Thesis (MPhil)--Stellenbosch University, 2014. / INTRODUCTION: For this MPhil research assignment, I have chosen to write an article based on a small scale research project conducted in the Clinical Skills Centre (CSC) at Stellenbosch University. Medical students’ perceptions were gathered in order to evaluate the usefulness and relevance of the Clinical Skills module and the different components thereof as experienced by the students themselves. This in the end led to valuable feedback that were given to the course coordinators which in turn may lead to curricula changes being made to improve the overall teaching and learning experience for future medical students rotating through the CSC.

The purpose of this study was to investigate the attitudes and treatment knowledge of medical student professionals regarding rape victims. In addition to generating normative data for a population which, as a function of their vocation may come in contact with victims, comparisons were made between a sample of those beginning their medical education process and those at the end of training in order to measure change in treatment knowledge and attitudes towards rape victims which occur during medical school. Also investigated were differences which exist in the attitude and treatment knowledge measures for rape victims compared to other emergency room patient populations, and the effect of gender of the physician upon those measures. A final element investigated the physicians' perceptions of a "real" rape as it relates to those measures.

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Worldwide the stigma attached to psychiatric patients, psychiatric disorders, psychiatrists and the field of Psychiatry is of great concern. The stigmatising perceptions of medical practitioners and medical students towards psychiatric patients have a negative impact on effective treatment, considering the increasing burden psychiatric disorders are placing on communities and health systems. Numerous efforts were attempted and recommendations made for destigmatising medical students' perceptions towards psychiatric patients. It was found that perception usually improved after a clinical rotation in Psychiatry, but the stigmatising perceptions mostly returned a year later. The first clinical exposure to Psychiatry for medical students at the Faculty of Medicine and Health Sciences, Stellenbosch University, is during the fourth or fifth year of study. This rotation was revised in 2010 and a service-learning component added. The research question which consequently developed, is: What is the influence of a service-learning approach on destigmatising students' perceptions towards psychiatric patients? The research followed a phenomenological school of thought in an interpretative paradigm with a qualitative-inductive approach. On the last day of a rotation students handed in their written reflections and an in-depth focus group interview was conducted. The focus group interviews were repeated a year later. Students' reflections and the transcribed texts were analysed. This served as the basis for conclusions from which recommendations were made. It was found that students had stigmatising perceptions towards psychiatric patients before their first clinical rotation in Psychiatry. Directly after that students' perceptions were destigmatised to a greater extend. A year later non-stigmatising perceptions of understanding, acceptance, comfortableness, compassion, respect and responsibility were still present, although a few students experienced the limited return of stigmatising perceptions. Students attributed the positive changes to their service-learning experience in combination with the clinical placement at a psychiatric hospital with a friendly atmosphere and where they were exposed to patients not suffering from complex and extreme psychiatric disorders. The non-stigmatising perceptions a year after a clinical rotation in Psychiatry demonstrates the transformative value of service-learning. Service-learning is where meaningful and relevant service is rendered with and in the community, social responsiveness is purposefully emphasised and structured reflections are done to enhance academic learning. As a result of this study medical schools worldwide can take cognisance that a service-learning approach made a significant contribution to the stained destigmatisation of medical students' perceptions towards psychiatric patients. / AFRIKAANSE OPSOMMING: Stigma teenoor psigiatriese pasiënte, psigiatriese steurings, psigiaters en Psigiatrie as vakgebied is wêreldwyd ʼn groot bron van kommer. Medici en mediese studente se stigmatiserende persep-sies teenoor psigiatriese pasiënte het ʼn negatiewe impak op effektiewe behandeling, veral gesien in die lig van die groterwordende las wat die toename in psigiatriese steurings op gemeenskappe en gesondheidsisteme plaas. Heelwat pogings is aangewend en aanbevelings gemaak om mediese studente se persepsies teenoor psigiatriese pasiënte te destigmatiseer. Daar is bevind dat persepsies gewoonlik verbeter direk na ʼn kliniese rotasie in Psigiatrie, maar dat stigmatiserende persepsies meestal binne ʼn jaar terugkeer. Mediese studente aan die Fakulteit Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch, se eerste kliniese blootstelling aan Psigiatrie is tydens die vierde of vyfde studiejaar. In 2010 is dié rotasie hersien en ʼn diensleerkomponent bygevoeg. Die navorsingsvraag wat hieruit ontwikkel is, is: Wat is die invloed van ʼn diensleerbenadering op die destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte? Die navorsing het ʼn fenomenologiese denkrigting gevolg in ʼn interpretatiewe paradigma met ʼn kwalitatief-induktiewe benadering. Studente het skriftelike refleksies op die laaste dag van ʼn rotasie ingehandig en ʼn in-diepte fokusgroeponderhoud is gevoer. ʼn Jaar later is die fokus-groeponderhoude herhaal. ʼn Ontleding van studente se refleksies en die getranskribeerde tekste en gedoen. Dit het gedien het as basis vir die gevolgtrekkings waaruit aanbevelings gemaak is. Daar is gevind dat studente voor hulle eerste kliniese rotasie in Psigiatrie, stigmatiserende persepsies teenoor psigiatriese pasiënte gehad het. Direk daarna was studente se persepsies grotendeels gedestigmatiseer. Na ʼn jaar was nie-stigmatiserende persepsies van begrip, aanvaar-ding, gemaklikheid, deernis, respek en verantwoordelikheid steeds teenwoordig, alhoewel stigma-tiserende persepsies tot ʼn mate by sommige teruggekeer het. Studente het die positiewe verande-ring toegeskryf aan die diensleerervaring in kombinasie met 'n kliniese plasing in die psigiatriese hospitaal waar ʼn vriendelike atmosfeer geheers het en waar daar blootstelling was aan pasiënte wat nie aan komplekse en ekstreme psigiatriese steurings gely het nie. Die nie-stigmatiserende persepsies ʼn jaar na ʼn kliniese rotasie in Psigiatrie toon die transformatiewe waarde van diensleer. Met diensleer word sinvolle en relevante diens met en in die gemeenskap gelewer, doelbewuste klem word op sosiale verantwoordbaarheid gelê en ge-struktureerde refleksie word gedoen om beter akademiese leer te laat plaasvind. Na aanleiding van hierdie studie kan mediese skole wêreldwyd kennis neem dat ʼn diensleer-benadering ʼn betekenisvolle bydrae gelewer het tot die volhoubare destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte.

