Decentralised training for medical students: Towards a South African consensus

Abstract

Introduction: Health professions training institutions are challenged to produce greater numbers of graduates who are more relevantly trained to provide quality healthcare. Decentralised training offers opportunities to address these quantity, quality and relevance factors. We wanted to draw together existing expertise in decentralised training for the benefit of all health professionals to develop a model for decentralised training for health professions students.

Method: An expert panel workshop was held in October 2015 initiating a process to develop a model for decentralised training in South Africa. Presentations on the status quo in decentralised training at all nine medical schools in South Africa were made and 33 delegates engaged in discussing potential models for decentralised training.

Results: Five factors were found to be crucial for the success of decentralised training, namely the availability of information and communication technology, longitudinal continuous rotations, a focus on primary care, the alignment of medical schools' mission with decentralised training and responsiveness to student needs.

Conclusion: The workshop concluded that training institutions should continue to work together towards formulating decentralised training models and that the involvement of all health professions should be ensured. A tripartite approach between the universities, the Department of Health and the relevant local communities is important in decentralised training. Lastly, curricula should place more emphasis on how students learn rather than how they are taught.

FIGURE 1

A mind map of decentralised training. This mind map organises a decentralised learning organisation (DLO) in terms of the how, why, where, what, when and who. Under each of these headings, various critical elements that need to be considered are listed. The term ‘hybrids’ refers to clinician educators at the decentralised sites who are also involved in supervising and training students.

FIGURE 2

Three-legged stool. This figure uses a traditional African three-legged stool to show that three categories of stakeholders, namely the Department of Health, the community and the academic faculty, are all required to provide a stable decentralised learning platform for health professions students. This interdependent partnership has the power to achieve that despite the uneven and irregular terrain of real-world healthcare. Through supporting learning, such a platform has the potential to improve the health of the population.

FIGURE 3

Concentric circles. This diagram depicts decentralised learning as a holistic concept. Student learning is in the centre of two concentric circles. This vision when shared amongst the community, the university and the health system can deliver successful and relevant decentralised learning.

FIGURE 4

The train model. Decentralised medical education is depicted as a train moving towards the goal of producing fit-for-purpose healthcare professionals for healthier communities, climbing ever higher towards outcomes that will impact on the quality of healthcare and on access to care. The project requires an engine of strategic partnerships with leadership and governance shared amongst higher education institutions, the Department of Health and the communities that are served. This engine will function optimally in the presence of mission alignment, service delivery, teaching and learning and partnerships. It will then be able to pull along the carriage of operational processes required by students, healthcare workers, and community and faculty members. This would be eased by sharing resources, monitoring and evaluation, curriculum and criteria for site accreditation. There are bumps along the line that need to be negotiated. These may be critical challenges within the learning environment, which need to be resolved, or disorienting dilemmas faced by students in the process of learning.

FIGURE 5

A process model. This model for decentralised learning is characterised by a focus on the process to be followed towards the creation of an enabling decentralised training environment. The model recognises the inputs of all the key role players – the Department of Health, the community in which the decentralised site is established and the academic institution responsible for the training programme. The academic institution’s approach is influenced by its specific context, culture and philosophy. These combine to form a vision and a mission for the learning that takes place at the HPCSA accredited decentralised site, which requires the development first of the core curriculum and then the decentralised site. Implementation strategies require shared resources, namely curricula, sites and opportunities for faculty development. Importantly, this entire process is underpinned by principles that include continuity, life-long learning, approaches to learning, inter-professional education and the embedding of graduate attributes.