African Health Sciences Makerere University Medical School ISSN: 1680-6905 EISSN: 1729-0503 Vol. 8, Num. 4, 2008, pp. 261-262

African Health Sciences, Vol. 8, No. 4, Dec, 2008, pp. 261-262

Letter to the Editor

Health and social care curricula future perspectives for learner experience in Europe and Africa

Usama ALAlami and Ross G. Cooper

Physiology Division, Faculty of Health, Birmingham City University, Franchise Street, Perry Barr, Birmingham B42 2SU, UK. Phone: 0121 331 5490, Fax: 0121 331 6592, E-mail: usama.alalami@bcu.ac.uk

Code Number: hs08056

Sir,

The health and social care sector is dynamic in nature, and the delivery of a curriculum that meets the needs of the educational establishment, governing bodies, students and the future employers is essential. Interprofessional education at an early stage of integrative student learning usually results in favourable satisfaction amongst students and faculty as well as significant effect on attitudes toward interprofessional teamwork and education¹. Indeed, interprofessional learning is one solution for students embarking on nursing programmes². Within this context, internet-based environments have been used in a variety of ways including as a forum for communication between the university faculty, students, and preceptors at clinical sites; didactic lectures from expert clinicians to students assigned to distant clinical sites; small group problem-based-learning modules designed to enhance students analytical skills; and conversion of traditional face-to-face lectures to asynchronous learning modules. Recognized advantages include improved communications between the college faculty and the students and clinical preceptors; enhanced access to a national network of clinical experts in specialized techniques; opportunities for student distant clinical rotations with continued didactic course work; and improved continuity and consistency of clinical experiences between students through implementation of asynchronous learning modules³.

In the current article, we propose that the successful health and social care curriculum should be interprofessional, multidimensional, needs-led and evidence-based. It is important when interprofessional learning is articulated into the curriculum that it is not merely a formal exercise, but fully integrated into, and meets the practice demands of the various health professions⁴. The introduction of problem-based learning, multimedia tools and the integration of the basic clinical sciences is also essential⁵. However, with students in some of the health related programmes attending placements for 50% of the time they are enrolled on the academic programme, and with the restriction in time and staffing issues, there is a tendency to dilute the delivery of the basic sciences of physiology, psychology and sociology in the curriculum. This impacts negatively on the students' learning experience and may have deleterious effects in terms of clinical practice. It is therefore vital that the curriculum is structured in such a way to allow sufficient time for delivery of the basic sciences as stand alone topics, with effective integration into practice units. This allows students to deepen their knowledge and appreciate the relevance of these sciences within their clinical practice.

The move away from didactic lecturing and the utilisation of the virtual learning environment (VLE) is vital for the delivery of high quality teaching to students. VLE is a valuable methodology for the creative implementation of interprofessional learning amongst health professionals. With continuous professional development a necessity for health professional, and with many enrolling on part time programmes, VLE becomes a valuable tool for communication and for flexible methods of teaching and learning. It is a liberating tool that allows peer discussions and student staff discussions. VLE has an added benefit to staff in terms of freeing up some time to pursue their research interests.

A study in South Africa using WebCT, a web-based virtual learning environment (VLE) and Interactive TV (ITV) resulted in a scoring that was highly valued by students and lecturers participating in distance-learning programmes and students rated courses using both technologies as moderately interactive⁶. This study, however, was conducted in a country with access to financial resources, and it would be impossible to detect similarities in third-world countries and due to deficiencies of infrastructure, power cuts and computerised facilities. Therefore didactic teaching is much the norm in these countries. A recent paper in Zimbabwe does, however, express the need to evaluate the outcomes of medical education in Africa in order toarrest further declines in the quality of health care services⁷. Students, as the "customers" of the university, should be involved in clinical programme design and their suggestions should be taken on board by faculty administrators⁸. Another study has suggested a multi-disciplinary approach to translational studies in medical courses whereby students undertake a scientific evaluation of selected diseases⁹. Results showed that students highly valued this method, although there was some inequality in the time and amount of work needed for individual core courses and an imbalance between excessive didactic material and inadequate clinical exposure⁹. A study in Nigeria utilised a three-day didactic and laboratory course with emphasis on the initial assessment and treatment of patients, with favourable knowledge-acquisition amongst physicians, suggesting a useful addition to academic medical schools in developing countries¹⁰. Further didactic methods can be promulgated via workshops in distant-learning curricula¹¹.

It is also important to complement the future curriculum with effective student support mechanisms. We suggest that this can take the form of conference-style induction and fresher's events, development days, personal tutor support and peer-assisted student support. This aids students to adjust quickly to university life, feel less isolated, improve study habits and prepare better for course work. We suggest that funding in African institutions through promotion of external collaboration through joint ventures (e.g. medical schools and pharmaceutical companies); sponsorship from the WHO; external links with industry, schools, government departments and institutions; and utilising an apportionment of student fees for VLE development, will all assist in overcoming financial and logistic hurdles in universities in poorer countries.

References

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2. McKinlay, E., Pullon, S. Interprofessional learning—the solution to collaborative practice in primary care. Nursing New Zealand, 2007, 13(10), 16-18.
3. Riley, J.B., Austin, J.W., Holt, D.W., Searles, B.E., Darling, E.M. Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs. The Journal of Extra-Corporeal Technology, 2004, 36(3), 235-239.
4. Lloyd-Jones, N., Hutchings, S., Hobson, S.H. Interprofessional learning in practice for pre-registration health care: interprofessional learning occurs in practice is it articulated or celebrated? Nurse Education in Practice, 2007, 7(1), Epub 2006 May 24.
5. Azer, S.A. Medical education at the crossroads: which way forward? Annals of Saudi Medicine, 2007, 27(3), 153-157.
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7. Mufunda, J., Chatora, R., Ndambakuwa, Y., Samkange, C., Sigola, L., Vengesa, P. Challenges in training the ideal Doctor for Africa: lessons learned from Zimbabwe. Medical Teacher, 2007, 29(9), 878-881.
8. de Villiers, M., Bresick, G., Mash, B. The value of small group learning: an evaluation of an innovative CPD programme for primary care medical practitioners. Medical Education, 2003, 37(9), 815-821.
9. Herold, B.C., McArdle, P., Stagnaro-Green, A. Translational medicine in the first year: integrative cores. Academic Medicine: Journal of the Association of American Medical Colleges, 2002, 77(11), 1171.
10. Tortella, B.J., Swan, K.G., Donahoo, J.S., Tischler, C., Marangu, J.A., Orjiako, A.B., Sharples, C., Swan, B.C., Hill, D.W. Trauma life support education: a didactic and caprine laboratory course for Nigerian physicians. Injury, 1996, 27(5), 329-331.
11. Kotze, A.J. [Workshops: the workshop as a didactic form for the presentation of clinical practice in public health nursing]. [Article in Afrikaans]. Nursing RSA = Verpleging RSA, 1990, 5(2), 23-27.

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