Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 31;25(1):466.
doi: 10.1186/s12909-025-06848-x.

Assessing clinical associate students' views on learning opportunities and involvement during primary health care placements: a mixed methods study in Tshwane

Sanele Ngcobo  1 , Murray Louw  2 , Luvuyo Bayeni  2   3 , Edith Madela-Mntla  2
Affiliations

Assessing clinical associate students' views on learning opportunities and involvement during primary health care placements: a mixed methods study in Tshwane

Sanele Ngcobo et al. BMC Med Educ. .

Abstract

Background: The training model for Clinical Associates (Clin-As), initially centered on district hospitals, has increasingly involved primary healthcare (PHC) facilities over the past few years. This study explore and compare the perceptions and experiences of Clin-A students regarding learning opportunities and involvement during hospital and clinic rotations.

Methodology: This cross-sectional mixed-methods study involved two primary data collection techniques: the administration of the validated medical education instructional questionnaire (MedIQ) questionnaire and the facilitation of focus group discussions.

Results: A total of 74 Clin-A students participated in the quantitative study, including 20 s-year students from 2022, 35 s-year students from 2023, and 19 third-year students from 2023. The only statistically significant difference was noted in follow-up care, where student involvement was significantly higher in clinics (M = 3.39) compared to hospitals (M = 2.96), with a t-value of 2.933 (p = 0.002). For learning opportunities, the highest mean difference was observed in 'participation in patient education', where clinics (M = 4.38) had a higher mean than hospitals (M = 3.96), but without statistically significance (t = 1.715, p = 0.089). Students perceived better learning diversity and proficiency development in clinics (M: 3.91, SD: 1.31; M: 4.18, SD: 1.203) compared to hospitals (M: 4.00, SD: 1.489; M: 3.97, SD: 1.385). Clinics generally outscored hospitals, especially in involvement in patient education, chronic illness, and procedures. Ten students attended two focus group discussion: one with 2023 third-years (n = 5) and one with 2023 s-years (n = 5). Students valued clinics for skill development and patient journey exposure but faced challenges such as feeling like employees, disrupted learning from frequent rotations, patient overcrowding, and poor communication between the program and healthcare staff.

Conclusion: This study underscores the importance of primary healthcare settings in Clin-A training, demonstrating that clinics provide learning opportunities and involvement in patient care comparable to hospitals. To address challenges such as high workload areas where students feel like employees, insufficient teaching, lack of staff awareness, limited learning in low-volume clinics, and disrupted rotations requires, structured rotations, enhanced preceptor training, and improved communication between programs and clinical sites are essential.

Keywords: Clinical associates; Healthcare system strengthening; Primary health care; South African healthcare system; Students.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study received ethical approval from the Research Ethics Committee at UP’s Faculty of Health Sciences under reference number 580/2018. Authorization to gather data was secured from the Tshwane health district and all affiliated facilities. Before their involvement in the study, every participant provided informed consent, with no personal identifying information being recorded. Consent for publication: This manuscript is our own original work and has not been submitted elsewhere for publication. All authors have approved the manuscript and agree with its submission to BMC Medical Education. Competing interests: The authors declare no competing interests.

References

    1. Naidoo S. The South African national health insurance: a revolution in health-care delivery! J Public Health. 2012;34(1):149–50. - PubMed
    1. Mohapi MC, Basu D. PHC re-engineering may relieve overburdened tertiary hospitals in South Africa. SAMJ: South Afr Med J. 2012;102(2):79–80. - PubMed
    1. Tshabalala Z, Smalley S, Louw M, Capati J, Cooke R. Clinical associates in South Africa: optimising their contribution to the health system. In: Moeti T, Padarath A, editors. South African Health Review 2019. Durban: Health Systems Trust; 2019.
    1. Ngcobo S. Clinical associates in South Africa. South Afr Med J = Suid-Afrikaanse Tydskrif vir Geneeskunde. 2019;109(10):12736. - PubMed
    1. Ngcobo S, Bust L, Couper I, Chu K. The role of clinical associates in South Africa as a health workforce: a scoping review. Afr J Prim Health care Family Med. 2024;16(1):4421. - PMC - PubMed

LinkOut - more resources