Distribution, incidence, prevalence and default of patients with diabetes mellitus accessing public healthcare in the 11 districts of KwaZulu-Natal, South Africa

Background. The global increase in the prevalence of diabetes mellitus is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu-Natal Province (KZN), South Africa. Data are routinely collected at all public healthcare facilities in the province and are aggregated per facility.Objective. To investigate the distribution, incidence and prevalence of diabetes in the public healthcare sector of KZN.Methods. Data collected by the DHIS for all patients with diabetes in KZN from 1 January 2010 to 31 December 2014 inclusive were analysed. Additional open-source databases were accessed to enable further exploration of the data collected.Results. The study showed that the majority (38.7%) of patients with diabetes on the public sector register were from the district of eThekwini. Positive correlations were found between the prevalence of diabetes, the mortality rate and the number of defaulters (patients with diabetes who did not return for regular treatment).Conclusions. Provincial estimates of the prevalence of diabetes in this study were higher than the known national prevalence. This may be due to the large proportion of Indians in KZN, who have a genetic predisposition to diabetes mellitus. However, allowance must be made for possible inaccurate data collection at source with miscounting of individuals. This study supports the global trend of an association between diabetes and urbanisation and highlights the need for regular diabetes screening and education, particularly in the public healthcare domain

Effects of personality traits on mindful self-care practices of healthcare workers

Background: Coronavirus disease 2019 (COVID-19) placed healthcare professionals (HCPs) at a higher risk for stress-related conditions. Implementing a brief online mindfulness-based intervention (MBI) was hypothesised to transform the HCPs’ ability to cope with stress by enhancing their self-care. Aim: This study aimed to explore the impact of an online MBI on HCPs’ self-care practices and determine if personality traits were a moderating variable. Setting: An online MBI was implemented for HCPs working in South Africa during the COVID-19 pandemic lockdowns. Methods: A quantitative study design included a pre-assessment and post-assessment component, which allowed paired comparison and regression analysis to confer correlations. Data were collected via two validated instruments: the Mindful Self-Care scale-2018 and the Big Five Personality test. Results: Forty-nine HCPs participated in the study. Significant improvements were found in all the major self-care subscales post-intervention (p 0.05). No significant associations were found between the personality traits and self-care except for neuroticism, which appeared to be an essential moderating variable. Conclusion: An online MBI significantly impacted health professionals’ ability to care for themselves, despite their personality styles. Contribution: The impact of an online MBI on HCPs’ self-care during the most intense time of stress and with a cohort of people known to be the most vulnerable to stress, namely those with neuroticism to date, has not been commented on

The Whole is Greater than the Sum: A Longitudinal Study of Demographic Influences on Medical Student Assessment Scores

Abstract The literature on academic success has contributed to our understanding of positive and negative influences on learners' accomplishments. With some exceptions, however, their subjects have been school pupils, who represent the community at large. Relatively few studies have examined tertiary education students, and these studies generally focus on subsets of a particular factor in isolation. Taking a systems theory view, we addressed the question: What factors regarding the learner contribute to the teaching and learning 'system'? Using mixed methods, this longitudinal study explores a range of demographic characteristics that influenced the assessment scores of medical students through their five-year curriculum. For the initial analysis we used the general linear model. A generalised estimating equation was used to analyse the characteristics collectively to assess their influence relative to each other. Students' and staff members' opinions on these factors were also explored through thematic analysis. Of the nine factors investigated, only four appeared statistically to exert independent influences on students' academic achievements. These four influences (high school attended, previous higher education experience, the sequence of tests through the years, final school-leaving marks) seemed to A Longitudinal Study of Demographic Influences on Assessment Scores 29 apply throughout the five year course. The variety of our interviewees' responses helped us to understand the nuances of these influences. While not negating the findings of studies on isolated factors, this study does also challenge the validity of such analyses. The use of a different methodology -two layers of statistical analysis, plus qualitative dataallowed us to demarcate which of the factors examined appeared to be of overall significance in the system related to student achievement in assessments, and to understand why that might be so

“For most of us Africans, we don’t just speak”: a qualitative investigation into collaborative heterogeneous PBL group learning

Collaborative approaches such as Problem Based Learning (PBL) may provide the opportunity to bring together diverse students but their efficacy in practice and the complications that arise due to the mixed ethnicity needs further investigation. This study explores the key advantages and problems of heterogeneous PBL groups from the students’ and teachers’ opinions. Focus groups were conducted with a stratified sample of second year medical students and their PBL teachers. We found that students working in heterogeneous groupings interact with students with whom they don’t normally interact with, learn a lot more from each other because of their differences in language and academic preparedness and become better prepared for their future professions in multicultural societies. On the other hand we found students segregating in the tutorials along racial lines and that status factors disempowered students and subsequently their productivity. Among the challenges was also that academic and language diversity hindered student learning. In light of these the recommendations were that teachers need special diversity training to deal with heterogeneous groups and the tensions that arise. Attention should be given to create ‘the right mix’ for group learning in diverse student populations. The findings demonstrate that collaborative heterogeneous learning has two sides that need to be balanced. On the positive end we have the ‘ideology’ behind mixing diverse students and on the negative the ‘practice’ behind mixing students. More research is needed to explore these variations and their efficacy in more detail

Using deliberate practice framework to assess the quality of feedback in undergraduate clinical skills training

