Browsing by Author "Cilliers, Francois"
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- ItemOpen AccessCurriculum renewal in acute care: a South African based study for returning Cuban-trained students(2025) Khan, Waseela; Jansen, Marvin; Cilliers, FrancoisBackground: Emergency Care plays an integral role in Universal Health Coverage (UHC), yet several limitations have been identified in Low- and Middle-Income Countries (LMIC), one of which is the lack of dedicated, integrated curricula. In 1996 the Nelson Mandela Fidel Castro (NMFC) student program was developed in response to societal health needs for equitable health care in rural and under-served areas, affirmative action, and the low doctor-to-population ratios nationally. Cuban medical education is Primary Health Care focussed and not aligned with Acute Care competencies. This study explores the NMFC students' needs, the barriers to learning, and the role of transition in this process, as a first integral step in curriculum renewal in Acute Care. Methods: A qualitative approach of focus group interviews with 18 UCT NMFC students and semi-structured interviews with preceptors was conducted. Data was then analysed thematically and with the lens of the chosen theoretical framework framed by Transition theory and Situated Learning theory. Results: The findings indicate that skills and simulation-based teaching methodologies are favoured. A structured orientation within an Acute Care transition program and supervised and integrated workplace supervision is needed. Barriers to student learning include time, a perceived sense of ‘othering,' and educational ‘differences' to Cuban training. NMFC students were identified for their willingness to learn. Preceptors further identified a lack of dedicated time for Acute Care and a lack of resources as barriers to facilitation. Conclusions: As socially responsible educators we must be considerate of student needs and respond with a robust curriculum. The challenge is designing a curriculum in Acute Care that addresses the specific learning needs of a group of designated adult learners from previously disadvantaged backgrounds, transitioning between institutions with different educational outcomes, in the care of undifferentiated critically ill patients, within the short timeframes in resource-constrained educational and health institutions. Recommendations include the addition of a robust transition program to integrate, orientate and scaffold Acute Care knowledge and skills deficits. The curriculum must include skills and simulation-based methodologies for ‘hands-on' practice, opportunities for self-directed learning, and situated learning within supportive communities of practice.
- ItemUnknownFactors influencing lecturer assessment practice in diverse southern contexts(2020) Sims, Danica Anne; Cilliers, FrancoisAssessment practice in Health Professionals Education (HPE) has serious consequences for the student and public as it impacts on student learning and outcomes, ultimately certifying a graduate as safe for public practice, and thereby affecting patient care. The goal is for assessment to be practiced in such a way as to drive student learning and outcomes in a desirable manner using assessment to help contribute to the creation of powerful learning environments. Critically, this may not take place without the assessor. In resource-constrained, Southern contexts, the individual lecturer is usually responsible for practicing assessment, as opposed to a collective assessment committee. It is crucially important to explore how lecturers practice assessment and if their practice positively drives learning. Although lecturers are the key role players in assessment practice in the South, little is known of lecturer HPE assessment practice in the global South. Additionally, these lecturers in HPE generally have no or little formal training in assessment. There is a need for evidencebased, theory-informed, valid and appropriate interventions for faculty training and continued professional development that target lecturer assessment practice. I propose that lecturer assessment practice is a behaviour, and that how lecturers' think of assessment (their underlying understanding or conceptions, including assessment literacy) and interacting factors (personal and contextual influences), shape their assessment behaviour. In order to explore this behaviour, the conceptual frameworks of Health Behaviour Theory (HBT) and Southern Theory were employed as theoretical underpinnings guide this research study into lecturer assessment practice in the global South. To this end, using purposive and maximum variant sampling, lecturers in diverse Southern contexts were interviewed (South Africa and Mexico) and lecturers' conceptions of assessment and factors influencing their assessment practice were identified and described in a Phenomenographic outcome space and novel HBT-derived model of lecturer assessment practice respectively. The findings from this study, while needing to undergo further validation in additional Southern contexts, may assist in guiding the design and implementation of strategic and targeted faculty assessment training interventions to enhance lecturer assessment practice leading to the creation of powerful learning environments, thereby improving student outcomes and ultimately improving patient care.
