Browsing by Department "Department of Health Sciences Education"

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    A detailed study of persons admitted to the spinal unit of conradie hospital, Pinelands, Cape, during 1985.
    (1988) KETTLES_AN; Klopper, Jack
    Part I of this study has highlighted certain aspects pertaining to the patients admitted to the Spinal Cord Unit at the Conradie Hospital, Pinelands, with Spinal Cord Injury (s.c.i.). The main points of interest are as follows: 0 The majority of victims of s.c.i. in this series are young men, mainly Black or Coloured, with a low educational and poor employment status, with little in the way of pension or sick leave benefits. 0 Post injury employment opportunities are very limited, as are vocational training facilities. 0 The main causes of injury are examined, and while Motor Vehicle Accidents, Falls and Gunshot wounds are commonly described in the literature as causes of s.c.i., what is unique at the Conradie Hospital is the high percentage of stab wounds (29,6%) causing spinal cord lesions. 0 The method of injury in patients coming from Cape Town is compared and contrasted with the methods of injury in other areas. 0 The levels of the cord lesions and the clinical sequelae are analysed, and while Tetraplegia and Paraplegia are well described in all series on spinal cord injuries, this series is unique in the large number of Brown-Sequard type lesions (36, or 12,7% of all patients) that exist, associated with the large number of stab wounds.
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    A social realist study of the mechanisms that condition lecturers emerging assessment practices
    (2022) Pienaar, Lunelle L; Behari-Leak, Kasturi; Kathard, Harsha
    Assessment as part of the enacted curriculum is underscored by the professional judgement of the lecturer, who decides on the body of knowledge that should be learned. A vacuum exists in understanding how the practice of assessment is shaped by the lecturer and between the social groups within departments and the academic institution at large, as well as the transformational policies within the higher education space. Assessment is a key driver to advance a socially just medical curriculum, especially in the context of the legacy of colonialism and apartheid in South Africa (SA). Using the existing body of knowledge about assessment from the global North, without re-contextualising it for a South African context, has led to decontextualised practices that treat assessment as a one-size- fits-all phenomenon. In this study, the influences on lecturers' assessment practices within an undergraduate medical programme were explored. Enabled by the critical realist paradigm, this study sought to illuminate the structural and cultural mechanisms that enabled or constrained medical lecturers' assessment practice. Margaret Archer's social realist theory was used to theorise assessment by using analytical dualism and giving powers and properties to structure, culture, and agency independently, as a way to explore and critically analyse the mechanisms that condition lecturers' assessment practice. Using collective case study design, individual interviews were conducted, and the assessment documentation was gathered from six lecturers in the medical programme at one institution. Narratives from two pre-clinical and four clinical lecturers and the assessment documentation were analysed to provide a way to better understand the influences guiding lecturers' assessment practices. More importantly, how lecturers exercise their personal emergent powers and properties to enact assessment was examined. The analysis shows that the interplay of the systemic mechanisms that emerged in the assessment practice of lecturers set up complex choices for the transformation of assessment. In the context of historic transformation imperatives and the student protests, the study's findings show that lecturers exercised their agential powers and properties to elaborate the ideas and theories towards conventional evidence-based assessment practices that were predominantly teacher-led. Lecturers relied on their own experience of assessment, learning about assessment formally in education programmes and informally through colleagues and courses. However, the systemic constraints such as timetabling, limited integration, disciplinary power, insufficient human, and financial resources to innovate and transform assessment, encouraged choices that were ill aligned to inclusive assessment practices. The support of lecturers' assessment endeavours is desperately needed at all levels, national, institutional, departmental and programmatic, to transform assessment practice. The findings highlight the need for re-evaluation of current interventions to elevate the ontological and epistemological issues. The results have implications for the design of staff development activities and the way assessment is designed, created, and administered.
