A comparative study of decentralised training platforms in undergraduate medical education at four South African universities

Abstract

Background The World Health Organization (WHO) has underscored the importance of transforming health professional education and their training institutions in order to meet population and health care system needs. The acceleration of “transformative, high-quality education” to ensure that “all health workers have skills that match the health needs of populations” was reiterated by the 2016 Report of the United Nations High-Level Commission on Health Employment and Economic Growth. Decentralised training platforms (DTPs), defined as any learning environment such as a clinic, district hospital or non- governmental organisation used for medical (or health professional) education and training, have been proposed as an important strategy to achieve educational reforms. These DTPs are situated away from the main university campus, exclude tertiary academic hospitals, and are close to and engaged with communities. The benefits of DTPs include the expansion of the teaching platform that enables an increase in the production of medical graduates, attraction to and retention of graduates in rural and other underserved areas, enhanced social accountability of graduates, and changing negative views about PHC or non-tertiary level services. Aim The aim of the study is to examine decentralised training platforms (DTPs) utilised in undergraduate medical education by the health science faculties of four South African universities and their role in transforming medical education. The specific objectives of the research were to: 1. Describe the typology of DTPs at the four selected universities, specifically: a. Context or evolution of DTPs at each university b. The profile of DTPs (number, type, size, etc.) c. Inputs (e.g. staff, finance, infrastructure) d. Process of engagement with stakeholders e. Envisaged outputs or product of DTPs 2. Compare the teaching or learning objectives at the DTPs - a. Within each institution’s DTPs b. Across the four institutions 3. Compare the experiences and perceptions of preceptors and staff at the existing DTPs 4. Explore the medical student experiences at the existing DTPs. Methodology Between 2017 and 2020, a cross-sectional mixed methods study was conducted at the University the Witwatersrand (Wits), the University of KwaZulu-Natal (UKZN), Walter Sisulu University (WSU) vii and Sefako Makgato University (SMU). These universities represent a wide spectrum of South African universities – from a mainly rural environment (WSU), a mixed environment (UKZN & SMU) to a mainly urban environment (Wits). This PhD study consisted of four components: in-depth interviews with 18 key informants combined with a document analysis; site observations at 8 DTPs; and 13 preceptors and staff, 4 focus group discussions (FGDs) with final year medical students and 60 Log diary analysis. Thematic analysis was used to analyse the qualitative data. Results The study highlighted the financial and human resource requirements needed from institutions to sustain the use of DTPs. The teaching objectives emphasise critical competencies like critical thinking, evidence-based practice, clinical application and how DTPs help students understand patients and their backgrounds better. The study revealed the experiences of preceptors and staff at DTPs, highlighting the challenges they face in balancing clinical duties and education. It emphasised the importance of continuous professional development and effective communication for shaping competent healthcare professionals. The study also highlighted the benefits of hands-on patient interaction in developing communication skills and empathy for students trained at DTPs. Conclusion The PhD generated new knowledge on the utilisation of decentralised training platforms in undergraduate medical students training. The findings highlight the conceptual and theoretical discourse on DTPs in South Africa and the transformation in medical education.