Background South Africa is faced with an overburdened public healthcare system and physiotherapists need to be equipped to address these challenges. Community-based primary healthcare clinical training (CBPHCT) offers physiotherapy students with learning opportunities to develop core competencies in order to address the needs of a disparate healthcare system. Objectives To explore the experiences of physiotherapy students participating in a CBPHCT platform. Method An explorative qualitative approach was adopted, using focus group discussions with final year physiotherapy students exposed to a year of CBPHCT. Data from the focus groups were transcribed and analysed using content analysis. Results Four overarching themes were identified: prerequisite community-based primary healthcare competencies, positive factors associated with CBPHCT, negative factors associated with CBPHCT and recommendations. Conclusion The CBPHCT experience was seen to present challenges to, and have benefits for, physiotherapy students. The students felt that communication between stakeholders, such as academic staff and hospital personnel, could be developed, while the lack of resources, such as Internet access, posed a barrier to learning. Students felt core competencies, such as professionalism of caring, were influenced by their exposure to the clinical personnel. Furthermore, they saw themselves as health advocates and felt there was mutual benefit from engagement with communities during their clinical placements. Recommendations included a review of physiotherapy curricula to prepare students for CBPHCT. Clinical implications Community-based primary healthcare clinical training provides learning opportunities for undergraduate physiotherapy students to develop core competencies, such as health advocacy, necessary to address the unique needs of a disparate South African healthcare system.

The dynamic transitions in healthcare systems globally necessitate the training of healthcare professionals who are responsive to the needs of the community that they serve to ensure quality and relevance of care. [1] Undergraduate clinical education is therefore critical for the development of socially competent graduates who are equipped with technical skills and insight to function purposefully within these changing social and health contexts. [2] Students' clinical competence, proficiency and aptitude are core to their clinical education and training, which should be rooted in a competency-based undergraduate programme. [3-5] In South Africa (SA), the gaping disparity in health provision between the over-accessed public health facilities and well-resourced private healthcare settings prompted government to introduce the National Health Insurance (NHI), with the incorporation of the primary healthcare (PHC) approach. [6,7] NHI is a government funding model that ensures disenfranchised communities access to quality healthcare. Through NHI, PHC has proposed re-engineering focused on prevention of diseases, promotion of health and ensuring availability of rehabilitative services at community level. PHC is a strategy to ensure that healthcare services are available in resource-scarce communities, but the uptake in healthcare systems nationally remains poor. [8] Innovative approaches of actualising the implementation of the ideal PHC model are necessary to influence the disparity in public v. private healthcare in SA. [8] Perpetuating the vision for NHI, the University of KwaZulu-Natal (UKZN) College of Health Sciences (CHS), in collaboration with the KwaZulu-Natal (KZN) Department of Health (DoH), embarked on the roll-out of community-based training within a PHC (CBTPHC) approach. [9] UKZN adopted this approach to equip health science students with the necessary skills to serve communities in dire need of healthcare. For the purpose of this article, we refer to this method of training as decentralised clinical training (DCT). This study focused on the discipline of physiotherapy within the CHS at UKZN, which offers a 4-year undergraduate degree programme with a professional qualification (Bachelor degree). There is a greater theoretical bias in years 1 and 2, with a deliberate shift to clinical training and competency development in years 3 and 4 of study. Intake varies between 50 students in year 1 and up to 55 students in the final year, depending on the throughput of students during the programme. For 2017, final-year students were introduced to the DCT framework in which they were placed at urban, rural and peri-urban sites in KZN Province, where they were predominantly under the care and supervision of physiotherapy clinicians at the respective settings. The facilities provided them with clinical exposure to neurological, cardiopulmonary and neuromusculoskeletal conditions and communitybased rehabilitation. Each physiotherapy student spent 5 weeks at 4 of the clinical sites, 2 of 6 newly introduced settings t...

