The contribution of South African curricula to prepare health professionals for working in rural or under-served areas in South Africa (original) (raw)
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MEDICC review, 2008
Introduction The South African health system has disturbing inequalities, namely few black doctors, a wide divide between urban and rural sectors, and also between private and public services. Most medical training programs in the country consider only applicants with higher-grade preparation in mathematics and physical science, while most secondary schools in black communities have limited capacity to teach these subjects and offer them at standard grade level. The Faculty of Health Sciences at Walter Sisulu University (WSU) was established in 1985 to help address these inequities and to produce physicians capable of providing quality health care in rural South African communities. Intervention Access to the physician training program was broadened by admitting students who obtained at least Grade C (60%) in mathematics and physical science at standard grade, and who demonstrated appropriate personal attributes. An innovative curriculum, combining problem-based learning with commun...
Curriculum challenges faced by rural-origin health science students at South African medical schools
Background. The current shortage of healthcare workers in rural communities demands attention. The sourcing of rural-origin students (ROSs) has been suggested, but retention of these students in their chosen degrees is crucial. Addressing the tertiary education challenges that ROSs face is critical to ensuring their success. Objective. To focus on the various challenges influencing throughput of ROSs. Method. This article is one of a series of investigations into various aspects of university life and career choices of health science students. Data were collected at three South African universities by the Collaboration for Health Equity through Education and Research (CHEER) collaborators. Ethical permission was sought from each institution. Health science students at the relevant institutions consented to completing a self-administered questionnaire. The data were analysed on SPSS and χ 2 tests were used to describe the statistical significance of the results. Results. Academic course content was the greatest challenge as perceived by students. Differences between rural and urban students were significant in all aspects of university life studied. Technological challenges were five times more common for ROSs. Differences between first-and final-year students were not as marked, although the personal challenges and academic course content became easier as students progressed through their degree. Conclusion. Although ROSs face similar challenges as students of urban origin, in some instances these are enhanced and magnified. These students are more likely to find various aspects of university life challenging. To improve the success and retention of ROSs, adequate support structures are essential.
African Journal of Health Professions Education, 2016
There is a growing recognition of the need for medical curricula to address health systems changes and challenges faced by health professionals. In particular, the focus has been on developing a competency-based curriculum to ensure graduates are able to address the needs and context of countries' health systems. [1] Celletti et al. [2] reported that 'insufficient collaboration between the health and education sectors creates a gap between professional education and the realities of health service delivery'. As a result, graduates are faced by a number of health systems challenges mostly related to lack of taught competencies to address them. Consequently, some graduates are migrating to where opportunities to grow are offered, resulting in maldistribution of health professionals, especially in low-and middle-income countries (LMIC). [3-5] A transformative approach to education is therefore essential to align educational institutions and health systems through curriculum reform to address neglected topics and local relevance in an integrated way. [6] This can be enhanced by placing contextually relevant training sites in, and recruiting medical students from, areas where doctors are most needed. [2] Studies have suggested that change in medical curriculum content (e.g. incorporating key competencies such as system-based and team-based approaches) may result not only in improved quality of healthcare but also in an improved healthcare system. [7-11] The Faculty of Medicine and Health Sciences (FMHS) of Stellenbosch University (SU) has adapted the CanMeds framework [12] as a foundation for the development of the 'graduate attributes' framework which was adopted in 2013. [13] The adoption of the graduate attributes has called for a change of the current medical curriculum through review and alignment to the graduate attributes and implementation of a community-based education (CBE) approach for medical graduate training to fulfil not only the role of medical expert, but also of scholar, health advocate, manager, collaborator, communicator and professional. [12] Towards supporting this approach, the SU Rural Medical Education Partnership Initiative (SURMEPI) undertook to review the content related to health systems research (HSR) (Box 1 below) and health systems strengthening in the undergraduate medical curriculum; to assess the perception of recent graduates about their preparedness to address health systems problems in their practice; and to obtain faculty perceptions about the teaching of HSR in the curriculum. All of this aimed to inform curriculum renewal to empower graduates to address challenges experienced while working, especially in rural and underserved areas. Background. Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) aims to enhance health systems knowledge and skills to empower medical graduates to address health systems challenges especially in rural and underserved areas. Objectives. To assess the content of health systems research (HSR) and strengthening, and understand perceptions of medical graduates and faculty about HSR in the undergraduate medical curriculum at Stellenbosch University. Methods. We defined HSR and strengthening competencies for medical graduates through a literature review and expert consultations. Learning outcomes in terms of knowledge, skill or attitude in the 64 module guides of the curriculum were compared with the competencies required. A survey of recent medical graduates assessed whether their training equipped them to address health systems challenges. Interviews with faculty assessed their views on teaching health systems competencies. Results. HSR foundational competencies were covered at a basic knowledge level, with little progression of learning levels, and several key competencies were not taught at all. Teaching was not integrated throughout the curriculum. Of 189 graduates, 63 (33.3%) agreed while 67 (35.4%) disagreed that their training prepared them to address health system challenges; 128 (67.7%) agreed on the importance of learning health systems competencies as undergraduates, and proposed learning areas of health system knowledge, leadership and management, problem solving, community service, evaluation methods and health economics. They wanted more practical, problem-oriented HSR training. Faculty supported the relevance and inclusion of HSR and strengthening in the curriculum. Conclusion. The curriculum needs adaptation to better equip students with HSR and strengthening competencies.