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    Clinical education in physiotherapy: The experiences of final year students workplace-based learning at the University of Cape Town
    (2022) Timothy, Nastassia; Pienaar, Lunelle; Manie, Shamila
    Clinical education in the profession of Physiotherapy involves the teaching and training of students in real life clinical settings such as hospitals and clinics. The pedagogical support that Physiotherapy students receive in clinical settings is both formal and informal (Dornan, 2012). In the South African context and at the University of Cape Town (UCT), educational and professional support is provided to Physiotherapy students by both academic representatives from the university, clinical educators, and physiotherapy clinicians who are employed by the clinical site in which the clinical education occurs. The phenomenon of clinical education in Physiotherapy is well described in literature emanating from the global North, with fewer studies focused on the learning experiences of students in the South African context. Aligning with the need for curriculum transformation, specifically in this study landscape which is Physiotherapy at UCT, a better understanding of learning on the clinical platform is warranted. This study was conceptualised and conducted through an interpretivist lens and by drawing on the theoretical underpinnings of Lave and Wenger's (1991) Situated Learning Theory (SLT) and Communities of Practice (CoP). Encompassed within SLT is an understanding that learning is not isolated and internal but rather a social process which is dependent on interactions with others and the context in which the learning takes place (Jackson, 2007). Thus this study set out to determine how sociocultural and contextual elements influence learning experiences of final year Physiotherapy students during their clinical placements. This was done by the use of a qualitative, cross-sectional exploratory study design as this was determined to best capture the experiences of students (Austin & Sutton, 2014). Research data was collected by the use of both video diaries and follow-up semi-structured interviews with the six study participants. Discourse Analysis was used to analyse the data, using an analysis framework informed by concepts from both the theoretical framework and the literature review. The study results signify that for this cohort of participants, sociocultural influences, including influences of participation in the clinical site and the interactions and relationships with others, were more important than contextual influences such as the physical learning environment. Unanticipated findings included emotional and mental wellbeing and issues of power related to the physiotherapy clinician. Three main themes emerged from the evaluation of the study findings. Theme one: Student attributes and approach to learning; Theme two: Teacher attributes, skill and power and Theme three: Resources and support at clinical placement site. These themes were able to answer the research question for the study. What has been determined in this research study is that Physiotherapy students bring their own personal and learning attributes to the clinical placement which contribute to their development as a student physiotherapist and their ability to engage actively with learning opportunities. In addition the teacher, either a clinician or clinical educator, must have certain preferable qualities which allows for the development of good relationships between teacher and student, as well as fostering the student's ability to be agentic in maximising learning opportunities. Furthermore the study demonstrated that supported participation in physiotherapy practice allowed participants to learn, thus necessitating that the clinical site possess a culture which is accepting of students and their clinical learning. It is therefore of utmost importance that any limitation to student participation be addressed with urgency at the institution. Appropriate clinical sites must also be considered carefully in relation to the demands of the curriculum, the needs of Physiotherapy as a profession and the institutional culture of the placement.
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    Competencies needed to prepare intermediate life support (ils) paramedics in Gauteng to manage traumatic stress in the work environment
    (2019) Zana, Tonny; Alperstein, Melanie; Jansen, Marvin Jeffrey
    This qualitative study explored the effects of trauma as well as coping mechanisms used to deal with post-traumatic stress experienced by ILS paramedics providing emergency care services in the Gauteng Province, South Africa. It also looked at the competencies needed to cope with traumatic stress and promote biopsychosocial well-being. It is argued that it is important to look at this subject from a South African perspective since most of the published research on the sources and effects of trauma on paramedics and other frontline emergency services personnel experience comes from developed countries. It was discovered that there is minimal empirical research from South Africa on similar topics, except for a study in the Cape Town metropole. In addition to that, most published research relied on quantitative data collection methods. Through qualitative case study research this thesis draws on observations and relevant data gathered by way of semi-structured face to face interviews with eleven operational Intermediate Life Support (ILS) paramedics who work in the Gauteng province. Data is gathered on the sources of stress and coping mechanisms currently used by the paramedics. The gathered data was analysed using thematic analysis. The results show that the sources of stress for paramedics include attending gruesome scenes, extreme pressure to save lives and attending a scene where a child or a colleague is involved. It was also observed that the paramedics have a set of coping strategies to manage post-traumatic stress which are both positive and negative coping strategies. In addition to interviews with ILS paramedics from whom data is gathered on their education and training, the results in this thesis gathered insight from a panel of six experts who were engaged through a focus group discussion. These experts have demonstrable expertise in curriculum development, trauma counselling and training. The panel recommended that the training of the paramedics must be more realistic such that the paramedics are better equipped to deal with the challenges they may encounter in the work environment. It was also revealed that those who train paramedics are not well equipped to deliver the health and wellness module. It can be concluded that some paramedics are not well equipped to deal with traumatic events they encounter in the field. The researcher recommends that the health and wellness module be delivered by people who are specifically trained to deal with mental health issues. Insights gathered in this study will help the paramedics, those they help and their families.