- ItemOpen AccessThe impact of a training programme incorporating the conceptual framework of the International Classification of Functioning (ICF) on knowledge and attitudes regarding interprofessional practice in Rwandan health professionals: a cluster randomized control trial(2021-03-01) Sagahutu, Jean B; Kagwiza, Jeanne; Cilliers, Francois; Jelsma, JenniferBackground The first step in improving interprofessional teamwork entails training health professionals (HP) to acknowledge the role and value the contribution of each member of the team. The International Classification of Functioning, Disability and Health (ICF) has been developed by WHO to provide a common language to facilitate communication between HPs. Objective To determine whether ICF training programme would result in improved knowledge and attitudes regarding interprofessional practice within Rwandan district hospitals. Design, setting and participants A cluster randomised, single blinded, control trial design was used to select four district hospitals. Participants included physicians, social workers, physiotherapists, nutritionists, clinical psychologists/mental health nurses. Intervention Health professionals either received one day’s training in interprofessional practice (IPP) based on the ICF (experimental group) as a collaborative framework or a short talk on the topic (control group). Outcome measures Validated questionnaires were used to explore changes in knowledge and attitudes. Ethical approval was obtained from the relevant authorities. Results There were 103 participants in the experimental and 100 in the control group. There was no significant difference between Knowledge and Attitude scales at baseline. Post-intervention the experimental group (mean = 41.3, SD = 9.5) scored significantly higher on the knowledge scale than the control group (mean = 17.7, SD = 4.7 (t = 22.5; p < .001)). The median scores on the Attitude Scale improved in the Experimental group from 77.8 to 91.1%, whereas the median scores of the control remained approximately 80% (Adjusted Z = 10.72p < .001). Conclusion The ICF proved to be a useful framework for structuring the training of all HPs in IPP and the training resulted in a significant improvement in knowledge and attitudes regarding IPP. As suggested by the HPs, more training and refresher courses were needed for sustainability and the training should be extended to other hospitals in Rwanda. It is thus recommended that the framework can be used in interprofessional education and practice in Rwanda and possibly in other similar countries. Trial registration Name of the registry: Pan African Clinical Trial Registry. Trial registration number: PACTR201604001185358 . Date of registration: 22/04/2016. URL of trial registry record: www.pactr.org
- ItemUnknownOptimizing learning & teaching on paediatric ward rounds(2023) Mantzor, Savarra; Cilliers, FrancoisBandura's Social Cognitive Theory asserts that an individual's perceptions of his/her self-efficacy influence not only their ability to learn knowledge and skill, but more importantly, influences their ability to act utilizing that knowledge or skill. In the context of health professional education, it is not enough to know the facts of medicine, but learners must also have a positive perception of their selfefficacy in order to practice medicine as a competent physician. The aim of this study was to improve the quality of ward round learning and teaching for University of Botswana medical trainees working in the Department of Paediatrics at Princess Maria Hospital in order to enhance their self-efficacy beliefs regarding their ability to provide paediatric patient care. Specifically, we utilized a threepronged approach to 1) improve trainees' participation in, and sense of belonging to, a local community of clinical practice, 2) introduce a structured bedside teaching model, and 3) promote a favourable clinical learning environment, all of which we postulated could improve trainees' selfefficacy beliefs. In this research I assert that four educational elements, (i) the method of teaching (i.e. bedside teaching), (ii) the environment in which learning occurs (i.e. the clinical learning environment), (iii) the epistemological value of social participation (i.e. communities of practice), and (iv) an individual's ability to both acquire and utilize their knowledge (i.e. perceived self-efficacy), are not distinct phenomena, but are interrelated, dynamic forces that influence each other in meaningful ways. This study was conducted as an action research (AR) project using mixed methods evaluation for data capture and analysis. Following the iterative Plan-Act-Observe-Reflect cycles of action research, a total of three phases occurred. In Phase 1, we developed an in-depth understanding of trainees' and faculty's perceptions of the prevailing paediatric ward rounds. In Phase 2, through ongoing departmental collaboration and review of the literature, we conceptually analysed the findings from Phase 1 to determine specific interventions for Phase 3. In Phase 3, we implemented the Phase 2 generated solutions, including the introduction of a structured bedside teaching model, SNAPPS (Summarize-Narrow-Analyse-Probe-Plan-Select); this was subsequently adapted to provide local and contextual relevance. Throughout all Phases, we conducted serial measurements of trainees' perceptions of (i) the clinical learning environment (CLE) on ward rounds, (ii) their sense of participation in, and belonging to, the community of practice on ward rounds (COP); and (iii) their perceived self-efficacy (PSE) to provide paediatric patient care. The types of study instruments and data sources included focus group discussions, interviews, debriefs, my action research journal, and questionnaires. Four consecutive types of data analysis occurred throughout the project: qualitative data analysis, quantitative data analysis, mixed methods integration, and critical reflection. Over the 28-month study period, there was a total of 208 participants, including representation from faculty, senior residents, junior residents, and medical students. There were three primary outcomes of this action research project. 