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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.
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    Teaching and learning coping strategies adopted by teenage mothers during coronavirus disease lockdown in Makhado Municipality, Limpopo Province.
    (2023) Moganedi, Shonisane Emily.; Mudau, Tshimangadzo Selina.
    Background: The COVID-19 pandemic exposed inequalities in access to technology between rich and poor, rural, and urban, girls and boys and across and within countries. The other negative social and health related impacts that COVID-19 and related restrictions had on the poorest, most marginalized, and vulnerable sectors of society are likely to have been disproportionately affected by school closures due to COVID-19. Teenage mothers living in rural areas have fewer resources such as access to the internet, smartphones, and computers to adapt to and implement measures needed to continue with online learning during school closures. The aim of the study was to explore and describe teaching and learning coping strategies adopted by teenage mothers in the rural communities of Makhado Municipality during the coronavirus disease lockdown in Limpopo Province, South Africa. Design: The study adopted a qualitative critical participatory action research through the community engagement approach. Methods: Purposive and snowballing recruitment were employed in this study. Methods of generation of data included semi-structured face-to-face interviews which were audio-taped, transcribed verbatim, and participatory arts were also applied to generate data. Data was analysed using qualitative thematic analysis. Findings: Thematic analysis of data revealed that teenage mothers experienced challenges such as stigma and discrimination, stress, inability to cope with self-study, financial constraints in caring for and supporting their babies, lack of gadgets and the internet essential for home learning, and inconsistent support from parents and teachers. Recommendations: Policies need be reviewed to address the issue of stigmatization and discrimination in schools. Authorities in education need to be geared in enriching social change towards transformative learning and addressing the issue of the digital divide in rural communities. Conclusion: It was concluded that the COVID-19 pandemic has broadened a huge gap between the rich and the poor, urban and rural learners. It was concluded by the researcher that there was evidence of social segregation and social injustice for teenage mothers in teaching and learning.