Research Article: Family medicine training in Africa: Views of clinical trainers and trainees

Date Published: April 12, 2018

Publisher: AOSIS

Author(s): Louis S. Jenkins, Klaus von Pressentin.

http://doi.org/10.4102/phcfm.v10i1.1638

Abstract

This article reports on the findings of a workshop held at the joint 5th World Organisation of Family Doctors (WONCA) Africa and 20th National Family Practitioners Conference in Tshwane, South Africa, in 2017. Postgraduate training for family medicine in Africa takes place in the clinical workspace at the bedside or next to the patient in the clinic, district hospital or regional hospital. Direct supervisor observation, exchange of reflection and feedback, and learning conversations between the supervisor and the registrar are central to learning and assessment processes.

The aim of the workshop was to understand how family medicine registrars (postgraduate trainees in family medicine) in Africa learn in the workplace.

Thirty-five trainers and registrars from nine African countries, the United Kingdom, United States and Sweden participated. South Africa was represented by the universities of Cape Town, Limpopo, Pretoria, Sefako Makgatho, Stellenbosch, Walter Sisulu and Witwatersrand.

Six major themes were identified: (1) context is critical, (2) learning style of the registrar and (teaching style) of the supervisor, (3) learning portfolio is utilised, (4) interactions between registrar and supervisor, (5) giving and receiving feedback and (6) the competence of the supervisor.

The training of family physicians across Africa shares many common themes. However, there are also big differences among the various countries and even programmes within countries. The way forward would include exploring the local contextual enablers that influence the learning conversations between trainees and their supervisors. Family medicine training institutions and organisations (such as WONCA Africa and the South African Academy of Family Physicians) have a critical role to play in supporting trainees and trainers towards developing local competencies which facilitate learning in the clinical workplace dominated by service delivery pressures.

Partial Text

This article reports on the findings of a workshop held at the joint 5th World Organisation of Family Doctors (WONCA) Africa and 20th National Family Practitioners Conference in Tshwane, South Africa, in August 2017. Postgraduate training for family medicine in Africa takes place in the clinical workplace at the bedside or next to the patient in the clinic, district hospital or regional hospital.1,2 Direct observation of the registrar by the supervisor with a learning conversation that evokes reflection and provides feedback is central to both training and assessment processes.3

Thirty-five people participated in a 2-h workshop and included trainers and trainees from nine African countries, the United Kingdom, United States and Sweden (see Table 1). South Africa was represented by the universities of Cape Town, Limpopo, Pretoria, Sefako Makgatho, Stellenbosch, Walter Sisulu and Witwatersrand.

Six major themes were identified and are discussed below.

The group appreciated the richness of the discussion and the value of having a variety of countries represented in the workshop. The group members expressed feeling encouraged and felt motivated to use ‘small moments, little bits, part of the mini-CEX’ during learning interactions in the workplace (teachable moments). This will allow the supervisors and registrars to be ‘more real’ in the workplace, as opposed to striving for the hard-to-reach perfect or ideal learning interactions. It will necessitate a more honest and pragmatic approach to harness these learning moments. Ongoing discussions are needed around the validity of continuous assessments in the workplace for national examinations, such as the Fellowship of the College of Family Physicians of South Africa (FCFP[SA]), and the contribution of the learning portfolio to exit examination results. Collaborative training projects, like Training the Clinical Trainers (TCT) project and ‘FamLEAP’ initiative, are trying to address the need for training of supervisors in South Africa and also now Malawi and other countries in Africa in basic workplace-based educational skills, such as formative assessment and giving feedback.13

It was clear from this workshop discussion that the training of family physicians across Africa shares many common themes. However, there are also big differences among the various countries and even programmes within countries. The way forward would include exploring the local contextual enablers that influence the learning conversations between trainees and their supervisors. Family medicine training institutions and organisations (such as WONCA Africa and SAAFP) have a critical role to play in supporting trainees and trainers towards developing local competencies that facilitate learning in the clinical workplace dominated by service delivery pressures.

 

Source:

http://doi.org/10.4102/phcfm.v10i1.1638

 

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