Abstract
Background:Medical schools in Africa are responding to the call to increase numbers of medical graduates by up-scaling decentralized clinical training. One approach to decentralized clinical training is the longitudinal integrated clerkship (LIC), where students benefit from continuity of setting and supervision. The ability of family physician supervisors to take responsibility for the clinical training of medical students over a longer period than the usual, in addition to managing their extensive role on the district health platform, is central to the success of such training.Objective:This study investigated the teaching experiences of family physicians as clinical supervisors in a newly introduced LIC model in a rural sub-district in the Western Cape, South Africa.Method:Nine semi-structured interviews were conducted with six family physicians as part of the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) five-year longitudinal study. Code lists were developed inductively using Atlas.ti v7, they were compared, integrated, and categories were identified. Emerging common themes were developed.Findings:Three overarching themes emerged from the data, each containing subthemes. The rural platform was seen to be an enabling learning space for the LIC students. The family physicians’ experienced their new teaching role in the LIC as empowering, but also challenging. Lack of time for teaching and the unstructured nature of the work emerged as constraints. Despite being uncertain about the new LIC model, the family physicians felt that it was easier to manage than anticipated.Conclusion:The centrality of the rural context framed the teaching experiences of the family physicians in the new LIC, forming the pivot around which constraints and opportunities for teaching arose. The African family physician is well positioned to make an important contribution to the upscaling of decentralized medical training, but would need to be supported by academic institutions and health service managers in their teaching role.
Highlights
Medical schools in Africa are responding to the call to increase numbers of medical graduates by up-scaling decentralized clinical training
One approach to decentralized clinical training is the longitudinal integrated clerkship (LIC), where medical students benefit from continuity of the clinical setting and Faculty of Medicine and Health Sciences, Stellenbosch University, ZA Corresponding author: Prof
The LIC model is seen as an innovative way to do clinical training, while supporting workforce challenges – such as recruitment and retention of medical doctors for rural and primary care practice [8, 9, 10]
Summary
Medical schools in Africa are responding to the call to increase numbers of medical graduates by up-scaling decentralized clinical training. Medical schools in Africa are responding to the call for increasing the numbers of medical graduates by upscaling decentralized clinical training [1, 2, 3] Many of these initiatives have been prompted by the President’s Emergency Plan for AIDS Relief (PEPFAR)-funded Medical Education Partnership Initiative (MEPI) [4]. Students can choose to work at a rural district health complex for the entire final year of their studies This model is classified as a comprehensive LIC [7], where students learn by participating in the context of undifferentiated and continuous care at the district hospital and at primary health care clinics (PHCs) in the district. A specialist family physician is primarily responsible for their supervision and learning for the year, supported by regular visits by medical specialists from the regional hospital [11, 12]
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