Background:Effective leadership is essential for the performance of healthcare systems, and university faculty play a key role in educating healthcare professionals. However, in many countries, including Zambia, health professions training does not include substantial leadership training. To address this need, faculty at Zambian universities designed and launched a leadership training programme to equip health professions faculty with the knowledge and skills necessary to impart leadership competencies to their students. Objective:To evaluate programme efficacy by assessing changes in trainees' leadership knowledge and behaviours. The results of this evaluation will help inform these and other universities about the utility of an in-house leadership programme. Methods:Using a mixed-methods study design framed by the Kirkpatrick model for programme evaluation, we administered a survey to trainees (n=35) before and immediately after the programme. The survey included 5-point scales on which participants self-rated their knowledge and skills in leadership competencies. One month after the programme, semi-structured focus groups were conducted to gather trainees' perceptions of the programme. Descriptive statistics were calculated for quantitative data and categorised qualitative data according to salient, recurring themes. Results:Analyses of qualitative and quantitative data from the 35 faculty trainees revealed that they enjoyed the programme and experienced growth in all leadership competencies taught, although they felt that more time could have been allocated to workshops. Trainees' leadership knowledge increased by an average of 48% across all nine domains taught, with the greatest growth in 'social and emotional intelligence' (73%) and 'diversity, inclusion and equity' (58%). Trainees also reported substantial growth (42%) in their confidence of their leadership behaviours. Other areas of significant growth included 'using tools and strategies to address microaggressions' (88%) and 'exploring types of microaggressions faced by diverse groups' (84%). Conclusion:These results indicate that a short, intentional and locally relevant training programme can address gaps in leadership training and effectively equip faculty with leadership knowledge and skills. Unique elements of this programme include its development by an interdisciplinary team of university faculty who also taught the workshops, the use of a 'train-the-trainer' model to promote programme sustainability, and collaboration among three academic institutions in the development and assessment of the course. This programme could serve as a model for academic institutions interested in developing leadership courses for faculty.
Background. Formative assessment approaches in the form of multiple and varied assessment opportunities have been shown to positively influence and promote self-regulated learning.Objective. This research aims to explore how first-year medical students experienced ongoing, multiple, varied, low-stakes (no- or low-grade) assessments during a newly developed introductory module implemented as part of a renewed curriculum process.Method. A qualitative and exploratory research design drawing on an interpretivist paradigm was used. Twenty-seven purposively sampled first-year students participated in four focus group discussions where they discussed their experiences of assessment. The discussions were recorded and transcribed. Transcriptions were thematically analysed.Results. Three themes were identified, reflecting a range of experiences pertaining to the assessment approach, namely: (i) students experienced several emotions; (ii) students underwent a series of adjustments and changes in response to the assessment requirements; and (iii) students’ experiences are viewed as journeys as they transitioned into higher education. Assessment literacy and assessment-specific factors were key contributors to shaping student experiences. Conclusions. The study revealed that the development of self-regulatory skills and assessment literacy is necessary as students transition from secondary education into an integrated medical curriculum, and that the assessment design and tasks are important for student self-regulation. The findings support literature on the role of formative assessment and highlight how assessment literacy can enable self-regulated learning and smoother transitions into higher education.
