Perceptions and attitudes of fifth year
medical students of Stellenbosch
University regarding the Rural Clinical
School in Worcester.
The scarcity of healthcare professionals in rural communities is
a global concern that causes a serious challenge to equitable
healthcare delivery.
Rural Clinical Schools (RCS) are being implemented in some
countries to promote awareness of rural health career and to
expand clinical placement networks.
The most important factors leading graduates to consider rural
practice are rural origin and positive training experiences in rural
platforms.
Therefore, the university has extended their clinical exposure
to rural medicine by establishing a RCS for teaching of
undergraduate medical students in the rural areas of the Cape
Winelands and the Overberg District
Selected senior students will spend their entire clinical year in
a rural platform.
The RCS is expected to support and secure the rural education
and training network to increase the availability and viability of
rural health services in the long term.
•The plan is to allocate 30 medical students to the RCS every year, where
most students will be placed in Worcester Regional Hospital and some
students distributed to the District Hospitals.
•For the first placement in 2011, 8 medical students were allocated to the
RCS.
•6 students placed in Worcester Hospital and 2 students in Ceres Hospitals.
•Specialities included in the curriculum for the Rural Clinical School are:
Internal medicine, Surgery, Orthopaedics, Paediatrics, Obstetrics &
Gynaecology, Family medicine and Psychiatry
Rationale – continued
To ensure the success of the RCS program, it is necessary to
understand:
 why students would/would not choose a rural placement.
 Explore their views and understanding of rural health issues.
Explore the relevance of rural clinical school placement to their
learning .
Research Question
What factors do students perceive as contributors to them selecting the
RCS and barriers that students think can prevent them from selecting
the Rural Clinical School for placement?
Aims
To gaining a deeper understanding of the fifth year medical
students’ perceived factors that can lead to them choosing the
RCS and barriers that can prevent them from selecting the RCS.
Objectives
The objectives were to:
Identify the barriers that may have prevented students from
choosing a RCS placement.
Identify factors that may have influenced medical students to
choose a RCS placement.
An exploratory study design
Quantitative: A survey was distributed to all fifth year MB,ChB students
either manually or electronically. Items in the questionnaire were taken
from the FRAME Questionnaire (Krahe, McColl, Pallant, Cunningham
& DeWitt, 2010).
The questionnaire focused on the following areas:
• demographic information;
• students’ preference for clinical practice;
• factors important to students when choosing a clinical school for
training
• suggested ways to make the RCS more attractive.
Qualitative: Structured Focus Group Interviews.
Participants
Quantitative Survey:
All fifth year medical students
Structured focus group interviews:
Purposive sampling: all students going for RCS placement.
Convenient sampling: Students who did not select RCS for
placement.
Analysis
Quantitative: Data was captured on SPSS and analysed using
descriptive statistics.
Qualitative: Audio taped interviews were transcribed and analysed
using categories and clusters.
•80/176 questionnaires issued were returned giving us a 45%
response rate
•26 students were part of the structured focus group interviews
•Group 1 = 7 students (students who selected RCS placement)
•Group 2 = 19 students (students remaining at Tygerberg campus)
Demographic information of students
• Gender: Males
43.8%
56.2%
Females
• Age: 22 – 25
92.5%
7.5%
26 – 29
• Marital Status: Single
Living with partner
• Background: Rural
93.7%
6.3%
40%
57.2%
Urban
• Preferred place of future practice: Urban area in RSA
Rural area in RSA
Outside RSA
33.8%
52.5%
8.8%
Factors important to students when choosing the RCS
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Quantitative – responses from open ended questions
Other factors important to selecting the RCS:
•Not being well prepared for exams
•Uncertainty of teaching in rural areas
Suggested ways of making the RCS more attractive:
•Positive report of previous students
•More consultations and tutorials with doctors
•More teaching and learning opportunities
•More information and good planning of the RCS
•Safe accommodations with meals and internet access
Quantitative – responses from open ended questions
Positive comments about the RCS
•Rural settings have good doctors
•It is a great learning opportunity and to learn practical skills
•Good for preparing students for the hardship of internship.
Quantitative – responses from open ended questions
Concerns about the RCS
•Being well prepared for exams
•Worried district doctors won’t give good teaching
•Not much academic input in rural hospitals
•Patients in rural hospitals are less complex as compared
Tygerberg Hospital
•Concern that they will be equipped to pass final exam
•Enough time to study in the RCS
Qualitative data:
Category
Clusters
In-depth hands on training
experience.


Training experience
Opportunities
University preparing medical
students for rural practice.

Good exposure
Rural Clinical School







Expectations
Future
Rural learning opportunities
Fear of the unknown
Work environment
New environment
Application procedure and
selection criteria
Accommodation environment

•Positive experience in rural hospitals does have an effect on students
choices of choosing rural practice.
•There are existing barriers that could prevent students from selecting the
RCS placement
•As well as factors that could influence students to select the RCS placement
•It is evident from the findings that with good planning and more exposure
to RCS, a great future for the RCS is possible.
•It is therefore recommended that RCS should be introduced to students at
an earlier academic level.
•More information regarding the RCS placement should be made available
to students in order for them to make more informed decisions of being
placed in such a setting.