Browsing by Author "Van Wyk, Jacqueline Marina."

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An exploration of the learning environment and career intentions: a mixed methods study of paediatric interns at KwaZulu-Natal.
(2018) Naidoo, Kimesh Loganathan.; Van Wyk, Jacqueline Marina.
Background: Globally, there is increased pressure on health professions education to be responsive to inequities in health care. These imperatives are clearly evident in KwaZulu-Natal (KZN) with its high disease burden. Poor doctor to patient ratios here are exacerbated by migration of medical practitioners to urban areas, private practice and developed countries. South Africa’s two–year internship aims at producing primary health care clinicians for the public health system. Gaps in knowledge of internship and intern career intentions, in resource challenged contexts, have translated to the failure by both higher education authorities and national health departments to include the internship period in strategies, to ensure that the inequities in health care are addressed. Aim: This explorative study used a mixed methodology approach to explore the factors that influence perceptions of the learning environment (LE) during internship and their influence on career intentions. Methods: The study used a social constructivist worldview drawing on a sequential explanatory mixed methods design to understand the construct of the LE and its influence on career intentions. Both quantitative and qualitative methods that included surveys using a locally validated version of the Postgraduate Hospital Educational Environment Measure (PHEEM) and focus group discussions were generated. This study was conducted among interns in Paediatrics at four hospital complexes in KwaZulu-Natal in 2015. The Communities of Practice theory and the Social Cognitive Career Theory were drawn on and supplemented by the theory of alienation and engagement to develop a conceptual framework that informed the analyses of the relationship between perceptions of the LE and career intentions. Results/Findings: Perceptions of the LE were found to be influenced by both external (disease burden, workload and resource constraints) and individual related contextual factors (supervisor -intern relationships, mentorship, feedback and demography). These factors acted as alienating influences that curtailed access and restricted participation within communities of practice in internship. A narrow view of the role and scope of interns was reflected in significant differences between interns and their supervisor’s perceptions of the LE and gaps in assessment practices of SA interns compared with international best practices. Poor perceptions of the LE drove interns away from SA’s public health system and from caring for children. There were strong aspirations to specialise and weaker aspirations to enter primary health care amongst the sampled interns. Conclusion: Contextual factors in a resource limited LE impacted on identity and career self-efficacy formation of SA interns who failed to see a future role for themselves in primary health care and child health within the public health system. Expanding on the framework of communities of practice a new model of understanding, of how the interplay of contextual factors in resource challenged contexts affects internship learning and career interest formation, was developed. This new knowledge of context on learning and career interest provides the framework to understand the discordance between national health needs and career aspirations of interns in resource challenged environments. This new understanding provides the theoretical underpinning for changes in policy, practice, curricula content and future research to improve access and create an expansive participatory framework for SA interns. These proposed changes in the SA learning environment has the potential to ensure a sustainable public health system and redress the inequity seen in distorted doctor patient ratios in areas of need.
Application of communication skills in an authentic clinical setting: assessing the communication competency of sixth year medical students during history taking.
(2017) Ntando, Ekanda Alfred.; Van Wyk, Jacqueline Marina.; Matthews, Margaret Glynnis.
