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Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.

Funding has become an established means of promoting the professionalisation of teaching and learning. Various funding schemes in Higher Education have incentivised innovation and research aimed at developing a scholarship of teaching. However, a causal relationship is impossible to prove and the underlying subjective processes of scholarly development are contested. It has been suggested that funding might become another instrument to achieve a neoliberal agenda of increased performativity. This paper explores the affordances generated at a particular institution in South Africa from the perspective of recipients of relatively small awards. Qualitative data were generated in face-to-face individual interviews and analysed thematically. Insight generated included how funding acted as a catalyst for further scholarly development of individuals, disciplines and project teams. A culture of flexibility, nurture and care-full operational management were considered enablers. Using 'slow scholarship' as a lens allowed understandings of developmental pathways and multiple contextual influences on scholarly trajectories.

What knowledge matters in health professions education is an issue of debate in the literature, foregrounded by the COVID-19 pandemic and informed by calls for students who are not only clinically competent, but also critically conscious of global health inequity. Building on this work, this paper explores what kinds of knowledge are legitimated in two health science programmes at a South African university. Thirty-four health professions teachers participated in the study. Legitimation Code Theory (LCT) Specialisation was used as an analytical framework, with Epistemic and Social Relations as coding categories. Results revealed the dominance of a knowledge code, with the social dispositions and attributes relating to the development of critical consciousness often not considered knowledge at all. Our contention is that both knowledge and social dispositions are equally important in the development of future healthcare professionals and that collaborative curriculum conversations are needed to enable them being interwoven throughout curricula.

This article reports on the role and value of social reflexivity in collaborative research in contexts of extreme inequality. Social reflexivity mediates the enablements and constraints generated by the internal and external contextual conditions impinging on the research collaboration. It fosters the ability of participants in a collaborative project to align their interests and collectively extend their agency towards a common purpose. It influences the productivity and quality of learning outcomes of the research collaboration. The article is written by fourteen members of a larger research team, which comprised 18 individuals working within the academic development environment in eight South African universities. The overarching research project investigated the participation of academics in professional development activities, and how contextual, i.e. structural and cultural, and agential conditions, influence this participation. For this sub-study on the experience of the collaboration by fourteen of the researchers, we wrote reflective pieces on our own experience of participating in the project towards the end of the third year of its duration. We discuss the structural and cultural conditions external to and internal to the project, and how the social reflexivity of the participants mediated these conditions. We conclude with the observation that policy injunctions and support from funding agencies for collaborative research, as well as support from participants' home institutions are necessary for the flourishing of collaborative research, but that the commitment by individual participants to participate, learn and share, is also necessary.

Supervision is generally recognised as playing a crucial role in the quality of a research student's doctoral experience and their academic outcomes and, in common with most areas of higher education, there is an oft-stated desire to pursue excellence in this important area. Excellence in research degree supervision is, however, an elusive concept and on close scrutiny most of the discussions of high-quality supervision, even those that purport to be identifying excellence, refer to competence rather than excellence. This paper examines two potentially national authoritative perspectives from which excellence in research degree supervision might be explicated (codes of practice and learning and teaching awards) from Australia, New Zealand, South Africa and the United Kingdom but concludes that the complex nature of the activity and the complexity of the concept itself mean that rather than identifying excellence in supervision we can only respond to claims for excellence.

This study features the concept of "context" and how various macro, meso and micro features of the social system play themselves out in any setting. Using South Africa as an example, it explores the features that may constrain or enable professional development, quality teaching and the work of teaching and learning centres at eight universities in varied socio-cultural settings. The article draws on the work of critical realists and their explication of the concepts of structure, culture and agency. The research design was participatory, where members of teaching and learning centres at the eight institutions defined the aims and key questions for the study. They collected the data on which this article is based, namely a series of descriptive and reflective reports. The findings clustered around six themes: history, geography and resources; leadership and administrative processes; beliefs about quality teaching and staff development; recognition and appraisal; and capacity, image and status of the TLC staff. These features play out in unique and unpredictable constellations in each different context, while at the same time, clusters of features adhere together. Whilst there is no one to one, predictive relationship between university type and outcome, there is a sense that socio-economic contextual features are salient and require greater attention than other features.

This article foregrounds the iterative journey of a group of educational development (ED) practitioners at a research-led university towards an enhanced understanding of the ED opportunities we offer. Reflecting on the intention of our interventions to facilitate academics' professional learning, we developed a framework within which the range of growth opportunities we provide might be meaningfully situated. Our objective was to extend our insight into both the journeys that academics follow towards adopting a more scholarly approach to their teaching and our own journeys of growth in ED as well as professionally. (Contains 1 note, 1 figure, and 3 tables.)

