Strengths and challenges of community-based clinical training as viewed by academics at the University of KwaZulu-Natal, Durban, South Africa

Abstract

Community-based education (CBE) is a pedagogical approach that allows a student to develop professional skills in a community setting and gain a deeper understanding of patients in varied social and cultural contexts. [1] From the literature, CBE is shown to be beneficial to students in various ways, including improved practical skills and clinical reasoning, increased self-confidence and development of a positive attitude toward patients. [2-5] By experiencing real work situations, students develop a greater awareness of the responsibilities they have as health professionals. [4] Through student placements in community-based settings, CBE is equally beneficial to communities, leading to improved access to healthcare and improved quality of care owing to the use of current practice techniques. [4,6] Communities also benefit through home visits and health promotion activities that students undertake. [4] Health systems have been noted to benefit from CBE, as students are seen to expand the workforce, especially in rural areas, where there is a scarcity of healthcare workers. [6] Moreover, student CBE placements in rural areas have the potential to influence students' responsiveness to community needs and their future decisions to work in these areas. [4] This can contribute to long-term benefits for the health system. Institutions of higher education that implement CBE programmes are viewed as demonstrating social accountability. [7] Health professions education is undergoing major reform owing to two main external influences: (i) the Council for Higher Education (CHE) that advocates the integration of community engagement into curricula in the South African (SA) context; [8] and (ii) the Lancet Commission that called for health professionals to graduate with appropriate competencies to be fully functional in a patient-and population-centred health system. [9] Given this context, the University of KwaZulu-Natal (UKZN), Durban, SA strives for reform through its goal of responsible community engagement as outlined in its vision and mission statement. This goal aims to transform health professions education from one with a traditionally structured basis to one with a more competency-based focus that adds value to the communities it serves. [10] To achieve this goal, the College of Health Sciences (CHS) at UKZN embarked on a business plan to adopt a primary healthcare curriculum (PHCC) to address service delivery and health professions training. [11] The business plan proposes that a primary healthcare (PHC) approach be followed for all programmes offered by the CHS. [11] In line with this approach, the CHS seeks to produce socially accountable, competent and relevant healthcare professionals with discipline-specific technical skills and generic higher education competencies and attributes. In this way, graduates become more responsive to provincial and national health priorities, the burden of disease and the health system. The CHS is therefore committed to offering community-based under-and postgraduate education. [...

Modelling the historical distribution of schistosomiasis-transmitting snails in South Africa using ecological niche models

“…According to the results, temperature and rainfall can influence the distribution of schistosomiasis in SA. The results of this study were supported by [65]. Figs 8-10 illustrate the results for the three chosen ENMs.…”

“…Thus, B. africanus suitability depends primarily on precipitation, temperature, and seasonal variations rather than annual averages. This is because the environment in SA varies significantly from season to season, and the parasites that cause schistosomiasis require specific conditions to survive and thrive [65,66]. Thus, precipitation, temperature, and seasonality are critical factors in determining the suitability of the environment for these parasites.…”

“…The GLM and MaxEnt models showed that B. pfeifferi prefers a climate with more variability in temperature throughout the year. As a result, the snail is provided with the temperature fluctuations it needs to thrive [65]. Based on GLM and MaxEnt, bio4 accounts for 46.9% of B. pfeifferi's suitability.…”

“…Manyangadze et al [21] studied schistosomiasis in the Ndumo area of the uMkhanyakude district and found that B. pfeifferi were suitable in the cold and dry seasons (winter) following the rainy season. Moodley [65] concluded that B. pfeifferi was influenced by winter minimum temperatures. Christensen et al [72] found similar results, in which B. pfeifferi bred extensively following rainy seasons.…”

“…of the Eastern Cape province. Bulinus africanus is better adapted to colonising cooler environments and cannot tolerate high temperatures [65]. The mortality of intermediate hosts may be due to temperature increases [23].…”