The Nelson R. Mandela School of Medicine (NRMSM) launched a new 6 year MBChB programme in 2010. This curriculum includes a clinical communication course which emphasises the patient centred approach in line with the Health Professions Council of South Africa Core Competency Framework for undergraduate students. The Calgary-Cambridge Guide to the Medical Interview was adopted as a method for teaching communication. The 2015 final year medical students constituted the first cohort to have been taught clinical communication skills in this manner in the pre-clinical phase. Aim of the study The study was conducted to investigate the transfer of communication skills taught using the Calgary-Cambridge Method (CCM) in the pre-clinical phase to the clinical setting. This study focused mainly on the process skills of history taking and had the following objectives: 1. to determine whether students used the CCM as taught at medical school. 2. To measure and compare process skills of students in two different phases of MBChB programme. 3. To explore role modelling of the CCM by clinical teachers. 4. To describe challenges encountered by students for or in the application of the CCM. Methods The study was observational, analytical and cross-sectional. The population was the 2015 final year class of medical students (n=198) with exception of 13 students who were trained in a different method in Cuba. The study was conducted in the Internal Medicine wards of four teaching hospitals affiliated to the medical school in the Durban functional region. Results The population of the study comprised 185 eligible students; 107 participants were enrolled, and the final number of participants was 105 (57%). In response to the four objectives of the study, the findings revealed that most students used the CCM in a modified manner. There was a marked decline in some of the process skills of history taking, specifically in subcategories such as providing structure and eliciting the patients’ perspective. Educators in Internal Medicine wards did not model the use of the CCM and discouraged its application due to workload and time constraints. Challenges encountered by students included negative attitudes of clinical trainers towards the CCM and language barriers, as most patients spoke in isiZulu. Discussion Results demonstrated that the clinical communication teaching and learning of the pre-clinical phase had some positive impact on application, even if students only used the Calgary Cambridge Method in a modified manner in the clinical phase. The environment of clinical training influenced the transfer, development and the progress of the communication skills learnt in the pre-clinical phase. The decline of process skills in providing structure and eliciting the patient’s perspective was associated with negative attitudes and the poor role modelling of educators. This observation is contradictory to the increase shown in the process skills of building relationship and initiating the session, which probably reflects students’ accumulated experience in the wards. Students encountered challenges associated with language barriers and with different approaches used for personal and organizational reasons. Conclusion With regard to students’ attainment of the HPCSA core competency of communication, and despite communication teaching in the pre-clinical phase and its application in the disciplines of Family Medicine and Rural Health, communication was not equally valued or reinforced in all disciplines involved in undergraduate teaching on the MBChB programme. Key words: communication skills, transfer, application, clinical setting
Does gender impact on female doctors' experiences in the training and practice of surgery?
(2016) Umoetok, Flora.; Van Wyk, Jacqueline Marina.; Madiba, Thandinkosi Enos.
Abstract available in PDF file.
Exploring the impact of experience-based medical learning on students' clinical preparedness : a case study of the South African-Cuban medical training collaboration programme at the University of KwaZulu-Natal, South Africa.
(2014) Motala, Munirah Ismail.; Van Wyk, Jacqueline Marina.
Background: The South-African-Cuban Medical Collaboration (SACMC) programme involves medical training being offered to rural South African (SA) origin students in Cuban facilities with the view of future medical practice in local rural SA settings. The students on the SACMC programme return to South African medical schools to complete their training and clinical practice in their 4th academic year. The students experience difficulty in adapting to local clinical demands and integrating their prior knowledge as required at the Nelson R Mandela, School of Medicine, (NRMSM) of the University of KwaZulu-Natal (UKZN) in Durban, South Africa as evidenced from examination board minutes. Aim: In an effort to inform educators of the extent to which students’ prior clinical training and experiences in Cuba matched the clinical skills taught at the NRMSM, this study investigated the similarity or difference in approach to the curriculum, clinical skills content and perceived competence of the SACMC students to a set of 75 core clinical skills which are deemed essential during training in years 1-3 at the institution. Methods: A mixed methodology study used a phenomenological approach to explore the clinical experiences of 11 South-African-Cuban medical collaboration students. Qualitative data collected by means of interviews and a questionnaire were used to determine the curriculum approach and content. A questionnaire generated quantitative data about students’ familiarity; exposure and perceived competence (ability to perform independently, with supervision or not at all) on 75 specific skills which are considered a prerequisite to enter the 4th academic year at the NRMSM. The skills in 9 major categories, included communication, resuscitation, adult examination, new-born examination, general procedural skills, specimen collection, obstetrics and gynaecology procedures, airway management procedures and radiological examination. Findings: The didactic, lecture intensive Cuban curriculum with its emphasis on primary health care principles and predominance of ward-based clinical training was found to be vastly different from the problem-based, systematic and practical oriented laboratory-based clinical training offered to local students. The majority of students self-reported a lack of exposure to 35 of the overall 75 identified skills. Most students claimed an inability to independently perform 95% (4 out of 75 skills- able to perform 5%) of clinical skills. The qualitative data revealed that many primary health care skills were neither taught nor practiced by students within the first 5 years of training in Cuba. Conclusion: This study has highlighted the mismatch between the focus and scope of clinical training offered to students on the South African-Cuban Medical Collaboration programme and those at the NRMSM. In the light of continued collaboration in health education and to ensure that returning students are adequately supported and integrated into the SA clinical setting, it is important that educators work towards improving the alignment of the training programs.
