Primary Health Care Electives
The purpose of the 5th year PHC Electives has been to provide students with the opportunity over four weeks to enhance their clinical skills and to deepen their understanding of the PHC Approach in a variety of health care settings. All students who performed satisfactorily throughout their 4th year of study were permitted to choose the site of their elective within the SADC region or internationally. Facilities ranged from district/regional/provincial/tertiary/specialized hospitals (in public or private sectors) to clinics/CHCs/GP practices/medical centres/paramedics in any of the 9 provinces. At the end of the elective period students were required to write a report on the placement that formed part of their fifth year assessment. Students who undertook their electives at rural hospitals within South Africa were part or fully subsidized by the Faculty and these hospitals were required to be situated in a rural area where the facility offered the experience of learning in a multi-disciplinary environment, provided a suitable range of services, as well as clinical supervision.
The revised MBChB curriculum makes provision for a 6-week elective period in the 6th year from 2016 which students will need to organize, undertake and report on as part of their academic requirements. Elective students will be required to write reflective reports on their clinical activities and their observations of the application of the principles of the PHC Approach, which is an equity-driven lead theme in the health sciences curricula. They will also be assessed by an on-site clinical supervisor.
A 2014 qualitative study of perceptions of agency with 13 elective students found that the medical elective programme makes a valuable contribution to developing students’ clinical skills and competencies within the health team and to a better understanding of their role as future doctors. The electives taught students to be more self-confident and empathetic with a clearer understanding of their agency at a patient and health system level. Restoring funding for rural electives was one of the recommendations of the study, as the offer of a rural elective subsidy had previously proved successful in incentivising more students to choose rural electives.
Some student reflections on their Electives
I feel that I have grown tremendously as a person as well as a health professional. I feel so much more confident in myself and my abilities related to life itself, but very importantly related to my medical knowledge and clinical skill ability. Bronwyn Abrahams (Kraaifontein CHC)
My elective experience far exceeded my expectations in all that it provided me in the way of developing and furthering my knowledge and skills. I had a wonderful time and was really made to feel part of the team. The dedication not only to the hospital community but also to the wider communities was evident in the encouraging and helpful rapport they had with their patients and I was really proud to be part of that. Karen van der Spuy (Swartland District Hospital)
This was a great opportunity to be given a snapshot of what rural medicine is like. There are some difficulties including limited resources, little specialist support, limited access to investigations, and communication barriers. However, there are also many attractants, like the fact that one can function as a surgeon, a psychiatrist, an anaesthetist and a clinician all in one, and that one can get to know the community. There are loads of adventures to be had and great opportunities to make positive changes in the community. Lydia Darby (Emmaus Hospital)
My week in Hogsback was an enriching experience. I gained an all-round understanding of private practice, appreciating the joys of the work such as the continuity of care, the availability of resources and also noting the challenges that GPs face. My elective at Madwaleni Hospital was a maturing and extremely beneficial experience. The insight gained into the life of a doctor in rural medicine, and the personal, emotional and spiritual development I feel occurred were most significant. I have returned, feeling grateful to be a student able to benefit from the teaching available to me, yet with renewed and re-defined eagerness to be a doctor and serve the people of my country. Tricia Main (Hogsback GP Practice & Madwaleni Hospital)
My time in Frontier Hospital was a productive time for me as an individual and in my clinical development. I learnt about the assessment and management of paediatric, medical and HIV patients, problem-solving skills were demonstrated and my experience in HIV medicine and HIV management was sealed. Camagu Potelwa (Frontier Hospital)
My rural elective experience has been an invaluable one. I was able to be of service to the hospital and learn new skills while doing so. The motto of Maluti Adventist Hospital is ‘Not to be ministered unto, but to minister’. What I really admired about the doctors, was the sincere compassion shown to patients. Resources may be limited, staff salaries delayed, a shortage of hospital beds, but despite the many problems and challenges, the staff are still dedicated in their mission. Jo-anne Kammies (Maluti Adventist Hospital)
The elective has shown me the real health care reality I will one day work in. It has taught me to remain determined to be a good doctor, to forget about competing with other students or trying to know all the facts, but rather to concentrate on the patient and how I can give them the best service. I pray to remember the lessons learnt and work on the weaknesses I identified. Nadia Vorajee (GF Jooste Hospital, Casualty)