BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionsThis 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.

Health reform in post-apartheid South Africa (SA) has been geared to improve health outcomes and rectify historical inequalities 1,2. The majority of the SA population (70%) generally access the public health system while only 18,4%, with medical insurance, access the much better resourced-private healthcare system 3. The district health system facilitates the delivery of services in the public sector through geographically-zoned districts where services are offered at quaternary, tertiary, secondary, district and primary levels 4. Factors such as the burden of disease, trauma and violence led to the implementation of the National Health Insurance (NHI) by the Department of Health (DoH) to ensure greater access to health 5-6. The primary healthcare (PHC) plan acknowledges "health care as a universal right, encompassing the promotion of healthy living, early disease detection, prevention and treatment, community-based disease management and rehabilitation" 6:1. The re-engineered PHC plan is key to the success of the NHI 7. Occupational therapists form part of the multidisciplinary teams that provide rehabilitative, preventative and promotive programmes in hospital and community settings. Despite the positive intent of the health policies, implementation at grassroots level remains a problem. A key challenge for occupational therapy relates to an expectation that they offer services at community-and primary health care (PHC) clinics, in addition to those already being rendered at the district hospital level 8 .

There are promising shifts towards transforming health professions education in South Africa, which include the development of interprofessional education undergraduate curricula. Interprofessional education was conceived as a means to improve quality of care by bringing together professions to learn and work in teams, thereby overcoming negative stereotypes and understanding and valuing the roles of the different health care professions. This paper aims to advance the agenda of transforming health professions education by showcasing the development of exemplars of interprofessional education offered in the Faculty of Community and Health Sciences at the University of the Western Cape in order to assist other higher education institutions in the process of developing interprofessional curricula. Each exemplar encompasses a range of interactive learning methods. Lessons learnt include the need for a common framework for interprofessional education; "buy in" and a mind-set change of academics and institutional structures to support and operationalize interprofessional education.

Health promotion initiatives in the schools concerned are uncoordinated, erratic, based on the resources that the school has access to at a given time and the demands of the curriculum.

Background: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.Aim: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.Setting: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa.Methods: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis.Results: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective.Conclusion: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.