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Pålsson P, Hulegårdh E, Wahlqvist M, Naredi S, Jood K. Physicians' self-perceived preparedness for clinical supervision of medical students at university and non-university hospitals -results from a Swedish survey. BMC MEDICAL EDUCATION 2023; 23:914. [PMID: 38049767 PMCID: PMC10694957 DOI: 10.1186/s12909-023-04908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The need for clinical placements outside traditional teaching hospitals for medical students is growing, both due to a decrease in hospital beds and the expansion of medical students. In this survey, distributed to supervisors at university and non-university hospitals, we investigated supervisors' self-perceived preparedness for the training assignment and searched for factors associated with self-perceived pedagogical knowledge and familiarity with the students' learning objectives. METHODS A pilot survey was developed using results from qualitative studies regarding clinical supervision of medical students and included questions on the supervisors' education and preparation, if they were familiar with the students' learning objectives, self-perceived pedagogical knowledge, and characteristics of the learning environment. The pilot survey was tested on a smaller group of supervisors. The results from the pilot survey were used to develop an e-survey that was distributed to all hospital employed physicians in Region Västra Götaland. RESULTS The survey was completed by 1732 physicians (response rate 43%). Among 517 respondents at the university hospital who reported activity as supervisor, 240 (46%) had attended preparatory supervisor training, 423 (82%) perceived enough pedagogical knowledge for the teaching assignment, and 391 (76%) reported familiarity with the learning objectives. The corresponding proportions at non-university hospitals were 159/485 (33%), 363/485 (75%), and 298/485 (61%), respectively (p ≤ .007 all through, compared to the university hospital). Perceiving that goal description and written information from the course management was sufficient for being able to complete the training assignment showed strong association with both self-perceived pedagogical knowledge and familiarity with the students' learning objectives. CONCLUSIONS We found consistent differences between university and non-university hospitals with respect to the supervisors' self-perceived preparedness for the training assignment. Efforts to convey the learning objectives and support to clinical supervisors are crucial for supervision of students at non-university hospitals.
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Affiliation(s)
- Paul Pålsson
- Department of Education, Region Västra Götaland, NU-hospital group, Trollhättan, 46185, Sweden.
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Erik Hulegårdh
- Department of Research, Region Västra Götaland, Sahlgrenska University Hospital, Development, Education and Innovation, Gothenburg, Sweden
| | - Mats Wahlqvist
- Department of Research, Region Västra Götaland, Sahlgrenska University Hospital, Development, Education and Innovation, Gothenburg, Sweden
| | - Silvana Naredi
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Wolcott MD, McLaughlin JE, Hubbard DK, Williams CR, Kiser SN. Using Design Thinking to Explore Rural Experiential Education Barriers and Opportunities. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:2382120521992333. [PMID: 33644400 PMCID: PMC7890746 DOI: 10.1177/2382120521992333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/13/2021] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Design thinking is a creative problem-solving framework that can be used to better understand challenges and generate solutions in health professions education, such as the barriers to rural education. Rural education experiences can benefit students, providers, and patients; however, placement in and maintenance of rural education experiences offer unique challenges. Design thinking offers strategies to explore and address these challenges. METHODS This study used a design thinking framework to identify barriers of student placement in rural locations; this was accomplished using strategies to empathize with users (eg, students, practitioners, and administrators) and define the problem. Data were collected from focus groups, interviews, and a design thinking workshop. Design activities promoted participant discussion by drawing pictures, discussing findings, and creating empathy maps of student experiences. Qualitative data were analyzed to identify salient barriers to rural experience selection and opportunities for support. RESULT Focus group (n = 6), interview (n = 13), and workshop participants (n = 18) identified substantial advantages (eg, exposure to a wider variety of patients, less bureaucracy and constraints, more time with faculty) and disadvantages (eg, isolation, lack of housing, and commuting distances) of rural experiences. Participants identified physical, emotional, and social isolation as a significant barrier to student interest in and engagement in rural experiences. Workshop participants were able to generate over 100 ideas to address the most prominent theme of isolation. DISCUSSION Design thinking strategies can be used to explore health professions education challenges, such as placement in rural settings. Through engagement with students, practitioners, and administrators it was identified that physical, social, and emotional isolation presents a significant barrier to student placement in rural experiences. This perspective can inform support systems for students, preceptors, and communities that participate in rural educational experiences.