Abstract Background In this research paper we report on the quality of feedback provided in the logbooks of pre-clinical undergraduate students based on a model of ‘actionable feedback’. Feedback to clinical learners about their performance is crucial to their learning, which ultimately impacts on their development into competent clinicians. Due to students’ concerns regarding the inconsistency and quality of feedback provided by clinicians, a structured feedback improvement strategy to move feedback forward was added to the clinical skills logbook. The instrument was also extended for peer assessment. This study aims to assess the quality of feedback using the deliberate practice framework. Methods A feedback scoring system was used to retrospectively assess the quality of tutor and peer logbook feedback provided to second and third year medical students to identify deliberate practice components i.e. task, performance gap and action plan. The sample consisted of 425 second year and 600 third year feedback responses over a year. Results All three deliberate practice components were observed in the majority of the written feedback for both classes. The frequency was higher in peer (83%, 89%) than tutor logbook assessments (51%, 67%) in both classes respectively. Average tutor and peer task, gap and action feedback scores ranged from 1.84–2.07 and 1.93–2.21 respectively. The overall quality of feedback provided by the tutor and peer was moderate and less specific (average score < or = 2). The absence of the three components was noted in only 1% of the feedback responses in both 2nd and 3rd year. Conclusion This study found that adding in a feed-forward strategy to the logbooks increased the overall quality of tutor and peer feedback as the task, gap and action plans were described. Deliberate practice framework provides an objective assessment of tutor and peer feedback quality and can be used for faculty development and training. The findings from our study suggest that the ratings from the tool can also be used as guidelines to provide feedback providers with feedback on the quality of feedback they provided. This includes specifically describing a task, performance gap and providing a learning plan as feed-forward to enhance feedback given

“Growing as a Stronger Clinician in Adverse Conditions”—A Snapshot of Clinical Training during COVID-19

Transformative learning theory has been recommended as a pedagogy of uncertainty for accommodating new beliefs that enable humans to thrive amid the challenges and complexity of our world. As higher education institutions embrace new roles and responsibilities, few studies have focused on how the disruptions caused by COVID-19 may facilitate formative learning experiences. This study explored how registrars responded to the challenges facing clinical training during the first wave of COVID-19, and how the impact of these disruptions prompted personal and professional development. Registrars completed an online qualitative SWOT (strengths, weaknesses, opportunities, and threats) analysis of their training experiences during the COVID-19 pandemic. Data were thematically analysed. Four hundred and five responses were received from 54 registrars. Themes related to challenges included mental distress, resource constraints, and compromised and inadequate training. Themes related to strengths and opportunities included new learning experiences, resilience, coping strategies, and enhanced graduate competencies related to leadership, collaboration, communication, and health advocacy. The disruptive and disorienting elements of COVID-19, although situated in chaos, aggravating the constraints of training in under-resourced settings, also provided unexpected learning opportunities. These findings highlight the transformative potential of disrupted learning contexts and the need for responsive curricular to enhance graduate competencies, adaptability, and resilience

&ldquo;Growing as a Stronger Clinician in Adverse Conditions&rdquo;&mdash;A Snapshot of Clinical Training during COVID-19

Transformative learning theory has been recommended as a pedagogy of uncertainty for accommodating new beliefs that enable humans to thrive amid the challenges and complexity of our world. As higher education institutions embrace new roles and responsibilities, few studies have focused on how the disruptions caused by COVID-19 may facilitate formative learning experiences. This study explored how registrars responded to the challenges facing clinical training during the first wave of COVID-19, and how the impact of these disruptions prompted personal and professional development. Registrars completed an online qualitative SWOT (strengths, weaknesses, opportunities, and threats) analysis of their training experiences during the COVID-19 pandemic. Data were thematically analysed. Four hundred and five responses were received from 54 registrars. Themes related to challenges included mental distress, resource constraints, and compromised and inadequate training. Themes related to strengths and opportunities included new learning experiences, resilience, coping strategies, and enhanced graduate competencies related to leadership, collaboration, communication, and health advocacy. The disruptive and disorienting elements of COVID-19, although situated in chaos, aggravating the constraints of training in under-resourced settings, also provided unexpected learning opportunities. These findings highlight the transformative potential of disrupted learning contexts and the need for responsive curricular to enhance graduate competencies, adaptability, and resilience

Relationships between Language Background, Secondary School Scores, Tutorial Group Processes, And Students’ Academic Achievement in PBL: Testing a Causal Model

Little is known about the influence of language background in problem-based learning (PBL) tutorial groups on group processes and students’ academic achievement. This study investigated the relationship between language background, secondary school score, tutorial group processes, and students’ academic achievement in PBL. A validated tutorial group effectiveness questionnaire was administered to undergraduate medical students in a PBL curriculum at the Nelson R. Mandela School of Medicine (NRMSM) in South Africa.Although 58 percent of the students did not speak English as their first language, the tutorials were in English. Furthermore, secondary school scores differed strongly due to inadequate resources between secondary schools. A path analysis was conducted to test a causal model in which the two independent variables were English as the First Language (EFL) and secondary school scores. These variables were assumed to influence the process variables (cognitive, motivational, and demotivational group processes). Input and process variables were assumed to influence the two output variables, being overall group productivity and students’ academic achievement. All data were analyzed at the individual student level (N = 387). A very good model fit was found (CMIN/DF = 0.68, GFI = 1.00, TLI = 1.02, CFI = 1.00, RMSEA = 0.00). EFL and secondary school scores positively affected students’ academic achievement (respectively beta = 0.24 and beta = 0.16). EFL negatively affected motivational group processes (beta = -0.22). Cognitive group processes positively influenced overall group productivity (beta = 0.31) and so did motivational group processes (beta = 0.27). Demotivational group processes negatively predicted academic achievement and overall group productivity (beta = -0.15, and beta = -0.25). The model resulted in an R-square of 0.15 and 0.45 for academic achievement and overall group productivity, respectively. EFL and secondary school scores had a positive effect on academic achievement. Cognitive and motivational group processes had a positive effect on overall group productivity, while EFL negatively impacted motivational group processes. We recommend English language development courses to be formally included into curricula to enhance student learning