African Journal of Health Professions Education

Student perceptions of an online surgical teaching programme during the COVID-19 pandemic at the University of KwaZulu-Natal: A short report

S Ebrahim — 2023-04-02

Background. The COVID-19 pandemic has led to an unprecedented global health crisis, with impacts on many facets of the health system, including lack of access to regular training wards and the need for social distancing, which posed particular challenges to undergraduate teaching.
Objectives. To explore the perceptions of students of the online surgical programme at the University of KwaZulu-Natal (UKZN). Methods. An online survey was administered to 258 final-year students. Data were collected on student demographics, the impact of COVID-19 restrictions on the teaching programme, engagement and learning from live Zoom sessions, overall perceptions about the module and general feedback on students’ experience of the programme.
Results. Most students (84%, 77/91) supported the need to change to the virtual programme. The module was perceived as well-structured (89%, 81/91). Most students (87%, 79/91) regarded the online resource materials as beneficial. Analysis of open-ended responses showed that asynchronous delivery allowed students to review and revisit resources in their own time. Student challenges included poor internet connectivity, difficulty in concentrating where live sessions exceeded an hour, and lack of clinical exposure.
Conclusion. Online teaching in medical education is a feasible option for remote learning. However, it cannot replace the benefits gained during clinical exposure. Findings from this study will help to set a benchmark for online surgical training at UKZN and develop best practices for blended teaching models. As we adapt to a new normal in the era of COVID-19, the disruptions and results of innovative teaching methods have the potential to change the future of medical education.

COVID‑19 and medical educator perceptions: Sense-making during times of crisis

I Govender — 2023-04-02

Background. Although crises are generally considered uncommon, health professions education (HPE) literature gives evidence of repeated and ongoing crises. This has been most recently demonstrated by the global impact of COVID‑19. Crisis management literature proposes that such recurrent crises are opportune moments for learning. While there has been much literature published that describes changes made to the format of HPE amid COVID‑19, there has been little attention given to the perceptions of medical educators. Medical educators’ experiences may serve as a resource to uncover lessons that may have been learnt during this period.
Objective. To address the gap in the literature, by analysing the perceptions of medical educators at the University of Cape Town (UCT) during the COVID‑19 pandemic of 2020-2021.
Methods. A qualitative case-study approach was adopted. Rich data were collected from four medical educators using semi-structured interviews and a focus group discussion, and then analysed using a reflexive thematic approach.
Results. The data indicated that educators grappled with a multitude of struggles during the COVID‑19 pandemic. These were analysed thematically as: tensions with technology, balancing expectations, and the distribution of support. However, surface-level challenges faced by educators seem to belie a much deeper personal struggle.
Conclusion. The data suggest that whether any learning occurs and what is learnt are embedded within the process of sense-making. If institutions of higher education aim to adopt proactive responses to crises, then further research – as well as support for these sense-making processes during crises – should form a critical part of overall institutional preparedness.

Promoting critical thinking through simulation-based healthcare training (SBHT): A scoping review

K Henrico — 2023-04-02

Background. Critical thinking (CT) is an essential graduate attribute for health professions (HP) students. Yet, achieving a higher level of CT in HP students through education is often difficult for educators. SBHT has proven to be an effective strategy to promote CT, but it is not clear how this educational pedagogy should be implemented to achieve higher levels of CT.
Objective. To identify and describe the use of simulation-based healthcare training (SBHT) strategies to promote CT in HP students.
Methods. Based on the revised methodology of Levac et al., a scoping review was conducted on studies reporting an improvement in CT through simulation-based healthcare education published between January 2010 and August 2021.
Results. Twenty articles were included. Through thematic analysis, three main themes were identified: contact simulations, computer-based simulations, and debriefing. The focus was on how these approaches were used to promote CT. Various subthemes were also identified.
Conclusion. Correctly planning and implementing a simulation-based experience that relates to the relevant learning activities, combined with repeat practice and guided reflection during the debriefing stage, improves the CT skills of HP students.

