School of Clinical Medicine (ETDs)

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    Final-year medical students' experiences and perceptions of integrated primary care learning at decentralised training sites during the COVID-19 pandemic: A mixed-methods study
    (University of the Witwatersrand, Johannesburg, 2023-09) Ruch, Aviva; George, Ann; Francis, Joel
    Background: There is limited data on the effectiveness of online learning to augment theory and clinical knowledge and skills across decentralised training (DCT) sites. This study explored the 2021 cohort of final-year medical students’ experiences and perceptions of the integrated primary care (IPC) online teaching and learning across five DCT sites affiliated with the University of the Witwatersrand in South Africa. This information is essential to determine what online IPC teaching and learning should be retained and what adjustments are needed to enhance and standardise IPC online learning across our DCT sites. IPC is a final-year Bachelor of Medicine and Bachelor of Surgery (MBBCH) subject at Wits University. The subject focuses on primary health care, integrating Internal Medicine, Surgery, Psychiatry, Obstetrics and Gynaecology, Family Medicine, Community Paediatrics and Public Health. Training across different sites poses challenges for standardising learning content and the nature and quality of patient engagement and interaction. The Covid-19 pandemic not only exacerbated the difficulties associated with decentralised teaching and learning, but also decreased student-patient interaction. The rapid shift to emergency remote teaching left teachers with limited time to prepare for online and blended teaching and highlighted shortcomings in some health-professions educators’ ability to create meaningful, authentic learning interactions. The study design was underpinned by the Technology Acceptance Model, the Community of Inquiry Model and the Theory of Self-Regulated Learning. Methods: This explanatory sequential mixed-methods design consisted of a cross-sectional online survey conducted in November 2021, followed by two focus-group discussions in December 2021. The 316 final-year medical students who had completed their IPC block were purposively sampled to participate in this study. Medical students who had not yet completed the IPC block were excluded from the study. Twenty-one closed and four open-ended questions explored the students’ perceptions of how the online materials supported their learning and augmented their clinical skills and management of patients, their challenges with learning online, and ways to improve the online-learning experience. The closed and open-ended survey answers were analysed using descriptive and inferential statistics and content analysis, respectively. The results of the content analysis are presented graphically. The survey findings informed the questions asked in the focus-group discussions (n = 2 and n = 3). The discussions were audio-recorded and transcribed verbatim. The transcripts were analysed inductively in MAXQDA. The findings are presented as thematic maps. Results: The survey response rate was 52% (164/316). The respondents were representative of the study population. Most respondents easily accessed the online content, with more than 70% accessing the online content several times a week. More than 80% found the online content logically organised; the content analysis highlighted three categories of reasons why the online content and interactions influenced their learning. The content analysis also identified three categories of reasons why the online content influenced patient management, but more than a third of respondents remained neutral when asked if the online content introduced them to new clinical skills. Quizzes and tests were the preferred learning method. The features that best supported the respondents’ online learning were grouped into five categories: ‘Range of activities’ (n = 73), ‘Content selection’ (n = 56), ‘Flexible access to content’ (n = 8), ‘Organisation of content’ (n = 4) and ‘Other’ features (n = 7). Respondents highlighted several categories that presented challenges to online learning: ‘Pedagogical issues’ (n = 30), ‘Excessive workload’ (n = 27), ‘Operational issues’ (n = 20), ‘Learning issues’ (n = 17), ‘Technical issues’ (n = 11) and ‘Unclear course expectations’ (n = 50). Participants in the focus-group discussions (FGD) concurred with many of the perceptions and experiences of the questionnaire respondents. Three themes were identified in the thematic analysis of the FGD: ‘Features supporting learning’, ‘Challenges of learning online’, and ‘Ways to improve learning’. Conclusions: The respondents and focus-group participants displayed a positive attitude to the IPC online content and interactions offered to them during the Covid-19 pandemic. Their experiences and perceptions offered insights to better support learning through practical suggestions for students and faculty, especially around faculty competency to design meaningful learning interactions, both online and blended. While this study focused on IPC, the student recommendations may apply to other subjects nationally and internationally, suggesting the need for further research into using online teaching to support clinical teaching.
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    Exploring the students’ perceptions of factors that enable or constrain the learning of neurophysiology at a South African metropolitan university: a qualitative study
    (2024) Nyakudya, Trevor Tapiwa
    Some undergraduate medical and biomedical students grasp neurophysiology easily while others struggle to understand neurophysiology, suggesting that that there are factors that enhance or constrain epistemic access to neurophysiology. Students that struggle with neurophysiology concepts often fail to progress in terms of knowledge building and find it difficult to integrate and associate the control of other systems by the nervous system. The aim of this study was to explore and describe the undergraduate biomedical students’ perceptions of factors that enhance or constrain the learning of neurophysiology at a metropolitan university in South Africa. This was a qualitative descriptive study in which a general thematic analysis approach was used. Semi-structured interviews were conducted with a purposive sample of 10 male and female undergraduate biomedical students studying Physiology and registered in the Faculty of Health Sciences at a metropolitan university in South Africa. Interview transcripts were coded using MAXQDA for data management and analysed using a general thematic analysis approach. Students’ perceptions of the factors that enhance or constrain the learning of neurophysiology including troublesome knowledge and potential threshold concepts were identified and described. Findings show that students identified prior learning of biological concepts in high school, availability of learning resources and practical sessions as enhancing the learning of neurophysiology while the amount of work to be covered, language and terminology, prerequisite knowledge of physical sciences and the existence of troublesome knowledge and potential threshold concepts were identified as constraining factors in the learning of neurophysiology. Neurophysiology topics such as somatosensory and somatomotor pathways, functions of the different regions of the brain and special senses were recognised as 2 troublesome knowledge while the generation and propagation of action potentials was described as a threshold concept that acted as a barrier to the learning of neurophysiology. We conclude that exploring the students’ perceptions of the factors that enhance or constrain the learning of neurophysiology could improve epistemic access to neurophysiology knowledge. This study suggests how academics can design physiology teaching to support students in the learning of neurophysiology. Thus to improve learning outcomes in neurophysiology, it may be important to address the factors that constrain the learning of neurophysiology. Moreover, provision of targeted support and resources for students to overcome potential barriers to learning may be useful in the teaching of neurophysiology.