Medical students' attitudes towards the primary healthcare approach—what are they and how do they change?

Abstract

BackgroundThe context of the research presented in this article is the new MBChB curriculum at the University of Cape Town (UCT) that has been in operation since 2002. This new curriculum is primary health care (PHC) driven and puts emphasis on the integration of biological and psychosocial elements. The context of curriculum reform at UCT can be placed within the broader South African context, in which the South African Department of Health has made a commitment to the PHC approach. The aim of this research was to provide an understanding of medical students' attitudes towards the PHC approach. The findings presented in this article form part of a broader set of findings for a PhD research study aimed at qualitatively exploring medical students' attitudes towards and perceptions of PHC. MethodsA qualitative approach was used and focus groups and interviews were conducted with second-, third-and fourthyear medical students at UCT. A total of 82 students were purposively selected to participate in the research. A content analytic approach was used to analyse the focus group and interview data. ResultsThe students generally had a positive attitude towards the PHC approach and were positive about UCT's decision to promote this approach. Some, however, were concerned about the international relevance and status of their degree, and concerns were also raised about the contrast between the theory and reality of the approach, with many labelling PHC as idealistic. The students' responses indicated that their attitudes towards the PHC approach were open to change during the course of their academic career and were influenced by a range of factors. Some of these factors are related to the medical school environment, such as the PHC approach itself, how PHC is taught, and the views of other students and staff at UCT. Other factors that were not related to the university included personality, the students' background and exposure to health facilities, and clinical exposure outside UCT. ConclusionThese findings raise the question of whether students are able to think and feel positively about the PHC approach, but not actually internalise the philosophy of the approach. The students' struggle with the incongruence between what is perceived as the idealistic theory of PHC and the reality of health care in South Africa is also an issue that needs to be acknowledged. These issues have international relevance, and are particularly significant in South Africa, where a commitment has been made by the South African Department of Health to the PHC approach and where doctors are set to play a vital role in its implementation and success. SA Fam Pract 2007;49(2):17

Medical education in sub-Saharan Africa: a literature review

“…Many SSA nations have officially endorsed the primary health care (PHC) approach to health care, and some authors have also made the case for ‘regional’ or ‘rural specialists’ to advance a concept of PHC modelled after conditions in underserved areas 47,48 . Moreover, students in many countries have mixed feelings about PHC versus specialisation and may sometimes favour the latter 49,50 . Schools utilising the community‐based education and service (COBES) model have reported high student and community satisfaction, 51,52 but students may also express negative views of PHC if faculty commitment is perceived as weak and curricula are seen as unfocused and unmatched to realities in communities 53 .…”