Marietjie de Villiers

The Delphi technique in health sciences education research.

The Delphi technique is a method of collecting opinion on a particular research question. It is based on the premise that pooled intelligence enhances individual judgement and captures the collective opinion of a group of experts without being physically assembled. The conventional Delphi uses a series of questionnaires to generate expert opinion in an anonymous fashion and takes place over a series of rounds. The technique is becoming a popular strategy that straddles both quantitative and qualitative realms. Issues that are critical to its validity are the development of the questionnaire; definition of consensus and how to interpret non-consensus; criteria for and selection of the expert panel; sample size; and data analysis. The authors used the Delphi technique to assist with making recommendations regarding education and training for medical practitioners working in district hospitals in South Africa. The objective of this Delphi was to obtain consensus opinion on content and methods relating to the maintenance of competence of these doctors. They believe the experience gained from their work may be useful for other health science education researchers wishing to use the Delphi method.

The value of small group learning : an evaluation of an innovative CPD programme for primary care medical practitioners.

Introduction  A ‘competence’ model of CPD using facilitated small groups covering a range of clinical topics is an alternative model to lecture‐based CPD. The aim of this study was to evaluate a new small group CPD programme and to determine whether the anticipated improvements in the quality of learning were realised.

The current status and future needs of education and training in family medicine and primary care in South Africa.

South Africa is undergoing tremendous political and social change affecting every sphere of society, including medical education and the delivery of health services. The legacy of its history created a health system that in some respects can be compared to the best in the world, but one also characterized by inequity, discrimination and lack of access to even basic services for the rural and the poor. Its medical education system trails behind modern trends such as problem‐based learning, community‐based education and the utilizing of general/family practitioners as trainers. Vocational training in family practice is not compulsory for independent practice. The discipline of family practice has nevertheless developed the programmes and core infrastructure for such a future undertaking in the form of masters programmes in family medicine at all medical schools. The recently introduced system of compulsory recertification through continuous professional development provides a window of opportunity to develop locally relevant curricula and appropriate education and training methods for family practitioners. Challenges for family practice include the establishment of the role and value of the discipline in a developing country with a health system based on a nurse‐driven primary care service and the re‐orientation of family medicine teachers, trained in a biomedical paradigm, to the patient‐centred approach. The aspirations of family practice are to define the core content of the discipline, establish and nurture a culture of research in primary care, and to develop and introduce appropriate under and postgraduate training programmes for the new generation of family doctors.

Community-based training in Family Medicine : a different paradigm

Community‐based education is an important strategy for training students appropriately for delivering primary health care services. A community‐based training rotation in Family Medicine and Primary Care was introduced at the University of Stellenbosch, South Africa, in January 1998.

Medical Education in South Africa–Exciting times

The dramatic political changes of the first ten years of democracy in South Africa have seen major shifts in vested power. Social change and political will have resulted in a new face of our medical student population. Diversity of colour, gender, religion and previously disadvantaged groups make student profiles as different as they could be from a decade ago. The forces of curriculum change, the devolution of power and resources from tertiary centres to primary care facilities and the financial squeeze on university coffers have resulted in enormous challenges for medical educators. South African doctors have been readily accepted in English-speaking countries around the world as they have been well trained, resourceful and usually extensively experienced in clinical situations. Some of these attributes remain. This paper outlines the new prospects facing those who will be educating the future doctors of South Africa.

Understanding rural clinical learning spaces: Being and becoming a doctor.

Abstract Context: Calls for health professions education that can foster transformative educational experiences have been voiced. Studies suggest that extended clinical training at rural sites potentially provides transformative learning spaces. This article explores ‘being and becoming’ as a construct for understanding the student experience at a rural clinical school (RCS). Methods: Sixty-two in-depth interviews were conducted over a three-year period with RCS students, graduates (as interns) and intern supervisors. Thematically analysed data were mapped according to the adapted Kirkpatrick model for appraising educational interventions. Drawing on realist perspectives, findings were further analysed to discern the mechanisms influencing the being and becoming of junior doctors. Results: Responses provided evidence of changed attitudes and behaviour, and the adoption of professional practice that was seen to influence patient outcomes. Analysis highlighted sharing of values through role modelling, engagement with preceptors, being respected as part of a team, and being trusted to assume responsibility for a patient as key mechanisms. The outcome was confident, competent and caring interns. Discussion: Rural clinical learning spaces influence the ‘being and becoming’ of a junior doctor. Understanding this process in the context of place (rural platform), participation (community of practice) and person can inform expanded agendas for students’ clinical learning.