This paper describes the implementation of a university-wide initiative aimed at providing a holistic view of a student's academic standing by conducting early, formative assessment for all first-year students. It tracks the Early Assessment System as a student support intervention at Stellenbosch University and suggests that the system has been instrumental in effecting change across the entire university. The early focus on student success and the establishment of dedicated structures to facilitate such focus have served as catalysts for dialogue around issues of teaching and learning. The coordination of resources across the university to support faculty activities around first-year student learning has set-up powerful collaborations with the potential to influence thinking across the campus. Using Hersey, Blanchard, and Johnson's (2001) "participative change cycle" as base, and drawing on the associated work of Pennington (2003), the successes and ongoing challenges of implementing an initiative of this nature are explored. (Contains 1 figure.)

Introduction: There has been a marked increase in institutional structures developed to support health professions education scholarship recently. These health professions education scholarship units (HPESUs) engage in a diverse range of activities. Previous work provided insight into factors that influence the functioning of such units, but data from European, Asian, Latin American, and African contexts was absent, potentially leading to a single world-view informing international standards for HPESUs. This aim of this study was to explore perspectives from sub-Saharan Africa (SSA) in response to this omission. Methods: Situated within an interpretivist paradigm, the research team conducted semi-structured interviews with nine HPESU leaders in SSA, exploring how participants experienced and understood the functioning of their units. Despite efforts to have representation from across the region, most participants were from South Africa. The researchers analysed data thematically using the theory of institutional logics as an analytical frame. Results: Several aspects of the HPESUs aligned with the previously identified logics of academic research, service and teaching; and of a cohesive education continuum. By contrast, leaders described financial sustainability as a more prominent logic than financial accountability. Discussion: The similarities identified in this study may reflect isomorphism—a process which sees institutions within a similar field becoming more alike, particularly as newer institutions seek to acquire legitimacy within that field. An important caveat, however, is that isomorphism tends to occur across similar institutional contexts, which was not the case in this study. Understanding these differences is key as these HPESUs move to foster scholarship that can respond to the region's unique context. [ABSTRACT FROM AUTHOR]

It is incumbent upon doctoral students that their work makes a substantive contribution to the field within which it is conducted. Dissemination of this work beyond the dissertation, whether whilst studying or after graduation, is necessary to ensure that the contribution does not remain largely dormant. While dissemination can take many forms, peer-reviewed journal articles are the key medium by which knowledge is shared. We aimed to establish the proportion of doctoral theses that results in journal publications by linking South African doctoral thesis metadata to journal articles authored by doctoral candidates. To effect this matching, a customised data set was created that comprised two large databases: the South African Theses Database (SATD), which documented all doctoral degrees awarded in South Africa (2005-2014), and the South African Knowledgebase (SAK), which listed all publications submitted for subsidy to the South African Department of Higher Education and Training (2005-2017). The process followed several iterations of matching and verification, including manual inspection of the data, in order to isolate only those records for which the link was established beyond doubt Over the period under review, 47.6% of graduates, representing 22 of the 26 higher education institutions, published at least one journal article. Results further indicate increasingly higher publication rates over time. To explore whether the journal article identified was a direct product of the study, a similarity index was developed. Over 75% of records demonstrated high similarity. While the trend towards increasing publications by graduates is promising, work in this area should be ongoing. Significance: • In spite ot increasing trends in publications by graduates, many are not disseminating their work, suggesting that significant bodies of research are potentially not being shared with the academic community and are therefore not contributing to the relevant discipline or field. • This study provides baseline data tram which a number of further investigations can be launched, such as exploring the extent to which doctoral candidates who are also academics are publishing their work; the factors that enable or constrain publication; the other avenues of dissemination used; and whether publishing or not publishing can serve as a proxy for the quality of the doctoral work. [ABSTRACT FROM AUTHOR]

Background: The increasing prevalence of treated end-stage renal disease and low transplant rates in Africa leads to longer durations on dialysis. Dialysis should not only be aimed at prolonging lives but also improve quality of life (QOL). Using mixed methods, we investigated the QOL of patients on chronic haemodialysis (HD) and peritoneal dialysis (PD).Methods: We conducted a cross-sectional study at Tygerberg Hospital in Cape Town, South Africa. All the PD patients were being treated with continuous ambulatory peritoneal dialysis. The KDQOL-SF 1.3 questionnaire was used for the quantitative phase of the study. Thereafter, focus-group interviews were conducted by an experienced facilitator in groups of HD and PD patients. Electronic recordings were transcribed verbatim and analysed manually to identify emerging themes.Results: A total of 106 patients completed questionnaires and 36 of them participated in the focus group interviews. There was no difference between PD and HD patients in the overall KDQOL-SF scores. PD patients scored lower with regard to symptoms (P = 0.005), energy/fatigue (P = 0.025) and sleep (P = 0.023) but scored higher for work status (P = 0.005) and dialysis staff encouragement (P = 0.019) than those on HD. Symptoms and complications were verbalised more in the PD patients, with fear of peritonitis keeping some housebound. PD patients were more limited by their treatment modality which impacted on body image, sexual function and social interaction but there were less dietary and occupational limitations. Patients on each modality acknowledged the support received from family and dialysis staff but highlighted the lack of support from government. PD patients had little opportunity for interaction with one another and therefore enjoyed less support from fellow patients.Conclusions: PD patients experienced a heavier symptom burden and greater limitations related to their dialysis modality, especially with regards to social functioning. The mixed-methods approach helped to identify several issues affecting quality of life which are amenable to intervention. [ABSTRACT FROM AUTHOR]