Background. Effective communication, particularly history-taking, is essential for medical professionals to ensure accurate diagnoses and treatment plans. Traditional training methods, such as role-playing and standardised patients, can be resource intensive. Advances in artificial intelligence (AI) offer new solutions, with ChatGPT, an advanced AI language model, capable of simulating patient interactions, providing scalable and flexible practice opportunities that enhance clinical skills training. Objectives. This pilot study explores medical students’ perceptions of using ChatGPT as a virtual patient for history-taking practice and evaluates its potential impact on objective structured clinical examination (OSCE) preparedness by comparing pre- and post-intervention OSCE scores. Methods. Two hundred second-year medical students were invited to participate; 40 students completed the post-practice survey. These participants used ChatGPT (versions 3.5 and 4.0) to practice history-taking using prompts aligned with the Calgary-Cambridge framework. The survey evaluated usability, realism, skill improvement, feedback quality, and satisfaction. Separately, OSCE performance data for the entire class from the 2023 cohort (pre-ChatGPT) and 2024 cohort (post-ChatGPT) were compared using a two-sample t-test to assess differences in history-taking scores. Qualitative survey responses were thematically analysed. Results. Among survey respondents, 85% found ChatGPT easy to use, 75% rated the scenarios as realistic, and 80% reported improvements in history- taking skills. Additionally, 78% felt better prepared for their OSCE. A statistically significant 4% increase in OSCE history-taking scores was observed between the 2023 cohort (mean 39/50, 78%) and the 2024 cohort (mean 41/50, 82%; p<0.05). Qualitative feedback highlighted ChatGPT’s flexibility, ease of access, and immediate feedback, though students noted limitations in emotional nuance and occasional technical challenges. Conclusion. The improvement in OSCE history-taking scores at a class-wide level suggests a potential association between ChatGPT use and enhanced clinical performance. While only a subset of students completed the survey, their responses indicate that ChatGPT is a valuable supplement to traditional training, particularly for self-directed practice. These findings support the integration of AI into clinical education to strengthen communication skills and OSCE preparedness. Future research should include broader participation and long-term evaluations to fully determine the role of AI in medical education.
Background. Education and training of undergraduate physiotherapy students in exercise prescription to cancer patients have recently come under the spotlight, with studies highlighting the absence of this focus in training programmes in numerous countries. However, no literature investigating exercise prescription to cancer patients by physiotherapists in South Africa (SA) could be found. Objectives. To explore the perceptions of final-year physiotherapy students at an SA university about their preparedness to include exercise in the management of cancer patients. Methods. A qualitative study design was used, with focus groups as data collection method. Purposive sampling was applied that resulted in 13 students volunteering to participate in one of two focus group discussions. Ethical approval was obtained to conduct this study. A semi-structured interview guide was followed. Manual thematic analysis was conducted using Braun and Clarke’s six-step process. Results. Two themes were identified, i.e. students’ lack of knowledge within the context of physiotherapy and their responses to prescribing exercises to cancer patients. The students’ lack of basic knowledge of cancer made them feel unsure of their role and unsafe in prescribing exercises to their patients. Many participants reported reacting emotionally to the complex and life-threatening nature of their patients’ condition. Participants further described a lack of debriefing channels to manage their feelings. Conclusion. This study highlighted the need for foundational knowledge and skills to enable a safer transition for healthcare students to include exercises in the management of cancer patients. Future research should consider the impact of managing patients with life-threatening conditions on the emotional wellbeing of health professions students and their professional identity development
Background. Clinical associate (ClinA) students from various clinical learning centres (CICs) need to show timely evidence of their longitudin Integrated clerkship (LIC) exposure; therefore, an electronic logbook was introduced Objective. To describe patients logged by second and third-year ClinA students during their LIC rotation in 2022 from 15 CLCs in four Sout African propinces Method. This study was a retrospective cross-sectional analysis of patients logged in 2022 by students in hospitals and clinics. Second- and third-yea ClinA students were allocated to rural and urban CLCs where patient logging was done electronically. 1 Results. Across 15 CLCs, 88 ClinA students logged 26 392 patients. The age range of the patients was between 0 days and 106 years. Of the 12925 patient. logged by third-year students, most patients (28%) were logged in the emergency medicine discipline. Second-year students logged most patients in the musculoskeletal theme (18% of 13 406). The students selected specific diagnoses for 12 417 patients. The top five diagnoses were: HIV (n-3 217 hypertension (n=3 173), trauma (n = 2, 223) pregnancy related (n=2 123) and diabetes (n=1734), Second-year students did not log many paediatric ane mental health patients. Conclusion Because of authentic learning and exposure to various diagnoses, patients and procedures during their LIC, ClinA students will most likely be well prepared for the workplace. The students' e-logbook data recorded during LIC demonstrate their clinical exposure and learning opportunities.
Experiential learning is increasingly recognised as an effective teaching approach in health sciences, promoting active engagement and translation of theory into practice. This article describes the implementation of an experiential group work week for third-year occupational therapy students at the University of Cape Town, South Africa. Students participated in small groups, facilitated by clinician-educators, engaging in diverse therapeutic modalities including life skills, role play, projective art and activity-based assessment. These sessions provided hands-on opportunities to explore group dynamics, develop interpersonal and therapeutic skills and enhance clinical reasoning. Reflection sessions enabled students to integrate experiential insights into their professional development and future practice. By combining theory with practical experience, this teaching approach bridges gaps between academic learning and clinical application, fostering self-awareness and preparedness for practice. Recommendations include the continued integration of structured experiential learning and guided reflection throughout the curriculum to strengthen student competence and readiness for clinical environments.
