South-South cooperation in health professional education : a literature review

In the literature on the evolution of funding approaches there is criticism of traditional funding strategies and the promotion of inclusive models, such as South-South Cooperation (SSC) and triangular models. The latter are felt to have a number of advantages. This article has four broad objectives: (i) to present a literature review on the evolution of Southern approaches to development co-operation; (ii) to indicate examples of current co-operative programmes in health and health professional education in Africa; (iii) to assess the advantages and disadvantages of these models; and (iv) to mention some emerging issues in monitoring and evaluation. The Boolean logic approach was used to search for applicable literature within three topic layers. Searches were conducted using PubMed, PLoS and other accessible databases. An initial draft of the article was presented to a group of academics and researchers at the Flemish Inter-University Council (VLIR-UOS) Primafamed annual workshop held in August 2010 in Swaziland. Comments and suggestions from the group were included in later versions of the article. It is important to note that the existence of various funding models implemented by a variety of actors makes it difficult to measure their effects. In health and health professional education, however, SSC and triangular models of aid provide conditions for more effective programming through their focus on participation and long-term involvement. With an eye towards evaluating programmes, a number of salient issues are emerging. The importance of context is highlighted

How do doctors learn the spoken language of their patients?

Background In South Africa, many doctors consult across both a language and cultural barrier. If patients are to receive effective care, ways need to be found to cross this communication barrier. Methods Qualitative individual interviews were conducted with 7 doctors who had successfully learned the language of their patients to determine their experiences and how they did so. Results All doctors used a combination of methods to learn the language. Listening was found to be very important, as was being prepared to take a risk or appear to be foolish. The doctors found it was important to try out the newly learnt language on patients and stressed that learning the language was also learning a culture. The importance of motivation in language learning, the value of being immersed in the language one is trying to learn, and the role of prior experience in language learning, were commonly mentioned. The doctors deeply valued the better rapport and deeper relationships with patients that resulted from their language learning efforts

The impact of interpersonal relationships on rural doctors’ clinical courage

Introduction: Clinical courage occurs when rural doctors push themselves to the limits of their scope of practice to provide the medical care needed by patients in their community. This mental strength to venture, persevere and act out of concern for one’s patient, despite a lack of formally recognised expertise, becomes necessary for doctors who work in relative professional isolation. Previous research by the authors suggested that the clinical courage of rural doctors relies on the relationships around them. This article explores in more depth how relationships with others can impact on clinical courage. Methods: At an international rural medicine conference in 2017, doctors who practised rural/remote medicine were invited to participate in the study. Twenty-seven semistructured interviews were conducted exploring experiences of clinical courage. Initial analysis of the material, using a hermeneutic phenomenological frame, sought to understand the meaning of clinical courage. In the original analysis, an emic question arose: ‘How do interpersonal relationships impact on clinical courage’. The material was re-analysed to explore this question, using Wenger’s community of practice as a theoretical framework. Results: This study found that clinical courage was affected by the relationships rural doctors had with their communities and patients, with each other, with the local members of their healthcare team and with other colleagues and health leaders outside their immediate community of practice. Conclusion: As a collective, rural doctors can learn, use and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion rural doctors’ way of working

Will clinical associates be effective for South Africa?

South Africa has developed an innovative mid-level medical worker model that can contribute substantively to the development of quality district level health care. These clinical associates entered the South African job market in 2011 and have reportedly been received favourably. The first cohorts performed well on local and national examinations, with pass rates >95%. They have demonstrated confidence and competence in the common procedures and conditions encountered in district hospitals; reportedly fitted in well at most of the sites where they commenced working; and made a significant contribution to the health team work, resulting in a demand for more such health workers. Universities and provinces involved in producing clinical associates are enthusiastic and committed. However, priorities are to: establish sustainable funding sources for training and deployment, provide adequate supervision and support, monitor the initial impact of the new cadre on health services, and manage the sensitivities of the medical and nursing professions around scopes of practice and post levels. Longer-term concerns are national leadership and support, scaling up of training, the development of career pathways, and the improvement of working conditions at district hospitals