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Affiliation(s)
- Michael D Wolcott
- Division of Oral and Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, Chapel Hill, USA
- Department of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, USA
| | - Jacqueline E McLaughlin
- Department of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, USA
- Jacqueline E McLaughlin, UNC Eshelman School of Pharmacy, 322 Beard Hall, Chapel Hill, NC 27599, USA.
| | - Devin K Hubbard
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina and North Carolina State University, Raleigh, NC, USA
| | - Charlene R Williams
- Department of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, USA
| | - Stephanie N Kiser
- Department of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, USA
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van Schalkwyk S, Couper I, Blitz J, Kent A, de Villiers M. Twelve tips for distributed health professions training. MEDICAL TEACHER 2020; 42:30-35. [PMID: 30696315 DOI: 10.1080/0142159x.2018.1542121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Increasing numbers of health professions students are being trained in healthcare facilities that are geographically removed from central academic hospitals. Consequently, studies have evaluated this distributed training, assessed the impact that it has on student learning as well as on the facilities where the training occurs, and explored factors that enable and constrain successful clinical training at such sites. The 12 tips presented in this article have been developed from a longitudinal project that has focused on developing a framework for effective distributed health professions training through an extensive review of the literature and a national consultative process. These 12 tips should, therefore, have applicability across multiple contexts. The purpose of this article is to assist people in implementing, adapting, upscaling, maintaining, and evaluating the distributed training of students in the health professions.
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Affiliation(s)
- Susan van Schalkwyk
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - Athol Kent
- Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
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Shulruf B, Velan G, Forster L, O’Sullivan A, Harris P, Taylor S. Insights into student assessment outcomes in rural clinical campuses. BMC MEDICAL EDUCATION 2019; 19:380. [PMID: 31627749 PMCID: PMC6798341 DOI: 10.1186/s12909-019-1828-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is an ongoing debate about the impact of studying medicine in rural vs. metropolitan campuses on student assessment outcomes. The UNSW Medicine Rural Clinical School has five main campuses; Albury-Wodonga, Coffs Harbour, Griffith, Port Macquarie and Wagga Wagga. Historical data of student assessment outcomes at these campuses raised concerns regarding potential biases in assessment undertaken, as well as the availability and quality of learning resources. The current study aims to identify the extent to which the location of examination (rural versus metropolitan) has an impact on student marks in OSCEs. METHODS Assessment data was employed for this study from 275 medical students who sat their final examinations in Years 3 and 6 of the undergraduate Medicine program at UNSW in 2018. The data consists of matched student assessment results from the Year 3 (Y3) MCQ examination and OSCE, and from the Year 6 (Y6) MCQ, OSCE and management viva examinations. The analysis used Univariate Analysis of Variance and linear regression models to identify the impact of site of learning and site of examination on assessment outcomes. RESULTS The results demonstrate that neither site of learning nor site of examination had any significant impact on OSCE or Management Viva assessment outcomes while potential confounders are controlled. CONCLUSION It is suggested that some of the supposed disadvantages inherent at rural campuses are effectively mitigated by perceived advantages; more intensive interaction with patients, the general and medical communities at those sites, as well as effective e-learning resources and moderation of assessment grades.
