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Communities’ views, attitudes and recommendations on community-based education of undergraduate Health Sciences students in South Africa: A qualitative study

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      Abstract

      BackgroundMedical and Health Sciences students in South Africa undertake community-based education (CBE). Health professionals based at host sites are jointly responsible for training of these students in conjunction with university staff. This study explored the communities’ views, attitudes and recommendations regarding CBE undertaken by these students, in order to improve the quality of community support for these programmes.MethodA qualitative descriptive study was conducted at CBE placement sites of students from the Faculties of Health Sciences of the University of Limpopo (UL), University of KwaZulu-Natal (UKZN) and University of the Western Cape (UWC) during 2010 and 2011. Focus group discussions were held with site facilitators, community leaders and patients, and interviews were audio recorded, transcribed and translated into English where necessary. Data were analysed using NVivo (version 9).FindingsCBE was seen to benefit communities, students and host institutions as there was perceived improvement of service delivery, better referral to hospitals and reduction of workloads on site staff. CBE was also seen as having potential for recruiting professionals who have better orientation to the area, and for motivating school pupils for a career in health sciences. Students acquired practical skills and gained confidence and experience. Challenges included poor communication between universities and host sites, burden of student teaching on site facilitators, cultural and religious sensitivity of students and language barriers.ConclusionThe study revealed that communities have an important role to play in the CBE of future health care professionals. CBE activities could be better organised and managed through formalised partnerships.

      Abstrait

      Les points de vue, les attitudes et les recommandations des communautés sur l'enseignement communautaire suivi par des étudiants de premier cycle en Sciences de la santé en Afrique du Sud : Une étude qualitative ContexteEn Afrique du Sud, des étudiants en médecine et en sciences de la santé suivent un enseignement communautaire. Des professionnels de la santé basés sur des sites d'accueil partagent la responsabilité de former ces étudiants conjointement avec un personnel universitaire. Cette étude a analysé les points de vue, les attitudes et les recommandations des communautés sur l'enseignement communautaire suivi par ces étudiants, en vue d'améliorer la qualité du soutien communautaire en faveur de ces programmes.MéthodeUne étude qualitative descriptive a été réalisée en 2010 et 2011 sur les sites d'enseignement communautaire auprès d’étudiants venant des facultés des sciences de la santé de l'université du Limpopo, de l'université du KwaZulu-Natal et de l'université du Cap occidental. Les discussions des groupes de discussion ont été organisées avec des facilitateurs sur le site, des responsables communautaires et des patients, et les entretiens ont été enregistrés, retranscrits et traduits en anglais si nécessaire. Les données ont été analysées en utilisant NVivo (version 9).RésultatsL'enseignement communautaire est considéré comme bénéficiant aux communautés, aux étudiants et aux institutions d'accueil en raison d'une amélioration perçue des prestations de service, d'une meilleure orientation vers les hôpitaux et d'une réduction de la charge de travail du personnel sur place. On considère également que l'enseignement communautaire a des effets positifs sur le recrutement des professionnels qui seront mieux orientés vers la région, et sur la motivation des élèves à s'engager vers une carrière dans les sciences de la santé. Les étudiants ont acquis des compétences pratiques, une confiance en eux et de l'expérience. Les défis rencontrés sont une faible communication entre les universités et les sites d'accueil, le fardeau de l'enseignement pour les facilitateurs sur place, les sensibilités culturelles et religieuses des étudiants et les barrières de la langue.ConclusionL’étude a montré que les communautés ont un rôle important à jouer dans l'enseignement communautaire des futurs professionnels de la santé. Les activités de l'enseignement communautaire pourraient être mieux organisées et gérées par le biais de partenariats officiels.

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      Qualitative researcher and evaluation methods

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        How can experience in clinical and community settings contribute to early medical education? A BEME systematic review.

