Background: Medical educational programmes strive to produce competent and skilled graduates. However, studies have shown that undergraduate medical students experience varying degrees of stress which impacts on their health, academic performance and social functioning. This study explored the prevalence and causes of stress, its impact on students and their coping strategies in a racially diverse cohort of final-year medical students exposed to a problem-based learning curriculum in South Africa. Method: This descriptive cross-sectional study was undertaken by final-year medical students in 2008 at a South African medical faculty with a racially diverse student population. Semi-structured interviews were conducted. Data were thematically analysed. Results: Ninety-four students, representing 47% of the final-year medical student cohort, participated in the study. Seventy-eight per cent of the participants (n = 73) experienced stress during the programme, and the majority (n = 49) were females. Ethnic and gender differences were observed for the variables studied. Academic and personal problems were the main sources of stress. Coping strategies included individual lifestyle adaptations, family support, religious structures and study groups. Conclusion: Maladaptive stress impacts negatively at multiple levels on undergraduate medical students. Mentorship and educational support programmes should be integrated into the undergraduate medical curriculum and made available to all preclinical and clinical students. Students need to be taught and guided to identify and monitor their own well-being and to select positive strategies to overcome stress. These measures should assist students to manage their workload and time effectively.

Background: The shortage of doctors and their maldistribution between urban and rural areas contribute to inequitable health care delivery. Strategies are being sought by the government and universities to address these challenges. At the Nelson R Mandela School of Medicine of the University of KwaZulu-Natal the admissions policy ensures greater access to rural students and curricular interventions have been introduced to increase an awareness of the plight of vulnerable communities. This study attempted to ascertain the career intentions of final-year medical students and the influence of area of origin and gender on the location of their proposed future practice. Methods: The 2005 final-year cohort was surveyed by means of an anonymous questionnaire. Demographic information, area of origin and career intentions were canvassed. Students of rural origin were identified as those who matriculated from rural schools and lived more than 200 km from the nearest city. The data were analysed descriptively. Results: Female and rural students accounted for 63% and 11% of the sample respectively. Women were less likely than men to practise in rural areas. Thirty-five per cent indicated a preference for a public government service career as opposed to a private medical (26%) career. Slightly more than 13.7% (n = 26) of the cohort wished to pursue practice or postgraduate careers overseas. Nearly 62% (n = 90) of the students in the current cohort received government subsidies for their studies. Conclusions: The increased intake of students from rural origin and curricular attempts to increase social awareness of vulnerable rural communities are inadequate to alter the perceptions of medical graduates towards rural practice. While government initiatives and medical schools are starting to work together to service rural communities, alternative strategies need to be explored to entice physicians to rural practice.

In South Africa, the smoking prevalence among adults has declined from 34% (52% male and 17% female) in 1995 4 to 21.4% (35.8% male and 8.1% female) in 2003. 5 The smoking prevalence among health care workers (HCWs) varies widely around the world. A study carried out in 1991 among hospital staff at Llandough Hospital, Cardiff, showed that 20% of nurses and 5% of doctors smoked. 6 A review by Smith and Leggat carried out in 2004 showed a high smoking prevalence among physicians in Greece (49%), China (45%), Japan (43%), Kuwait (38%) and the United Arab Emirates (36%), and the lowest smoking prevalence among doctors in the United States of America (2%), Australia (3%), the United Kingdom (3%) and Nigeria (3%). 7

introduction: Oral health practitioners may be affected by occupational health-related conditions associated with their work environment. There is a lack of relevant data on the prevalence of these conditions among dentists, dental therapists and oral hygienists in KwaZulu-Natal. aim: To describe the burden of occupational health-related conditions among oral health practitioners in KwaZulu-Natal, South Africa. Methods: This cross sectional study evaluated data obtained through a self-administered questionnaire that sought information on demographics, occupational health, psychosocial risk factors, work tasks and planning. Data was exported from QuestionPro and analysed in SPSS version 24. Frequencies and means with standard deviations were calculated for categorical and continuous variables respectively. results: Oral hygienists most frequently reported symptoms of musculoskeletal disorders affecting the neck (70%) and the hand (56.5%). Dentists reported the highest prevalence of shoulder pain (55.8%) and of percutaneous injuries (42,3%). The dentists, dental therapists and oral hygienists also reported latex allergy (10.4%) and percutaneous injuries (32.6%). conclusion: The prevalence of occupational health-related conditions reported by the oral health care workers indicate the need to raise awareness about occupational health and warrants the inclusion of these issues on education programs and dental curricula to ensure a healthy work environment.

