J van Wyk

Will graduating medical students prefer to practise in rural communities

Abstract Background: The shortage of doctors and their maldistribution between urban and rural areas contribute to inequitable health care delivery. Strategies are being sought by the government and universities to address these challenges. At the Nelson R Mandela School of Medicine of the University of KwaZulu-Natal the admissions policy ensures greater access to rural students and curricular interventions have been introduced to increase an awareness of the plight of vulnerable communities. This study attempted to ascertain the career intentions of final-year medical students and the influence of area of origin and gender on the location of their proposed future practice. Methods: The 2005 final-year cohort was surveyed by means of an anonymous questionnaire. Demographic information, area of origin and career intentions were canvassed. Students of rural origin were identified as those who matriculated from rural schools and lived more than 200 km from the nearest city. The data were analysed descriptively. Results: Female and rural students accounted for 63% and 11% of the sample respectively. Women were less likely than men to practise in rural areas. Thirty-five per cent indicated a preference for a public government service career as opposed to a private medical (26%) career. Slightly more than 13.7% (n = 26) of the cohort wished to pursue practice or postgraduate careers overseas. Nearly 62% (n = 90) of the students in the current cohort received government subsidies for their studies. Conclusions: The increased intake of students from rural origin and curricular attempts to increase social awareness of vulnerable rural communities are inadequate to alter the perceptions of medical graduates towards rural practice. While government initiatives and medical schools are starting to work together to service rural communities, alternative strategies need to be explored to entice physicians to rural practice.

An evaluation of stress in medical students at a South African university

Background: Medical educational programmes strive to produce competent and skilled graduates. However, studies have shown that undergraduate medical students experience varying degrees of stress which impacts on their health, academic performance and social functioning. This study explored the prevalence and causes of stress, its impact on students and their coping strategies in a racially diverse cohort of final-year medical students exposed to a problem-based learning curriculum in South Africa. Method: This descriptive cross-sectional study was undertaken by final-year medical students in 2008 at a South African medical faculty with a racially diverse student population. Semi-structured interviews were conducted. Data were thematically analysed. Results: Ninety-four students, representing 47% of the final-year medical student cohort, participated in the study. Seventy-eight per cent of the participants (n = 73) experienced stress during the programme, and the majority (n = 49) were females. Ethnic and gender differences were observed for the variables studied. Academic and personal problems were the main sources of stress. Coping strategies included individual lifestyle adaptations, family support, religious structures and study groups. Conclusion: Maladaptive stress impacts negatively at multiple levels on undergraduate medical students. Mentorship and educational support programmes should be integrated into the undergraduate medical curriculum and made available to all preclinical and clinical students. Students need to be taught and guided to identify and monitor their own well-being and to select positive strategies to overcome stress. These measures should assist students to manage their workload and time effectively.

Learning Anatomy Through Dissection: Perceptions of a Diverse Medical Student Cohort

El debate sobre la mejor manera de ensenar la anatomia y la relevancia de las disecciones de cadaveres en la formacion medica sigue siendo un tema de actualidad. A pesar del uso de una variedad de metodologias de ensenanza, por ejemplo especimenes plastinados, la diseccion de cadaveres y el aprendizaje asistido por computador, el tiempo dedicado a un programa de diseccion de cuerpo completo, su relevancia clinica y el promover un aprendizaje mas profundo se ha convertido en un tema de discordia en el contexto del aprendizaje de los estudiantes y sus percepciones del ambiente de aprendizaje. Este estudio investigo las percepciones desde un punto de vista educativo en un grupo de estudiantes de medicina en un programa de aprendizaje basado un estudio observacional, en un programa de 5 anos basado en problemas a traves del metodo de diseccion, evaluando el valor de este tema para sus estudios de medicina. Los datos cuantitativos y cualitativos fueron recolectados y analizados tematicamente. Un centenar de estudiantes de la cohorte MBChB2 (44%) completaron el cuestionario. La mayoria de los encuestados (70%) reporto una experiencia positiva durante la diseccion anatomica en terminos de aplicacion visual y clinica, mientras van adquiriendo comprension de la anatomia y habilidad. Los estudiantes con titulos de estudios previos (maduros) y los recien egresados de la escuela secundaria expresaron quejas similares. Las respuestas de los estudiantes difieren cualitativamente en la forma en que se beneficiaron de la diseccion. Este estudio confirma que la diseccion sigue siendo un metodo eficaz para la ensenanza de anatomia basica incluso en contextos de ABP. El estudio concluye con estrategias para mejorar las experiencias de aprendizaje de los estudiantes basado en diversos problemas.