Background. Clinical simulation in healthcare education for teaching, learning and assessment is growing. Debate continues regarding the reliability and validity in simulation-based teaching, learning and assessment and the intersect of the three domains. The Simulation Assessment Tool Limiting Assessment Bias (SATLAB) seeks to bridge the gap between the classroom, the clinical environment and assessment. SATLAB uses competency outcome descriptors specific to an outcome or intervention, ranked on a six-point scale of competence, to define expected student performance for each component of a clinical simulation. Objective. To explore student perceptions of the SATLAB as a tool within simulation-based teaching, learning and assessment.Method. The study followed a quantitative, cross-sectional design that used a purpose-designed online questionnaire hosted on the university’s learning management system. Data were collected using purposive sampling from second- to fourth-year students. Quantitative data were analysed using SPSS. A total of 43 responses were received, representing a response rate of 45%.Results. Overall feedback from student respondents was positive. Respondents indicated that SATLAB addressed several perceived challenges in simulation-based teaching, learning and assessment and helped bridge the gap between the classroom, the clinical environment and the assessment domain.Conclusion. The findings of this study demonstrate that SATLAB is positively perceived, with student buy-in among those exposed to its use. On this basis, SATLAB may be considered a student-centred method of teaching, learning and assessment within clinical simulation
Background. Despite the benefits of serious games as an effective teaching tool in professional training, it is important to acknowledge that games are not neutral, as they often reinforce hegemonic Western and Eurocentric perspectives. Game-based learning (GBL) has proven to be an effective educational tool, however, it often reproduces these dominant cultural ideologies. Therefore, there is a need for culturally sensitive alternatives that reflect the health needs of Black communities. Objective. This paper reports the innovative process of developing ‘Afrogames’, a series of board games designed to facilitate the professional development of healthcare professionals through culturally relevant Afro-referenced content that supports inclusive and equitable health professions education (HPE). Methods. Using a design thinking approach, six board games were developed to address core topics such as skin care, mental health, sex education, aging, self-care and indigenous medicine. The approach used the following design stages: ideation, immersion, prototyping, and development. Results. The games incorporate elements of Black cultural values, civilisational principles and biological specificities. Each game was iteratively tested with healthcare professionals and students, with feedback used to refine the design and educational content. Conclusion. Afrogames offer a culturally responsive and engaging method for training healthcare professionals. By centering Afro-referenced narratives and values, they help challenge systemic biases in education and, in doing so, support the development of culturally competent healthcare professionals. Furthermore, the games mediate positive engagement towards the provision of equitable healthcare.
Background. Human anatomy is central to health professions education. However, recently anatomical education has faced increased challenges in the form of enlarged class sizes, reduced lecturer-to-student ratios, limited training time and variable practical exposure. Technological advances, particularly tailor-made video-based content, may enhance the anatomy teaching experience by providing an interactive and engaging visual experience, without compromising the quality of optimal education. Objective. The aim of this study was to define the ability and affinity of lecturing staff at the Faculty of Medicine and Health Sciences, at a large South African university, and their need for the use of anatomy teaching videos as educational material. Methods. To achieve this, an observational, survey-based design tool incorporating both quantitative and qualitative research elements was administered. Results. Twelve responses were used for final analysis. Results revealed an increased use of online and video-based content by lecturing staff to structure and create teaching material; however, videos for anatomy-specific teaching purposes are underutilised. This can possibly be attributed to a lack of available, reliable and relevant anatomy teaching videos. There is a great need for such a resource with results showing an enthusiastic response from participants at the prospect of creating and integrating tailor-made, subject-specific videos for anatomy learning in current curricula. Conclusion. This initiative will help address the challenges currently faced in medical and health professions education and lead the way for future transformative learning, bridging the gap between traditional teaching methods and interactive technology-assisted education.