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Affiliation(s)
- Boaz Shulruf
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Gary Velan
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Lesley Forster
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Anthony O’Sullivan
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Peter Harris
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
| | - Silas Taylor
- Office of Medical Education, University of New South Wales, Sydney, 2052 Australia
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Tarimo CN, Kapanda GE, Muiruri C, Kulanga AT, Lisasi E, Mteta KA, Kessi E, Mogella D, Venance M, Rogers T, Mimano L, Bartlett J. Building Clinical Clerkships Capacity in a Resource-limited Setting: The Case of the Kilimanjaro Christian Medical University College in Tanzania. Ann Glob Health 2018; 84:129-138. [PMID: 30873784 PMCID: PMC6748287 DOI: 10.29024/aogh.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The shortage of medical doctors in sub-Saharan Africa (SSA) has resulted in increased enrolment in medical schools, which has not been matched with increased faculty size or physical infrastructure. This process has led to overcrowding and possibly reduced quality of training. To reduce overcrowding at its teaching hospital, the Kilimanjaro Christian Medical University College introduced eight-week peripheral clerkship rotations in 2012. We explore students' perceptions and attitudes towards peripheral hospital placements. METHOD The clerkship rotations were conducted in eight hospitals operating in the northern Tanzania, after evaluating each hospitals' capabilities and establishing the optimum number of students per hospital. Paper-based surveys were conducted after student rotations from 2014 to 2016. RESULTS Overall student satisfaction was moderate (strength of consensus measure (sCns), 77%). The three cohorts exhibited improving trends over three years with respect to satisfaction with clinical skills and attitude towards placements. student-preceptor interaction was rated highly (sCns 81-84%). The first cohort students expressed concerns about limited laboratory support, and poor access to Internet and learning resources. Specific interventions were undertaken to address these concerns. CONCLUSIONS Student experiences in peripheral rotations were positive with adequate satisfaction levels. Opportunities exist for medical schools in SSA to enhance clinical training and relieve overcrowding through peripheral clerkship rotations.
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Affiliation(s)
| | | | - Charles Muiruri
- Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Durham, North Carolina, US
| | - Ahaz T Kulanga
- Kilimanjaro Christian Medical University College, Moshi, TZ
| | - Esther Lisasi
- Kilimanjaro Christian Medical University College, Moshi, TZ.,University of Cape Town, ZA
| | - Kien A Mteta
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Moshi, TZ
| | - Egbert Kessi
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | | | - Maro Venance
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | - Temu Rogers
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | - Lucy Mimano
- Kilimanjaro Christian Medical University College, Moshi, TZ
| | - John Bartlett
- Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Durham, North Carolina, US.,Medicine, Global Health, and Nursing, Duke University, US
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Parlier AB, Galvin SL, Thach S, Kruidenier D, Fagan EB. The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:130-140. [PMID: 28767498 DOI: 10.1097/acm.0000000000001839] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To examine the literature documenting successes in recruiting and retaining rural primary care physicians. METHOD The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention. RESULTS The authors' proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work-life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice. CONCLUSIONS Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.
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Affiliation(s)
- Anna Beth Parlier
- A.B. Parlier was research project coordinator, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina, at the time of writing. As of August 2017, she will be a graduate student, Psychology Department, Virginia Commonwealth University, Richmond, Virginia. S.L. Galvin is director of research, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina, and adjunct assistant professor, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. S. Thach is director of clinical and community outreach, Western North Carolina Rural Health Initiative, Mountain Area Health Education Center, Asheville, North Carolina. D. Kruidenier is research and clinical librarian, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina. E.B. Fagan is chief education officer, Mountain Area Health Education Center (MAHEC), assistant program director, Family Medicine Residency Program, MAHEC, and assistant medical director, Department of Family Medicine, MAHEC, Asheville, North Carolina. He is also associate professor, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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de Villiers M, van Schalkwyk S, Blitz J, Couper I, Moodley K, Talib Z, Young T. Decentralised training for medical students: a scoping review. BMC MEDICAL EDUCATION 2017; 17:196. [PMID: 29121923 PMCID: PMC5680751 DOI: 10.1186/s12909-017-1050-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/02/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Increasingly, medical students are trained at sites away from the tertiary academic health centre. A growing body of literature identifies the benefits of decentralised clinical training for students, the health services and the community. A scoping review was done to identify approaches to decentralised training, how these have been implemented and what the outcomes of these approaches have been in an effort to provide a knowledge base towards developing a model for decentralised training for undergraduate medical students in lower and middle-income countries (LMICs). METHODS Using a comprehensive search strategy, the following databases were searched, namely EBSCO Host, ERIC, HRH Global Resources, Index Medicus, MEDLINE and WHO Repository, generating 3383 references. The review team identified 288 key additional records from other sources. Using prespecified eligibility criteria, the publications were screened through several rounds. Variables for the data-charting process were developed, and the data were entered into a custom-made online Smartsheet database. The data were analysed qualitatively and quantitatively. RESULTS One hundred and five articles were included. Terminology most commonly used to describe decentralised training included 'rural', 'community based' and 'longitudinal rural'. The publications largely originated from Australia, the United States of America (USA), Canada and South Africa. Fifty-five percent described decentralised training rotations for periods of more than six months. Thematic analysis of the literature on practice in decentralised medical training identified four themes, each with a number of subthemes. These themes were student learning, the training environment, the role of the community, and leadership and governance. CONCLUSIONS Evident from our findings are the multiplicity and interconnectedness of factors that characterise approaches to decentralised training. The student experience is nested within a particular context that is framed by the leadership and governance that direct it, and the site and the community in which the training is happening. Each decentralised site is seen to have its own dynamic that may foreground certain elements, responding differently to enabling student learning and influencing the student experience. The insights that have been established through this review have relevance in informing the further expansion of decentralised clinical training, including in LMIC contexts.
