Jacqueline Van Wyk

Faculty development: Yesterday, today and tomorrow

Medical education has evolved to become a discipline in its own right. With demands on medical faculties to be socially responsible and accountable, there is now increasing pressure for the professionalisation of teaching practice. Developing a cadre of professional and competent teachers, educators, researchers and leaders for their new roles and responsibilities in medical education requires faculty development. Faculty development is, however, not an easy task. It requires supportive institutional leadership, appropriate resource allocation and recognition for teaching excellence. This guide is designed to assist those charged with preparing faculty for their many new roles in teaching and education in both medical and allied health science education. It provides a historical perspective of faculty development and draws on the medical, health science and higher education literature to provide a number of frameworks that may be useful for designing tailored faculty development programmes. These frameworks can be used by faculty developers to systematically plan, implement and evaluate their staff development programmes. This guide concludes with some of the major trends and driving forces in medical education that we believe will shape future faculty development.

The small group in problem-based learning: more than a cognitive 'learning' experience for first-year medical students in a diverse population

In problem-based learning (PBL) curricula, first-year students need to adapt to a new learning environment and an unfamiliar new pedagogy. The small-group tutorial potentially offers a learning environment where students can become self-directed learners, collaborating with other group members to achieve individual and group learning goals. At the end of the first six-week theme in a relatively new PBL curriculum, new medical students were canvassed about coping with PBL (self-directed learning; content; time management; resources) and the value of the small-group tutorial, the latter of which is currently being reported. Almost 84% of students (n = 178) responded. The benefits of participating in small groups were categorized into three domains—cognitive, affective and social—as identified from student responses. Results were analysed in terms of gender and prior educational experience (secondary school vs. prior tertiary educational experience). For almost 94% of students, the small-group tutorial provided a conducive learning environment that influenced their personal development (i.e. tolerance, patience) and socialization into the faculty. Significantly more males indicated that they had developed social skills, while more school-leavers (matriculants) than mature students felt more receptive to the views of others. More mature students claimed to have made friends. Irrespective of some conflicting opinions in the literature, the present results suggest that the PBL tutorial may be important in facilitating student socialization into a new and unfamiliar academic environment, particularly when the pedagogy differs markedly from their past educational experiences. Through interacting with fellow students from diverse origins who hold different views in the intimate setting of the small group, students felt that they had not only increased their knowledge but had also developed personally and socially. It is proposed that the small group may be useful for integrating a diverse population of students into a new academic environment.

Twelve tips for recruiting and retaining facilitators in a problem-based learning programme

Successful curriculum reform requires considerable staff development. It is imperative for management to ensure that its academic staff members are committed to the change. This requires planning and negotiation. As facilitators form the ‘teaching’ backbone of a problem-based learning programme, faculty management must ensure mechanisms are in place to recruit facilitators, and that once recruited, the experience is sufficiently rewarding personally for their enthusiasm to be sustained. This article offers several solutions to difficulties which many medical schools encounter during the early years of an undergraduate PBL programme which replaces a traditional curriculum. The advice offered ranges from recruiting facilitators from the private sector to encouraging staff to become involved in other areas of curriculum development. Most importantly, however, is the reward and incentive system, which must be well advertised in advance of any programme implementation. The suggestions presented in this article will be useful to faculties planning to implement problem-based learning as well as those who already have a programme in place.

Maximizing the value of feedback for individual facilitator and faculty development in a problem-based learning curriculum.

