A framework for distributed health professions training: using participatory action research to build consensus

Abstract

Introduction There is a global trend towards providing training for health professions students outside of tertiary academic complexes. In many countries, this shift places pressure on available sites and the resources at their disposal, specifically within the public health sector. Introducing an educational remit into a complex health system is challenging, requiring commitment from a range of stakeholders, including national authorities. To facilitate the effective implementation of distributed training, we developed a guiding framework through an extensive, national consultative process with a view to informing both practice and policy.Methods We adopted a participatory action research approach over a four year period across three phases, which included seven local, provincial and national consultative workshops, reflective work sessions by the research team, and expert reviews. Approximately 240 people participated in these activities. Engagement with the national department of health and health professions council further informed the development of the Framework.Results Each successive ‘feedback loop’ contributed to the development of the Framework which comprised a set of guiding principles, as well as the components essential to the effective implementation of distributed training. Analysis further pointed to the centrality of relationships, while emphasising the importance of involving all sectors relevant to the training of health professionals. A tool to facilitate the implementation of the Framework was also developed, incorporating a set of ‘Simple Rules for Effective DHPT’. A national consensus statement was adopted.Conclusions In this project, we drew on the thinking and practices of key role players to enable a synthesis between their embodied and inscribed knowledge, and the prevailing literature, this with a view to further enaction as the knowledge generators become knowledge users. The Framework and its subsequent implementation has not only assisted us to apply the evidence to our educational practice, but also to begin to influence policy at a national level.

Transformative learning through participation: experiences at a rural clinical training site in South Africa

“…The global shortage of health care professionals in rural primary health care (PHC) environments has been an important motivator in the development of several distributed training interventions in undergraduate health professions education. Based on the understanding that the context of training influences future practice location [1,2], the distributed training interventions being applied to address this disparity include rural rotations, community-based training and longitudinal clerkships [3][4][5][6]. Distributed training has been cited as an opportunity that offers learning experiences that are potentially transformative, producing the kind of twentyfirst century graduates that health professions schools have been challenged to produce [7] and enabling a future workforce to address local needs [8,9].…”