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Affiliation(s)
- Marietjie de Villiers
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Julia Blitz
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kalavani Moodley
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Zohray Talib
- Departments of Medicine and Health Policy, George Washington University, Washington DC, USA
| | - Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Francis-Cracknell A, Maver S, Kent F, Edwards E, Iles R. Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study. J Physiother 2017; 63:243-249. [PMID: 28939310 DOI: 10.1016/j.jphys.2017.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022] Open
Abstract
QUESTION What strategies can clinical partners and universities implement to enhance physiotherapy student engagement in non-metropolitan clinical placements? DESIGN Mixed-method research design combining focus groups and survey. PARTICIPANTS First-year physiotherapy students from one university at the commencement of their course (n=26); third-year and fourth-year students who had completed a non-metropolitan placement (n=39 survey, n=25 focus group); and clinical educators from three non-metropolitan clinical sites (n=15). INTERVENTION The cohort of first-year physiotherapy students was surveyed to establish their perceptions regarding non-metropolitan clinical education placements. A survey and four focus groups were conducted with third-year and fourth-year students after they had attended non-metropolitan clinical placements, to explore recent experiences. Two focus groups were conducted with clinical educators regarding student engagement at non-metropolitan placements. Quantitative data were summarised with descriptive statistics. Qualitative data were analysed using thematic analysis, synthesising the perspectives of students and clinical educators. RESULTS At the commencement of their physiotherapy course, interest in undertaking a non-metropolitan clinical placement was higher for students with a non-metropolitan upbringing. Concerns about attending non-metropolitan sites included finances, change in living situation, and perceived inferior quality of clinical education. After completing a non-metropolitan placement, four themes were identified in an analysis of student and educator perceptions: individual factors, clinical experience, logistical challenges and strategies for success. CONCLUSION Strategies that were perceived to enhance student engagement in non-metropolitan placements included: tailoring preparation for students, paired rather than individual placements, and near-peer presentations for physiotherapy students prior to undertaking non-metropolitan placements. Dedicated clinical coordinator positions at non-metropolitan sites and assistance in accessing affordable accommodation are likely to positively influence the student experience. [Francis-Cracknell A, Maver S, Kent F, Edwards E, Iles R (2017) Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study. Journal of Physiotherapy 63: 243-249].