Equipping family physician trainees as teachers: a qualitative evaluation of a twelve-week module on teaching and learning

BackgroundThere is a dire need to expand the capacity of institutions in Africa to educate health care professionals. Family physicians, as skilled all-rounders at district level, are potentially well placed to contribute to an extended training platform in this context. To play this role, they need to both have an understanding of their specialist role that incorporates teaching and be equipped for their role as trainers of current and future health workers and specialists. A teaching and learning capacity-building module was introduced into a new master’s programme in family medicine at Stellenbosch University, South Africa. We report on the influence of this module on graduates after the first six years.MethodsA qualitative study was undertaken, interviewing thirteen graduates of the programme. Thematic analysis of data was done by a team comprising tutors and graduates of the programme and an independent researcher. Ethical clearance was obtained.ResultsThe module influenced knowledge, skills and attitudes of respondents. Perceptions and evidence of changes in behaviour, changes in practice beyond the individual respondent and benefits to students and patients were apparent. Factors underlying these changes included the role of context and the role of personal factors. Contextual factors included clinical workload and opportunity pressure i.e., the pressure and responsibility to undertake teaching. Personal factors comprised self-confidence, modified attitudes and perceptions towards the roles of a family physician and towards learning and teaching, in addition to the acquisition of knowledge and skills in teaching and learning. The interaction between opportunity pressure and self-confidence influenced the application of what was learned about teaching.ConclusionsA module on teaching and learning influenced graduates’ perceptions of, and self-reported behaviour relating to, teaching as practicing family physicians. This has important implications for educating family physicians in and for Africa and indirectly on expanding capacity to educate health care professionals in Africa.

Medical Education Partnership Initiative gives birth to AFREhealth

Francis Omaswa, Elsie Kiguli-Malwadde, Peter Donkor, James Hakim, Milliard Derbew, Sarah Baird, Seble Frehywot, Onesmus Wairumbi Gachuno, Steve Kamiza, Isaac Ongubo Kibwage, Kein Alfred Mteta, Yakub Mulla, Fitzhugh Mullan, Jean B Nachega, Oathokwa Nkomazana, Emilia Noormohamed, Vincent Ojoome, David Olalaye, Sandy Pillay, Nelson K Sewankambo, and Marietjie de Villiers African Centre for Global Health and Social Transformation, 13B Acacia Avenue, Kampala 9974, Uganda (FO, EK-M, VO); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (PD); University of Zimbabwe, Harare, Zimbabwe (JH); Addis Ababa University, Addis Ababa, Ethiopia (MD); George Washington University, Washington, DC, USA (SB, SF, FM); University of Nairobi, Nairobi, Kenya (OWG, IOK); University of Malawi, College of Malawi, Chichiri, Malawi (SK); Kilimanjaro Christian Medical University College, Moshi Tanzania (KAM); University of Zambia, Lusaka, Zambia YM); Stellenbosch University, Stellenbosch, South Africa (JBN, MdV); University of Botswana, Gaberone, Botswana (ON); Universidade Eduardo Mondlane, Maputo, Mozambique (EN); University of Ibadan, Ibadan, Nigeria (DO); University of KwaZulu-Natal, Durban, South Africa (SP); and Makerere University, Kampala, Uganda (NKS)

The Medical Education Partnership Initiative (MEPI): Innovations and Lessons for Health Professions Training and Research in Africa

MEPI was a

Teaching Medical Students in a New Rural Longitudinal Clerkship: Opportunities and Constraints

130 million competitively awarded grant by President’s Emergency Plan for AIDS Relief (PEPFAR) and National Institutes of Health (NIH) to 13 Medical Schools in 12 Sub-Saharan African countries and a Coordinating Centre (CC). Implementation was led by Principal investigators (PIs) from the grantee institutions supported by Health Resources and Services Administration (HRSA), NIH and the CC from September, 2010 to August, 2015. The goals were to increase the capacity of the awardees to produce more and better doctors, strengthen locally relevant research, promote retention of the graduates within their countries and ensure sustainability. MEPI ignited excitement and stimulated a broad range of improvements in the grantee schools and countries. Through in-country consortium arrangements African PIs expanded the programme from the 13 grantees to over 60 medical schools in Africa, creating vibrant South–South and South–North partnerships in medical education, and research. Grantees revised curricular to competency based models, created medical education units to upgrade the quality of education and established research support centres to promote institutional and collaborative research. MEPI stimulated the establishment of ten new schools, doubling of the students’ intake, in some schools, a three-fold increase in post graduate student numbers, and faculty expansion and retention. Sustainability of the MEPI innovations was assured by enlisting the support of universities and ministries of education and health in the countries thus enabling integration of the new programs into the regular national budgets. The vibrant MEPI annual symposia are now the largest medical education events in Africa attracting global participation. These symposia and innovations will be carried forward by the successor of MEPI, the African Forum for Research and Education in Health (AFREhealth). AFREhealth promises to be more inclusive and transformative bringing together other health professionals including nurses, pharmacists, and dentists.