Consequences, conditions and caveats: a qualitative exploration of the influence of undergraduate health professions students at distributed clinical training sites

Abstract

BackgroundTraditionally, the clinical training of health professionals has been located in central academic hospitals. This is changing. As academic institutions explore ways to produce a health workforce that meets the needs of both the health system and the communities it serves, the placement of students in these communities is becoming increasingly common. While there is a growing literature on the student experience at such distributed sites, we know less about how the presence of students influences the site itself. We therefore set out to elicit insights from key role-players at a number of distributed health service-based training sites about the contribution that students make and the influence their presence has on that site.MethodsThis interpretivist study analysed qualitative data generated during twenty-four semi-structured interviews with facility managers, clinical supervisors and other clinicians working at eight distributed sites. A sampling grid was used to select sites that proportionally represented location, level of care and mix of health professions students. Transcribed data were subjected to thematic analysis. Following an iterative process, initial analyses and code lists were discussed and compared between team members after which the data were coded systematically across the entire data set.ResultsThe clustering and categorising of codes led to the generation of three over-arching themes: influence on the facility (culturally and materially); on patient care and community (contribution to service; improved patient outcomes); and on supervisors (enriched work experience, attitude towards teaching role). A subsequent stratified analysis of emergent events identified some consequences of taking clinical training to distributed sites. These consequences occurred when certain conditions were present. Further critical reflection pointed to a set of caveats that modulated the nature of these conditions, emphasising the complexity inherent in this context.ConclusionsThe move towards training health professions students at distributed sites potentially offers many affordances for the facilities where the training takes places, for those responsible for student supervision, and for the patients and communities that these facilities serve. In establishing and maintaining relationships with the facilities, academic institutions will need to be mindful of the conditions and caveats that can influence these affordances.

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

“…[12,13,14,15] Motivating factors in the development of such DHPT include workforce effects in terms of the scaling up of training referred to above; educational advantages arising from distributing students; and the benefits afforded by having students training at these health facilities. [16] In SA, an inadequate number of health professions schools that are largely hospital-based and structured around specialist silos, produce too few graduates for the country's needs. [17,18] In a recent landmark report on reconceptualising health professions education, the Academy of Science of SA recommends inter alia that 'training of health professions students should be orientated towards addressing inequity and meeting the needs of the most underserved, through supporting a primary care focus and increasing the supply of health care workers to rural areas'.…”

Training for Transformation: Opportunities and Challenges for Health Workforce Sustainability in Developing a Remote Clinical Training Platform

“…Much of the positive evidence regarding the efficacy of educational strategies to address rural health workforce needs has been generated in high income countries (HICs)-Australia, USA and Canada (4)(5)(6). While there is growing evidence for efficacy in other contexts (7)(8)(9)(10), comparatively little is known about the effectiveness of these strategies in Low and Middle-Income Countries (LMICs) despite these contexts being most affected by rural health workforce shortages (11). Considerable differences in the healthcare climates between HICs and LMICs could plausibly impact the efficacy of rural training pathway strategies across these contexts.…”

“…There is emerging evidence that undergraduate distributed clinical training for final year health professional students can complement quality of care and help alleviate clinical workload in rural and resource constrained environments (8). Students are perceived to improve patient satisfaction, workforce competency development and community-based services in other rural and urban SA contexts (8).…”

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

“…[13,14,15] Motivating factors in the development of such DHPT include workforce effects in terms of the scaling up of training referred to above; educational advantages arising from distributing students; and the benefits afforded by having students training at these health facilities. [16] In SA, an inadequate number of health professions schools that are largely hospital-based and structured around specialist silos, produce too few graduates for the country's needs. [17,18] In a recent landmark report on reconceptualising health professions education, the Academy of Science of SA recommends inter alia that 'training of health professions students should be orientated towards addressing inequity and meeting the needs of the most underserved, through supporting a primary care focus and increasing the supply of health care workers to rural areas'.…”