Reporting quality of Master of Medicine (MMed) mini-dissertations using the STROBE checklist

E S Grossman — 2023-04-02

Background. The 2011 Health Professions Council of South Africa (HPCSA) directive to make a research component compulsory for specialist registration has been decried in some circles as encouraging low-quality research.
Objective. To assess the reporting quality of South African (SA) MMed mini-dissertations using the STROBE checklist.
Methods. A total of 100 monograph-format mini-dissertations reporting retrospective observational research were extracted from a pool of 335 minidissertations. Analysis of each was undertaken using a 24-point STROBE Statement checklist. Scoring was as follows: 1 = the item was compliant with STROBE recommendations; 0.5 = partially described; and 0 = not addressed at all. Satisfactory compliance was set at 66%, thus a STROBE score of 17-24 was considered satisfactory. Data were entered into an Excel spread sheet and analysed descriptively.
Results. STROBE item compliance for individual mini-dissertations was at a mean of 83.1%; range 50-97%; median 85% and mode 89%. Sixteen minidissertations were non-compliant, scoring below 17 as per the set threshold of 66%. This indicates an 84% satisfactory sample. Only Item 5 (Key settings and locations) was at 100% compliance. The four lowest scores were for STROBE items (9) Bias (29.5%); (10) Study size/power analysis (52%); (1) Title (69%) and (14) Missing data (69%).
Conclusion. The majority of sampled mini-dissertations, evaluated as per STROBE recommendations, are transparently reported to allow the reader to follow what was planned, done, found and which conclusions were drawn. As such the results confer a measure of reporting quality on the SA MMed research endeavour. The use of dissertation templates, commonly using STROBE-type headings and prompts, might have contributed to the good scores obtained. Importantly, areas of weakness in the writing of the SA MMed mini-dissertations have been highlighted and show which items require attention.

High-fidelity simulation: A practice model for nurse educators at a South African private higher education institution

E Powell — 2023-04-02

Background. The clinical skills development of student nurses is one of many challenges facing nursing education owing to a lack of available clinical placements and learning opportunities. Simulation training as an optional teaching-learning method creates an environment where clinical skills are developed and students are prepared for the nursing profession. The successful implementation of high-fidelity simulation (HFS) strategies as part of the nursing curricula requires nurse educators to have knowledge and skills. At the South African private higher education institution (SAPHEI) where the research for this study was done, it became evident that nurse educators do not have the required knowledge, skills or support to implement HFS. The absence of evidence in the literature of a practice model for a SAPHEI to facilitate the implementation of HFS reveals a gap in the practice base of nursing education.
Objective. To develop a practice model for nurse educators at a SAPHEI to facilitate the implementation of HFS.
Methods. The researcher used a theory-generative research design. The study was conducted in two phases, with two steps in each phase, to address four objectives in all.
Results. Phase 1 identified and described the main and related concepts. A resulting conceptual framework was used for the development of the practice model. Phase 2 addressed the relational meaning of the main and related concepts, as well as the construction of the practice model through theory synthesis.
Conclusion. The main aim of this research study was to develop a practice model for nurse educators at a SAPHEI to facilitate the implementation of HFS as part of the clinical skills development of student nurses. The practice model offers a schematic outline that represents HFS as a teaching-learning method. The importance of the outline lies therein that it specifies the context and situations in which the model is useful.

Men in the service of humanity: Sociocultural perceptions of the nursing profession in South Africa

S Shakwane — 2023-04-02

Background. The classification of nursing as a female-gendered profession, along with patriarchally determined cultural gender roles, makes it difficult for men to select nursing as a career and to excel in their caring capacity as nurses.
Objective. To gain in-depth insights into and an understanding of male nursing students’ perceptions of the nursing profession.
Methods. A generic qualitative approach, which was explorative, descriptive and contextual, was used to conduct the study. Sixteen male nursing students at two nursing education institutions in KwaZulu-Natal Province, South Africa, were purposively sampled to participate in the study. Data were collected using semi-structured interviews and unstructured observation. Thereafter, thematic analysis was used to analyse the data.
Results. Three main themes were developed from the interview data. The participants perceived nursing as the extension of women’s work, with low social status ‒ nursing is not considered to be a profession for men. During the provision of nursing care, feelings of discomfort and embarrassment were experienced. They feared misinterpretation of their care, especially when caring for the naked body when alone with a patient. They resorted to the use of cautious caring, where they do not provide physical care alone, but seek support, especially from female nurses.
Conclusion. Male nursing students require role models to support them in their academic journey towards becoming competent practitioners. A male-friendly environment should be created to enable them to provide quality nursing care to all patients. The society needs to be empowered in understanding that men choose the nursing profession to provide care, and that they are capable of caring for the sick.

