Abstract
BackgroundSouth Africa is committed to health reforms that strengthen primary health care. Preparing future doctors to work in primary care teams with other professionals is a priority, and medical schools have shifted towards community-based and decentralised training of medical students.AimTo evaluate the effect on student performance of the Practical Approach to Care Kit (PACK) (an integrated decision-making tool for adult primary care) during the final phase of medical student training at Stellenbosch University.SettingClinical rotations in family medicine at clinics in the Western Cape.MethodsMixed methods involving a quasi-experimental study and focus group interviews. Student examination performance was compared between groups with and without exposure to the PACK during their clinical training. Student groups exposed to PACK were interviewed at the end of their rotations.ResultsStudent performance in examinations was significantly better in those exposed to the PACK. Students varied from using the PACK overtly or covertly during the consultation to checking up on decisions made after the consultation. Some felt that the PACK was more suitable for nurses or more junior students. Although tutors openly endorsed PACK, very few modelled the use of PACK in their clinical practice.ConclusionThe use of PACK in the final phase of undergraduate medical education improved their performance in primary care. Students might be more accepting and find the tool more useful in the earlier clinical rotations. Supervisors should be trained further in how to incorporate the use of the PACK in their practice and educational conversations.
Highlights
The health system in South Africa is in the process of transformation with an emphasis on reengineering primary health care to achieve universal coverage and a more equitable system funded through national health insurance.[1,2]
In South Africa, there is no requirement for doctors to train as generalists in order to work in primary care, family medicine training was recognised in 2007 and the number of family physicians with four years of postgraduate training is slowly increasing.[4]
This study aimed to evaluate the effect on student performance of implementing the Practical Approach to Care Kit (PACK) by means of an inter-professional training model during the student internship in family medicine and primary care
Summary
The health system in South Africa is in the process of transformation with an emphasis on reengineering primary health care to achieve universal coverage and a more equitable system funded through national health insurance.[1,2] The Ideal Clinic initiative is committed to patients having access to a competent primary care doctor as part of a multidisciplinary team.[3]. In South Africa, there is no requirement for doctors to train as generalists in order to work in primary care, family medicine training was recognised in 2007 and the number of family physicians with four years of postgraduate training is slowly increasing.[4]. The educational system should be responsive to the needs of the population and the requirements of the health system.[5] Over the last few decades, medical schools have reformed their undergraduate curricula to include attention to family medicine and primary care and a more disseminated community-based educational experience. Preparing future doctors to work in primary care teams with other professionals is a priority, and medical schools have shifted towards community-based and decentralised training of medical students
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