Learning from Primary Health Care Centers in Nepal: reflective writings on experiential learning of third year Nepalese medical students

Abstract

BackgroundMedical education can play important role in cultivating the willingness among the medical students to work in underprivileged areas after their graduation. Experiential learning through early exposure to primary health care centers could help students better understand the opportunities and challenges of such settings. However, the information on the real experiences and reflections of medical students on the rural primary health care settings from low-income countries like Nepal are still limited. The aim of this study is to demonstrate the learning process of the medical students through their reflective writings based on Kolb’s theory of experiential learning.MethodsThe students wrote their experiences, observations and reflections on the experiential learning from the primary health care centers on individual logbook as part of their community posting assignments. We analyzed the data of 50 logbooks through content analysis using Kolb’s experiential learning cycle as a theoretical framework.ResultsThe students’ reflections are structured around the four main learning stages of Kolb’s experiential learning theory. Each learning stage consisted of different categories. The first stage consisted of concrete experiences on rural health and learning by doing. The second stage included their reflective observations on primary versus tertiary care, application of theoretical knowledge and role of supervisors. In the third stage, the students developed and refined their concepts on self-development, understanding reality, compassion and sense of responsibility. The final stage, active experimentation, included their immediate future plans, suggestions to improve curriculum, plans after becoming a doctor and suggestions to improve policies.ConclusionThis study provided important insights on different stages of experiential learning of medical students on primary health care in low resource rural settings. Reflective writing of experiential learning could be an important step to address the gaps in medical education for resource constraint settings like that of Nepal and other low-income countries.

General health service readiness and its association with the facility level indicators among primary health care centers and hospitals in Nepal

“…10 In the current analysis, PHCCs had the lowest score in all 5 domains of service readiness in comparison to private and public hospitals with worst status in availability of essential medicine, standard precaution for IP and diagnostic capacity. Since PHCCs are the first referral centers in rural and underserved areas of Nepal with the provision of a medical doctor, 23,24 GoN needs to heavily invest in strengthening PHCCs as referral facilities for lower level health facilities (health posts).Therefore, quality improvement initiatives must be national in scope and, in most cases, need a focus in health facilities located in rural areas and Terai region. Improvement of infrastructure, laboratory facilities, medical equipment and communication facilities, among others can contribute to retention of health workers in these rural health facilities, 24 eventually contributing to improved service readiness.…”

Experiential Learning Curriculum Delivery Approach for Quality Improvement in Resource Limited Settings: Mobile Learning for Point-of-Care Technologies

“…Most research both globally and locally focused on the outcomes of experiential learning, and minimal research has been done to demonstrate each step in the process, particularly in resource limited settings (Dhital et al, 2015). The findings of studies conducted in UMICs including China, Brazil and South Africa concerning experiential learning approaches' effectiveness in medical education are consistent with those of studies conducted in higher income countries (8,17,28).…”

“…It is also defined as the construction of knowledge and meaning from real-life experience (Yardley et al, 2012). Majority of studies conducted in Upper-middle-income countries UMICs, including those conducted within the last five years (de Oliveira et al, 2015;Dhital et al, 2015) refer back to Kolb (1984) four-stage experiential learning cycle: Concrete Experience, Reflective Observation, Abstract Conceptualization and Active Experimentation to define experiential learning. The Experiential Learning Theory (ELT) provides a holistic model of the learning process and a multi-linear model of professional development, both of which are consistent with what is known about how people learn, and develop (Boyatzis & Kolb, 2003).…”

“…This enabled students to acquire leadership skills and the ability to take action as they continued with service delivery (Wee et al, 2010). Like in HICs, experiential learning was shown to be acceptable largely in medical education (Dhital et al, 2015;Prose et al, 2013).…”

Experiential learning for junior residents as a part of community-based medical education in Japan

“…A previous study aimed to clarify the process of experiential learning of nurses with more than 10 years of experience [9] and another study investigated the learning process of radiological technologists [10]. In terms of what is being learned at community-based medical institutions, it was reported that student reflection on the practical experience in rural settings before graduation primarily comprises the four learning stages of the Kolb's experiential learning model [11]. However, only a few studies have analysed the process by which junior residents gain expertise in community-based medical institutions using the experiential learning model, and thus the process remains unknown.…”