Academic journal article International Journal of Child Health and Human Development

Integrating Learning through Rural Medicine: A Case Study

Academic journal article International Journal of Child Health and Human Development

Integrating Learning through Rural Medicine: A Case Study

Article excerpt


The focus of rural medical education is often on the expected outcomes, in terms of addressing the human resource challenges faced by rural communities, by giving students an orientation to and understanding of rural health care (1-5). While it is often recognised that many additional skills can be learnt in rural areas, an asset-based approach which focuses on what rural placements can offer medical training as a whole is seldom adopted.

It is for this reason that rural communities have seldom been considered as useful avenues to facilitate medical education, instead of simply as alternative geographical and demographic settings. Although there are some good examples of rural based medical education providing an innovative form of learning that is not offered in urban sites (6-8), the focus is more often on strategies that will improve access to health care.

This paper describes a clinical rotation introduced into the programme for final year medical students in the Faculty of Health Sciences of the University of the Witwatersrand (Wits), Johannesburg, South Africa. This rotation has been vital in achieving major goals of the overall degree programme, which has a commitment to integration, theoretically at least, at the same time as exposing students to primary care and rural practice.

The programme

The Wits Faculty of Health Sciences launched a new curriculum for medical students, the Graduate Entry Medical Programme (GEMP), in 2003. As part of the development of this curriculum, it was agreed that the new programme should maintain its international standards of excellence, while preparing students for the health care needs of all South Africa's citizens. Core competencies agreed upon included providing comprehensive patient care in a plurality of health and social contexts, developing and delivering appropriate care beyond the immediate consultation, and professional cultural and social competencies. The graduating doctor is expected to have an appreciation of the strengths and contributions of other members of the health care team, the organisation of primary care and community health services, referral systems linking primary secondary and tertiary care and the associated human resource needs in the main health care settings in South Africa, as well as the common clinical conditions presenting to primary, secondary and tertiary care settings.

As one contribution towards achieving these aims, the faculty supported a proposal from the Division of Rural Health for the development of a new rotation for final year medical students (GEMP 4) to spend six weeks of their training based in primary health care settings. As a consequence, the Integrated Primary Care (IPC) block became one of the seven compulsory rotations in final year.

A planning committee (the IPC team) was formed in 2004 comprising of representatives of each of seven disciplines identified as relevant to and which were interested to be involved in the rotation, namely Paediatrics, Family Medicine, Internal Medicine, Obstetrics and Gynaecology, Psychiatry, Public Health and Surgery. Under the leadership of the Chair of Rural Health this integrated planning team worked over an 18 month period to develop an operational framework for the IPC block, identifying objectives, key learning areas and assessment activities. A feature of the block, it was agreed, would be to integrate the three critical areas of student development, community engagement and service delivery. The IPC team decided the overarching aim of the block would be to provide an opportunity for students -to experience and to practise integrated primary care medicine that is responsive to patients, their families and communities". The IPC block was launched in January 2006, as the new curriculum rolled out for the final year students. The GEMP 4 class is divided into groups of about 30 students, each of which completes seven rotations of six weeks, one of which is the IPC block. …

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