1) Trainee use of SNAPPS was associated with (i) a CLE that was more favourable to respecting uncertainty; (ii) an increase in trainees' participation in and, sense of belonging to, a paediatric ward round; and (iii) positive influences on their perceived self-efficacy to manage patients. 2) We identified several non-traditional uses of SNAPPS that created opportunities for trainees to learn and faculty to teach beyond the primary diagnosis. 3) In contrast to the literature, we were unsuccessful at introducing SNAPPS at a department-wide level. Note, when I first set out to do this research, I postulated that bedside teaching, the clinical learning environment, and participation in a community of practice all had the potential to influence an individual's perceived self-efficacy. I assumed that while bedside teaching models (BTM) provide a structured approach to student engagement to enhance the content of bedside teaching, they do not, in and of themselves, regulate the clinical learning environment in which they occur. I did not consider the influence of a BTM on a learner's sense of belonging to a community of clinical practice. Through the findings of this project, I discovered the power of the BTM itself, which shifted the foci of influence, that not only does it have the potential to positively influence learner's PSE, but indeed has direct influential effects on the CLE and elements of COP. These findings compliment and broaden my original assumptions that the educational dimensions involved are not isolated elements, but together simultaneously impact learning and teaching. Note, during the course of this project, my positionality as the researcher underwent considerable shifts from “outsider” conducting “participatory action research” to “insider” conducting “practitioner research”. In turn, an unexpected secondary aim and outcome developed – to explore, understand and articulate the influences of SNAPPS on my own practice as a physician and clinical teacher. Limitations included: over utilization of traditional research instruments and analysis; lack of quality control of the implemented intervention; difficulty in interpreting results; delays in important critical reflections during the project; inability to achieve full collaboration with other department members; and unsuccessful attempt to introduce SNAPPS department-wide. Based on the findings from this study, a structured bedside teaching model, specifically SNAPPS, offers a holistic approach to maximize learning and teaching, addressing several learner and environmental needs concurrently. That said, when clinical teachers set out to introduce SNAPPS, they ought to be prepared to offer ongoing support for the successful implementation beyond a brief SNAPPS sensitization. The flexibility and potential advantages of SNAPPS promotes its use, especially in clinically challenging teaching environments.
- ItemOpen AccessOptimizing learning & teaching on paediatric ward rounds(2023) Mantzor, Savarra; Cilliers, FrancoisBandura's Social Cognitive Theory asserts that an individual's perceptions of his/her self-efficacy influence not only their ability to learn knowledge and skill, but more importantly, influences their ability to act utilizing that knowledge or skill. In the context of health professional education, it is not enough to know the facts of medicine, but learners must also have a positive perception of their selfefficacy in order to practice medicine as a competent physician. The aim of this study was to improve the quality of ward round learning and teaching for University of Botswana medical trainees working in the Department of Paediatrics at Princess Maria Hospital in order to enhance their self-efficacy beliefs regarding their ability to provide paediatric patient care. Specifically, we utilized a threepronged approach to 1) improve trainees' participation in, and sense of belonging to, a local community of clinical practice, 2) introduce a structured bedside teaching model, and 3) promote a favourable clinical learning environment, all of which we postulated could improve trainees' selfefficacy beliefs. In this research I assert that four educational elements, (i) the method of teaching (i.e. bedside teaching), (ii) the environment in which learning occurs (i.e. the clinical learning environment), (iii) the epistemological value of social participation (i.e. communities of practice), and (iv) an individual's ability to both acquire and utilize their knowledge (i.e. perceived self-efficacy), are not distinct phenomena, but are interrelated, dynamic forces that influence each other in meaningful ways. This study was conducted as an action research (AR) project using mixed methods evaluation for data capture and analysis. Following the iterative Plan-Act-Observe-Reflect cycles of action research, a total of three phases occurred. In Phase 1, we developed an in-depth understanding of trainees' and faculty's perceptions of the prevailing paediatric ward rounds. In Phase 2, through ongoing departmental collaboration and review of the literature, we conceptually analysed the findings from Phase 1 to determine specific interventions for Phase 3. In Phase 3, we implemented the Phase 2 generated solutions, including the introduction of a structured bedside teaching model, SNAPPS (Summarize-Narrow-Analyse-Probe-Plan-Select); this was subsequently adapted to provide local and contextual relevance. Throughout all Phases, we conducted serial measurements of trainees' perceptions of (i) the clinical learning environment (CLE) on ward rounds, (ii) their sense of participation in, and belonging to, the community of practice on ward rounds (COP); and (iii) their perceived self-efficacy (PSE) to provide paediatric patient care. The types of study instruments and data sources included focus group discussions, interviews, debriefs, my action research journal, and questionnaires. Four consecutive types of data analysis occurred throughout the project: qualitative data analysis, quantitative data analysis, mixed methods integration, and critical reflection. Over the 28-month study period, there was a total of 208 participants, including representation from faculty, senior residents, junior residents, and medical students. There were three primary outcomes of this action research project. 