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Consequences, conditions and caveats: a qualitative exploration of the influence of undergraduate health professions students at distributed clinical training sites

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      Abstract

      BackgroundTraditionally, the clinical training of health professionals has been located in central academic hospitals. This is changing. As academic institutions explore ways to produce a health workforce that meets the needs of both the health system and the communities it serves, the placement of students in these communities is becoming increasingly common. While there is a growing literature on the student experience at such distributed sites, we know less about how the presence of students influences the site itself. We therefore set out to elicit insights from key role-players at a number of distributed health service-based training sites about the contribution that students make and the influence their presence has on that site.MethodsThis interpretivist study analysed qualitative data generated during twenty-four semi-structured interviews with facility managers, clinical supervisors and other clinicians working at eight distributed sites. A sampling grid was used to select sites that proportionally represented location, level of care and mix of health professions students. Transcribed data were subjected to thematic analysis. Following an iterative process, initial analyses and code lists were discussed and compared between team members after which the data were coded systematically across the entire data set.ResultsThe clustering and categorising of codes led to the generation of three over-arching themes: influence on the facility (culturally and materially); on patient care and community (contribution to service; improved patient outcomes); and on supervisors (enriched work experience, attitude towards teaching role). A subsequent stratified analysis of emergent events identified some consequences of taking clinical training to distributed sites. These consequences occurred when certain conditions were present. Further critical reflection pointed to a set of caveats that modulated the nature of these conditions, emphasising the complexity inherent in this context.ConclusionsThe move towards training health professions students at distributed sites potentially offers many affordances for the facilities where the training takes places, for those responsible for student supervision, and for the patients and communities that these facilities serve. In establishing and maintaining relationships with the facilities, academic institutions will need to be mindful of the conditions and caveats that can influence these affordances.

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      Most cited references 31

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      Using thematic analysis in psychology

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        Health professionals for a new century: transforming education to strengthen health systems in an interdependent world.

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          Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study.

          Qualitative content analysis and thematic analysis are two commonly used approaches in data analysis of nursing research, but boundaries between the two have not been clearly specified. In other words, they are being used interchangeably and it seems difficult for the researcher to choose between them. In this respect, this paper describes and discusses the boundaries between qualitative content analysis and thematic analysis and presents implications to improve the consistency between the purpose of related studies and the method of data analyses. This is a discussion paper, comprising an analytical overview and discussion of the definitions, aims, philosophical background, data gathering, and analysis of content analysis and thematic analysis, and addressing their methodological subtleties. It is concluded that in spite of many similarities between the approaches, including cutting across data and searching for patterns and themes, their main difference lies in the opportunity for quantification of data. It means that measuring the frequency of different categories and themes is possible in content analysis with caution as a proxy for significance. © 2013 Wiley Publishing Asia Pty Ltd.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Centre for Health Professions Education, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Stellenbosch, South Africa
            [2 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Stellenbosch, South Africa
            [3 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Stellenbosch, South Africa
            [4 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, MB,ChB Unit, Faculty of Medicine and Health Sciences, , Stellenbosch University, ; Stellenbosch, South Africa
            Contributors
            ORCID: http://orcid.org/0000-0003-1596-6791, scvs@sun.ac.za
            ORCID: http://orcid.org/0000-0001-5229-3907, juliablitz@sun.ac.za
            ORCID: http://orcid.org/0000-0003-1587-6075, icouper@sun.ac.za
            ORCID: http://orcid.org/0000-0001-5431-3801, mrdv@sun.ac.za
            guin@sun.ac.za
            ORCID: http://orcid.org/0000-0002-3225-6268, janamuller@sun.ac.za
            ORCID: http://orcid.org/0000-0003-4570-9729, bbvh@sun.ac.za
            Journal
            BMC Med Educ
            BMC Med Educ
            BMC Medical Education
            BioMed Central (London )
            1472-6920
            19 December 2018
            19 December 2018
            2018
            : 18
            30567523
            6299970
            1412
            10.1186/s12909-018-1412-y
            © The Author(s). 2018

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: Fund for Innovation and Research in Rural Health
            Award ID: n/a
            Categories
            Research Article
            Custom metadata
            © The Author(s) 2018

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