Fifth-year medical students’ perspectives on rural training in Botswana: A qualitative approach

Abstract

Many medical schools currently offer medical students the opportunity to spend time in rural settings as part of their education. . The expectation is that such experience will encourage future interest in rural practice. This approach is supported by studies showing that rural experiences during training can increase the likelihood of students choosing to practise in rural areas after graduation. [1][2][3] The first medical school in Botswana opened at the University of Botswana in 2009 and the first cohort of students graduated in 2014. The school trains doctors in Gaborone, an urban setting, with rural clinical placements in Serowe, Molepolole, Mahalapye and Maun. The teaching curriculum emphasises that the training should take place at all levels of the health system; therefore, the curriculum includes rural training to enhance students' learning and experiences.The curriculum includes exposure to rural healthcare in various formats throughout the 5-year programme. The places where students do rural training are highlighted in Fig. 1. During each of the 1st and 2nd years students complete 4 weeks' training in a public health community, in each of the 3rd and 5th years they complete 8 weeks of family medicine, and in the 4th year they complete 8 weeks of public health. This gives a total of 32 weeks of rural exposure throughout the 5 years. As an example, the curriculum for the family medicine rotation involves problem-based learning sessions, ward rounds and outpatient care, as well as attendance at continuing medical education lectures. Tutorials and practicals focus on patient-centred consultations, the doctor, the patient and environmental factors in consultation, communication skills (e.g. breaking bad news), motivational interviewing and counselling skills.Although the medical students in Botswana are exposed to rural training at different levels, their perceptions of the current rural training are unknown. Exploring students' rural experiences and perceptions of the clinical rural training relevance is important to a newly established school. Understanding their experiences and perceptions can help the Faculty of Medicine to improve future rural development and maximise Background. The curriculum of the Faculty of Medicine at the University of Botswana includes rural community exposure for students throughout their 5 years of training. In addition to community exposure during the first 2 years, students complete 16 weeks of family medicine and 8 weeks of public health medicine. However, as a new faculty, students' experiences and perceptions regarding rural clinical training are not yet known. Objective. To describe the experiences and perceptions of the 5th-year medical students during their rural training and solicit their recommendations for improvement. Methods. This qualitative study used face-to-face interviews with 5th-year undergraduate medical students (N=36) at the end of their family medicine rotation in Mahalapye and Maun villages. We used a phenomenological paradigm to underpin the study. ...