Support nurses and midwives to strengthen healthcare systems

CITATION: Fields B, Sibanda B, Couper I. Support nurses and midwives to strengthen healthcare systems. Rural and Remote Health 20: 6110.doi.10.22605/RRH6110The original publication is available at: .rrh.org.auNurses and midwives make up more than half of the global health workforce1. WHO has designated 2020 as the Year of the Nurse and Midwife2 to recognize their contribution, and to highlight the challenges they face in meeting the needs of the communities they serve. Both the International Council of Nurses’ International Nurses Day3 and the first State of the World’s Nursing report4, recently launched by the International Council of Nurses and WHO respectively, highlight the crucial role played by nurses and midwives in health promotion, disease prevention and treatment. Their role is even more important in Africa, and in low- and middle-income countries (LMICs) in other regions, where nurses are often the only health professionals accessible to rural and remote communities.Publisher’s versio

Investigating competencies needed by European-trained doctors in rural South African hospitals

Barnacle JR, Johnson O,Couper I. Investigating competencies needed by European-trained doctors in rural South African hospitals.Afr J Prm Health Care Fam Med. 2020;12(1), a2322. https://doi.org/10.4102/phcfm.v12i1.2322Barnacle JR, Johnson O, Couper I. Investigating competencies needed by European-trained doctors in rural South African hospitals. Afr J Prm Health Care Fam Med. 2020;12(1), a2322. https://doi.org/10.4102/ phcfm.v12i1.2322The original publication is available at http://www.phcfm.orgBackground: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work

Lessons from innovation in medical education during the COVID-19 pandemic: student perspectives on distributed training

Introduction: Can the forced adaptation brought about by COVID-19 inform the future of clinical education? This study brings a low- and middle-income country perspective to this question. Most studies of the impact of COVID-19 on medical students' training have been conducted in high-income countries, where the infrastructure to convert to alternative virtual or COVID-19-friendly training platforms (online teaching or case discussions and skill development centres) is more established than in low- and middle-income countries. In South Africa, Stellenbosch University instead chose to move substantial components of clinical training away from the traditional city tertiary campus and into smaller district hospitals. The main objective of this study was to ascertain the perspectives of these student interns regarding the quality of their restructured training at distributed health facilities during the COVID-19 pandemic and compare the perspectives of rural-site students with those of metropolitan (metro)-site students. Methods: A cross-sectional study was conducted by REDCap survey. Quantitative data were analysed by SPSS Statistics by doing descriptive and inferential statistics. The statistical significance of associations was determined by a p-value of <0.05. Likert-scale questions were analysed as ordinal variables to determine distribution of the responses, and non-parametric Mann-Whitney tests were used to compare distributions between rural and metro groups. Qualitative questions were analysed thematically by identifying common themes. Ethical approval was obtained for the study. Results: There were 155 respondents (62% response rate). Although 74.6% of participants indicated that they developed approaches to undifferentiated problems and illnesses, rural-site students were more likely to perceive that they learnt new procedures (p=0.006) and improved their ability to perform procedures previously learnt (p=0.002) compared to metro-site students. Rural-site students reported that they saw more patients independently than during previous training (p<0.001) and felt that they took more responsibility for patient management (p<0.001) than metro-site students. Students at rural sites were more likely to agree that training during the pandemic provided good learning opportunities (p<0.001) and that medical students form a necessary part of the pandemic response. Overall, students at both distributed sites felt that their training gave them more confidence for their future internship than previous training at central teaching hospitals (median=2 (agree)). Conclusion: The COVID-19 pandemic provided challenges for the continuation of quality medical training. It also provided the opportunity for innovative changes. This study demonstrates the successful outcomes, even during the pandemic, of distributed-site training, where students are immersed in the healthcare team, take responsibility of patient management and report that they improve their skills. Students at rural sites tended to report a more positive perspective on their clinical training. Rather than seeing the end of the pandemic as a time to revert to the previous status quo, the students in this study suggest to us that the lessons learnt from this forced innovation in distributed learning can now inform a better approach to clinical education for the future