Background. Interprofessional education (IPE) promotes collaborative practice through transformative learning, yet evidence on the longitudinal outcomes of home-based IPE for students, educators, and communities remains limited.Objective. This research aims to evaluate the outcomes of interprofessional education (IPE) by examining its impacts on students, lecturers, and communities. Methods. The mixed methods study was conducted in three target samples: three cohorts of students (n=1 304) from the 2016, 2017, and 2018 academic years; lecturers (n=54), both groups were drawn from six faculties (Medicine, Pharmacy, Architecture, Nursing, Informatics, and Veterinary Sciences); and patients (n=150) and the representatives (n=18) from seven communities in the Muang municipality and its primary care units. Results. Across the three cohorts of students, 868 students responded (response rate 66.63%). Students’ attitudes towards IPE increased significantly after participation in the IPE programme. Students’ team performance, assessed by lecturers after their second patient home visit, was higher than after their first visit, with both visits yielding scores above 70%. Participation also generated new knowledge and fostered innovative thinking. Patient satisfaction with IPE home visits exceeded 80%. Levels of approval of IPE among both lecturers and community members were also greater than 80%. Conclusion. Both qualitative and quantitative findings showed improvements in students’ attitudes towards IPE, benefits for lecturer’s and high levels of patient satisfaction with home-based IPE. IPE at MSU achieved beneficial outcomes across all three perspectives: students, lecturers and communities.
Background. The purpose of remediation is to provide targeted support and interventions to individuals who are struggling academically, providing support for the improvement and achievement of learning goals.Objective. The purpose of this study was to explore the perceptions and experiences of undergraduate medical students regarding academic remediation within the Nelson Mandela Fidel Castro (NMFC) final-year integration programme at the University of the Witwatersrand (Wits) and, by so doing, present a Global South narrative around providing remediation as a pedagogical intervention for medical education.Methods. In a qualitative exploratory study design, in-depth interviews were conducted with Wits-NMFC students as part of a wider study that included focus group discussions with clinical educators with thematic analysis.Results. The findings revealed a need to deconstruct the meaning of remediation in a student-centred manner, clarify the procedural approach to successful remediation for students, provide student-centred support, and consider the multidimensional reasons for poor academic performance by students through an individualised approach.Conclusion. Holistic and structured remediation of learners with identified gaps is crucial in health profession education to achieve the outcomes of clinically competent healthcare providers. A comprehensive approach that is student-centred and addresses individual factors that impact academic performance is imperative to a successful remediation programme
Background. Optometry students are primarily trained using didactic lectures, supported by essential in-person practical training to enable transfer of clinical skills. However, the COVID-19 pandemic and subsequent lockdown measures forced universities worldwide to move to online learning. The disruption to teaching and learning caused by lockdown measures significantly changed the way optometry students experienced both teaching and learning. Objective. To understand optometry students' learning experiences during the COVID-19 lockdown. Methods. This qualitative study employed purposive sampling to explore the learning experiences of optometry students during the COVID-19 lockdown. Data were collected through virtual focus group interviews, utilising a semi-structured interview guide. Data were anonymised, transcribed and thematically analysed using conventional content analysis. Results. A total of 13 students in the second, third and fourth years of study participated in the study. The analysis revealed four key themes, namely: 'Personal and peripheral influences', 'Environmental and organisational limitations', 'Direct barriers to the new online teaching and learning platform' and 'Student perceptions on the way forward for teaching and learning'. Conclusion. Preparedness for abrupt shifts to online learning is crucial for maintaining quality learning outcomes. In optometry a hybrid approach that integrates both online learning with in-person training is recommended during times of major disruptions, to ensure that essential clinical competence is developed and that students have continued access to peer support.
Unconscious bias involves making decisions, interpreting situations and forming assumptions about people based on past experiences, stereotypes, ingrained thoughts and deep-seated ideas. In diverse multicultural societies, unconscious bias has been extensively studied for its impact on social inequity including access to quality healthcare. In addition, unconscious bias can influence assessment outcomes in medical practitioner training, potentially hindering advancement towards establishing a diverse health workforce. This paper reflects on perspectives on unconscious bias in postgraduate assessments utilising a South African model as an illustration. The authors propose some practical strategies to address unconscious bias in specialist training and assessment.