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Affiliation(s)
| | - Shari Maver
- Department of Physiotherapy, Barwon Health, Geelong, Australia
| | - Fiona Kent
- Faculty Medicine, Nursing and Health Sciences Monash University, Melbourne
| | - Emma Edwards
- Department of Physiotherapy, Barwon Health, Geelong, Australia
| | - Ross Iles
- Faculty Medicine, Nursing and Health Sciences Monash University, Melbourne
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Kapanda GE, Muiruri C, Kulanga AT, Tarimo CN, Lisasi E, Mimano L, Mteta K, Bartlett JA. Enhancing future acceptance of rural placement in Tanzania through peripheral hospital rotations for medical students. BMC MEDICAL EDUCATION 2016; 16:51. [PMID: 26861915 PMCID: PMC4746898 DOI: 10.1186/s12909-016-0582-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 02/04/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Mal-distribution of health care workers is a global health challenge that exacerbates health disparities, especially in resource-limited settings. Interventions to mitigate the problem have targeted qualified personnel with little focus on medical students. However, studies have demonstrated that rural rotations positively influence students to practice in rural settings upon graduation. To evaluate the influence of peripheral rotations in a resource-limited setting, the Kilimanjaro Christian Medical University College introduced a 12-week clerkship rotation in peripheral hospitals for third-year medical (MD3) students in 2012. We administered an end-of-rotation survey to assess student perceptions, and attitudes toward rural practice after graduation. METHODS Questionnaires were voluntarily and anonymously administered to MD3 students in April 2014. The questions assessed perceptions of the experience, and attitudes towards rural practice upon graduation. The perceptions were assessed using strength of consensus measures (sCns). The effect of the experience on likelihood for rural practice was assessed using Crude Odds Ratio (COR), and predictors using Adjusted Odds Ratio (AOR) with 95 % Confidence Intervals (CI) tested at a 5 % level of significance. Variation was assessed using Hosmer and Lemeshow test Chi-square. RESULTS 111 out of 148 MD3 students participated; 62 % were male; 62 % <25 years old; and 72 % matriculated directly from secondary school. Overall, 81 % of MD3 students were satisfied with rural rotations (sCns = 83 %). The likelihood of accepting rural practice deployment after graduation was predicted by satisfaction with the peripheral hospital rotation program (AOR, 4.32; 95 % CI, 1.44-12.96; p, 0.009) and being male (AOR, 2.73; 95 % CI, 1.09-6.84; p, 0.032). Students admitted in medical school after health-related practice trended toward a higher likelihood of accepting rural practice after graduation compared to those enrolled directly from secondary school, although the difference was not significant (AOR, 4.99; 95 % CI, 0.88-28.41; p, 0.070). The Hosmer and Lemeshow test p-value was 0.686, indicating a good fit of the model. No significant differences in satisfaction between these two groups were observed, and also no significant differences between students born in rural areas compared to those born in urban areas existed. CONCLUSION Results indicate that satisfaction with rural rotations is associated with increased likelihood of rural practice after graduation. We conclude that opportunities may exist to reduce mal-distribution of healthcare workers through interventions that target medical students.
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Affiliation(s)
| | | | - Ahaz T Kulanga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | | | - Esther Lisasi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Lucy Mimano
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - John A Bartlett
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
- Duke Global Health Institute, Durham, NC, USA.
- Duke University School of Medicine, Durham, NC, USA.
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Moffatt JJ, Wyatt JE. Using evaluation to improve medical student rural experience. AUST HEALTH REV 2015; 40:174-180. [PMID: 26254631 DOI: 10.1071/ah14195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 06/09/2015] [Indexed: 11/23/2022]
Abstract
Objective The aim of this evaluation was to see whether interventions implemented to improve the Rural Medicine Rotation made this a more effective rural medical education experience. Multiple interventions targeting the student experience, lecturers and preceptors were implemented. Methods A quasi-experimental design using pre- and post-measures was used. The participants were all University of Queensland, School of Medicine, Rural Medicine Rotation students who completed the 2009 and 2010 rural medicine rotation evaluations. There were 769 students, with an 84% response rate in 2009 and an 80% response rate in 2010. In addition, all the 25 program preceptors who were visited in 2009 and the 34 who were visited in 2010 participated in the study. Results The implementation of interventions resulted in significant improvement in three outcome measures, namely teaching effectiveness, provision of an environment supportive of learning in a rural/remote setting and opportunities for professional growth. Two of the three other outcome measures - ensuring a safe clinical placement and opportunities for procedural skills experience and development - were very positively evaluated in both 2009 and 2010. Conclusions The interventions contributed to a more effective rural medical education experience, providing students with the opportunity to develop skills and knowledge relevant for rural medicine and to gain an understanding of the context in which rural medicine is practiced. What is known about the topic? Many Australian medical schools offer students rural-based educational opportunities based on the premise that placing medical students in a rural setting may ultimately lead to them choosing careers in rural medicine. However, there is a paucity of evidence on the factors that are considered necessary for medical students to gain a positive rural experience of short conscripted rural placements. What does the paper add? This paper identifies successful interventions to the rotation and placements that provide a positive experience of the rural clinical placement for students. These interventions occurred within an ongoing evaluation program embedded in the rotation. What are the implications for practitioners? Through ongoing evaluation, interventions can be selected and implemented that succeed in contributing to students having a positive rural clinical placement experience. This paper demonstrates how an embedded continuous improvement program serves to provide direction for ongoing modifications.
