Allied health professional rural education: Stellenbosch University learners’ experiences

Abstract

ResearchRural clinical training is not a new concept, especially for medical doctors, and is a global phenomenon. In South Africa (SA), the earliest account of medical rural training was the Pholela Health Centre, started in KwaZulu-Natal (KZN) in the 1940s.[1] Later, in 1992, KZN tertiary educators pioneered multidisciplinary, rural clinical education for various allied health sciences (AHS) disciplines [2] along with medical and nursing education. SA has a history of an urban service bias, with 12% of SA's medical practitioners, 19% of nurses [3] and an unrecorded, but possibly small percentage of AHS practitioners being rural based.[4] The advent of compulsory community service inspired the development of Stellenbosch University's uKwanda Rural Clinical School, which began training medical doctors in 2011.[5] Training broadened from 2012 onwards to include final-year learners from AHS and included Human Nutrition (HN), Physiotherapy (PT), Speech-Language Therapy (SLT) and Occupational Therapy (OT). Rotations include clinical blocks and/or 1-year placements for students of some of the disciplines at rural sites and for others at urban sites. On average, 44 of 100 Stellenbosch University AHS students experienced the uKwanda Rural Clinical School training platform during their final year of training. We hope to increase the number in future. As this is a relatively new learning site, we are curious about what, or more specifically how, our learners experience practice changes, i.e. from urbanbased, individualised care and/or traditional medi cal training sites to the more rural-based clinical training.In this study, the Curriculum of Practice (Fig. 1), [6] a conceptual framework, was used to situate learners' practice experiences, the components of which include (i) clinical practices (and associated resources); (ii) professional educational curricular policies; and (iii) practice policies.Practice is promoted as integrally connected to theory, policy and factors such as clinical resources -and not as abstract, decontextualised things that we do. [7] Clinical practice activities are understood relative to what learners are taught in their professional curricula. For example, the manner in which a child with cerebral palsy eats, may, for an occupational therapist, mean focusing on the mealtime as an activity of daily living. However, a speech therapist will assess 'feeding/swallowing abilities' . They are also guided by best practice local and/or national or international guidelines from organisations such as the World Health Organization. Hence, policy interacts with practice.Clinical practice also comprises available resources. What happens when we have no standardised tests for isiXhosa speakers? Or, how does one begin Background. Rural clinical training is not widely established or documented for allied health sciences (AHS) learners. This article focuses on the experiences of AHS learners from Stellenbosch University's uKwanda Rural Clinical School. Objective. To explore learners' practices with regard to ru...

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“…For example, during interactions with a patient, clinical practice activities would include assessments to reach a diagnosis. The knowledge base of the clinical practice activities, informed by research and curriculum, facilitates and reflects practice and are understood as unfolding in close relationship with professional education and research (Pillay et al, 2016). Curriculum is broadly defined as "…interlinked complex of who is taught [i.e.…”

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“…Policy is a key aspect of context which influences practice across individual, organisational and systems levels. Practice, as a space for policy engagement and implementation, is influenced by how and what people learn about policy (Duncan et al 2012;Pillay et al 2016). While there are texts or guides on basic policy analysis methods in other disciplines (Patton, Sawicki and Clark 2015) and even a useful locally developed South African policy analysis framework in rehabilitation studies (Law 2008), a gap remains in terms of what should be taught, and how the development of policy literacy in disability and rehabilitation studies can be supported (Neille and Penn 2015).…”

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“…The earliest account of this in South Africa was in KwaZulu-Natal in the 1940s and later in 1992 with the Allied Health Sciences (AHS). In a study by Pillay et al (2016) on AHS learners’ perceptions of rural clinical training in their final year of study, it was evident that rural training changes students’ experience practice from urban-based, individualised care to the more rural-based clinical training. Students found that rural clinical training is undoubtedly challenging for both the educators and the learners given its complexity.…”

“…The purpose of this school was to equip students with the skills and willingness to work in rural and underserved areas (Van Schalkwyk et al 2011). Initially, only medical students were trained at the RCS, but in 2013 the school offered rotating rural programmes for all four health care training programmes, namely Occupational Therapy (OT), Physiotherapy (PT), Human Nutrition (HN) and Speech Language and Hearing Therapy (SLHT) (Pillay et al 2016). This article focuses on these four divisions.…”

“…Students from the four disciplines are placed in their final year for short clinical block rotations. A portion of students are placed at rural sites and others at urban sites in a 1-year cycle (Pillay et al 2016). Pillay et al (2016) further reported that, on average, 44 of 100 SU AHS students experienced the RCS training platform during their final year of training.…”