Background. Clinical reasoning is a critical skill that nursing practitioners must develop. Positive patient outcomes have been linked to nurses with clinical reasoning skills. While experienced nurse practitioners often demonstrate clinical reasoning skills, evidence shows that these skills can be taught and mastered, even by less experienced nurses. Objective. To determine whether a cooperative clinical reasoning activity can aid nursing students in developing their clinical reasoning skills. Methods. A quasi-experimental, non-equivalent, pre-test-post-test control group method was used, employing an Outcome-present-state (OPT) worksheet and a marking rubric to assess the results. The study population consisted of 208 final-year nursing students who were purposively assigned to either the experimental group (n=84) or the control group (n=124). Results. Participants in the experimental group showed higher clinical reasoning scores after engaging in cooperative clinical reasoning activities, compared with participants in the control group who did not participate (p=007). Conclusion. Clinical reasoning is a skill that can be developed through the deliberate inclusion of targeted activities in a nursing programme.
Background. To improve the quality of care provided to women in their reproductive years, midwives need to be competent, confident and safe practitioners. Investment in education and training is necessary to ensure midwives are prepared for practice after entering the profession. Objective. To investigate final-year university nursing students' self-perception of preparedness for midwifery practice in the Western Cape, South Africa (SA). Method. A quantitative descriptive study was conducted with final-year undergraduate nursing students at a university in the Western Cape, SA, after completing the midwifery component of their four-year integrated programme. The self-administered Casey-Fink Readiness for Practice Survey assessed respondents' perceived ability to perform independently, manage multiple women during childbirth and demonstrate confidence in vital practice skills. Results. The survey achieved a 53% response rate. Most respondents indicated difficulty performing fundamental midwifery skills independently. Low confidence levels were reported in independently managing the care of multiple women, delegating tasks to nursing support staff, dealing with ethical issues related to patient care responsibilities and assuming the midwife role. Conclusion. Nursing students lacked confidence and perceived themselves as unprepared to practise as registered midwives upon completion of the midwifery component of the undergraduate nursing programme. In integrated nursing programmes, limited time for midwifery clinical experience may hinder the development of students' competence and confidence. Mentorship training and dedicated facility preceptors are recommended to support students and newly qualified midwives. Structured support and continuous professional development should be integral to new graduate induction programmes to promote learning and competence.
Background. The personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There is limited evidence on the prevalence of modifiable NCD risk factors among medical students in South Africa (SA). Objectives. To determine the prevalence of modifiable behavioural and metabolic NCD risk factors in first-year medical students at a SA university. Methods. This cross-sectional observational study included 256 first-year students. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep quality). NCD-related metabolic markers including body composition, blood pressure, total cholesterol and random glucose concentrations, were measured. The prevalence of risk factors was calculated using internationally accepted criteria, and sex differences were reported using one-way ANOVA or chi(2) test (p<0.05). Results. The prevalence of poor sleep quality was 79.7%, followed by low-to-moderate diet quality (66.8%), low levels of physical activity (64.1%), overweight/ obesity (26.2%), current/past smoking (13.3%) and harmful use of alcohol (12.5%). Most (88.3%) participants had two or more NCD-related risk factors. The prevalence of multiple NCD risk factors differed significantly between male and female participants, with more male participants having >= 2. Conclusions. This study found that first-year medical students at a South African university have a high prevalence of lifestyle-related risk factors, specifically poor sleep quality, low levels of physical activity and low-to-moderate diet quality. Sleep hygiene, regular activity and good nutrition should be promoted, and interventions focusing on nutrition, smoking cessation and alcohol consumption could be targeted by sex.
