Indiana University-Purdue University Indianapolis (IUPUI) / This project contributes to the improvement of the healing encounter between physician and patient and broadens the scope of medical ethics via application of a methodology that creatively communicates patient experience. Contemporary medical training and socialization can create emotional distance between patients and physicians, which has both positive and negative effects. A physician’s “detached concern” often renders patients’ ways of knowing irrelevant to their care. This has a negative effect on patient autonomy, trust, and the healing encounter in general. Herwaldt (2008) developed a pedagogical tool of distilling patient interviews in narrative form into “found poems,” in which the patient experience is expressed in verse; Herwaldt contends that the resulting poems hold the possibility of cultivating empathy in medical practitioners. My research extends Herwaldt’s work with a new set of ten patients currently in cancer treatment, translating their stories of illness into verse. The resulting poems have the potential to empower patients by legitimizing their narrative or experiential ways of knowing as complementary to physician perspectives and approaches to treatment. Clinical and feminist ethics are similar in their attention to case context, empathy, and legitimacy of narrative. However, there are aspects of feminist ethical theory that are not thoroughly delineated in clinical ethics—specifically, attention to power imbalances in medical structures and variations in ethical perspectives. When the poems are examined using a feminist bioethical framework, patients are empowered by expanding both the idea of justice and the principlist definition of autonomy to include the feminist conception of relational autonomy.

Problem-based learning (PBL) was developed for use in medical education to incorporate more active, learner-centered instruction. Central to problem-based learning is the problem, which in medical education is usually case a case presentation, revealed in stages to allow learners to form and research learning objectives. The purpose of this study was to identify themes present across the PBL cases, including the patient-centeredness of the cases. Content analysis was used to examine 62 PBL cases that comprised the first and second years' core curriculum at a public medical school. The cases included a patient population similar to the local population, but care was more hospital-centric than would be expected from the actual patterns of medical utilization in the United States. Analyzing along two axes of patient-centeredness, the PBL cases demonstrated a good understanding of the patient (knowing the patient), but other qualities such as shared decision making was not as exemplified. Medical educators can use the results to understand elements that contribute to patient-centeredness and apply the analysis framework to evaluate future cases.

Thesis (D.Tech.: Postgraduate Nursing Studies)-Dept. of Postgraduate Nursing Studies, Durban Institute of Technology, 2006 2 v. (920 leaves) / An educational course for post-basic multi-cultural South African nurses, based on a model for critical reflective practice, forms the case study for a participatory action research paradigm that frames this qualitative study