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Affiliation(s)
- Jennifer J Moffatt
- University of Queensland, School of Medicine, 288 Herston Road, Herston, Brisbane, Qld 4006, Australia
| | - Janine E Wyatt
- University of Queensland, School of Medicine, Level 2, Health Science Learning and Discovery Centre, PO Box 4143, Rockhampton, Qld 4700, Australia. Email
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Diab P, McNeill PD, Ross AJ. Review of final-year medical students' rural attachment at district hospitals in KwaZulu-Natal: student perspectives. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2014.10844584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- P Diab
- Department of Rural Health; University of KwaZulu-Natal
| | - PD McNeill
- Centre for Rural Health; University of KwaZulu-Natal
| | - AJ Ross
- Department of Family Medicine, University of KwaZulu-Natal
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Cox ED, Koscik RL, Behrmann AT, Olson CA, McIntosh GC, Evans MD, Kokotailo PK. Care of the underserved: faculty development needs assessment. J Natl Med Assoc 2010; 102:713-9. [PMID: 20806683 DOI: 10.1016/s0027-9684(15)30657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Because role models are crucial to training physicians to care for the underserved, we examined pediatric faculty's knowledge, attitudes, self-efficacy, skills, and precepting behaviors regarding care for this population. METHODS Faculty knowledge, attitudes, self-efficacy, and skills/precepting behaviors were surveyed. RESULTS Fifty-five (65%) of 85 faculty responded. The mean (standard deviation) knowledge score was 5.9 (1.3) of 8 possible. More than one-third of faculty did not recognize the eligibility criteria, services, and outcomes associated with common resources serving the underserved. Overall attitudes toward underserved families were positive, mean 3.3 (0.3), as was mean self-efficacy, 3.0 (0.7). Self-efficacy was lowest for accessing community resources for underserved families, 2.4 (0.7). Although most faculty performed the surveyed skills, fewer than 50% reported, precepting of these same skills with students. Precepting was lowest for accessing public and community resources. CONCLUSIONS Low rates of student precepting as well as specific knowledge and self-efficacy deficits highlight potential targets for faculty development.
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Affiliation(s)
- Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Maley M, Worley P, Dent J. Using rural and remote settings in the undergraduate medical curriculum: AMEE Guide No. 47. MEDICAL TEACHER 2009; 31:969-83. [PMID: 19909036 DOI: 10.3109/01421590903111234] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The goal of global equity in health care requires that the training of health-care professionals be better tuned to meet the needs of the communities they serve. In fact medical education is being driven into isolated communities by factors including workforce undersupply, education pedagogy, medical practice and research needs. Rural and remote medical education (RRME) happens in rural hospitals and rural general practices, singly or in combination, generally for periods of 4 to 40 weeks. An effective RRME programme matches the context of the local health service and community. Its implementation reflects the local capacity for providing learning opportunities, facilitates collaboration of all participants and capitalises on local creativity in teaching. Implementation barriers stem from change management, professional culture and resource allocation. Blending learning approaches as much as technology and local culture allow is central to achieving student learning outcomes and professional development of local medical teachers. RRME harnesses the rich learning environment of communities such that students rapidly achieve competence and confidence in a primary care/generalist setting. Longer programmes with an integrated (generalist) approach based in the immersion learning paradigm appear successful in returning graduates to rural practice and a career track with a quality lifestyle.
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Affiliation(s)
- Moira Maley
- The University of Western Australia, Western Australia.
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