Preparedness of graduates in occupational therapy for clinical practice : perceptions of students and supervisors in a KwaZulu-Natal case study.
(2013) Naidoo, Deshini.; Joubert, Robin Wendy Elizabeth.; Van Wyk, Jacqueline Marina.
Background: Investigating the development of competent occupational therapists through an academic programme and fieldwork placement is an emerging field in South African occupational therapy research. It is an essential aspect of educational research, as new graduates are often required to work autonomously during their community service. Aim: The aim of this study was to explore the perceptions of the final year University of KwaZulu-Natal occupational therapy students and their clinical supervisors’ regarding their undergraduate education and preparedness for independent clinical practice. Methods: Seventeen final year students and seven clinical supervisors participated in focus groups and semi-structured interviews. Document analysis was used to explore the Health Professions Council of South Africa evaluation report of the undergraduate programme and methods used to assess the final year students. The conceptual framework was based on the World Federation of Occupational therapist Minimum Standards for Training Occupational therapists and deductive reasoning was used to analyse the data. Findings: Most final year students and clinical supervisors felt that students were partially prepared for clinical practice and lacked confidence. The students’ level of confidence was linked to the areas of occupation therapy that they enjoyed and their positive experiences during fieldwork placements. Curriculum design and content were some of the areas highlighted as needing review. Conclusion: The overall perception of both the clinical supervisors and the students was that the new graduates would be able to cope with basic clinical practice. However, there were aspects of the curriculum that could be improved to ensure that the new clinicians have more confidence and are equipped to deliver an occupational therapy service that specifically meets the need for diverse African healthcare settings.
Preparing medical graduates to care for older adults.
(2020) Naidoo, Keshena.; Van Wyk, Jacqueline Marina.
Background: Social accountability in medical training requires medical schools in South Africa to respond to the health needs of the country’s rapidly increasing number of older adults. Reports, however, indicate that elderly patients in South Africa receive poor quality of care from health professionals. Reports also indicate that students’ empathy towards older adults declines as they progress through their studies. These disparities necessitate greater awareness of the health needs and expectations of older adults and an inquiry into the geriatric care training of medical professionals. Aim: This 360-degree study investigated the geriatric medical curriculum at one institution from the perspectives of geriatric patients, learners and health professions educators to make recommendations for improvement, and to develop policy guidelines for the enhancement of undergraduate medical education in geriatric care. Methodology: A sequential mixed methods approach was adopted for this study. Four focus group discussions were conducted with patients aged 60 years and older from primary care facilities served by graduates of the medical institution (n=28). Data that emerged from this phase regarding patients’ expectations of quality geriatric healthcare were triangulated with a review of curriculum documents, semistructured interviews with health professions educators (n=5) and an evaluation of the levels of knowledge and attitudes of final year medical students regarding the care of older adults. Results: The key principles for quality healthcare of older adults that were elicited from patients were respectful communication, compassion, appropriate prescribing, patient-centredness and coordinated care. However, professional attributes such as compassion and patient-centered care that were valued by geriatric patients are not explicitly taught or assessed in the curriculum. The current curriculum includes a wide variety of topics relevant to the care of older adults. Teaching and assessment relevant to geriatric care were further integrated into other modules, but no minimum standards are applied in assessment of the geriatric component. Students lacked exposure to older adults in ambulatory settings and received little teaching on health promotion or rehabilitative services relevant to the care of older adults. Despite the opportunities afforded by the problem-based learning approach in the curriculum for team-based learning and collaboration, interprofessional education was absent in teaching and learning relevant to older adults. Overall, final year medical students possessed minimal levels of geriatric knowledge despite their perceptions of having had adequate exposure to geriatrics in the current curriculum. The majority of students had positive attitudes towards working with elderly patients. In particular, older students and those with a prior higher education qualification had significantly higher levels of knowledge and attitudes towards caring for older adults. Of note, there was no association between geriatric knowledge and attitudes. Medical students also reported challenges in communicating with older adults and believed that their training had not prepared them adequately for this aspect. Conclusion: The findings of the study affirmed the need to enhance the geriatric curriculum for undergraduate medical students, and to develop and implement minimum core competencies in geriatric care. Curriculum planners should consider greater attention to patient-centred care, communication skills training with older adults and interprofessional education, as well as broader community engagement. Policy guidelines based on the findings of this study were developed and recommended to the Undergraduate Committee for Teaching and Learning to improve the preparedness of medical graduates to care for older adults.