Background. The South African (SA) healthcare system's colonial legacy continues to impact its institutions, including in higher education. The integration of African traditional medicine (ATM) into medical curricula offers one avenue for meaningful decolonisation within the health sciences. This could enhance sensitivity towards the significant portion of the population that relies on and uses ATM. However, the extent of ATM integration in medical curricula remains unclear. Objective. To assess the integration of ATM into current medical curricula at SA universities. Methods. We used a mixed-methods approach, including: (i) an online search of peer-reviewed publications; (ii) a review of open-access/grey literature from SA medical universities; and (iii)) a direct approach to SA medical universities for relevant information. The structured literature review included a search of English full-text articles on PubMed, EBSCOhost, Scopus and Web of Science databases published between 1994 and 2023, using the search terms: 'African Traditional Medicine', 'health sciences curriculum', and 'medical education'. Grey literature, including websites, policy documents and curricula of medical universities, was also reviewed. Faculties of health sciences of the 10 medical universities were directly approached via email to provide details of the integration of ATM into their curricula. Results. There was limited integration of ATM into medical curricula. The structured literature search demonstrated that only one medical university significantly integrated ATM into their curriculum. Open-access/publicly available evidence revealed some ATM integration in only two universities. Of the four responses received from the direct approaches, two universities integrated some ATM while two had no integration of ATM. Conclusion. There is a need for deliberate and sustained efforts to integrate ATM into medical universities through policy change and provision of resources for teaching and learning.
Background. The job description of principals of the Christian Health Association of Malawi (CHAM) nursing and midwifery colleges highlights instructional leadership. However, it is not known whether CHAM college principals practise instructional leadership as stipulated in their job descriptions. Objective. To explore the instructional leadership of CHAM college principals in managing their institutions. Methods. This descriptive qualitative study was conducted with six CHAM college principals. Purposive sampling was used, and data were collected through in-depth interviews and analysed using thematic analysis. Results. The study found that principals tried to indirectly implement instructional leadership practices in their institutions. However, they experienced a level of strain between their instructional leadership and their administrative practices. Conclusion. We recommend that principals be equipped with the knowledge, skills, and attitudes to provide instructional leadership. They should also take advantage of professional development opportunities to improve instructional leadership.
Background. The aim of foundation provision (FP) in higher education (HE) is focused on the concept 'access to success' through the provision of academic and curriculum support to previously disadvantaged students. Same-year/level peer-assisted learning (SPAL) is implemented increasingly in medical curricula worldwide to support the academic, personal and professional development of students in the same year of study. However, there is no literature available on the strategic alignment between SPAL implementation objectives and the aim of FP for health sciences education (HSE) offered in South Africa (SA). Objective. To establish SPAL implementation objectives that were expertly and strategically aligned with the aim of FP in HSE in support of vulnerable students' academic, personal and professional development. Methods. A four-round qualitative Delphi method was used. The qualitative questionnaires were electronically distributed to 12 purposively sampled experts in the field of HSE and health professions education (HPE). A consensus level of 75% agreement between panel members was applied for the identification of endorsed statements. Results. SPAL implementation objectives for 16 students and four departments were identified and strategically aligned with the aim of FP for HSE students and departments. Conclusion. A SPAL strategy was expertly validated in support of the academic, personal and professional development of previously disadvantaged students. This article offers SPAL implementation objectives that are strategically aligned with the access to success aim of FP. These implementation objectives are recommended for consideration by SA higher education institutions (HEIs) when planning SPAL for extended curriculum programme students and departments offering HSE.
Background. In Tanzania, health training institutes in the Lake and Western Zones initially conducted their examination moderation independently. To improve the examination process, the Ministry of Health has initiated efforts to establish a joint examination moderation system. Objectives. To determine the extent of joint examination moderation in the Lake and Western Zones of Tanzania, evaluate tutors' experiences and benefits as well as identify challenges associated with joint examination moderation. Methods. This cross-sectional study employed both quantitative and qualitative methods for data collection and analysis. This study was conducted in Kigoma from 20 to 23 February 2024, following the completion of moderation activities. The study focused on government health training institutes in the Lake and Western Zonal Health Resources Centre. A Likert scale was used to determine the level of joint examination moderation, while we assessed tutors' experience as well as the benefits and challenges of joint examination moderation using structured interviews. Results. The study reports that more than half of the participants (n=21/39, 53.8%) rated the level of joint examination moderation as high. Tutors highlighted several benefits of joint examination moderation including standardisation of examinations, improved use of assessment plans, enhanced computer skills, teamwork and networking opportunities. Challenges encountered by participants during moderation included poorly prepared examination papers, insufficient time for moderation, limited tasks for semester 1 in the assessment plan, incomplete submitted examination papers, lack of reference materials and regular power outages. Conclusion. The study found that tutors rated the level of joint examination moderation as high, highlighting several benefits and challenges. We recommend ongoing capacity building programmes for tutors to improve examination quality.