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    Exploring first year health sciences students' perceptions and experiences of teamwork: an introduction to interprofessional education
    (2020) Hendricks, Adibah; Hartman, Nadia
    Teamwork has become an important goal of contemporary healthcare. Therefore, one of the objectives of educating health professionals is to impart teamwork skills. While teamwork skills have become widely acknowledged as important for health sciences education (HSE), teamwork pedagogy within the ambit of interprofessional education within HSE is contested in the literature. The need to trouble the meaning of concepts within the interprofessional field to understand its nature and process in different contexts has been highlighted and remains an area in which further research is needed. Understanding the point of view of students can help educators, curriculum planners and evaluators make optimal use of their opportunities and resources within HSE. Thus, the present study sought to explore students' perceptions and experiences of teamwork within a HSE context with a view to contributing to this resource base. Implicit in the study context is the occurrence of first year health sciences students coming into contact with each other in a mixed professions course “Becoming a health professional” (BHP). A theory about social interaction, contact theory, postulates that when individuals from different groups have opportunities to come together under certain conditions, positive social outcomes may result. On the contrary, contact between distinct groups could also bring about adverse effects. In this study different groups referred to students registered for different health professional degree programmes. Based on the proviso that teamwork can be associated with positive, functional interactions between people, which of contact theory's suppositions were experienced by the students in this study was explored. Since teamwork is innately a social activity which is experienced in relation to others, one of the assumptions underpinning this study was that students' perspectives of teamwork may be co-constructed. Thus, the study was positioned within an interpretivist paradigm in which reality is subjective but also co-constructed by individuals, including participants and researchers. Using a qualitative design, this exploratory study offers insight into first year students' perspectives of teamwork within the undergraduate mixed professions course BHP. The primary data production method was focus group discussion and data were evaluated using thematic analysis. The thematic analysis yielded three broad themes: the purpose of teamwork in BHP; the persons involved in teamwork; and the process of teamwork in BHP. The findings of this study revealed that students had a comprehensive perception of what teamwork entails in their educational context, although their experiences of teamwork varied. These perspectives have been linked in concrete ways to the literature reviewed in this study and its theoretical framework. Thus, the findings were used to generate a heuristic for teamwork learning for health sciences students. The impact of this study is that students' perspectives of teamwork may be useful to the future design and delivery of entry level interprofessional courses aiming to instil teamwork skills. The underlying rhetoric of this thesis is that students are capable of contributing to their own learning, and the present findings manifested in one such contribution, the development of a pedagogical tool for teamwork.
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    Exploring students' conceptions of the racial and socio-cultural differences in the learning environment of a medical specialty
    (2018) Wamono, Aye Aye; Hartman; Nadia
    Study problem In the education of South African postgraduate medical specialities, various challenges that could have negative impacts on learning are evident. Racial and socio-cultural diversity in South Africa has roots in a previous societal structure that systematically discriminated against particular social groups resulting in significant political, economic and social inequalities between the groupings. With the current processes of transformation underway, the sphere of training postgraduate students in medical specialities reveals visible differences in racial backgrounds between students and consultants at the training centres across the nation, with the majority of consultants being Whites and Indians, whilst the majority of students are Black Africans and a few Indians. The recent high failure rate of the summative exit examination in certain specialities has stimulated a high level of interest into how racial and socio-cultural diversity may have influenced the training and learning of postgraduate students or registrars. Theoretical framework In this thesis, a conceptual framework is used that combines dimensions from the theories of Collins (1987), Collins, Brown and Holum (1991) on cognitive apprenticeship, Vygotsky (1978), Lave and Wenger (1991) on socio-cognitive and socio-cultural learning, and Bronfenbrenner’s (1977) theory on Human Ecology. Collectively they posit that relationships are central to the quality of learning and training. The education of postgraduate students, so called registrars or intermediary novices, is structured as personal mentoring in the form of cognitive apprenticeship and their legitimate participation in the departmental Community of Practice. Learning in this context occurs through daily service provision under supervision or