Students undertake their clinical placement in various clinical settings for the exposure to and acquisition of skills related to that particular context. The operating room is a context that offers the opportunity to develop critical skills related to the perioperative care of the patient. Despite numerous studies that have been undertaken in this field, few have investigated the operating room as a clinical learning environment in the South African private healthcare context. The aim of this study was to determine nursing students' perceptions of the operating room as a clinical learning environment. An exploratory, interpretive and descriptive design generating qualitative data was utilized. Eight nursing students completed an open-ended questionnaire, and twelve nursing students participated in the focus group discussion. Four themes emerged, namely, ‘interpersonal factors’, ‘educational factors’, ‘private operating room context’, and ‘recommendations’. The opinion that the operating room offers an opportunity to gain skills unique to this context was expressed. However, despite the potential learning opportunities, the key findings of this study reveal negative perceptions of nursing students regarding learning experiences in the operating room. Exploration into the preparatory needs of students specific to learning outcomes before operating room placement should be considered. It will also be necessary to improve collaboration between lecturers, mentors and theatre managers. [ABSTRACT FROM AUTHOR]

Following the adoption of key national policy, several campaigns aimed at increasing the number of adult males receiving circumcisions have been implemented across South Africa. Evidence as to the likely effectiveness of such interventions comes predominantly from three large randomized-controlled trials. However, little has been written about how these campaigns are perceived by the participants. This is significant given the importance of the social issues that are implicit in determining both the ethical acceptability, and effectiveness of these campaigns. We report on a study aimed at identifying and exploring motivating factors for participation, behavioral effects, and cultural attitudes of participants towards a circumcision campaign undertaken in the Northern Cape Province. For this interpretive sociological research project, semi-structured interviews were conducted with 29 participants. These were recorded, transcribed, and qualitatively analyzed. The main reasons given for participation included that of reducing the risk of acquiring HIV and other sexually transmitted infections (STIs), as well as the enhancement of sexual experience. Participants insisted that they would continue to use condoms after the circumcision, although felt that other community members receiving circumcisions would not do so. Several advantages were described when receiving a circumcision at a public health facility, as opposed to the manner more traditional to the participant's culture. Whilst they did not report intentions for risk compensation, the reasons given for participation and their willingness to attribute this problem to other community members casts doubt on the veracity of their reported intentions. Furthermore, participants did not appear to have a complete understanding as to how circumcision is protective. Participants shared the belief that circumcisions as performed in the context of this campaign were safer than the traditional circumcision occurring in the area, which represents an important area for further research. [ABSTRACT FROM PUBLISHER]

Background: The coronavirus disease 2019 (COVID-19) pandemic hit South Africa in March 2020, severely disrupting health services and health education. This fundamentally impacted the training of future health professionals and catalysed a significant response from across the health education sector. In 2020, the South African Association of Health Educationalists requested members to submit reflections on different aspects of their COVID-19 related educational responses.Responding to the pandemic: Seven vignettes focused specifically on clinical training in the context of primary care and family medicine. This short report highlights the key insights that emerged from these vignettes, considering what has been learnt in terms of health professions education and what we need to take forward. These insights include building on what was already in place, the student role, technology in the clinical learning context, taking workshops online, vulnerability and presence and the way going forward., Discussion and Conclusion: The contributions emphasised the value of existing relationships between the health services and training institutions, collaboration and transparent communication between stakeholders when navigating a crisis, responsiveness to the changed platform and dynamic environment and aligning teaching with healthcare needs. It is more important than ever to set explicit goals, have clarity of purpose when designing learning opportunities and to provide support to students. Some of these learning points may be appropriate for similar contexts in Africa. How we inculcate what we have learned into the post-pandemic period will bear testimony to the extent to which this crisis has enabled us to re-imagine health professions education.

Increasing numbers of health professions students are being trained in healthcare facilities that are geographically removed from central academic hospitals. Consequently, studies have evaluated this distributed training, assessed the impact that it has on student learning as well as on the facilities where the training occurs, and explored factors that enable and constrain successful clinical training at such sites. The 12 tips presented in this article have been developed from a longitudinal project that has focused on developing a framework for effective distributed health professions training through an extensive review of the literature and a national consultative process. These 12 tips should, therefore, have applicability across multiple contexts. The purpose of this article is to assist people in implementing, adapting, upscaling, maintaining, and evaluating the distributed training of students in the health professions.

