Ukwanda Centre for Rural Health

Background

Background

The Longitudinal Integrated Model (LIM) program is a unique opportunity offered to a few students where they can develop their clinical reasoning skills, diagnostic skills, perform many procedures and be exposed to the realities of rural medical practice.

For the previous five years, their training was quite different and it will take some time to adjust to the new way of learning.

Student Orientation on day one:

Students are briefed about the year, their assessments at the Worcester campus on the first day of their academic year. They will report to you on the next day. Please do the orientation for the students or arrange that someone orientate them when they arrive. Please encourage students to wear protective eyewear when suturing / assisting in theater.

Some of the topics for the orientation that should be covered:

  • A short tour of the hospital and introduction to some of the healthcare personnel.
  • An agreed upon program for the next few weeks, including two hours of white space per student per week. (time to work on their portfolios)
  • Which days visiting specialists will do outreach at your facility. If possible provide a roster.
  • Basics of how the clinic or hospital functions (where to find files, etc.).
  • Clinical activities that will allow them to do procedures (fracture clinic, etc.)
  • Overtime arrangements (they should do 1 call per week)
  • Arrangements with regards to clinic visits and “adopt a clinic”.
  • Arrangements with regards to ward rounds, administrative tasks, booking of appointments, etc.

Take note the students will be flooded with new info and it is probably best to meet with them the following week to check on them with regards to their understanding of what is required of them.

Making the student rotation a win-win experience:

The University of Stellenbosch understands that site facilitators and other health care personnel’s primary responsibility is their clinical work.

It is therefore important that both the University and the site facilitators are clear of what is expected of the students and the facilitators.

Students have to complete the following tasks during their clinical training:

  1. Write up 10 portfolios for each clinical domain, except psychiatry (eight) and family medicine (six). They will be assessed in beginning of May and in October.
  2. Do clinical work in the Emergency Centre, wards and clinics. Their portfolios should be written up form patients which they saw and followed up.
  3. Do home visits on their family medicine patients. NB Students are allowed to use patients from other clinical domain portfolios also for family medicine patients. For example; a surgery portfolio patient can also be used for a family medicine portfolio.
  4. Perform a quality improvement cycle for their Community Health Module. Dr Bart Willems will oversee these projects.

It is expected of Site facilitators and doctors:

  • To communicate with the students and introduce them to an allied health professional or the rehabilitation student coordinator early in the year.
  • To communicate with students if appointments have to be cancelled.
  • To supervise or delegate supervision of students when they perform clinical procedures.
  • To sign the scripts of students.
  • To be present at the patient portfolio assessments where possible.
  • To complete the graduate attribute assessments for all the students at the site by October of the year. These assessments look at the student’s professionalism, leadership, conflict management, etc.
  • To support the students with regards to their quality improvement cycle. This can include directing them to the right stakeholders in the community, providing contact numbers and guidance with the planning of the project tasks.
  • To support the students learning by challenging their thinking and guiding them as they write up their portfolios. It is not expected to give all the answers, but rather stimulate some reading. See Addendum B.
  • To give students timely feedback on their performance in the clinical environment, see Addendum A.
  • To provide some emotional support and mentoring as necessary, please notify me if you see that a student is not coping needs additional support.

Giving feedback after a clinical encounter (Good / bad):

  • Ideally this should be done in the absence of the patient, in order not to undermine the patient’s understanding and confidence
  • It is often useful to begin by asking the student to reflect on the consultation and to ask the student what they thought went well and what they would do different next time.
  • Feedback should be specific and not vague. “That was very good” vs “Your history was well structured, did not waste time with irrelevant questions and you made appropriate eye contact with the patient when asking difficult questions.”
  • Where areas of improvement are identified it needs to be coupled with a strategy to improve. “Your clinical examination was very poor and you missed the important clinical signs, what do they teach you at the University?” vs “I noticed that you did not auscultate correctly for renal artery bruit. It may help you to think of surface anatomy when deciding where to place your stethoscope. Go and watch a video on this topic and come and show me tomorrow where on the abdomen you should be listening.”
  • Feedback is not evaluation and therefore should not use judgmental language or make personal remarks.
  • Feedback should focus on addressing specific behaviors and decisions, not on general performance. It should report on actions not on one’s interpretation of the student’s motives.
  • Feedback needs to provide the student with a way to do better next time.
  • If multiple clinicians use multiple opportunities to observe students with real patients, you need only give short feedback about one thing that the student could do differently – all these little bits will add up to a lot!