mentorship, as well as unscheduled informal discussions (engagement) that reflect socio-cultural learning in which novices and consultant specialists interact socially and academically. This form of learning is dependent on effective mediation and participation, which depends upon understanding, trust and mutual respect in a relationship between the two parties. This relationship could be influenced by factors such as inter-personal differences. Whether the factors translate into socio-cultural differences such as language, culture and social identities, need to be determined. Aim and objectives The aim of the study was to explore the conceptions of two student groups, one who had left the specialist programme, and the other who had recently qualified, regarding the nature of racial and socio-cultural diversity in their learning environment, the influences on their learning, and how they responded to them. Methodology Using one of the medical speciality disciplines as a focus area, a qualitative enquiry using faceto-face in-depth interviews followed by a thematic analysis of descriptive data was employed. Participants were former students who had either left the formal training programme after being unsuccessful in the summative examination and reached the end of their employment contracts, or those who had recently passed the examination and qualified as junior specialists. The interviews were semi-structured to explore participant’s learning background through schooling, undergraduate and postgraduate studies, with focus on experiences in formative learning through these stages. The participant’s family socio-cultural background was also explored. Data analysis and interpretation were done using a social constructionist epistemology where meanings were co-constructed based on multiple perspectives Findings and analysis The following themes were identified from the data analysis: Theme 1: Racial and socio-cultural differences as barriers in learning, with the sub-themes: constructing ‘race’, ‘language’, ‘culture’, and ‘feeling excluded by social status’ as barriers to learning; Theme 2: Relationships in the learning environment shaping learning, with sub-themes: ‘relationships in the early learning stage’, ‘relationships in undergraduate medicine’, and ‘relationships in postgraduate learning stage of speciality training’; Theme 3: Challenges in the learning process, with sub-themes as: ‘lack of curricular clarity’, and ‘lack of formative learning structure’; Theme 4: Resilience, with sub-themes: ‘capacity for adaption’, and ‘the ways in which resilience has been shaped by the micro- and macro-environments’. The further analysis found the socio-cultural diversity and relationships affecting engagement during formative learning themes to be inter-related, whilst sub-themes race, language, culture and social identities were also inter-connected. The curriculum, formative training, relationships, people’s perspectives and culture of the community were found to be intricate and complex, yet difficulties could still be overcome using certain attributes and skills. Conclusion Participants perceived the racial and socio-cultural diversity such as language, culture, personality and socio-economic status in the postgraduate learning environment as barriers to learning. Participants in the group who had qualified were however able to negotiate the diversity by being resilient, adaptable and emotionally mature. These attributes enabled them to navigate difficulties and remain focussed on their goal. An ability to initiate and form relationships with new peers and consultants emerged as an important feature in this group. These findings could hopefully benefit both current and future students and highlight the need to create opportunities for cross-cultural engagement activities in medical speciality training programmes.
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    Factors influencing lecturer assessment practice in diverse southern contexts
    (2020) Sims, Danica Anne; Cilliers, Francois
    Assessment 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.
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    I Be Africa Man Original: Towards a Contextual Conceptualization of Father Involvement in the Education of Children with Disabilities in Kenya
    (2022-01-10) Karisa, Amani; McKenzie, Judith
    Father involvement could play a significant role in the lives of children with disabilities. Research is scarce on father involvement in the education of children with disabilities in Africa. We seek to provide a context for father involvement in the formal education of children with disabilities in Kenya, with the aim of contributing to the development of a conceptual understanding for father involvement in such a circumstance. We examine general research on father involvement in Kenya, explore the policy frameworks that guide fatherhood in the country, and look at the specific area of involvement in education. We then present a case study that examines father involvement in the formal education of children with disabilities in Kenya. Our analysis flags up a key opportunity in the pursuit of education for children with disabilities when fathers are involved; they can support their children with disabilities’ access, participation and success in education. We highlight the need for research that builds upon the voices of fathers to illuminate their role in education and we also make some suggestions toward a conceptual lens that will highlight the contextual realities involved, particularly in regard to the education of children with disabilities.