Background: Recruiting and retaining facilitators in problem-based learning requires considerable staff development. Providing meaningful feedback to individual facilitators should contribute to improved management of the tutorial group. Aim: To ascertain the value ascribed by facilitators to feedback they received (based on student input) regarding their performance in the small group tutorial in a new problem-based learning curriculum. Methods: Thirty-seven facilitators from a purposive sample, selected for their facilitation experience during the 2001–2003 period, completed a comprehensive survey regarding their experiences. The aspect currently being reported deals with the perceived usefulness of the feedback they received from students and from Faculty following the evaluation of their participation in the small group tutorial. Data are reported for medically qualified and non-medically qualified facilitators. Results: Both clinical (50%) but more notably the non-clinical (70%) facilitators found the feedback (individual facilitator and general report) useful. Facilitators generally preferred the qualitative comments provided by students in the open-ended section of the evaluation to the Likert scale items. Student comments were valued for the specific direction they offered facilitators to reflect and improve on their management of the small group. For this feedback to be more useful, however, facilitators believed that it needed to be completed by more students who took time to critically engage with the criteria and reflect more honestly on their experiences. In addition, facilitators requested for feedback reports to be made available sooner such that they could improve their facilitation skills for the next group of students. Conclusions: Both qualitative and quantitative feedback are important for facilitator development and training. While quantitative feedback is important for summative purposes (e.g. quality assurance and promotion), individual student comments provide more formative feedback, allowing facilitators to reflect on and improve their management of the small group. In order for the feedback to be valid, the majority of students had to participate. Facilitators should receive feedback in time to allow them to modify their activities for the new group.

The impact of a faculty development programme for health professions educators in sub-Saharan Africa: an archival study

BackgroundIn 2008 the sub-Saharan FAIMER Regional Institute launched a faculty development programme aimed at enhancing the academic and research capacity of health professions educators working in sub-Saharan Africa. This two-year programme, a combination of residential and distance learning activities, focuses on developing the leadership, project management and programme evaluation skills of participants as well as teaching the key principles of health professions education-curriculum design, teaching and learning and assessment. Participants also gain first-hand research experience by designing and conducting an education innovation project in their home institutions. This study was conducted to determine the perceptions of participants regarding the personal and professional impact of the SAFRI programme.MethodsA retrospective document review, which included data about fellows who completed the programme between 2008 and 2011, was performed. Data included fellows’ descriptions of their expectations, reflections on achievements and information shared on an online discussion forum. Data were analysed using Kirkpatrick’s evaluation framework.ResultsParticipants (n=61) came from 10 African countries and included a wide range of health professions educators. Five key themes about the impact of the SAFRI programme were identified: (1) belonging to a community of practice, (2) personal development, (3) professional development, (4) capacity development, and (5) tools/strategies for project management and/or advancement.ConclusionThe SAFRI programme has a positive developmental impact on both participants and their respective institutions.

Community stakeholders’ perspectives on the role of occupational therapy in primary healthcare: Implications for practice

Background Primary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately. Objectives This study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum. Method An exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14). Results Two main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention. Conclusion The understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders’ on the role. This study highlighted the gaps in community-based services that OTs should offer in this context.

Evaluating logbooks to improve clerkship learning experiences

What problem was addressed? As in other parts of the world, diabetes prevalence in Cameroon is increasing. The few diabetic centres that there are in each region in Cameroon are located in cities. Diabetes management is not one of the package of activities carried out by nurse-run health centres that serve rural areas. The reasons for this include: lack of resources, such as diagnostic equipment, and qualified personnel. Given the increasing prevalence of diabetes in rural communities, measures are needed to address the problem. What was tried? Using point-of-care testing (POCT), final-year enrolled nursing students screened and cared for diabetic clients during their community placement in rural areas. A 12-hour curriculum was designed and taught to 14 final-year students of the St Francis School of Health Sciences. This included the use of POCT devices (glucometers, digital blood pressure machines and urine strips) and diabetes screening and management through education on lifestyle modification and self-monitoring. During their subsequent 10-week community placement in two rural areas, the students, with the involvement of the health centre nurses, organised screening campaigns for diabetes. Clients at high risk of diabetes and diabetics who emerged from the screening exercises, in addition to existing diabetics, were followed up. Education on lifestyle modification and the use of POCT for self-monitoring was completed. Nurses were involved in the project to allow them to learn from the process so that they would be able to continue managing clients after the students had left. The impact of the project on the followed up clients, nurses at the health centres and student nurses was evaluated. What lessons were learned? In total, 327 people were screened: 117 (35.78%) were at risk, 37 (11.31%) were at high risk, 16 (4.89%) were diagnosed with diabetes and 157 (48.01%) were free from any signs of diabetes. Most (81.66%) of the followed up clients gained knowledge and skills on the use of POCT devices, understanding of the disease condition and its management and the ability to carry out self-monitoring. Also, most (73.66%) clients (as confirmed by progress records used during the project) affirmed there had been significant improvements in their health. All of the nurses affirmed that they acquired knowledge and skills in the use of POCT devices, how to conduct screening for diabetes and how to empower diabetics to take charge of their own care, by working with the students. Among many points highlighted by students as their greatest achievements during the project was the fact that they were able to transmit knowledge to others and influence the health of the community with very limited resources. Being able to teach a senior colleague and searching for sick people in the community was something they indicated had increased their leadership potential and accountability awareness significantly. Problems faced by students included: resistance from some laboratory technicians (overcome by consulting them for their opinion on various matters), lack of patient compliance and reluctance of some clients participating in the screening for fear of knowing their status.

