Perceptions and attitudes of fifth Perceptions and attitudes of fifth year medical students of year medical students of Stellenbosch University Stellenbosch University

regarding the Rural Clinical regarding the Rural Clinical School in Worcester. School in Worcester.

The scarcity of healthcare professionals in rural The scarcity of healthcare professionals in rural communities is a global concern that causes a serious communities is a global concern that causes a serious challenge to equitable healthcare delivery.challenge to equitable healthcare delivery.

Rural Clinical Schools (RCS) are being implemented Rural Clinical Schools (RCS) are being implemented in some countries to promote awareness of rural in some countries to promote awareness of rural health career and to expand clinical placement health career and to expand clinical placement networks. networks.

The most important factors leading graduates to The most important factors leading graduates to consider rural practice are rural origin and positive consider rural practice are rural origin and positive training experiences in rural platforms. training experiences in rural platforms.

Therefore, the university has extended their clinical Therefore, the university has extended their clinical exposure to rural medicine by establishing a RCS for exposure to rural medicine by establishing a RCS for teaching of undergraduate medical students in the teaching of undergraduate medical students in the rural areas of the Cape Winelands and the Overberg rural areas of the Cape Winelands and the Overberg District District

Selected senior students will spend their entire Selected senior students will spend their entire clinical year in a rural platform. clinical year in a rural platform.

The RCS is expected to support and secure the rural The RCS is expected to support and secure the rural education and training network to increase the education and training network to increase the availability and viability of rural health services in the availability and viability of rural health services in the long term.long term.

•The plan is to allocate 30 medical students to the RCS every year, where most students will be placed in Worcester Regional Hospital and some students distributed to the District Hospitals.

•For the first placement in 2011, 8 medical students were allocated to the RCS.

•6 students placed in Worcester Hospital and 2 students in Ceres Hospitals.

•Specialities included in the curriculum for the Rural Clinical School are: Internal medicine, Surgery, Orthopaedics, Paediatrics, Obstetrics & Gynaecology, Family medicine and Psychiatry

Rationale – continued Rationale – continued To ensure the success of the RCS program, it is necessary To ensure the success of the RCS program, it is necessary to understand: to understand:

why students would/would not choose a rural placement. why students would/would not choose a rural placement.

Explore their views and understanding of rural health Explore their views and understanding of rural health issues. issues.

Explore the relevance of rural clinical school placement to Explore the relevance of rural clinical school placement to their learning . their learning .

Research QuestionResearch Question What factors do students perceive as contributors to them What factors do students perceive as contributors to them selecting the RCS and barriers that students think can selecting the RCS and barriers that students think can prevent them from selecting the Rural Clinical School for prevent them from selecting the Rural Clinical School for placement? placement?

AimsAimsTo gaining a deeper understanding of the fifth year To gaining a deeper understanding of the fifth year medical students’ perceived factors that can lead to medical students’ perceived factors that can lead to them choosing the RCS and barriers that can prevent them choosing the RCS and barriers that can prevent them from selecting the RCS. them from selecting the RCS.

Objectives Objectives

The objectives were to:The objectives were to:Identify the barriers that may have prevented Identify the barriers that may have prevented students from choosing a RCS placement. students from choosing a RCS placement.

Identify factors that may have influenced medical Identify factors that may have influenced medical students to choose a RCS placement.students to choose a RCS placement.

An exploratory study designAn exploratory study design

Quantitative: A survey Quantitative: A survey was distributed to all fifth year was distributed to all fifth year MB,ChB students either manually or electronically.MB,ChB students either manually or electronically. Items in Items in the questionnaire were taken from the FRAME the questionnaire were taken from the FRAME Questionnaire (Krahe, McColl, Pallant, Cunningham & Questionnaire (Krahe, McColl, Pallant, Cunningham & DeWitt, 2010).DeWitt, 2010). The questionnaire focused on the following areas: The questionnaire focused on the following areas: • demographic information; demographic information; • students’ preference for clinical practice; students’ preference for clinical practice; • factors important to students when choosing a clinical factors important to students when choosing a clinical school for training school for training • suggested ways to make the RCS more attractive. suggested ways to make the RCS more attractive.

Qualitative: Structured Focus Group Interviews.Qualitative: Structured Focus Group Interviews.