Background: Enhancing evidence-based practice and improving locally driven research begins with fostering the research skills of undergraduate students in the medical and health sciences. Research as a core component of undergraduate curricula can be facilitated or constrained by various programmatic and institutional factors, including that of choice. Self-Determination Theory (SDT) provides a framework for understanding the influence of choice on student motivation to engage in research., Aim: This study aimed to document the enablers and constraints of undergraduate research at a South African Faculty of Medicine and Health Sciences (FMHS) and to explore how the presence or absence of choice influenced students' engagement with research in this context., Methods: An exploratory descriptive design was adopted. Undergraduate students who had conducted research and undergraduate programme staff were recruited through purposive sampling. Semi-structured interviews were transcribed and thematically analysed. Findings were interpreted using SDT, focusing on how choice at various levels affects motivation and influences research experiences., Results: Many of the programmatic and institutional enablers and constraints-such as time and supervisory availability-were consistent with those previously identified in the literature, regardless of whether research was compulsory or elective. Choice itself seemed to operate as both an enabler and a constraint, highlighting the complexity of choice as an influence on student motivation. SDT provided insight into how programmatic and institutional factors-and in particular choice-supported or suppressed students' needs for autonomy, competence, and relatedness, thereby influencing their motivation to engage in research., Conclusion: While programmatic and institutional factors may enable or constrain undergraduate research, individual-level factors such as the influence of choice on students' motivation play a critical role. The implication for curriculum development is that research engagement might be enhanced if levels of choice are structured into the curriculum such that students' needs for autonomy, competence, and relatedness are met., Competing Interests: The authors have declared that no competing interests exist.

Background: Medical schools in Africa are responding to the call to increase numbers of medical graduates by up-scaling decentralized clinical training. One approach to decentralized clinical training is the longitudinal integrated clerkship (LIC), where students benefit from continuity of setting and supervision. The ability of family physician supervisors to take responsibility for the clinical training of medical students over a longer period than the usual, in addition to managing their extensive role on the district health platform, is central to the success of such training., Objective: This study investigated the teaching experiences of family physicians as clinical supervisors in a newly introduced LIC model in a rural sub-district in the Western Cape, South Africa., Method: Nine semi-structured interviews were conducted with six family physicians as part of the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) five-year longitudinal study. Code lists were developed inductively using Atlas.ti v7, they were compared, integrated, and categories were identified. Emerging common themes were developed. Findings: Three overarching themes emerged from the data, each containing subthemes. The rural platform was seen to be an enabling learning space for the LIC students. The family physicians' experienced their new teaching role in the LIC as empowering, but also challenging. Lack of time for teaching and the unstructured nature of the work emerged as constraints. Despite being uncertain about the new LIC model, the family physicians felt that it was easier to manage than anticipated. Conclusion: The centrality of the rural context framed the teaching experiences of the family physicians in the new LIC, forming the pivot around which constraints and opportunities for teaching arose. The African family physician is well positioned to make an important contribution to the upscaling of decentralized medical training, but would need to be supported by academic institutions and health service managers in their teaching role., Competing Interests: The authors have no competing interests to declare., (© 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.)

Context: The Medical Education Partnership Initiative (MEPI) is a $US 130 million program funded by the United States government supporting 13 African medical schools to increase the quantity, quality, and retention of physicians in underserved areas. This paper examines how community-based education (CBE) is evolving at MEPI schools to achieve these goals., Methods: We utilized data from the first two years of site visits and surveys to characterize CBE efforts across the MEPI network and provide detailed descriptions of three models of CBE among the MEPI programs., Results: There is widespread investment in CBE, with considerable diversity in the goals and characteristics of training activities among MEPI schools. Three examples described here show how schools are strengthening and evaluating different models of CBE to achieve MEPI goals. In Nigeria, students are being sent for clinical rotations to community hospitals to offload the tertiary hospital. In Uganda, the consistency and quality of teaching in CBE is being strengthened by adopting a competency-based curriculum and developing criteria for community sites. At Stellenbosch University in South Africa, students are now offered an elective year-long comprehensive rural immersion experience. Despite the diversity in CBE models, all schools are investing in e-learning and faculty development. Extensive evaluations are planned to examine the impact of CBE strategies on the health workforce and health services., Discussion: The MEPI program is stimulating an evolution in CBE among African medical schools to improve the quality, quantity, and retention of physicians. Identifying the strategies within CBE that are reproducible, scalable and optimize outcomes will be instructive for health professions training programs across the continent.