Background. Resource constraints and a high disease burden impact on the work-based assessment (WBA) of medical interns in South Africa (SA). Objectives. To review the use of workplace-based assessment frameworks in intern practice in SA and to compare these with international practices. Methods. A systematic review using a thematic analysis was performed to analyse 97 articles selected from an initial scoping of 360 sources of evidence on WBA in internship between 2000 and 2017. This process informed a synthesis of descriptive and analytic themes related to competency-based assessment practices relevant to internship in SA.Results. There was an overall dearth of studies on assessment of medical interns in lower-middle-income countries (LMICs). The context in which the assessment of interns in SA occurs has many challenges related to resources, workload and supervision. SA intern assessment is largely focused on core clinical competency, and this occurs without using competency-based frameworks. This focus was reflected in the finding that most studies in SA have dealt with the assessment of core procedural skills related to acute clinical care, while the assessment of non-clinical competencies and non-procedural skills was poorly addressed. Self-assessment by interns was the predominant strategy used in the SA context. The review revealed limitations in the use of multiple assessment strategies and direct observation in the local context, in contrast to practices in most high-income countries. Conclusions. A shift in focus to assess both procedural and non-procedural skills within a competency-based framework is advocated for SA internship, together with the use of multiple assessment tools and strategies that rely on direct observation of performance. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Afr J Health Professions Educ

introduction: Dental education, one of the most stressful fields of study, is associated with many occupational health hazards. Clinical training is focussed on patient care and occurs under the supervision of a qualified practitioner, and is thus the most appropriate time to educate students about the prevention of occupational health problems. The study aimed to report on the reflections of dental graduates on their undergraduate training from the perspective of occupational health. Methods: This cross sectional, descriptive study used both quantitative and qualitative methods in the collection of data from a study population comprising dentists, dental therapists and oral hygienists in KwaZulu-Natal, South Africa. results: The response rate was 41% (n=169), 80% (n=138) and 40% (n= 46) for dentists, dental therapists and oral hygienists respectively. There was little focus (77.7%) on health and well-being of students and self-care in their dental training. Clinical work had started in the first year for 30% of the participants, and in the third year for 54.4% of the students. Undergraduate training lacked modules on occupational health, practice/business management, posture training, ergonomics and stress management. conclusion: The perceptions of this study population indicated a need for the inclusion of occupational health training in undergraduate dental curricula.

Background. South African (SA) studies indicate that elderly patients receive poor-quality and inadequate medical care at primary care level. Medical schools must be responsive to the needs of the communities they serve. This article reviews medical students’ knowledge of and attitudes towards caring for older patients to identify areas to enhance their learning. Objective. To evaluate the knowledge and attitudes of final-year medical students regarding the care of older patients at the University of KwaZulu-Natal (UKZN), Durban, SA. Methods. All final-year medical students were invited to complete a self-administered questionnaire that evaluated their geriatric knowledge and attitudes. Geriatric knowledge was assessed with a modified Palmore’s Facts on Aging Quiz, and the UCLA geriatric attitudes scale was used to assess their attitudes. Ethical approval was obtained from the UKZN Biomedical Research Ethics Committee and data were collected from September to November 2019. Results. There was a 79% (n=173) response rate. The average age of participants was 24 (interquartile range (IQR) 23 - 24) years. The mean geriatric knowledge score was 56.8% (standard deviation 10.4). The mean attitude score was 3.67 out of 5, indicating mildly positive attitudes towards caring for older patients. The majority of students expressed difficulties in communicating with older patients. Conclusion. The poor knowledge and mildly positive attitudes of students necessitate educational interventions to stimulate student interest in geriatrics and improve learning in this field, including increased attention to communication skills training relevant to the care of older patients.

Background. Stress is prevalent among dental workers and students. A possible means to address this would be to include stress management programmes in undergraduate dental programmes. The purpose of this study was to establish how the current cohort of dental practitioners incorporate occupational health and self-care principles into professional practice, and their potential relevance to future curriculum design. Objectives. To gain input from participants regarding stress and burnout -their causes, implications and prevention -as linked to their practice in dentistry. Methods. A qualitative research design was used, with a purposive sampling technique. The study population consisted of dentists, dental therapists, hygienists and specialists. A total of 36 participants participated in four focus-group discussions to explore dental education, occupational health, stress and self-care. The data were thematically analysed. Results. Dental training in the South African context, occupational health experiences, self-care, coping strategies and education were the main themes that emerged. Dental services in the public sector were reported to be overwhelmed by high patient volumes and shortages of staff and resources, which added to these stressors. The coping strategies adopted were exercise, stretching, reducing workload and encouraging teamwork. The participants believed that the causes of musculoskeletal disorders, and their impact, should be taught in dental training, as students do not perceive this as a potential problem. A multidisciplinary approach and teamwork training are the recommendations for curricula. Conclusion. Stress management techniques and workplace posture assessment should be taught in preclinical training to make students aware of managing stress and correct working postures. A multidisciplinary approach should be used. Dental curricula should include occupational health safety principles. KZN (ref. no. HSS/1490/015D). Written informed consent was obtained from all participants, who were informed of their right to withdraw from the study at any stage. All participants agreed to participate and to have an audio recording made of the interview. Anonymity of participants was maintained throughout the study by using participant codes instead of names. The participants filled out an anonymous demographic information sheet. The audio recordings were transcribed verbatim, and the transcripts checked for accuracy. Member check, or respondent validation, was conducted to establish validity. The data were then analysed thematically. Broad themes were identified, according to the main aim, and then further refined and coded until the final analysis was complete. Afr J Health Professions Educ[6] The themes identified were analysed in line with the objectives of this study. ResultsFive main themes were identified, based on the questions that were explored. The themes were identified, refined and grouped. Dental training in the SA context, occupational health experiences, self-care and burnout, coping st...