Community-based primary healthcare training for physiotherapy in KwaZulu- Natal: perceptions of physiotherapy academics.
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ABSTRACT Background: The healthcare system in South Africa is faced with many challenges. There is an unequal distribution of health services between urban and rural communities, with rural communities having restricted access to healthcare services. Rural areas struggle to sometimes recruit and retain health professionals as a result of poor infrastructure and logistical obstacles. Clinical education is a rudimentary component of the undergraduate physiotherapy curriculum and is the means by which undergraduate students are exposed to a wide range of patients and conditions. It allows for relevant integration between theory and clinical practice. Clinical education has evolved into an educational model, with the aim of generating empirical learning strategies for undergraduate students. Clinical education generally commences in the second year of the degree, with hours of clinical practice escalating until the final, fourth, year of training; allowing undergraduate students to become independent, skilled therapists post- graduation. Community-based education is an efficient way of providing health services to under-resourced communities. The University of KwaZulu-Natal has initiated the community- based primary healthcare training (CBPHCT) platform, also referred to as decentralised clinical training (DCT), in an attempt to provide equal and fair access to health services to under- resourced communities, as well as to provide a holistic learning environment for undergraduate physiotherapy students. Exposure to the challenges experienced within the primary healthcare system allows for students to develop competent skills and core competencies to provide optimal healthcare services. In addition, community-based training in the primary healthcare (CBPHCT) setting reduces the load experienced by on-site clinicians. It is therefore highly beneficial in an overburdened healthcare system. In order to provide optimal service to under- resourced communities, the CBPHCT framework needs to be regularly reviewed to include current evidence-based health trends and new teaching and learning methods. Objective: The study aimed to explore the perceptions of physiotherapy academics about a novel clinical education platform in the primary healthcare setting in the province of KwaZulu- Natal. Methods: A qualitative research method was adopted. All academics at the UKZN physiotherapy department were interviewed, when their perceptions of CBPHCT were explored via open-ended interviews. The data was then transcribed and analysed using thematic analysis. v Results: Four overarching themes were identified, namely curriculum review, constraints to decentralised learning, benefits of community-based clinical education and recommendations for the learning platform. Conclusion: Participants reported both positive and negative experiences of the novel CBPHCT platform. It facilitated personal growth for both the students and academics. However, the framework was challenged by resource limitations, clinical educator challenges and lack of supervision. The academics felt that effective communication between the Department of Health (DoH) and the university needs to be well established in order to improve the partnership. The academics also recommended improving simple logistics and infrastructure on site in order to make the placements more attractive to students and to retain healthcare professionals. They also suggested the recruitment of local supervisors, even on a part-time basis. Engaging the community as part of the framework was recommended in order to enhance social accountability in the students. The academics concluded that the current curriculum needs to be regularly reviewed to address various challenges, whilst encouraging a cohesive relationship between all stakeholders in order to provide a well-integrated teaching and learning environment. Keywords: physiotherapy, clinical education, community-based primary healthcare, decentralised training.