Factors influencing choice of site for rural clinical placements by final year medical students in a South African university

Undergraduate students' choices around community service and internship: A single faculty study

Background

The Internship and Community Service Programme (ICSP) places newly graduated health professionals for a compulsory training period. Universities adopt multiple strategies to encourage students to select rural placements for ICSP.

Objectives

This study describes ICSP choices among final-year MBChB and Health and Rehabilitation Science students at a South African university and the factors influencing their decisions.

Method

A cross-sectional qualitative descriptive study was conducted using a self-developed online questionnaire. Eighty-five final-year students were recruited.

Results

Most respondents (n = 38, 45.8%) chose the Western Cape (WC) as their first choice placement. There was a significant difference between MBChB and other health science students' choice of level of healthcare (χ = 10.39, p = 0.006), with MBChB less likely to choose primary healthcare (PHC) level placements. District and tertiary care options were perceived as better sites for learning and practice, while PHC and rural sites, considered underresourced and understaffed, were avoided. Although MBChB students indicated a lower preference for rural placements, this was not significant.Factors influencing ICSP application decisions included professional support, work environment, and social and personal considerations.

Conclusion

Students' placement choices were based on their perceptions of clinical exposure, learning opportunities, mentorship and supervision. Placements closer to home were preferred. UG clinical exposure and rural background seem to have some impact on choice but need further investigation.

Clinical implications

Universities should continue to explore ways to improve students' readiness for practice in underresourced settings. Improved exposure to rural and PHC sites during training could encourage better uptake during ICSP placement.

Final-year medical students' reflections on types of significant events in primary care

BACKGROUND

 Adverse events are considered a universal challenge and a burden in the provision of healthcare. For that reason, significant event analysis (SEA) is a critical undertaking in primary health care (PHC), particularly in South Africa where 84% of the population relies on the public health system for their care.

AIM

 The study aimed to describe the types of perceived significant events medical students experienced during an integrated primary care block placement.

SETTING

 Eighteen PHC settings included clinics, community health centres and district hospitals across three provinces in Gauteng, Mpumalanga and the North West.

METHODS

 Using a qualitative descriptive design with purposeful sampling and maximum variation, structured reflection reports were retrieved from logbooks of final-year medical students studying at a South African university in 2014. Conventional content analysis was used to record the relevant facets of secondary data from 124 logbooks that contained a recording of a significant event using MAXQDA software version 2020.4.

RESULTS

 An iterative process revealed three major themes of significant events that were prevalent in PHC settings. These comprised medication and prescription errors, diagnostic errors and suboptimal patient management.

CONCLUSION

 Significant event analysis became a critical quality improvement reflective learning tool. Logbooks offered an opportunity for medical students to explore significant events as a strategic way towards addressing quality and safe practices in PHC settings.Contribution: This study demonstrated medical students' ability to identify incidents in the care of patients using the SEA approach and their role in assessing patient safety issues in PHC settings.

Increasing the availability of health workers in rural sub-Saharan Africa: a scoping review of rural pipeline programmes

INTRODUCTION

Rural pipeline approach has recently gain prominent recognition in improving the availability of health workers in hard-to-reach areas such as rural and poor regions. Understanding implications for its successful implementation is important to guide health policy and decision-makers in Sub-Saharan Africa. This review aims to synthesize the evidence on rural pipeline implementation and impacts in sub-Saharan Africa.

METHODS

We conducted a scoping review using Joanna Briggs Institute guidebook. We searched in PubMed and Google scholar databases and the grey literature. We conducted a thematic analysis to assess the studies. Data were reported following the PRISMA extension for Scoping reviews guidelines.

RESULTS

Of the 443 references identified through database searching, 22 met the inclusion criteria. Rural pipeline pillars that generated impacts included ensuring that more rural students are selected into programmes; developing a curriculum oriented towards rural health and rural exposure during training; curriculum oriented to rural health delivery; and ensuring retention of health workers in rural areas through educational and professional support. These impacts varied from one pillar to another and included: increased in number of rural health practitioners; reduction in communication barriers between healthcare providers and community members; changes in household economic and social circumstances especially for students from poor family; improvement of health services quality; improved health education and promotion within rural communities; and motivation of community members to enrol their children in school. However, implementation of rural pipeline resulted in some unintended impacts such as perceived workload increased by trainee's supervisors; increased job absenteeism among senior health providers; patients' discomfort of being attended by students; perceived poor quality care provided by students which influenced health facilities attendance. Facilitating factors of rural pipeline implementation included: availability of learning infrastructures in rural areas; ensuring students' accommodation and safety; setting no age restriction for students applying for rural medical schools; and appropriate academic capacity-building programmes for medical students. Implementation challenges included poor preparation of rural health training schools' candidates; tuition fees payment; limited access to rural health facilities for students training; inadequate living and working conditions; and perceived discrimination of rural health workers.

CONCLUSION

This review advocates for combined implementation of rural pipeline pillars, taking into account the specificity of country context. Policy and decision-makers in sub-Saharan Africa should extend rural training programmes to involve nurses, midwives and other allied health professionals. Decision-makers in sub-Saharan Africa should also commit more for improving rural living and working environments to facilitate the implementation of rural health workforce development programmes.

A road less travelled: Undergraduate midwifery students' experiences of a decentralised clinical training platform

Background

In South Africa, the critical skill base shortage of healthcare workers, the underperforming global health indicators and the planned roll out of the National Health Insurance have burdened South African higher education authorities to rapidly expand nursing student enrolments. The expansion in student numbers has placed increased demands on overstretched educational institutions, and students are confronted with challenges of congestion in classrooms and clinical facilities, while lecturers encounter difficulties in the process of clinical allocation. A solution is to utilise decentralised clinical training platforms (DCTPs) and allocate students in rural hospitals.

Aim

To explore and describe undergraduate midwifery students' reflections of their DCTP experiences, in order to inform future practice of decentralisation in student training.

Setting

The study was conducted in the nursing discipline of an urban-based university in KwaZulu-Natal, South Africa, involving undergraduate midwifery students. The university had commenced a programme of allocating students to decentralised clinical sites.

Method

Elo and Kyngäs' content analysis was used to analyse the experiences of DCTP by undergraduate midwifery students (n = 14) as expressed in a focus group (n = 11) and three individual interviews (n = 3).

Results

The following four categories emerged: Recognition as a team member, engaging support, win-win platform and juxtaposed challenges.

Conclusion

In the presence of support and teamwork, rural settings can develop undergraduate student midwives, not only in the areas of midwifery competency but also in their personal capacity, and strengthen the responsiveness, preparedness and relevance of midwifery graduates.