        Review period January 1992-December 2001. Final analysis July 2004-January 2005. BACKGROUND AND REVIEW CONTEXT: There has been no rigorous systematic review of the outcomes of early exposure to clinical and community settings in medical education. OBJECTIVES OF REVIEW: Identify published empirical evidence of the effects of early experience in medical education, analyse it, and synthesize conclusions from it. Identify the strengths and limitations of the research effort to date, and identify objectives for future research. Ovid search of: BEI, ERIC, Medline, CINAHL and EMBASE Additional electronic searches of: Psychinfo, Timelit, EBM reviews, SIGLE, and the Cochrane databases. Hand-searches of:Medical Education, Medical Teacher, Academic Medicine, Teaching and Learning in Medicine, Advances in Health Sciences Education, Journal of Educational Psychology. Authentic (real as opposed to simulated) human contact in a social or clinical context that enhances learning of health, illness and/or disease, and the role of the health professional. Early: What would traditionally have been regarded as the preclinical phase, usually the first 2 years. Inclusions: All empirical studies (verifiable, observational data) of early experience in the basic education of health professionals, whatever their design or methodology, including papers not in English. Evidence from other health care professions that could be applied to medicine was included. Not empirical; not early; post-basic; simulated rather than 'authentic' experience. Careful validation of selection processes. Coding by two reviewers onto an extensively modified version of the standard BEME coding sheet. Accumulation into an Access database. Secondary coding and synthesis of an interpretation. A total of 73 studies met the selection criteria and yielded 277 educational outcomes; 116 of those outcomes (from 38 studies) were rated strong and important enough to include in a narrative synthesis of results; 76% of those outcomes were from descriptive studies and 24% from comparative studies. Early experience motivated and satisfied students of the health professions and helped them acclimatize to clinical environments, develop professionally, interact with patients with more confidence and less stress, develop self-reflection and appraisal skill, and develop a professional identity. It strengthened their learning and made it more real and relevant to clinical practice. It helped students learn about the structure and function of the healthcare system, and about preventive care and the role of health professionals. It supported the learning of both biomedical and behavioural/social sciences and helped students acquire communication and basic clinical skills. There were outcomes for beneficiaries other than students, including teachers, patients, populations, organizations and specialties. Early experience increased recruitment to primary care/rural medical practice, though mainly in US studies which introduced it for that specific purpose as part of a complex intervention. Early experience helps medical students socialize to their chosen profession. It helps them acquire a range of subject matter and makes their learning more real and relevant. It has potential benefits for other stakeholders, notably teachers and patients. It can influence career choices.
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          Collaborations for Leadership in Applied Health Research and Care: lessons from the theory of communities of practice

          Background The paper combines the analytical and instrumental perspectives on communities of practice (CoPs) to reflect on potential challenges that may arise in the process of interprofessional and inter-organisational joint working within the Collaborations for Leaderships in Applied Health Research and Care (CLAHRCs)--partnerships between the universities and National Health Service (NHS) Trusts aimed at conducting applied health research and translating its findings into day-to-day clinical practice. Discussion The paper discusses seminal theoretical literature on CoPs as well as previous empirical research on the role of these communities in healthcare collaboration, which is organised around the following three themes: knowledge sharing within and across CoPs, CoP formation and manageability, and identity building in CoPs. It argues that the multiprofessional and multi-agency nature of the CLAHRCs operating in the traditionally demarcated organisational landscape of the NHS may present formidable obstacles to knowledge sharing between various professional groupings, formation of a shared 'collaborative' identity, and the development of new communities within the CLAHRCs. To cross multiple boundaries between various professional and organisational communities and hence enable the flow of knowledge, the CLAHRCs will have to create an effective system of 'bridges' involving knowledge brokers, boundary objects, and cross-disciplinary interactions as well as address a number of issues related to professional and organisational identification. Summary The CoP approach can complement traditional 'stage-of-change' theories used in the field of implementation research and provide a basis for designing theory-informed interventions and evaluations. It can help to illuminate multiple boundaries that exist between professional and organisational groups within the CLAHRCs and suggest ways of crossing those boundaries to enable knowledge transfer and organisational learning. Achieving the aims of the CLAHRCs and producing a sustainable change in the ways applied health research is conducted and implemented may be influenced by how effectively these organisations can navigate through the multiple CoPs involved and promote the development of new multiprofessional and multi-organisational communities united by shared practice and a shared sense of belonging--an assumption that needs to be explored by further empirical research.
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            Author and article information

            Affiliations
            [1 ]Department of Family Medicine and Primary Health Care, University of Limpopo, South Africa
            [2 ]Department of Rural Health, University of KwaZulu-Natal, South Africa
            [3 ]Primary Health Care, University of Cape Town, South Africa
            [4 ]Department of Public Health, University of Limpopo, South Africa
            [5 ]School of Health Sciences, University of KwaZulu-Natal, South Africa
            [6 ]Faculty of Community and Health Sciences, University of the Western Cape, South Africa
            [7 ]Community Engagement Unit, University of the Western Cape, South Africa
            [8 ]Centre for Rural Health, University of KwaZulu-Natal, South Africa
            Author notes
            Correspondence to: Langalibalele Mabuza Email: honeymanyosi@ 123456gmail.com , Postal Address: PO Box 222, Medunsa, 0204, South Africa.

            How to cite this article: Mabuza LH, Diab P, Reid SJ et al. Communities’ views, attitudes and recommendations on community-based education of undergraduate health sciences students in South Africa: A qualitative study.Afr J Prm Health Care Fam Med. 2013;5(1), Art. #456, 9 pages. http://dx.doi.org/10.4102/phcfm.v5i1.456

            Journal
            Afr J Prim Health Care Fam Med
            Afr J Prim Health Care Fam Med
            PHCFM
            African Journal of Primary Health Care & Family Medicine
            AOSIS OpenJournals
            2071-2928
            2071-2936
            11 June 2013
            2013
            : 5
            : 1
            4565441
            PHCFM-5-456
            10.4102/phcfm.v5i1.456
            © 2013. The Authors

            AOSIS OpenJournals. This work is licensed under the Creative Commons Attribution License.

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