As the cost for health care delivery increases, so does the demand for access to care. However, individuals in a rural community often do not have access to the care they need. Shortages of rural health care professionals are an ever-increasing problem. The Affordable Care Act of 2010 sought to increase health care access by focusing on team-based care delivery. Thus, the need to educate health care students in the fundamentals of team-based practice has led to an increased emphasis on Interprofessional Education (IPE). While past research focused on urban IPE, a literature gap exists for the effects of a rural team-based educational experience on practice location decisions. This study examined how rural IPE influenced health profession students' perspectives of what it means to be a member of a rural health care team and explored what factors go into making decisions of where to live and provide care. Motivational Theory provided the framework for a mixed methods approach with data from student reflective journaling and a post-experience Q sort. Analysis yielded important understandings about the impact of rural IPE. Accordingly, having a rural IPE experience provided positive motivation for returning after graduation. Further, the time spent in rural IPE generated understandings of what it means to live and provide care to a rural community. One important new discovery gained is the clinical setting is not where most IPE took place. As a result, social interactions with fellow students and community members achieved the goals of rural IPE. Despite these influential findings, noted barriers to genuine rural IPE persisted. In the end, students, educators, and rural health care professionals need to be aware of the multiple factors that guide decisions of where to live and provide care.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Recent literature on medical professionalism claims that self-awareness and the ability to reflect upon one’s experiences is a critical component of professionalism; however there is a paucity of empirical evidence to support this claim. This study employed a mixed methods approach to explore the utility of reflective writing and self- and peer assessments in explaining professionalism lapses among medical students. Methods: A retrospective case-control study was conducted using students from Indiana University School of Medicine (IUSM) who had been disciplined for unprofessional behavior between 2006-2013 (case group; n=70). A randomly selected control group (n=230) was used for comparison. Reflective ability was assessed using a validated rubric to score students’ professionalism journals. Mean reflection scores and assessment scores were compared using t-tests. Logistic regression analysis was used to determine the impact of reflection scores and self- and peer assessment scores on the likelihood of having been disciplined for unprofessional behavior. Subsequent qualitative analysis further explored when and how students learned professionalism during their clinical experiences. Results: The study found that students in the case group exhibited lower reflective ability than control students. Furthermore, reflective ability was a significant factor in explaining the odds that a student had been cited for professionalism lapses. There were no differences in self-assessment scores between the two groups, but students in the case group had significantly lower peer assessment scores than control students. Peer assessment scores also had the greatest influence on the odds that a student had been cited for professionalism deficiencies during medical school. Qualitative analysis revealed that students learn professionalism from role models who demonstrated altruism and respect (or lack thereof). Conclusions: These findings suggest that students should be provided with guidance and feedback on their reflective writing to promote higher levels of reflection, which may reduce the number of students who are cited for professionalism lapses. These findings also indicate that peer assessments can be used to provide students with insightful feedback regarding their professional development. Finally, role models have a strong influence on students’ professional development, and therefore must be cognizant of the implicit messages their behaviors convey.