ParticipantsParticipants

Quantitative Survey: Quantitative Survey: All fifth year medical studentsAll fifth year medical students

Structured focus group interviews: Structured focus group interviews: Purposive sampling: all students going for RCS Purposive sampling: all students going for RCS placement. placement. Convenient sampling: Students who did not select RCS Convenient sampling: Students who did not select RCS for placement. for placement.

AnalysisAnalysis

Quantitative: Data was captured on SPSS and analysed Quantitative: Data was captured on SPSS and analysed using descriptive statistics. using descriptive statistics.

Qualitative: Audio taped interviews were transcribed Qualitative: Audio taped interviews were transcribed and analysed using categories and clusters. and analysed using categories and clusters.

•80/176 questionnaires issued were returned giving us 80/176 questionnaires issued were returned giving us a 45% response ratea 45% response rate

•26 students were part of the structured focus group 26 students were part of the structured focus group interviewsinterviews

•Group 1 = 7 students (students who selected RCS Group 1 = 7 students (students who selected RCS placement)placement)

•Group 2 = 19 students (students remaining at Group 2 = 19 students (students remaining at Tygerberg campus)Tygerberg campus)

Demographic information of studentsDemographic information of students

• Gender: Males Gender: Males 43.8%43.8%

Females Females 56.2%56.2%

• Age: 22 – 25 Age: 22 – 25 92.5%92.5% 26 – 29 26 – 29 7.5%7.5%

• Marital Status: Single Marital Status: Single 93.7%93.7%

Living with partner Living with partner 6.3%6.3%

• Background: Rural Background: Rural 40%40% Urban Urban 57.2%57.2%

• Preferred place of future practice: Urban area in RSA Preferred place of future practice: Urban area in RSA 33.8%33.8%

Rural area in RSA Rural area in RSA 52.5%52.5%Outside RSA Outside RSA 8.8%8.8%

Quantitative – responses from open ended Quantitative – responses from open ended questions questions

Other factors important to selecting the RCS:Other factors important to selecting the RCS:•Not being well prepared for examsNot being well prepared for exams•Uncertainty of teaching in rural areasUncertainty of teaching in rural areas

Suggested ways of making the RCS more attractive:Suggested ways of making the RCS more attractive:•Positive report of previous studentsPositive report of previous students•More consultations and tutorials with doctorsMore consultations and tutorials with doctors•More teaching and learning opportunities More teaching and learning opportunities •More information and good planning of the RCSMore information and good planning of the RCS•Safe accommodations with meals and internet accessSafe accommodations with meals and internet access

Quantitative – responses from open ended questionsQuantitative – responses from open ended questions

Positive comments about the RCSPositive comments about the RCS•Rural settings have good doctors Rural settings have good doctors •It is a great learning opportunity and to learn It is a great learning opportunity and to learn practical skillspractical skills•Good for preparing students for the hardship of Good for preparing students for the hardship of internship. internship.

Quantitative – responses from open ended Quantitative – responses from open ended questionsquestions

Concerns about the RCSConcerns about the RCS•Being well prepared for examsBeing well prepared for exams•Worried district doctors won’t give good teachingWorried district doctors won’t give good teaching•Not much academic input in rural hospitalsNot much academic input in rural hospitals•Patients in rural hospitals are less complex as Patients in rural hospitals are less complex as compared Tygerberg Hospitalcompared Tygerberg Hospital•Concern that they will be equipped to pass final examConcern that they will be equipped to pass final exam•Enough time to study in the RCSEnough time to study in the RCS

Category Clusters

In-depth hands on training experience.

Training experience Opportunities

University preparing medical students for rural practice.

Good exposure

Rural Clinical School Expectations Future Rural learning opportunities Fear of the unknown Work environment New environment Application procedure and

selection criteria Accommodation environment

Qualitative data:Qualitative data:

•Positive experience in rural hospitals does have an effect on students choices of choosing rural practice.

•There are existing barriers that could prevent students from selecting the RCS placement

•As well as factors that could influence students to select the RCS placement

•It is evident from the findings that with good planning and more exposure to RCS, a great future for the RCS is possible.

•It is therefore recommended that RCS should be introduced to students at an earlier academic level.

•More information regarding the RCS placement should be made available to students in order for them to make more informed decisions of being placed in such a setting.