Volunteer, community-based student-run clinics for the underserved : can they be used to attain 21st century medical education goals?

[摘要] ENGLISH ABSTRACT: Background: Community-based education has increasingly become emphasised as an important aspect of health professions education. Not only does it provide opportunities for student-centred learning; it also facilitates the attainment of graduate attributes desired of health care professionals in the 21st century. Further, it can influence career choices and thus retain doctors in primary care, where the greatest practitioner deficit is. South Africa has committed to training community-based, primary care generalists who can attend to the country's greatest healthcare needs. Consequently, Health Science Faculties aim to include community-based teaching and learning opportunities in their curricula. At the University of Cape Town, this has proved a challenge due to the limited number of sites available for student placements. However, there are several voluntary community-based student-run clinics co-ordinated by the Students Health and Welfare Centres Organisation (SHAWCO), which could offer students community-based teaching and learning experiences.Objectives: To investigate students' perceptions of the benefits of SHAWCO clinic attendance to their learning and personal development, in order to determine these clinics' suitability for inclusion into the undergraduate curriculum as community-based teaching and learning sites.The research questions that guided this research were:Does attending volunteer SHAWCO clinics in under-serviced communities impact on student learning; the development of graduate attributes; and/ or students' development as individuals?Based on these findings, do SHAWCO clinics offer the same opportunities described for community-based education, and if so, could they be used as a formalised platform for community-based education at the University of Cape Town?Subsidiary questions1.How, if at all, do students think SHAWCO clinic involvement benefits their learning?2.How do students learn at these clinics?3.Does SHAWCO clinic involvement facilitate the development of desired graduateattributes?4. How, if at all, does SHAWCO involvement impact on students' personal development?5. Based on students' experiences of the SHAWCO environment, do SHAWCO clinics offer the same opportunities as standard CBE, and if so, could they be formalised into the UCT undergraduate medical curriculum?Methods: This was a descriptive case study using semi-structured focus group interviews for data collection. Ethical clearance for the study was obtained from The Universities of Cape Town and Stellenbosch. Seven focus groups were held with medical students; one with SHAWCO Steering Committee members in any year of study; three with preclinical students (years one and two); and three with clinical students (years four and five). A total of 49 students were interviewed. Interviews were analysed inductively using thematic content analysis.Results: SHAWCO clinic involvement did offer the same opportunities as standard community-based education, but the fact that SHAWCO is student-run conferred many additional qualities to this experience. Involvement in SHAWCO complimented and enhanced the curriculum but also took students far beyond curricular bounds, which allowed for the development of many graduate attributes, in addition to personal growth and professional identity development. The voluntary nature of SHAWCO attendance for both students and supervising clinicians was central to its success, as it created an enabling learning environment, where teachers were enthusiastic and patient. Other facets of the SHAWCO learning experience included peer-assisted learning and mentorship, early patient contact, accountability and emotional engagement.Conclusions: While SHAWCO clinics provide an ideal community-based teaching and learning opportunity, they should not be formalised into the curriculum to any great extent, as doing so would rob SHAWCO of the very essence that makes it so beneficial. However, one compulsory visit in students' first year of study during a period when many become disillusioned due to dry academic bookwork is suggested, after which time students could return if they so choose. Offering senior students, who are responsible for the majority of teaching, voluntary input on effective clinical teaching and mentorship methods could potentially enhance the educational value of the SHAWCO learning experience.

[发布机构] Stellenbosch University