1) Trainee use of SNAPPS was associated with (i) a CLE that was more favourable to respecting uncertainty; (ii) an increase in trainees' participation in and, sense of belonging to, a paediatric ward round; and (iii) positive influences on their perceived self-efficacy to manage patients. 2) We identified several non-traditional uses of SNAPPS that created opportunities for trainees to learn and faculty to teach beyond the primary diagnosis. 3) In contrast to the literature, we were unsuccessful at introducing SNAPPS at a department-wide level. Note, when I first set out to do this research, I postulated that bedside teaching, the clinical learning environment, and participation in a community of practice all had the potential to influence an individual's perceived self-efficacy. I assumed that while bedside teaching models (BTM) provide a structured approach to student engagement to enhance the content of bedside teaching, they do not, in and of themselves, regulate the clinical learning environment in which they occur. I did not consider the influence of a BTM on a learner's sense of belonging to a community of clinical practice. Through the findings of this project, I discovered the power of the BTM itself, which shifted the foci of influence, that not only does it have the potential to positively influence learner's PSE, but indeed has direct influential effects on the CLE and elements of COP. These findings compliment and broaden my original assumptions that the educational dimensions involved are not isolated elements, but together simultaneously impact learning and teaching. Note, during the course of this project, my positionality as the researcher underwent considerable shifts from “outsider” conducting “participatory action research” to “insider” conducting “practitioner research”. In turn, an unexpected secondary aim and outcome developed – to explore, understand and articulate the influences of SNAPPS on my own practice as a physician and clinical teacher. Limitations included: over utilization of traditional research instruments and analysis; lack of quality control of the implemented intervention; difficulty in interpreting results; delays in important critical reflections during the project; inability to achieve full collaboration with other department members; and unsuccessful attempt to introduce SNAPPS department-wide. Based on the findings from this study, a structured bedside teaching model, specifically SNAPPS, offers a holistic approach to maximize learning and teaching, addressing several learner and environmental needs concurrently. That said, when clinical teachers set out to introduce SNAPPS, they ought to be prepared to offer ongoing support for the successful implementation beyond a brief SNAPPS sensitization. The flexibility and potential advantages of SNAPPS promotes its use, especially in clinically challenging teaching environments.
- ItemOpen AccessUse of the International Classification of Functioning Disability and Health (ICF) as a theoretical framework to inform interprofessional assessment and management by health care professionals in Rwanda.: a cluster randomised control trial(2018) Sagahutu; Jean Baptiste; Jelsma, Jennifer; Cilliers, Francois; Kagwiza, JeanneBackground: Effective collaboration between health professionals can reduce medical errors and assist in interpretation of health information resulting in improved patient care. The International Classification of Functioning, Disability and Health (ICF) has been suggested as a potential framework to help health professionals develop a common language for better collaboration and to provide more holistic care. In the main, Rwandan district hospitals still utilise the hierarchical medical model of health. Aim: The aim of the study was to determine whether training on interprofessional practice, using the ICF framework, resulted in improved knowledge, attitudes and behaviour(as determined by improved recording of interprofessional assessment and management in patient records) in randomly selected Rwandan District Hospitals. Methodology: This study was composed of two phases. Phase I: Preparation. The intervention programme was developed based on a literature review and input from an international panel of experts. A feasibility study in which self-designed instruments and the training programme were tested was undertaken in one district hospital. Phase II: A Cluster Randomised Control Trial. Four district hospitals were randomly allocated to receive a day’s training in interprofessional practice using the ICF (experimental hospitals) or a short talk on the topic (control hospital). Participants included medical doctors, nurses, physiotherapists, social workers, nutritionists, and mental health nurses/clinical psychologists. Using self-designed and validated measures, pre- and postmeasurements of knowledge and attitudes towards Interprofessional Practice (IPP) were performed at baseline and after training and audit of patients’ records after discharge was performed at baseline and at two, four and six months. The independent t-test and Mann-Whitney U test were used to establish if the two sets of groups were equivalent before and after training at baseline and at two, four and six months. Repeated measures ANOVA and the post-hoc Tukey test were used to compare the audit scores at each time point. The Kruskal Wallis test was used to compare rankings of the scores of attitudes of different professions before and after the intervention. Ethical approval was obtained from the Human Research Ethics Committee of the University of Cape Town and the Rwandan National Ethics Committee.