African Journal of Health Professions Education, 2015
Background: Medical education in the 21st century needs to produce health professionals who can respond to health systems challenges and population health needs. Although research on medical education is increasing, insufficient attention is paid to the outcomes of medical training, in particular graduates’ competencies and the effects of their training on healthcare and population health in Africa. Method: This baseline study assessed whether the current Stellenbosch University medical curriculum enabled graduates to acquire health systems strengthening competencies. The teaching of competencies in public health, evidence-based healthcare, health systems and services research, and infection prevention and control was assessed through a document review of study guides and a survey of recent medical graduates. Results: We found that teaching of most competencies was included in the curriculum, but appeared fragmented with a lack of continuity across phases of the curriculum. Health s...
South African Family Practice, 2012
Research has shown that rural-origin students are more likely to return to rural practice after completion of their studies. 3-6 Therefore, although the strategy of recruiting greater numbers of rural-origin students is gaining popularity, challenges remain. 7 Undergraduate exposure to rural settings has been identified as an important factor in students' decisions to practise rural medicine. 8 Smith et al 6 studied the factors that influenced undergraduate health science students' career aspirations and choice of practice and found that participation in rural health club activities and rural placement experiences was significant. Similar results were found in other studies. 9 The Rural Support Network (RSN) is an undergraduate student society that was formed in 1996 at the South African Medical Student Association general assembly at the University of Cape Town (UCT). The RSN aims to raise awareness among the UCT student body of the plight of rural health in South Africa. One of its objectives is to provide students with an insight into rural health and development by organising individual and group placements in rural hospitals during vacations. This paper describes a qualitative evaluation, from the students' perspective, of the 2010 RSN rural health placements in order to make recommendations for the
African journal of primary health care & family medicine, 2017
Rural hospitals in South Africa, as elsewhere, face enduring shortages of, and challenges in attracting and retaining, suitably qualified staff. The Wits Initiative for Rural Health Education (WIRHE), based at the University of the Witwatersrand but covering three universities, is a rural scholarship programme established to find local solutions to these challenges in the North West and Mpumalanga provinces. The purpose of this evaluation was to ascertain whether the WIRHE project was achieving its objectives. This article draws from an evaluation commissioned by the Swiss-South African Cooperative Initiative, a major funder of the programme when WIRHE was launched in 2003. Qualitative interviews were conducted either as face-to-face meetings or telephonically with 21 WIRHE students and graduates. Content analysis was undertaken to identify common themes. There was a consistency in the findings as the students and graduates reported similar experiences. Many of the participants were...
AIDS Care, 2014
Community health workers (CHWs) are important resources in health systems affected by the HIV/AIDS pandemic. International guidelines on task-shifting recommend that CHWs can provide diverse HIV services, ranging from HIV prevention to counselling patients for lifelong antiretroviral therapy. There is, however, little evidence on the experiences with CHW delivery of these services in Africa. This qualitative study included 102 interviews that explored experiences with information, education and communication (IEC) activities provided by CHWs within rural South Africa. Semistructured interviews were conducted with CHWs (n = 17), their clients (n = 33) and the primary caregivers of these clients (n = 30), allowing for data source triangulation. Twenty-two follow-up interviews explored emergent themes from preliminary interviews. Despite limited formal education and training, CHWs in this study were significant providers of IEC, including provision of generic health talks and HIV-specific information and facilitation to support clients' entry and maintenance in the formal health system. They often incorporated local knowledge and understanding of illness in their communication. CHWs in this study were able to bridge the lifeworlds of the community and the formal services to expedite access and adherence to local clinics and other services. As mediators between the two worlds, CHWs reinterpreted health information to make it comprehensible in their communities. With growing formalisation of CHW programmes in South Africa and elsewhere, CHWs' important role in health service access, health promotion and health maintenance must be recognised and supported in order to maximise impact.
‘Processes in widening access to undergraduate Allied Health Sciences education in South Africa’
African Journal of Health Professions Educaton, 2012
The purpose of this manuscript is to describe the processes followed in initiating and managing widening access to allied health sciences education at the University of Cape Town, South Africa. In response to national higher education policy imperatives in South Africa and in anticipation of the first cohort of Outcome Based Education (OBE) school leavers entering tertiary education, the School of Health and Rehabilitation Sciences at the university launched an extensive intra-and cross-programme transformation project in 2004. The project afforded four undergraduate professional programmes, namely audiology, occupational therapy, physiotherapy and speech therapy, an opportunity to address common educational and contextual drivers. These included, among others, the need for increased access and throughput of historically under-represented students in higher education. An advisory task team, named the curriculum review management team (CRMT), was engaged in envisaging, navigating and containing a complex sociopolitical process involving many stakeholders with disparate ideas, practice approaches, and focal concerns. The use of the Gale and Grant model of change management, augmented by the Community of Practice conceptual framework, to assist with these processes is described.