusion The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level.

Sexual Medicine, Sep 17, 2022

IntroductionDoctors experience barriers in consultations that compromise engaging with patients o... more IntroductionDoctors experience barriers in consultations that compromise engaging with patients on sensitive topics and impede history taking for sexual dysfunction.AimThe aim of the study was to identify barriers to and facilitators of sexual history taking that primary care doctors experience during consultations involving patients with chronic illnesses.MethodsThis qualitative study formed part of a grounded theory study and represents individual interviews with 20 primary care doctors working in the rural North West Province, South Africa. The doctors were interviewed on the barriers and facilitators of sexual history taking they experienced during 151 recorded consultations with patients at risk of sexual dysfunction. Interviews were transcribed and line-by-line verbatim coding was done. A thematic analysis was performed using MaxQDA 2018 software for qualitative research. The study complied with COREQ requirements.OutcomeDoctors’ reflections on sexual history taking.ResultsThree themes identifying barriers to sexual history taking emerged, namely personal and health system limitations, presuppositions and assumptions, and socio-cultural barriers. The fourth theme that emerged was the patient-doctor relationship as a facilitator of sexual history taking. Doctors experienced personal limitations such as a lack of training and not thinking about taking a history for sexual dysfunction. Consultations were compromised by too many competing priorities and socio-cultural differences between doctors and patients. The doctors believed that the patients had to take the responsibility to initiate the discussion on sexual challenges. Competencies mentioned that could improve the patient-doctor relationship to promote sexual history taking, include rapport building and cultural sensitivity.Clinical implicationsDoctors do not provide holistic patient care at primary health care settings if they do not screen for sexual dysfunction.Strength and limitationsThe strength in this study is that recall bias was limited as interviews took place in a real-world setting, which was the context of clinical care. As this is a qualitative study, results will apply to primary care in rural settings in South Africa.ConclusionDoctors need a socio-cognitive paradigm shift in terms of knowledge and awareness of sexual dysfunction in patients with chronic illness.Pretorius D, Mlambo MG, Couper ID. “We Are Not Truly Friendly Faces”: Primary Health Care Doctors’ Reflections on Sexual History Taking in North West Province. Sex Med 2022;10:100565.

International journal of child health and human development, 2011

IntroductionThe focus of rural medical education is often on the expected outcomes, in terms of a... more IntroductionThe focus of rural medical education is often on the expected outcomes, in terms of addressing the human resource challenges faced by rural communities, by giving students an orientation to and understanding of rural health care (1-5). While it is often recognised that many additional skills can be learnt in rural areas, an asset-based approach which focuses on what rural placements can offer medical training as a whole is seldom adopted.It is for this reason that rural communities have seldom been considered as useful avenues to facilitate medical education, instead of simply as alternative geographical and demographic settings. Although there are some good examples of rural based medical education providing an innovative form of learning that is not offered in urban sites (6-8), the focus is more often on strategies that will improve access to health care.This paper describes a clinical rotation introduced into the programme for final year medical students in the Faculty of Health Sciences of the University of the Witwatersrand (Wits), Johannesburg, South Africa. This rotation has been vital in achieving major goals of the overall degree programme, which has a commitment to integration, theoretically at least, at the same time as exposing students to primary care and rural practice.The programmeThe Wits Faculty of Health Sciences launched a new curriculum for medical students, the Graduate Entry Medical Programme (GEMP), in 2003. As part of the development of this curriculum, it was agreed that the new programme should maintain its international standards of excellence, while preparing students for the health care needs of all South Africa's citizens. Core competencies agreed upon included providing comprehensive patient care in a plurality of health and social contexts, developing and delivering appropriate care beyond the immediate consultation, and professional cultural and social competencies. The graduating doctor is expected to have an appreciation of the strengths and contributions of other members of the health care team, the organisation of primary care and community health services, referral systems linking primary secondary and tertiary care and the associated human resource needs in the main health care settings in South Africa, as well as the common clinical conditions presenting to primary, secondary and tertiary care settings.As one contribution towards achieving these aims, the faculty supported a proposal from the Division of Rural Health for the development of a new rotation for final year medical students (GEMP 4) to spend six weeks of their training based in primary health care settings. As a consequence, the Integrated Primary Care (IPC) block became one of the seven compulsory rotations in final year.A planning committee (the IPC team) was formed in 2004 comprising of representatives of each of seven disciplines identified as relevant to and which were interested to be involved in the rotation, namely Paediatrics, Family Medicine, Internal Medicine, Obstetrics and Gynaecology, Psychiatry, Public Health and Surgery. Under the leadership of the Chair of Rural Health this integrated planning team worked over an 18 month period to develop an operational framework for the IPC block, identifying objectives, key learning areas and assessment activities. A feature of the block, it was agreed, would be to integrate the three critical areas of student development, community engagement and service delivery. The IPC team decided the overarching aim of the block would be to provide an opportunity for students -to experience and to practise integrated primary care medicine that is responsive to patients, their families and communities". The IPC block was launched in January 2006, as the new curriculum rolled out for the final year students. The GEMP 4 class is divided into groups of about 30 students, each of which completes seven rotations of six weeks, one of which is the IPC block. …