South African-Cuban Medical Collaboration: students' perceptions of training and perceived competence in clinical skills at a South African institution

Background: The South African–Cuban Medical Collaboration programme aims to alleviate the critical shortage of practitioners in local South African rural settings. The students who return from Cuban-based facilities in their fourth year experience difficulty, especially in clinical settings, upon joining the MB ChB final-year student programme at the University of KwaZulu-Natal. Attempts to support their skills acquisition for local practice have led to an investigation of their prior clinical skills exposures, the curricular context and exposures in Cuba in which skills had been acquired, and students’ perceptions of their competence in clinical skills. Methods: This descriptive, cross-sectional study explored the clinical experiences of the 2013 cohort of students. Qualitative and quantitative data were collected through questionnaires that explored the curricular approach and setting of clinical skills training in Cuba, the students’ exposure to clinical skills and their perceptions of their competence at performing these skills. Results: Students experienced the Cuban curriculum as didactic and lecture intensive as opposed to the systematic, problem-based curriculum offered in South Africa. Clinical training in Cuba occurs in hospital wards while local students first train in a clinical skills laboratory prior to hospital exposures. The majority of students self-reported a lack of clinical exposure to 35 of an overall 75 core-skills list as identified by the undergraduate UKZN curriculum. In addition, they reported an inability to perform 71 of the 75 (95%) skills independently. Conclusion: This study has highlighted a mismatch between the focus and scope of clinical training offered to students studying in Cuba and those at a South African institution.

Benefits of Group Learning As a Collaborative Strategy in a Diverse Higher Education Context

ABSTRACT This paper explored students’ perceptions of group work in advancing their communication, participation, understanding and overall learning following a compulsory collaborative exercise. An exploratory, descriptive quantitative study was conducted with second year students on an Epidemiology course. They used a self-administered questionnaire to rate their agreement regarding group work in the multi-racial, tertiary setting. Respondents reported greater control of learning (78%) and increased personal benefit (69%). They found the intervention useful (73%); perceived improved participation and communication (63%) amongst peers and reportedly read wider (56%) for this exercise. Some students (35%) reported ineffective work and some English first language users described the strategy as “a waste of time” (rho = 0.307; p = 0.027). Even the limited use of group work strategies can develop a positive learning climate, aid classroom cohesion and improve self-directedness of students during cross-cultural engagement on health science courses.

Tobacco and alcohol use among healthcare workers in three public hospitals in KwaZulu-Natal, South Africa

Abstract Background: Tobacco use is a risk factor for most of the leading causes of death in the world. Healthcare workers (HCWs) can play an important role in assisting patients to stop smoking, but this role is undermined if they themselves smoke. The study determined the prevalence of tobacco smoking and alcohol use among HCWs in public hospitals in KwaZulu-Natal, South Africa. Methods: In a cross-sectional study, 650 self-administered anonymous questionnaires (primary and secondary questionnaires) were administered to participants between December 2009 and June 2010. Six hundred and twenty primary questionnaires (on smoking) and 630 secondary questionnaires (on alcohol use) were returned, giving a response rate of 95% and 97% respectively. The Pearson chi-square test was used to test for statistical significance. Results: Eleven per cent of the participants were current smokers and 7.1% former smokers, while 27% of never- smokers were constantly exposed to second-hand smoke. Males were 13 times more likely to smoke than their female counterparts (P > 0.001). Never-smokers more frequently counselled their smoking patients to quit compared to former and current smokers (47.5%, 39.5% and 25.8% respectively). Alcohol use problems were reported by 22% of participants (P > 0.001). Current smokers were six times more likely to drink excessively than never-smokers (P > 0.001) and males were ten times more likely than females to drink excessively (P > 0.001). Conclusion: The smoking rate among HCWs is still high, although lower than the national average of 21.4%. A large number of participants reported exposure to second-hand smoke and alcohol use problems. Less than half of the HCWs counselled smoking patients to quit smoking.