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    Medical education and the importance of teaching medical teachers about teaching
    (1994) Kent, Athol Parkes; Parsons, Phillip; Boonzaier, David
    This is an overview of medical education today. It deals with tertiary education matters pertinent to medical schools in South Africa, the forces that will inevitably cause medical education to change and the responses of other countries to similar circumstances. These forces are medical, educational and political. The medical forces bringing about changes are concerned with the explosion in knowledge in the fields of medical facts, technologies, therapies and informatics. It is an ongoing educational problem as to how the burgeoning sciences can be balanced with the present call for the return to the humanities. Medical schools are being required, through their teaching and learning methodologies, to encourage the qualification of empathetic graduates with generalist (holistic) skills and attitudes to best serve their patients. Educational forces, in particular new curriculum strategies, will need to be explored to assist teachers and students to cope with the demands of communities and individuals for care with expertise. In many First World countries these demands have found expression in moves from Traditional to Innovative curricula. Fundamentally, Traditional schools teach normal Anatomy and Physiology first, then move to the abnormal, before students reach the Clinical Years where these "basic sciences" are applied. Innovative schools, on the other hand, employ Problem-Based Learning with Community-Orientation throughout their curricula, with early patient contact, horizontal and vertical integration of disciplines, group work and community interaction as crucial aspects of their students' learning. Supporters of the Innovative philosophy see as progressive the revising of Flexnerian notions of basic science building blocks, the debalkanising of instruction subject by subject and the motivational impetus achieved when learning takes place in context. Political factors can impinge on staff teaching and student learning by Governmental demands through statutory councils or through the power exerted by the universities. Macro politics dictate financial or other resources that are allocated and may in future directly influence what sort of doctor the various medical schools are expected to graduate. The politics of staffing the teaching institutions, the development of teachers, and the demographics of the student population raise important questions of direction and commitment, and may lead to new realignments. The recognition of the importance of teaching at a professional level is a crucial factor in educating students more appropriately. Teachers versed in the medical pedagogic process will be pivotal in producing a new breed of doctors. This new breed will not be expected to "know everything" but have a core knowledge carefully ascertained by each medical faculty and the ability to find information that is further required. Students will not be expected to acquire all the facts to sustain them through the rest of their professional lives, but to have enquiring minds and the motivation to continue their education, to satisfy their curiosity and provide improved patient care. Their skills in mastery of the behavioural sciences will be more pertinent than ever as preventative medicine becomes as important as curative. They will be expected to formulate ethical attitudes and provide leadership in community and individual dilemmas. These are challenges that will need to be faced critically by our medical teachers who are too often experts in content in ever-narrower sub-specialities. For these challenges to be met, teaching cannot be taken for granted, but must be viewed more seriously by the schools and changes made where appropriate. The University of Cape Town (UCT) has a considerable reputation in the quality of its medical graduates. However, for its medical faculty to remain in the forefront of medical education, it needs to reconsider the knowledge required, the skills and attitudes embodied in its graduates but, as importantly, it must take the lead in undergraduate training. The need for renewing strategies and the action required are the themes of this dissertation.
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    Optimizing learning & teaching on paediatric ward rounds
    (2023) Mantzor, Savarra; Cilliers, Francois
    Bandura'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.
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    Optimizing learning & teaching on paediatric ward rounds
    (2023) Mantzor, Savarra; Cilliers, Francois
    Bandura'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.