Background Community-based clinical training has been advocated as an excellent approach to transformation in clinical education. Clinical education for undergraduate physiotherapy students is a hands-on practical experience that aims to provide a student with the skills necessary to enable them to be fit to practice independently. However, in many countries, including South Africa, this training has been conducted only in large urban academic hospitals. Such hospitals are not a true reflection of the environment that these students will most likely be facing as practicing health care professionals. Objective The objective of this scoping review is to map out existing evidence on community-based clinical education models for undergraduate physiotherapy students globally. Methods A systematic scoping review will be based on the 2005 Arksey and O’Malley framework. Studies involving students and stakeholders in clinical education will be included. This review will not be limited by time of publication. An electronic search of relevant literature, including peer-reviewed primary studies and grey literature, will be conducted from the PubMed, Google Scholar, Medline, CINAHL, and Cochrane Library databases. The search strategy will include keywords such as “education,” “physiotherapy,” “undergraduate,” “community-based,” “training,” “decentralized,” and “distributed.” Boolean logic will be used for each search string. Two independent reviewers will conduct screening of titles, abstracts, and full text before extracting articles. A predesigned data-charting table will supplement the extraction of data. Version 12 NVIVO software will aide in the thematic analysis of data. Results Data collection will commence after publication of this protocol, and the results are expected to be obtained in the following 5 months. Conclusions The evidence obtained from the extracted data is expected to assist in the development of a model of community-based clinical education for undergraduate physiotherapy students in South Africa, and serve as a basis for future research. The discussion of this evidence will be guided by the research question utilizing a critical narrative approach to explore emerging themes. The enablers and barriers identified from the reviewed studies can guide the development of a community-based clinical education model. International Registered Report Identifier (IRRID) PRR1-10.2196/19039

Community-based primary healthcare training for health science students is based on the tenets of primary healthcare. The approach seeks to provide clinical education and training for health science students in previously disenfranchised communities. Some South African universities train their physiotherapy students through a community-based primary healthcare approach to undergraduate training. However, there is currently a lack of an integrated model guiding clinical education for physiotherapy clinical education in the country. The aim of this paper was to explore the perceptions of physiotherapy academics about a novel, community-based primary healthcare approach to clinical education for students at a university in South Africa. This study sought to inform the roll-out of an evidence-based model for physiotherapy education. A qualitative explorative approach, using semi-structured interviews with physiotherapy academics at the institution, was used to explore their perceptions of the community-based primary healthcare training platform. Data was analysed using conventional content analysis and was classified into themes and sub-themes. Four overarching themes emerged, namely: curriculum review, constraints to decentralised learning, benefits of community-based clinical education and recommendations for the learning platform. Participating academics believed that community-based primary healthcare training is an approach that influences students to be socially responsive, while providing access to healthcare services, such as rehabilitation, in resource-poor communities in South Africa.

BACKGROUND/AIM: Studies on likely sociodemographic and pre-surgical determinants of hand function and satisfaction following pyrocarbon proximal interphalangeal joint arthroplasty (PPIJA) are scarce. The primary aim of this study was to explore the association between pre-surgical sociodemographic and clinical characteristics and post-surgical hand function and satisfaction of patients who underwent PPIJA. A secondary aim was to evaluate the effects of the procedure on pain and active range of movement (AROM) using retrospective data and on-site follow-up assessment. METHODS: A panel survey of 48 patients (male = 13; female = 35) with median age of 64 years, who had PPIJA between 2001 and 2012, with a total of6l arthroplasties, was conducted. During follow-up, participants' pain and satisfaction, AROM, and hand disability were assessed using the Pain and Satisfaction Questionnaire (PSQ), goniometer, and the Disability of the Shoulder, Hand and Elbow (DASH) Questionnaire respectively. RESULTS: The main reason for surgery amongst participants was joint stiffness (68%) while 33.3% of the participants had a repeat surgery. Participants' median satisfaction and DASH scores at final assessment were 3 and 22.55 respectively. Patients who underwent arthroplasty once had significantly higher median PSQ scores (p = 0.011) than those who had their surgery repeated. Pain significantly reduced (p < 0.001) while AROM significantly increased (p = 0.001) from pre-operative assessment to final follow-up assessment CONCLUSIONS: Pyrocarbon arthroplasty improved treatment outcomes regarding pain and joint motion; post-operative satisfaction may be associated with patients having a repeat surgery. Keywords: Pyrolytic carbon, proximal interphalangeal joint replacement, arthritis, treatment outcome