Abstract
This article was migrated. The article was not marked as recommended. We implemented a series of facilitator-led, peer-driven journal club discussions at a teaching hospital in Malawi with over 40 medical interns and clinical officer trainees. Our interest was to investigate whether trainees working in a demanding clinical environment and having undergone classic uniform directive teaching would perceive meaningful change through the journal club experience. Findings indicated the learners showed positive responses throughout all assessments and reported lasting effects on their attitude and practice. Detailed examination of the questionnaire suggested that when teaching courses allowed for opportunities to reflect and criticise, improvements could be seen in student confidence, teamwork, and stress levels. We pose that an opportunity for learner-led discourse on educational and workplace matters could be a valuable component of a radical change in teaching style in low-resource settings.
Highlights
A great part of medical schools and teaching hospitals in Eastern and Central Africa founded in the late 1950s and 1960s originally adopted the British educational system of that time
Following the ideas of the remarkable primary health care conference of Alma-Ata and transferring these into the teaching context, enduring improvements in the African setting can only be achieved if health workers accept approaches to their work which are markedly different from the conventional paradigms of teaching in medicine, going from hospital-based to community-based, from creating dependency to encouraging self-learning and evidence-based decision-making, from post-test evaluation to continuous cycles of improvement and self-assessment (UNICEF, 1978)
When asked about long-lasting change, 79% reported almost always or always changing their practice. 85% reported that they experienced improved stress management and reduced frustration and 79% had the perception of improved teamwork secondary to the journal club discussions. 67% reported a moderate to major effect on changing their perspective on the public health system in Malawi and 72% reported a moderate to major effect on the way they approach scientific articles
Summary
A great part of medical schools and teaching hospitals in Eastern and Central Africa founded in the late 1950s and 1960s originally adopted the British educational system of that time. Postgraduate learners in resource-limited settings are suffering from a loss of freedom and expression of their own reflections, concentrating on coping with an overloaded curriculum and hospital system rather than being equipped with the skills for self-learning that are essential throughout a medical career. They face an overwhelming burden of patient care with extremely high patient–to-provider ratios, high mortality rates, and continuous system challenges related to limited resources that can contribute to an extremely difficult workplace environment
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