The progress examination as an assessment tool in a problem-based learning curriculum : a case study of the Nelson R. Mandela School of Medicine.
(2009) Van Wyk, Jacqueline Marina.; Moletsane, Relebohile.; McLean, Michelle.
Medical schools have been reviewing their curricula to prepare caring and competent health professionals in the midst of a knowledge and technology explosion. The implementation of problem-based learning curricula signalled attempts to make learning more significant, based on constructivist perspectives that emphasise social interaction for meaning making and understanding. Available literature suggests that learning in PBL should be assessed by authentic, contextual real-life tasks that support and encourage students’ learning. To this end, the Nelson R. Mandela School of Medicine implemented the progress examination (PE) to complement the aims of Curriculum 2001 (C2001). The potential formative function of the PE was specifically appealing in terms of allowing for the development of reflective, self-directed and deep learning. Early explorations revealed an apparent mismatch between the aims of C2001, the expectations of stakeholders and their experiences with the PE at the site and these resulted in a number of adaptations to the examination. Cognisant of the influence of assessment on students’ learning, this study sought to examine whether the educational principles governing the implementation of C2001 also informed the implementation and adaptations of the PE. Using a qualitative case study methodology, the study investigated stakeholders’ understandings of the PE and its goals and the lived experiences of its implementation as a suitable tool to assess students’ cognitive learning. In addition, the study also investigated the possible factors that influenced the reform. Findings suggest that the PE was not suitable to assess students’ learning in C2001. Despite the perceptions of a strong educational need for curriculum reform and the apparent suitability of the PE, some members of staff lacked understanding, skill and confidence to apply and implement its aims. Staff failed to apply transformative practices of teaching and learning, while the principles of the PE and C2001 were not well diffused through the organisation. Members of staff expected the PE to differentiate between high and low performing students, while students came to regard the examination as just another hurdle in an already hostile learning environment. Factors such as the unstable and poor leadership, the restructuring of the health and education sectors, impacted on the implementation of the reform. Curriculum and assessment reform is challenging for students and lecturers, requiring the transforming institution to actively prepare and support stakeholders in a conducive educational climate. This case study highlights the need for comprehensive planning for effective and sustained curriculum reform. Collaborative strategies and educational systems should be sought and implemented to sustain conceptual and practical reform.
Vocation-specific isiZulu language teaching and learning for medical students at the University of KwaZulu-Natal.
(2013) Matthews, Margaret Glynnis.; Van Wyk, Jacqueline Marina.
Being an effective communicator is a core competency required of all health care practitioners. Some undergraduate medical students at the Nelson R. Mandela School of Medicine (NRMSM), University of KwaZulu-Natal, Durban, are unable to communicate in isiZulu, the mother tongue of nearly 80% of the 10.2 million people in the province, and the most common home language spoken in South Africa. A one-year isiZulu course to teach communicative competence in the language, and assessed in the first three years of the 6-year MBChB programme, is currently offered at the first year level to medical students. This study was conducted in 2012 to assess how isiZulu clinical communication was perceived by a third year cohort of medical students, and whether current teaching in the period 2010-2012 had prepared them to communicate with their patients. An observational, cross-sectional study design was used to assess the knowledge, attitude and practice of the study group through a self-completed questionnaire. Their knowledge of isiZulu was assessed in a written test, and the students’ marks were compared with their marks in 2010. Oral competence was assessed in an isiZulu history-taking station in the objective structured clinical examination. Students’ comments on their experiences and their recommendations were recorded. Ethics approval was obtained to conduct the study, and informed consent was obtained from participants. Medical students’ competence in isiZulu had improved. They were largely positive about learning the language of their patients but seldom used the language in the clinical setting. Many students indicated that the current teaching of isiZulu in the programme was inadequate for their needs. Although isiZulu is taught to non-isiZulu students, this does not convert into an ability to use the language in the clinical setting. In order for medical students to acquire a satisfactory and safe level of communicative competence in isiZulu, and in line with the UKZN Language Plan to emphasize language training specific to various vocational groups, it is recommended that the teaching, learning and assessment of isiZulu language and culture be integrated into all levels of the undergraduate medical programme in the form of vocation-specific isiZulu for medical students.