Speaking the language of the patient: indigenous language policy and practice

South Africa faces numerous challenges in healthcare, with the result that communities in many rural provinces are grossly underserved. These problems are compounded when doctors are unable to communicate with their patients. IsiZulu is spoken by most people in KwaZulu-Natal. Older and rural patients often present as monolingual isiZulu speakers. The need and ability to speak an indigenous language is emphasised in communication, identified as a core competency for doctors. The benefits of language-concordant health care have been documented, and policies at national, regional and institutional level provide for language diversity. As first-language English users, medical students have to be trained to become competent in speaking isiZulu. This mixed-method study assessed the knowledge, attitudes and perceptions of third-year students who had received isiZulu-training during their first year at the University of KwaZulu-Natal. The results indicated an improvement in students’ communicative competence. In general, positive attitudes were held by the students towards the language, but there was a perceived need for additional input in order for the students to become competent.

Exploring the occupational therapist's role in primary health care: Listening to voices of stakeholders.

Background Re-engineering of primary healthcare (PHC) was initiated nationally in 2009. There is, however, little information on the role expected of occupational therapists (OTs) in PHC. Objectives This research aimed to understand how stakeholders of the Department of Health (DOH) perceived the role of OT in PHC service. Method This exploratory, qualitative study used purposive sampling to recruit community health-care workers (CHW; n = 23), primary healthcare nurses (PHC; n = 5), DOH management (n = 5), experienced (n = 14) and novice OTs (n = 37) who graduated from the University of KwaZulu-Natal. The PHC nurses and the CHW represented PHC clinics in one district in KwaZulu-Natal. Data were collected through semi-structured interviews and focus groups. Interviews with CHWs were conducted in isiZulu. These were transcribed and translated prior to data analysis. Audio recordings of English interviews and focus groups were transcribed. Data for each participant group were inductively and thematically analysed to identify the themes. Results The findings provided an indication of the role of OTs in PHC settings. All participants perceived the role of OTs as predominantly curative/rehabilitation-based and individualised. Participants had a limited understanding of the key principles of PHC. They identified a need for adult and paediatric rehabilitation and early childhood intervention. Limited mention was made of population-based approaches, collaborative, and health promotion and prevention programmes. Conclusion The study has highlighted that neither management nor OTs seemed to align practice and planning according to PHC principles. A review of the theory and experiential learning in the OT programme is required.

Perceptions of final-year medical students towards the impact of gender on their training and future practice

Introduction Following policy implementations to redress previous racial and gender discrepancies, this study explored how gender impacted on the clinical experiences of final-year medical students during their undergraduate training. It also gathered their perceptions and expectations for the future. Methods This cross-sectional, mixed-method study used a purposive sampling method to collect data from the participants (n=94). Each respondent was interviewed by two members of the research team. The quantitative data were entered into Excel and analyzed descriptively. The qualitative data were transcribed and thematically analyzed. Results The majority of the respondents still perceived clinical practice as male dominated. All respondents agreed that females faced more obstacles in clinical practice than males. This included resistance from some patients, poor mentoring in some disciplines, and less support from hostile nurses. They feared for their personal safety and experienced gender-based stereotyping regarding their competency. Males thought that feminization of the profession may limit their residency choices, and they reported obstacles when conducting intimate examinations and consultations on female patients. Both males and females expressed desire for more normalized work hours to maintain personal relationships. Conclusion Social redress policies have done much to increase equal access for females to medical schools. Cultural values and attitudes from mentors, peers, and patients still impact on the quality of their clinical experiences and therefore also their decisions regarding future clinical practice. More mentoring and education may help to address some of the perceived obstacles.