Towards tailored teaching: using participatory action research to enhance the learning experience of Longitudinal Integrated Clerkship students in a South African rural district hospital

Background: The introduction of Stellenbosch University’s Longitudinal Integrated Clerkship (LIC) model as part of the undergraduate medical curriculum offers a unique and exciting training model to develop generalist doctors for the changing South African health landscape. At one of these LIC sites, the need for an improvement of the local learning experience became evident. This paper explores how to identify and implement a tailored teaching and learning intervention to improve workplace-based learning for LIC students. Methods: A participatory action research approach was used in a co-operative inquiry group (ten participants), consisting of the students, clinician educators and researchers, who met over a period of 5 months. Through a cyclical process of action and reflection this group identified a teaching intervention. Results: The results demonstrate the gaps and challenges identified when implementing a LIC model of medical education. A structured learning programme for the final 6 weeks of the students’ placement at the district hospital was designed by the co-operative inquiry group as an agreed intervention. The post-intervention group reflection highlighted a need to create a structured programme in the spirit of local collaboration and learning across disciplines. The results also enhance our understanding of both students and clinician educators’ perceptions of this new model of workplace-based training. Conclusions: This paper provides practical strategies to enhance teaching and learning in a new educational context. These strategies illuminate three paradigm shifts: (1) from the traditional medical education approach towards a transformative learning approach advocated for the 21st century health professional; (2) from the teaching hospital context to the district hospital context; and (3) from block-based teaching towards a longitudinal integrated learning model. A programme based on balancing structured and tailored learning activities is recommended in order to address the local learning needs of students in the LIC model. We recommend that action learning sets should be developed at these LIC sites, where the relevant aspects of work-place based learning are negotiated

Deciphering the sophomore slump: changes to student perceptions during the undergraduate journey

The second year of university is little-researched, despite being a focal point for declining performance, persistence, and satisfaction. It is important to establish appropriate methods for studying this ‘sophomore slump’ and to pinpoint specific antecedents from broad domains noted in literature (e.g. students’ social integration, perceptions of the curriculum). Using a novel methodology, 166 undergraduates were surveyed in successive years of study to derive a gold standard ‘within-subjects’ data sample. Under a replicated design, a ‘between-subjects’ sample of over 1000 students completed the same e-survey just once, in year one, two, or three. Quantitative comparison of the responses across years showed over 85% agreement between samples. This endorses between-subject approaches (i.e. simultaneously surveying students from different years) to facilitate rapid interventions that benefit students before they graduate. In terms of detailed findings, year two saw positive trends in students’ academic engagement (e.g. self-reported independent study time), social integration (e.g. feeling accepted, involvement in extra-curricular activities), and views on teaching staff (e.g. approachability). Although appraisals remained broadly favourable, there was, in contrast, significant deterioration in global perceptions of the learning atmosphere (e.g. course enjoyment), as well as specific elements of the teaching provision (e.g. contact hours, feedback). Notably, there appeared to be little progression in students’ academic self-perceptions (e.g. confidence to make presentations, enter class debates). Year two also saw increased thoughts of drop-out. These results highlight the unique character of the second year at university and indicate potential target areas for enhancing this phase of the undergraduate journey

Do benefits accrue from longer rotations for students in Rural Clinical Schools?

Copyright © Harriet Denz-Penhey, Susan Shannon, J Murdoch, Jonathan Newbury 2005 A licence to publish this material has been given to ARHEN, http://www.rrh.org.auIntroductionThe Australian Government has provided funding for Rural Clinical Schools (RCS) to provide substantial rural clinical experience to medical students. The strategy aims to acculturate students into rural living with the intended long-term outcome of increasing the availability and viability of rural health services. When evaluators from two of the Rural Clinical Schools discussed findings and insights relating to rural rotations from their in-depth evaluation studies of their respective schools they found a range of similarities. This article is a collaboration that articulates parallel findings from evaluations over 2 years, using three different approaches to students' placements across the two RCS: (1) students based long term in one centre (with only a few days away at a time); (2) students based long term in one centre with short-term rotations of 3-6 weeks away from home base; and (3) week rotations without a home base.MethodThe two RCS, as part of their initial establishment, put comprehensive internal evaluation processes in place, including the employment of dedicated evaluators extant from the teaching and assessment of the rural medical curriculum. Data were collected and analysed according to standard education evaluation procedures.ResultsHome-base preference: most students preferred having a home base in one centre and having as little time as possible away from that centre, while recognising that sometimes the requirement to go and learn elsewhere was useful. The reasons for this were three-fold: academic, clinical and social. Academic benefits: students enjoyed the excellence of teaching and learning opportunities in their rural sites and did not want their discipline of learning interrupted by what they perceived as unnecessary change. Students with a home base used their learning opportunities qualitatively differently from those students who had 6 week rotations. Their learning became self-directed and students sought opportunities to extend and consolidate areas of need. Clinical benefits: contributions to the clinical team: students in their clinical years want to feel useful and to be allowed to become contributors to the medical care, even as they are learning. A longer rotation allows them to become known to their teachers who are then able to easily assess the type of contribution that is appropriate for their students to undertake. Students then become full participating members of the healthcare team, rather than observing learners. Social benefits: all students with a home base actively participated in a wide range of community activities outside their role as medical students. Those students undertaking short rotations without a home base seldom connected in the same way to any rural community.ConclusionEvaluation from these two RCS has shown that short rotations are likely to be less optimal than longer rotations for meeting the broader goals of the RCS to build future workforce capacity. Our results suggest that one opportunity to acculturate students into the rural lifestyle is lost when students' placements are insufficiently long for them to put down roots in their community, and to understand how to 'live' there more broadly. Good rural experiences and teaching and learning opportunities are not sufficient in themselves. Students' emotional attachment to rural living comes from experience related to time and the connection to local people that comes as a result of time spent in the community. Students on short rotations do not make that local connection.Denz-Penhey, H; Shannon, S; Murdoch, JC; Newbury, JWhttp://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=41

A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26

Background: Traditionally, clinical learning for medical students consists of short-term and opportunistic encounters with primarily acute-care patients, supervised by an array of clinician preceptors. In response to educational concerns, some medical schools have developed longitudinal placements rather than short-term rotations. Many of these longitudinal placements are also integrated across the core clinical disciplines, are commonly termed longitudinal integrated clerkships (LICs) and often situated in rural locations. This review aimed to explore, analyse and synthesise evidence relating to the effectiveness of longitudinal placements, for medical students in particular to determine which aspects are most critical to successful outcomes