Background: The importance of contextual factors, such as the learning environment and sociocultural characteristics of the student, are becoming increasingly evident. Mann [2001. Alternative perspectives on the student experience: Alienation and engagement. Stud High Educ 26(1): 7-19.] proposed that all learning experiences can be viewed as either alienating or engaging and Case expanded on this work. Aim: The purpose of this study was to explore perceptions of alienation or engagement as experienced by residents in anatomical pathology at one South African university. Method: A cross-sectional case study, with 16 semi-structured interviews was conducted. Residents were categorised as either alienated or engaged, based mainly on workplace experiences. Results: Four relevant dimensions were identified; individual, home, workplace and institution. The personal attributes, strategies for coping and reasons for choosing pathology of alienated residents differed from those with engaged experiences. Poor socioeconomic background and schooling did not lead to predominantly alienating experiences, but this group still lacked some generic skills. In the workplace, two main factors resulting in alienated experiences were the interaction between residents and consultants and residents' comprehension of workplace-based learning. Conclusions: We present a simple model which may be used to identify factors that engage and alienate students in the learning experience in the workplace-based setting. Addressing these factors can contribute towards a more engaging experience for all residents.

BackgroundTraining in communication skills is prominent in many undergraduate medical programmes. In South Africa, training in this highly complex skill is developing rapidly, especially against the backdrop of a multilingual and multicultural society. Little work has been done locally to evaluate which training works best in our context. In 1999, the Stellenbosch University Faculty of Health Sciences introduced a new curriculum that included considerably more communication skills training. The aim of this study was to assess and compare the communication skills used in the consultations of two groups of final-year medical students who had different levels of communication skills training in order to make recommendations on appropriate changes in this training. MethodsStandardised doctor-patient interviews performed by students during the final-year examinations in 2003 and 2004 were videotaped. These were assessed by two independent, blinded evaluators using an abbreviated version of the Calgary-Cambridge communication guide for skills not done (0) and done (1). The data was analysed using STATISTICA 7. ResultsA total of 161 interviews were analysed. Both groups performed well (mean = 1) in listening to the opening question, encouraging the patients to tell their story, and demonstrating appropriate non-verbal behaviour. However, ending the session by summarising and clarifying the plan was poorly performed (mean = 0.4). The 2004 group was statistically significantly better in structuring the consultation by using signposting (p value = 0.02). ConclusionThere are a number of influences on the effectiveness of communication skills training, including issues around language, culture and gender, student attitudes, the significance of communication skills training in the programme and, most importantly, the integration of this training into the curriculum as a whole. Merely adding more time to communication skills training does not seem to be the answer. Incorporating a wider range of training methods is also important. The results of this impact study acted as an impetus for innovative curriculum development in our faculty, leading to the development of a comprehensive clinical model and a "golden thread" for communication skills in the curriculum to ensure the longitudinal integration of communication skills.

BackgroundThere is a dire need to expand the capacity of institutions in Africa to educate health care professionals. Family physicians, as skilled all-rounders at district level, are potentially well placed to contribute to an extended training platform in this context. To play this role, they need to both have an understanding of their specialist role that incorporates teaching and be equipped for their role as trainers of current and future health workers and specialists. A teaching and learning capacity-building module was introduced into a new master’s programme in family medicine at Stellenbosch University, South Africa. We report on the influence of this module on graduates after the first six years.MethodsA qualitative study was undertaken, interviewing thirteen graduates of the programme. Thematic analysis of data was done by a team comprising tutors and graduates of the programme and an independent researcher. Ethical clearance was obtained.ResultsThe module influenced knowledge, skills and attitudes of respondents. Perceptions and evidence of changes in behaviour, changes in practice beyond the individual respondent and benefits to students and patients were apparent. Factors underlying these changes included the role of context and the role of personal factors. Contextual factors included clinical workload and opportunity pressure i.e., the pressure and responsibility to undertake teaching. Personal factors comprised self-confidence, modified attitudes and perceptions towards the roles of a family physician and towards learning and teaching, in addition to the acquisition of knowledge and skills in teaching and learning. The interaction between opportunity pressure and self-confidence influenced the application of what was learned about teaching.ConclusionsA module on teaching and learning influenced graduates’ perceptions of, and self-reported behaviour relating to, teaching as practicing family physicians. This has important implications for educating family physicians in and for Africa and indirectly on expanding capacity to educate health care professionals in Africa.

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