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

Nontsikelelo O Mapukata,Ian Couper,Rainy Dube,Motlatso G Mlambo

doi:10.4102/phcfm.v9i1.1226

Nontsikelelo O Mapukata, Ian Couper + Show 2 more

Open Access

https://doi.org/10.4102/phcfm.v9i1.1226

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Abstract

BackgroundMost of South Africa’s citizens who live in rural or underserved communities rely on the public health care sector to access quality health care. The value of rural exposure through clinical placements is well documented. Medical schools in South Africa have a responsibility to provide solutions that address the prevailing human resources challenges. Despite this commitment, medical students do not necessarily appreciate their role in resolving South Africa’s human resources challenges. This study aimed to assess the factors that influenced the choice of clinical learning sites in a self-selection process undertaken by Wits final year medical students for the compulsory 6-week integrated primary care block rotation.MethodsQualitative data related to reasons for choice of service learning site were gathered from 524 pre-placement questionnaires completed by final year medical students entering the rotation over a 3-year period (2012–2014). Thematic analysis was performed using the MAXQDA software.ResultsEight themes emerged from the study indicating that the majority of participants were in favour of local urban underserved placement. Contextual factors, such as work commitments or family responsibilities, being compromised socially and losing academic standing were the main reasons for seeking urban placement. Good supervision, opportunistic learning, skills development and moral support were reasons for seeking rural placements. Previous voluntary exposure to rural practice or being of rural origin was a strong indicator for uptake of rural placement.ConclusionThis study has demonstrated the challenges faced by coordinators in balancing personal and institutional needs with country needs and the contextual factors that must be considered when implementing medical education programmes that respond to social challenges.

Highlights

South Africa is a developing country with many of its citizens residing in rural or underserved communities dependent on the public health care sector to access quality health care
In the first 20 years of post-apartheid, South African universities had an opportunity to select a diverse group of health sciences students and adopt curricula that focused on reforms to benefit communities.[3,4]
This study revealed that not all final year medical students are keen to take up placement in rural areas despite a progressive preparatory exposure from Graduate Entry Medical Programme (GEMP) 1 to GEMP 3

Summary

Introduction

South Africa is a developing country with many of its citizens residing in rural or underserved communities dependent on the public health care sector to access quality health care. Universities across the country are tasked with the responsibility to provide solutions for prevailing challenges such as the shortage of health care workers, especially in the rural areas of South Africa.[1,2] In the first 20 years of post-apartheid, South African universities had an opportunity to select a diverse group of health sciences students and adopt curricula that focused on reforms to benefit communities.[3,4] Reflecting on some of these initiatives, Lehmann et al refer to a full spectrum of reforms that brought changes and innovations in many of the medical schools.[5] these initiatives varied from institution to institution, from student selection as an entry point right up to faculty development to incorporate a diverse body of staff members, the ultimate goal has always been to produce a graduate who will respond to the needs of South Africa It is for these reasons that rural exposure through clinical placements has gained prominence amongst policy makers, faculty members and clinical educators based on perceived benefits in familiarising students with the needs of rural communities and an opportunity to address the cumulative shortage of health care workers.[6,7,8] The question remains, whether these initiatives are having the impact that is desired, and whether medical students are changing in their attitudes to the perceived needs. This study aimed to assess the factors that influenced the choice of clinical learning sites in a self-selection process undertaken by Wits final year medical students for the compulsory 6-week integrated primary care block rotation

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