Perceptions of undergraduate allied health students of the clinical learning environment and clinical educators’ attributes at the University of Ghana

J Quartey — 2023-04-02

Background. Clinical education is a vital aspect of the education of health sciences students and consists of two components, i.e. the clinical learning environment and supervision.
Objectives. To determine the undergraduate allied health sciences students’ perceptions regarding clinical educators’ attributes and the clinical learning environment.
Methods. This cross-sectional study included 169 undergraduate students, randomly recruited from various allied health professions programmes of the University of Ghana. The McGill clinical teacher evaluation tool and the clinical learning environment inventory were used to determine students’ perceptions of clinical educators’ attributes and the clinical learning environment, respectively. The Kruskal-Wallis test and independent t-tests were used to test for relationships between students’ level and programme of study and their perceptions. The level of significance was set at 95%.
Results. Of the 169 participants, there were 99 (58.6%) male students, 79 (46.7%) third-year students and 82 (48.5%) medical laboratory science students. Only 16 (9.5%) participants indicated visits by lecturers during clinical rotations. The third-year students had a statistically significant perception of their clinical learning environment (p=0.000), while the differences between perceptions of clinical learning environment among the various programmes were also statistically significant (p=0.028), but not for clinical educators’ attributes (p=0.261).
Conclusion. Allied health sciences students have positive perceptions of their clinical learning environment and clinical educators’ attributes. More frequent visits by lecturers to students during clinical rotations may ensure that student innovation is achieved in accordance with their classroom tuition.

The use of peer physical examination in undergraduate health professions education: Exploring the perceptions of students and educators in a multicultural, multiracial institution

A Adefuye — 2023-04-02

Background. Teaching clinical skills is core content of the medical and allied health curricula of the Faculty of Health Sciences (FoHS) at the University of the Free State (UFS) in South Africa. A major pedagogical tool used for this purpose across the faculty is peer physical examination (PPE).
Objective. To investigate the lived experience and perceptions of students and educators on the use of PPE in undergraduate health professions education at a multicultural and multiracial institution. Suggestions on guidelines for a PPE policy for the FoHS at the UFS were also obtained from the participants.
Methods. This research was designed as a qualitative study that used focus group interviews involving 26 participants (19 students and 7 educators) to obtain verbal statements that described their experience and perceptions of the use of PPE in undergraduate health professions education.
Results. Participants reported that PPE was useful to create a safe learning environment and to prepare students for the clinical aspects of their training. Enhancing students’ empathy, competency and clinical confidence were among the advantages attributed to using PPE; it also encouraged peerassisted learning. Some of the disadvantages ascribed to PPE were that it made it difficult to maintain classroom discipline, and that it could promote memorisation over understanding. Finally, participants suggested that a guideline for PPE policy should address matters of consent, confidentiality, participation and gender, cultural, religious and racial considerations.
Conclusions. The findings of this study reveal that PPE is an acceptable and useful learning strategy for the majority of students and educators. Issues relating to consent, confidentiality and cultural, religious and racial considerations are some of the potential problems associated with the use of PPE at the UFS. We believe that the suggestions given by the participants of this study will inform the establishment of a PPE policy for the FoHS of the UFS.

Supporting undergraduate research capacity development: A process evaluation of an Undergraduate Research Office at a South African Faculty of Medicine and Health Sciences

D L Marais — 2023-04-02

Background. University-based research capacity development (RCD) mechanisms tend to focus on staff and postgraduate students, with few structures targeted at undergraduate students. Support for undergraduate research must be tailored to the unique requirements of research at this level, while maintaining links with relevant structures in both the RCD and teaching and learning domains.
Objective. To conduct a process evaluation of the Undergraduate Research Office (URO) in the Faculty of Medicine and Health Sciences at Stellenbosch University, South Africa, using RCD and characteristics of excellence in undergraduate research criteria as benchmarks.
Methods. A process evaluation of URO’s first 6 years was conducted using a logic model of URO’s inputs, activities, and outputs. Through a retrospective document review, a descriptive analysis of URO’s inputs and activities (narrative) and URO’s outputs (statistical) was conducted.
Results. Following a description of inputs and activities, results present URO’s outputs as a measure of the uptake of these activities. From 2015 to 2020, 259 undergraduate research projects were completed. Research consultations, workshops and undergraduate presentations at the faculty’s Annual Academic Day have more than doubled since URO’s inception. The Undergraduate Research Ethics Committee has reviewed 243 ethics applications since 2015, with a 1 - 2-week turnaround time. A total of 134 funding applications worth ZAR705 986 have been awarded for research project, conference presentation and publication costs.
Conclusion. Results show the potential impact of a formal undergraduate research support entity on the undergraduate research outputs of a Faculty of Medicine and Health Sciences. This article highlights elements for success for formal undergraduate research support, and identifies gaps going forward.