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    Patient-centred communication and patient education: a multimodal social semiotic approach
    (2017) Weiss, Rachel; Archer, Arlene
    Patient-centred communication and patient education: a multimodal social semiotic approach This study explores the phenomenon of patient-centred communication within the South African health context. Patient-centred communication involves several distinct but interlinked elements, namely, taking a holistic approach to illness, 'seeing' through the patient's eyes, 'co-constructing' a shared understanding or therapeutic alliance, and sharing decision-making and responsibility where possible. While adopted by medical curricula across the world, a lack of conceptual clarity is common among students, educators, researchers and policy-makers. Furthermore, little research has been done that accounts for contextual factors and non-western settings. This study looks at how fourth year medical students operationalise the 'classroom-taught' principles of patient-centred communication during a health education encounter with patients. Drawing on a qualitative, interpretivist paradigm, the research focuses on communication in the context of language barriers, cultural value differences and socio-economic inequality. This study views students' multimodal health education artefacts as instances of 'informed flexibility' to patients' needs and challenges. The research is located within a Pharmacology curriculum activity where medical students produce personalized health promotion artefacts for rheumatic heart disease patients. Their artefacts are instances of patient-centred communication as well as instances of purposeful pedagogic recontextualisation, in that they realise both epistemic and relational dimensions of health education. Students also write a critique on the process, reflecting on the patient interview and motivating their design choices. Taking a multimodal social semiotic approach, the study draws on Bezemer and Kress' semiotic principles of recontextualisation (2008) for analysis of artefacts. Thematic analysis of students' critical reflections as well as follow-up interviews with their patients illuminate the context and assumptions underpinning students' design choices. The study is significant in several ways. It highlights the complex, multifaceted, multi-layered nature of doctor-patient communication, argues for realism in what can be taught and assessed in a classroom and suggests novel pedagogic approaches. The study also brings an African perspective to patient-centred communication, and in highlighting challenges relevant to the South African health care system, it supports contemporary calls for 'decolonisation' of health sciences curricula. The research contributes to ongoing efforts to eradicate rheumatic heart disease by giving patients a 'voice', raising awareness and supporting preventative programs. Methodologically, the study contributes to Bezemer and Kress' (2008) pursuit of articulating a semiotic methodological framework for multimodal texts.
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    Positive attitudes toward adoption of a multi-component intervention strategy aimed at improving HIV outcomes among adolescents and young people in Nampula, Mozambique: perspectives of HIV care providers
    (2023-06-06) Mogoba, Phepo; Lesosky, Maia; Mukonda, Elton E.; Zerbe, Allison; Falcao, Joana; Zandamela, Ricardino; Myer, Landon; Abrams, Elaine J.
    Background Service providers' attitudes toward interventions are essential for adopting and implementing novel interventions into healthcare settings, but evidence of evaluations in the HIV context is still limited. This study is part of the CombinADO cluster randomized trial (ClinicalTrials.gov NCT04930367), which is investigating the effectiveness of a multi-component intervention package (CombinADO strategy) aimed at improving HIV outcomes among adolescents and young adults living with HIV (AYAHIV) in Mozambique. In this paper we present findings on key stakeholder attitudes toward adopting study interventions into local health services. Methods Between September and December 2021, we conducted a cross-sectional survey with a purposive sample of 59 key stakeholders providing and overseeing HIV care among AYAHIV in 12 health facilities participating in the CombinADO trial, who completed a 9-item scale on attitudes towards adopting the trial intervention packages in health facilities. Data were collected in the pre-implementation phase of the study and included individual stakeholder and facility-level characteristics. We used generalized linear regression to examine the associations of stakeholder attitude scores with stakeholder and facility-level characteristics. Results Overall, service-providing stakeholders within this setting reported positive attitudes regarding adopting intervention packages across study clinic sites; the overall mean total attitude score was 35.0 ([SD] = 2.59, Range = [30–41]). The study package assessed (control or intervention condition) and the number of healthcare workers delivering ART care in participating clinics were the only significant explanatory variables to predict higher attitude scores among stakeholders (β = 1.57, 95% CI = 0.34–2.80, p = 0.01 and β = 1.57, 95% CI = 0.06–3.08, p = 0.04 respectively). Conclusions This study found positive attitudes toward adopting the multi-component CombinADO study interventions among HIV care providers for AYAHIV in Nampula, Mozambique. Our findings suggest that adequate training and human resource availability may be important in promoting the adoption of novel multi-component interventions in healthcare services by influencing healthcare provider attitudes.
