What do medical students and their clinical preceptors understand by primary health care in South Africa? A qualitative study

Abstract

Background The definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that essential health care should be made accessible to individuals and their communities close to where they live and work. In 1992 Starfield articulated the four pillars of PHC: the patient’s first contact with healthcare, comprehensive care, coordinated care and continuous care. Using this literature guidance, this study sought to explore what undergraduate medical students and their clinical preceptors understood by PHC in four South African medical schools. Methods A qualitative study using the phenomenological design was conducted among undergraduate medical students and their clinical preceptors. The setting was four medical schools in South Africa (Sefako Makgatho Health Sciences University, Walter Sisulu University and the University of KwaZulu-Natal and the Witwatersrand University). A total of 27 in-depth interviews were conducted among the clinical preceptors and 16 focus group discussions among the students who were in their clinical years of training (MBChB 4–6). Interviews were digitally recorded and transcribed verbatim, followed by thematic data analysis using the MAXQDA 2020 (Analytics Pro) software. Results Four themes were identified in which there were similarities between the students and their preceptors regarding their understanding of PHC: (1) PHC as the patient’s first contact with the healthcare system; (2) comprehensive care; (3) coordination of care and (4) continuity of care. A further two themes were identified in which these two groups were not of similar understanding: (5) PHC as a level or an approach to healthcare and (6) the role of specialist clinical preceptors in PHC. Conclusions Medical students and their clinical preceptors displayed an understanding of PHC in line with four pillars articulated by Starfield and the WHO definition of PHC. However, there remains areas of divergence, on which the medical schools should follow the guidance provided by the WHO and Starfield for a holistic understanding of PHC.

What are the experiences of medical students and their trainers regarding undergraduate training in primary health care at four South African medical schools? A qualitative study

“…In the previous publication on the “understanding” of the students and their trainers regarding PHC (authored by the same authors of this paper) ( 17 ), there was common understanding of PHC among them, in line with Starfield’s four pillars of PHC, namely comprehensiveness, first contact access, coordination and continuity of care ( 24 ).…”

“…At the time when the current study was conducted, the main focus in South Africa had been on exposure of UG medical students to PHC through distributed training platforms ( 16 ). Recently, literature exploring the understanding of students and their trainers regarding PHC has been published ( 17 ). However, the experiences of students and their trainers in PHC training has not been explored.…”