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IntroductionStudies have reported that emergency medical care practitioners (EMCPs) encounter challenges when attending to psychiatric emergencies. The EMC provider's ability to understand, assess and manage psychiatric emergencies has been reported to be poor due to limited knowledge and insufficient training. In South Africa (SA), little is known about the knowledge of EMCPs on pre-hospital management of psychiatric emergencies. The objective of this study was to assess the knowledge of EMCPs working in the Free State province on aspects of pre-hospital management of psychiatric emergencies.MethodsThis descriptive study used a questionnaire survey to obtain data on the knowledge of EMCPs on aspects of pre-hospital management of psychiatric emergencies.ResultsOnly 159 of the initial 192 questionnaires distributed were returned, giving a response rate of 82.8%. The majority (87.4%) of the participants reported inadequate knowledge of pre-hospital management of psychiatric emergencies. More than a third of the participants reported that they are not knowledgeable on how to assess a psychiatric patient (P < 0.01), 64.2% and 73.6% (P < 0.001 in both cases) could not perform mental status examination and lack the knowledge of crisis intervention skills for managing a psychiatric emergencies. The majority (76.7%; P < 0.001) of the participants are not conversant with the Mental Health Care Act 2002 (Act no. 17 of 2002). Finally, participants (94.3% and 86.8%, respectively; P < 0.001) agree that teaching and prior exposure to a psychiatric facility, as in work integrated learning, will empower EMC graduates with skills required to effectively manage psychiatric emergencies.ConclusionEMC practitioners are often the first healthcare professionals arriving at any scene of medical emergencies including psychiatric emergencies. To avoid malpractices, which could be detrimental to patient's health, it is of utmost importance that EMCPs are well trained and equipped to manage any form of medical emergency including those involving psychiatric patients.

Higher education institutions, including medical schools, still grapple with the challenge of poor academic performance of students. Some studies report the positive results of providing academic guidance for common challenges such as poor and/or ineffective time management, study methods,test- and exam-taking techniques and management, and the high academic workload of undergraduate medical students. However, limited detailed insights and understanding of medical students who experience more complex challenges are available. This study was conducted at a medical school in South Africa to determine undergraduate medical students’ perceptions of factors affecting their academic performance. A total of 89 semi-structured interviews were held with undergraduate medical students who were identified as having academic problems between 2012 and 2015. According to the results, more blacks, males and first- and secondyear students experienced poor academic performance. Prominent findings included the harsh realities and implications of lack of accommodation for black students; how poor academic performance can lead to an array of other social and psychological problems, such as withdrawal of bursaries and negative achievement emotions that some students experience. Compared to the usual objective measures of individual ability, the rich qualitative data of cases presented in this study reveal critical, real insights and understanding of students’ challenges from their own perspective.

The highest attrition rates occur among first-year students. Universities have designed different curricular programmes, such as the development of generic skills, to address this challenge. In the medical school at the University of the Free State in South Africa, these skills were incorporated in the MBChB curriculum as an eight credit-bearing module in 2000 and later increased to 12 credits in 2009. To date, the effectiveness of this first-year module in equipping students with generic skills was last determined in 2002. The aim of this research was to determine the perceptions of first-year students regarding the effectiveness of this module in equipping them with generic skills. A questionnaire survey was distributed to 596 first-year medical students each year from 2013 to 2016. A focus group discussion (FGD) was held with 13 students who failed the first year of study in 2016 and had to repeat in 2017. According to the results, most students had a positive perception about the structure and organisation as well as the benefits of the module. However, from the questionnaire results, the overall rating of the effectiveness of the module was not very positive, with 35% of students rating it effective, 45% rating it relatively effective and 20% rating it not effective. However, during the FGD, seven (54%) of the 13 students rated it effective. In the qualitative statements of the questionnaire, a common comment related to the poor rating was about the unnecessary long hours in some sessions. Other comments from the questionnaire were medically related, with some students suggesting more practical and clinical demonstrations. During the FGD, students could not understand why their peers needed practical demonstrations in the first year. The incorporation of generic skills should be contextand discipline-specific and students should be "re-equipped" with certain skills during different stages of the curriculum.

Purpose The workplace is an important element of the learning ecosystem for medical students during their competence development. It offers engagement opportunities that enable students to participate in clinical activities as part of learning in their preparation for future clinical practice. The purpose of this study was to explore the perceptions and experiences of lecturers, administrators, and students of Makerere University College of Health Sciences about the workplace, at Mulago National Referral and Teaching Hospital, as a learning environment for the undergraduate medical students with the ultimate aim of identifying opportunities and challenges to learner competence development in the learning environment for purposes of improvement. Methods The study design was cross-sectional descriptive with a qualitative approach using key informant interviews for the lecturers and administrators and focus group discussions for the students. The framework method was used to perform thematic data analysis. Results The workplace was perceived to be well endowed with adequate patient numbers, a suitable case mix and unrestricted access to patients which enhanced competence development. The challenges reported included inadequate resources, such as infrastructure, equipment and supplies and overcrowding, which compromised competence development. The resource challenge appeared insurmountable in the context of two autonomous institutions with divergent planning priorities in terms of teaching, research, and patient care. Conclusion There were mixed perceptions about the learning environment at the hospital with both enabling and challenging factors on the backdrop of two autonomous institutions with divergent planning priorities in terms of teaching, research, and patient care. In order to improve the workplace as a learning environment, it is imperative that the two institutions find common ground in terms of clinical care, students’ teaching and provision of supplies that are essential not only for patient care but competence development of the learners who are the clinicians of tomorrow.