Abstract
It is well-recognised that medical students whose training exposure is largely limited to tertiary-level training hospitals may be inappropriately equipped to deal with the most relevant health issues affecting rural communities. This article evaluated the perceived educational value of a 2 week clinical rotation undertaken by senior undergraduate medical students at rural district hospitals and health care centers in the Western Cape Province, South Africa. Students completed a daily log diary to provide an overview of time spent on specific academic activities, ranking the educational and enjoyment value of each activity. At the end of the 2 week rotation students completed an open-ended questionnaire capturing the main positive and negative aspects of their experience, followed by focus group discussions with a randomly selected subgroup. In addition, a formal feedback seminar was arranged with the academic supervisors at each of the training sites to triangulate the information received and to document their perspective. Thirty-seven students consented to study participation and 25 (68%) adequately completed the log diaries and questionnaires, rating the following activities as most educational: 'assisting in theatre', 'teaching by doctor', 'seeing patients in clinic/health centre/OPD' and 'mobile clinic excursions'. The rural experience allowed practical application of their theoretical knowledge, which improved their levels of confidence and enjoyment. The most enjoyed activities were: 'mobile clinic excursions', 'performing medical procedures' and 'teaching by doctor'. The students were critical of some aspects: (i) the rural rotation was not structured efficiently; (ii) compulsory written reports and additional projects prevented them from maximizing the rural experience; and (iii) a time period of 2 weeks was felt to be too short for optimum benefit from the rotation. The feedback obtained from this log diary study demonstrates that well-functioning rural health care centers provide excellent opportunities for students to develop the most relevant practical skills required of generalist doctors working in resource-limited settings. In addition to a more efficiently structured rural program, students requested an increase in the length of the rotation and a reduction in the written academic workload.
Highlights
It is well-recognised that medical students whose training exposure is largely limited to tertiary-level training hospitals may be inappropriately equipped to deal with the most relevant health issues affecting rural communities
We report the successful use of the log diary approach to documenting how students spend their time on rural clinical rotations
Our results are in agreement with what has previously been reported in the literature, confirming that medical students derive great educational value from wellsupervised rural clinical rotations[44,45,46]
Summary
It is well-recognised that medical students whose training exposure is largely limited to tertiary-level training hospitals may be inappropriately equipped to deal with the most relevant health issues affecting rural communities. Healthcare systems in many countries have been reformed, assigning a more prominent role to primary health care and the general medical practitioner[6,7,8,9,10,11,12] Based on these and other significant developments[13], family medicine is recognized as a specialty discipline in South Africa, with family medicine practitioners being called ‘family physicians’[14]. During the 1970s, ambulatory settings were already suggested for training of medical students[17], and the functions of a family medicine preceptorship was studied in the years 1976-197718 Following these developments, a model using local health centres in undergraduate medical education was proposed[19]. Primary health care centres (PHCC, or ‘clinics’) and district level general hospitals, both urban and rural, subsequently became the settings of choice for training undergraduate medical students[20,21,22]
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