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    Proposing clinician competency guidelines for the inclusion of disability in the undergraduate medical curriculum of South Africa - an exploratory study
    (2023) Whitehead, Sarah Nicole; Kathard, Harsha; Lorenzo, Theresa
    Introduction Persons with disability make up the largest minority group in the world yet there is a dearth of research both internationally and nationally on how disability is included in professional training curricula for medical doctors. Aim of the study The purpose of this study is to add to the body of knowledge that would facilitate the inclusion of disability in the undergraduate medical curriculum in South Africa. Methods This is a mixed method, sequential study – Phase one followed by Phase two. Phase one, data was collected - via focus groups and in-depth interviews - from Medical Doctors, Medical Students, Physiotherapists, Occupational Therapists, Speech and Language Therapists and Persons with disability. Phase two used a modified Delphi Method with an expert panel of disabled and abled Disability Studies Academics, Medical Educators, Disability Rights Activists and Medical Doctors. The experts were asked to rate – using a 5-point Likert Scale - each competency according to its importance and language clarity. They were also asked in open-ended questions, to make any suggestions relating to the language of each competency and whether any competencies could be combined. 2 Findings Four main themes emerged from Phase one data: Experience of disability, Attitudes towards disability, Knowledge about Disability and Life beyond the disability. Data from these four themes contributed to the generation of an initial competency set – 17 competencies and 13 sub-competencies. In Phase two the initial competency set was presented to an expert panel as part of a modified Delphi Method. In the first iteration consensus was regarding the importance of each competency. In the second iteration consensus was reached regarding the language of each competency and a final competency set – containing 13 competencies and 9 sub-competencies - was generated. Competencies and sub-competencies 1-6 are clustered as knowledge competencies, 7-10 as attitudes and 11-13 as skills. Conclusion This study sets an important precedent for the inclusion of the subject of disability in undergraduate medical curricula. It proposes an approach to teaching and learning about disability inclusion for medical students. The list of disability specific competencies set forth by this study are a steppingstone in the process of curriculum transformation. The use of this guideline to improve the understanding of disability, and as a catalyst for undergraduate medical curriculum review is recommended.
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    Re-imagining doctor-patient relationships in an African context: a transformative educational perspective
    (2023) Ras, Tasleem; Reid, Stephen
    Clinician-patient relationships are central to health care, health systems and medical education. Current educational practice of doctor-patient relationships emerged from an episteme rooted in a biomedical understanding of disease, having epistemic and pedagogical roots in Global North contexts. The thesis offers an analysis of clinician-patient relationships that includes medical ethics, communication skills, and the development of the widely accepted (in Family Medicine) Biopsychosocial model of the clinical consultation. Using a South African clinical postgraduate Family Medicine training programme as a case study, this project answered two central research questions: (i) How do students learn to navigate relationships with patients in this training programme? And (ii) Can we develop an educational model of doctor patient relationships based on local experiences? Mezirow's transformative learning theory, Mbiti's conceptualisation of Ubuntu as an African philosophy, and Foucault's thoughts on structural power provided a conceptual framework. Aim The project aimed to understand the process of student learning about the doctor-patient encounter and to develop a model for teaching about the doctor-patient relationship. Methodology A qualitative longitudinal case study was conducted, drawing data from postgraduate students, educators, and patients. Data was collected from educational, clinical, and reflective activities, and analysed thematically using an inductive approach. Findings The key themes describe students' learning in relation to critical self-awareness, contextual awareness, the dialogic nature of learning, and the impact of transformed perspectives. Patients valued that their patient-hood and personhood were validated, and educators highlighted the theme that vulnerability has pedagogical implications. A new perspective of power dynamics in the clinical encounter is described and an Ubuntu-inspired episteme and pedagogy is synthesised from the findings. Conclusion This decolonial project provides evidence and proposes a model for incorporating an indigenous philosophy (Ubuntu) into mainstream health sciences education. Recommendations are made for educational and clinical practice, as well as future research.