South African Family Practice, Aug 1, 2006

Research Square (Research Square), Apr 15, 2020

Background There is a global trend towards providing training for health professions students out... more Background There is a global trend towards providing training for health professions students outside of tertiary academic complexes. In many countries, this shift places pressure on available sites and the resources at their disposal, specifically within the public health sector. Introducing an educational remit into a complex health system is challenging, requiring commitment from a range of stakeholders, including national authorities. To facilitate the effective implementation of distributed training, we developed a guiding framework through an extensive, national consultative process with a view to informing both practice and policy. Methods We adopted a participatory action research approach over a four year period across three phases, which included seven local, provincial and national consultative workshops, reflective work sessions by the research team, and expert reviews. Approximately 240 people participated in these activities. Engagement with the national department of health and health professions council further informed the development of the Framework. Results Each successive 'feedback loop' contributed to the development of the Framework which comprised a set of guiding principles, as well as the components essential to the effective implementation of distributed training. Analysis further pointed to the centrality of relationships, while emphasising the importance of involving all sectors relevant to the training of health professionals. A tool to facilitate the implementation of the Framework was also developed, incorporating a set of 'Simple Rules for Effective distributed health professions training'. A national consensus statement was adopted. Conclusions In this project, we drew on the thinking and practices of key stakeholders to enable a synthesis between their embodied and inscribed knowledge, and the prevailing literature, this with a view to further enaction as the knowledge generators become knowledge users. The Framework and its subsequent implementation has not only assisted us to apply the evidence to our educational practice, but also to begin to influence policy at a national level. Background As the body of knowledge around health professions education (HPE) research continues to grow,

The Collaboration for Health Equity through Education and Research (CHEER) was formed in 2003 to ... more The Collaboration for Health Equity through Education and Research (CHEER) was formed in 2003 to examine strategies that would increase the production of health professional graduates who choose to practise in rural and under-served areas in South Africa. It consists of an academic from each of nine universities in South Africa with a health science faculty, who is involved in communitybased education, service-learning or rural health, or similar activities that prepare students for rural and under-served areas. Literature reviews, 1,2 a qualitative study 3 and a case-control quantitative study 4 have been completed, around the same research question. An integral component has been peer reviews at each university in the collaboration, to identify in more detail how each faculty is preparing its students for service in rural or under-served areas. All nine participating institutions have held a review to date, and this article reports on the outcomes. Each university has a different approach and operates in a unique context. The reviews therefore amount to a series of case studies, each complete in itself. We report the insights, learning and recommendations arising from each peer review around common themes and assess these in terms of proposed best practices for South Africa.

African Journal of Primary Health Care & Family Medicine, Apr 23, 2022

Background: Sexual history taking seldom occurs during a chronic care consultation and this resea... more Background: Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction. Aim: This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations. Setting: The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas. Methods: One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data. Results: Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time. Conclusion: Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care.

PLOS Global Public Health

We sought to evaluate the impact of transitioning a multi-country HIV training program from in-pe... more We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% a...

Frontiers in Public Health