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Baboolal SO, Singaram VS. Specialist training: workplace-based assessments impact on teaching, learning and feedback to support competency-based postgraduate programs. BMC MEDICAL EDUCATION 2023; 23:941. [PMID: 38082397 PMCID: PMC10712152 DOI: 10.1186/s12909-023-04922-w] [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: 06/13/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Workplace-based assessments (WBAs) are part of a competency-based curriculum where training progression is dependent on the achievement of defined competencies in a real-world clinical environment. There is a significant literature gap on the impact of WBAs implemented in resource constrained countries and their contextual challenges. This study aimed to examine the use, impact, and educational context of WBAs in South African medical specialist training programs drawing on perspectives from both trainees and trainers to identify educational challenges and propose effective solutions. METHODS A mixed methods national electronic survey was conducted with specialist medical trainees and supervising trainers from all eight specialist training institutions in South Africa involving 16 specialities. The survey responses were voluntary and anonymous. The survey was closed after seven months when data saturation was achieved. Descriptive statistical analysis was performed using SPSS Version 27 (SPSS Inc, 2012, Chicago, IL) for the quantitative analysis. The thematic coding framework for the qualitative analysis was facilitated by NVivo Version 12 software. RESULTS There were 108 ethnically diverse supervising trainers and 248 specialist trainees' survey respondents. Across the 16 medical specialities, 45% of the respondents were using WBAs. Despite contextual resource and staff challenges, this study found that WBAs had a positive impact to Kirkpatrick level 2 in providing actionable feedback to improve competency. WBA users had a significantly higher rating for trainee supervision (p < 0.01), general quality of feedback on trainee competence (< 0.01) and the specialist training program (p = 0.03) compared to WBA non-users. They also had a higher rating for the assessment of the trainee as a professional (p < 0.01); scholar (p < 0.01); communicator (p < 0.01); collaborator (p = 0.001) and leader/manager (p < 0.001) based on the AfriMEDS competency framework. Racism, sexism and favouritism were challenges that negatively affected the training programs. CONCLUSION Overall, this study reports that the use of WBAs had a substantially favourable impact on teaching, learning, feedback and supports a competency-based approach to specialist training programs. Addressing the contextual concerns that negatively impact training; training the trainees and trainers about their relationship, roles and responsibilities; and focusing on a trainee-centred, inclusive and empowering teaching approach will help further enhance its effectiveness.
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Affiliation(s)
- Sandika O Baboolal
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
- Ophthalmology Department, James Paget University Hospital, Great Yarmouth, UK.
| | - Veena S Singaram
- School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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Key KD, Carrera J, McMaughan DJ, Lapeyrouse L, Hawa R, Carter A, Bailey S, de Danzine V, Blanchard C, Hall J, Shariff N, Hailemariam M, Johnson J. Advancing Equity Through Centering Societal Values to Operationalize Racism as a Public Health Crisis: The KKey Values Inequities Model. Health Equity 2023; 7:477-486. [PMID: 37731777 PMCID: PMC10507931 DOI: 10.1089/heq.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/22/2023] Open
Abstract
Background The past two decades have been marked by increased efforts to advance equity in various disciplines, including social sciences, public health, environmental health, and medicine. In 2020, a national movement of municipalities declared racism a public health crisis. These efforts have coincided and likely shaped a growing sphere of federal and philanthropic funding for health equity, which frequently calls for practical interventions toward reducing and ultimately eliminating disparities. Disparities in health such as maternal mortality, infant mortality, diabetes, cancer, and stroke have been linked to root causes such as racism. Often, root causes are also linked to disparities in other sectors (i.e., finance/wealth attainment, educational attainment, career attainment, and home ownership). In 2021, in a study published in the New England Journal of Medicine, suggested that racist policies were root causes of U.S. racial health inequities. While racism, sexism, and classism, etc., are characterized as root causes, we posit that there is a deeper driver that has yet to be advanced. This presents a disparity-inequity model that maps disparities and inequities to the societal value system, not root causes. Methods The KKey Values Inequities Disparities Model described in this article combines a case study of the Flint Water Crisis to explore the historic impact of human devaluation and its role in systemic racism and classism, which ultimately creates and exacerbates inequities that produce disparities in communities. The model integrates the value system and its contribution to societal causes (formerly known as root causes). Conclusions A broadly defined values-inequities-disparities model will allow researchers, practitioners, decision makers, lawmakers, and community members to (1) assess the core root of inequities and disparities; (2) identify solutions in the human value domain; (3) design appropriate course corrective programming, interventions, processes, and procedures; and (4) create actions to integrate new systemic procedures and practices in our laws and governance to advance equity.
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Affiliation(s)
- Kent D. Key
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA
| | - Jennifer Carrera
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Darcy Jones McMaughan
- College of Education and Human Sciences School of Community Health Sciences, Department of Counseling and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Lisa Lapeyrouse
- Department of Public Health and Health Sciences, University of Michigan, Flint, Michigan, USA
| | - Roula Hawa
- School of Behavioural and Social Sciences, Brescia University, London, Ontario, Canada
| | | | | | | | - Courtney Blanchard
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA
| | | | | | - Maji Hailemariam
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA
| | - Jennifer Johnson
- Charles Stewart Mott Department of Public Health, Michigan State University, Flint, Michigan, USA
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