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    The role of medical simulation curriculum in developing acute care clinical competence in undergraduate medical students in South Africa
    (2022) Jansen, Marvin Jeffrey; Hartman, Nadia; Grant, David
    The study aim was to explore the role, including the limits and possibilities, of medical simulation as a pedagogical method in an undergraduate acute care clinical skills curriculum within a South African tertiary education environment. The study consisted of two phases. During phase one, I conducted a modified Delphi study to identify the acute care clinical skills competencies undergraduate medical students need to acquire to prepare them, in the role as newly qualified clinicians, for managing acute care cases within a South African in-hospital environment. Phase two explored what acute care clinical competencies would lend themselves to a medical simulation modality within a South African tertiary education environment, as well as exploring the role, the limits and possibilities of medical simulation as an educational modality in developing acute care clinical skills curriculum within a South African tertiary education environment. The data was collected through Focus Group Discussion (FGD) and semi-structured interviews with simulation experts within South Africa. The findings of the modified Delphi study contributed to developing a comprehensive list of undergraduate acute care clinical skills competencies, previously unavailable, for SA. The value of engaging with medical practitioners at the forefront of societal engagement such as practising medical practitioners, who on a day-to-day basis are exposed to the healthcare needs of society, became evident. Having empirically established a comprehensive set of acute care competencies for SA undergraduate medical education, phase 2 sought to identify the simulation modality/modalities that these competences would lend themselves to. Thereafter, pesent the SimSMART framework for curriculum developers exploring the possibility of implementing simulation as pedagogy in their context. The findings were significant as they provided curriculum developers with contextually relevant literature to consider which competencies would best be suited to medical simulation as pedagogy, which is particularly important when considering the resource constraints within developing world contexts. The findings provided valuable insights into complex contextual issues such as the effects of the Apartheid legacy on teaching within health sciences, communication, and social inequality.
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    Understanding leadership development within new medical schools in Africa
    (2022) Wessels, Quenton Bester; Reid, Stephen; Rennie, Timothy
    The transient and multifaceted nature of leadership in Health Professions Education has changed over time. Programme directors associated with medicine, pharmacy, nursing, allied health and those involved in a clinical setting typically serve as managers and leaders concurrently. Furthermore, managers in modern organisations are expected to fulfil leadership roles. Leader and leadership development are inter-reliant phenomena. Moreover, the growth of leaders, the mutual development within a group and the consequent development of an organisation in the context of health professions education HPE require framing. This is especially true when leaders are faced with an array of constraints in low- and middle-income countries. In order to appreciate leader development, we need to ask “what qualities do we need to develop in our leaders?” and for leadership development “what qualities do we need to develop in our organisation?”. Thus, within the context of the current study we essentially ask: “What qualities have developed in our leaders, organisation and the consortium?” The current study sought to understand leadership development of appointed and emergent leaders in new medical schools in Africa. A mixed-methods approach was employed and the data collection instruments included: a Likert scale survey, a multiple case study approach and a qualitative document analysis (QDA). A total of 29 surveys (64.5% response rate) were returned and 10 successful interviews were conducted after ethical approval and obtaining consent. Many of the participants fulfilled multiple roles as lecturer (linked to the basic medical sciences), departmental head and/or a clinical teaching position in the hospital. Their academic positions and seniority as leaders included deans, a deputy dean, a programme director, heads of departments (HODs), medical educationalists and lecturers. Any additional biographical information was excluded in the study in order to ensure anonymity of the participants. Finally, the QDA relied on a four-step Scott method and considered a total of 58 documents that ranged from meeting agendas and reports, scholarly works, book chapters, newsletters, external reports, conference proceedings, and the CONSAMS (Consortium of New Sub-Sahara African Medical Schools) constitution. Findings from the current study led to the development of a framework to navigate the complex nature of leadership development in new medical schools in Africa. The three-tier framework views leadership development of the individual, the institution and within the context of collaboration such as a consortium. Leadership development at an individual level is dependent on the interplay between an institutional climate, contextual forces and resultant responses of leaders. Five archetypes of leadership development were identified at an individual level: the leader in front, the strategist, the silenced leader, becoming a leader and the leader as manager. The archetypes are the result of biographical, programmatic, institutional and contextual forces. The leader subsequently interprets these forces in order to negotiate their roles, position and course of action. Leadership development at an institutional level occurs within a hierarchical system and can sometimes occur in isolation. Development is often hampered by day-to-day activities that are reactive in nature in a bid to negotiate the various forces. The formation of teams and coalitions are hampered by climate factors such as ineffective engagement of colleagues, poor bilateral communication, perceived misalignment of the values and unsuccessful collaboration. The formation of networks and alliances, as in the case of CONSAMS, drives the leadership development at a collaborative level. Within this context, leadership development is largely dependent on effective communication and feedback. Within a consortium, each participant contributes from the position of their dominant archetype, but are also temporarily freed from institutional constraints to think more strategically. The consortium generates a unique climate where the heterogeneity of leaders through their archetypes can be challenged, tested and strengthened. Interaction within the consortium permits freedom, more so than within the domain of an institution.