Thesis (MPhil)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: On entry to medical school, students are confronted with a worldview that can be typified as materialistic monism. The student progressively becomes a materialistic monist, not only because of the teaching, but also because medical schools fail to address the question of suffering. One would expect the biopsychosocial model to surmount the limitations of the biomedical model, but it in itself has to deal with both suffering and materialistic monism. Suffering cements the collapse into materialistic monism in the way the student practises medicine. What life strategies would transcend this materialistic monism? This thesis examines potential educational interventions that might help the student to analyse the philosophy of medical school and find ways of dealing with the question of suffering. / AFRIKAANSE OPSOMMING: Met toelating tot mediese skool word studente gekonfronteer met ’n wêreldsiening wat as materialistiese monisme beskryf kan word. Die student verander progressief in ’n materialistiese monis, nie slegs as gevolg van die onderrig nie, maar ook omdat mediese skole nie daarin slaag om die kwessie van lyding aan te spreek nie. ’n Mens sou verwag dat die biopsigies-sosiale model die beperkinge van die biomediese model sou oorkom, maar instede moet dit self beide lyding en materialistiese monisme aanspreek. Lyding moedig die verval in materialistiese monisme in die wyse waarop die student geneeskunde beoefen aan. Watter soort lewensstrategieë is nodig om hierdie materialistiese monisme te transendeer? Hierdie tesis ondersoek die opvoedkundige intervensies wat die student kan help om die mediese skool se filosofie te analiseer en wyses te vind om die kwessie van lyding te hanteer.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Since the SPICES (S: student centred; P: problem-based learning; I: integration; C: community based/hospital based; E: electives; and S: systematic apprenticeship based) model of medical curriculum was proposed by Harden, most medical schools worldwide have introduced curriculum changes toward a paradigm shift in teaching and learning. Walter Sisulu University (WSU) introduced such changes in 1992 when problem-based learning (PBL) was implemented in the medical school. This research assignment examines the level of horizontal integration within the WSU Bachelor of Medicine and Bachelor of Surgery (MBChB III) programme. The purpose of the study was to determine the students’ and tutors’ perceptions of integration in the curriculum. A cross-sectional descriptive survey was designed and piloted in 2009 and the questionnaire was then administered to MBChB III students who agreed to form part of the study. The tutors’ opinions on integration were also explored. A questionnaire on integration using a five-point Likert scale, was administered to both the students (12 questions) and the tutors (six questions). Six open-ended questions on integration were added to the students’ instrument and one to the tutors’ instrument, for qualitative analysis and to assist in triangulation. In addition, semi-structured interviews were conducted with the tutors individually. As a result of the survey, it seemed that all the students were “satisfied” or “very satisfied” with the level of integration of content and learning. All the tutors were aware of the need for integration, but some were not familiar with how the learning environment could be modified to enhance students’ approach to integration. MBChB III students at WSU highly valued the integration of learning and teaching during tutorials. Thirty-three per cent of the tutors, though, believed that integration increased their workload. All the tutors thought that integration facilitated students’ learning skills and promoted student engagement, learning and interaction with faculty. / AFRIKAANSE OPSOMMING: Sedert Harden die SPICES-model as mediese kurrikulum voorgestel het, het die meeste mediese skole in die wêreld kurrikulumveranderings ingevoer as ʼn paradigmaskuif in onderrig en leer. (S – studentgesentreerde; P – problemgebaseerde leer; I – integrasie; C – gemeenskaps-/hospitaalgebaseer; E– keusevakke; en S – gebaseer op sistematiese vakleerlingskap.) Die Walter Sisulu-universiteit (WSU) het in 1992 sulke veranderings aangebring toe probleemgebaseerde leer (PBL) in die mediese skool geïmplementeer is. Hierdie navorsingswerkstuk ondersoek die mate van integrasie in die Baccalaureus in Geneeskunde-program en Baccalaureus in Chirurgie-program (MBChB III) aan die WSU verder as die PBL-tutoriale kan vorder. Die doel van die studie was om te bepaal wat studente en studieleiers se persepsies oor die integrasie van die kurrikulum is. ʼn Beskrywende deursnee-opname is in 2009 opgestel en ’n loodsstudie is gedoen. Die opname is weer gebruik met MBChB III-studente wat ingestem het om aan die studie deel te neem. Studieleiers se menings oor integrasie is ook ondersoek. ʼn Vraelys oor integrasie volgens 'n vyfpunt Likert-skaal, is aan die studente (12 vrae) sowel as die studieleiers (ses vrae) gestel. Ses oop vrae oor integrasie is by die studente se instrument gevoeg en een by die vraelys vir die studieleiers ter wille van kwalitatiewe ontleding en triangulasie. Daarbenewens is ʼn semigestruktureerde onderhoud met elke studieleier individueel gevoer. Na afloop van die toepassing en ontleding van die opname was al die studente “tevrede” of “baie tevrede” met die vlak van integrasie van leer, met begrip en met die vlak van integrasie van inhoud. Al die studieleiers was bewus van die behoefte aan integrasie, maar sommige was nie vertroud met hoe die leeromgewing aangepas kan word om die studente se benadering tot integrasie te bevorder nie. MBChB III-studente aan die WSU het 'n hoë waarde geheg aan die integrasie van leer en onderrig tydens tutoriale. Drie-en-dertig persent van die studieleiers het egter geglo dat integrasie hulle werkslading verhoog. Al die studieleiers was van mening dat integrasie die studente se leervaardighede fasiliteer en die studente se deelname, leer en interaksie met akademiese personeel bevorder.

Thesis (MPhil)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: At the core of clinical education, within the allied health professions, is the teaching-learning relationship between the clinical educator and the student which is reinforced by and grounded in the explanatory theories of socio-constructivism, experiential learning and positioning. A good teaching-learning relationship is fundamental to the success of the students’ learning in the clinical environment. Clinical educators fulfil a dual role as mentors and assessors to students. The purpose of this study is to explore the students’ and clinical educators’ perceptions of the dual role of a clinical educator of students in the physiotherapy clinical environment, and how the perceptions of both parties influence the teaching-learning relationship. By following a phenomenological qualitative research approach with an interpretivist paradigm the researcher obtained data from focus groups and individual interviews. Data analysis involved a contextualised interpretive content analysis paradigm. The perceptions of the participants in the teaching-learning relationship, their particular expectations, challenges and preferences, reflect their experiences and are presented in the findings of the study. The findings of this study are comprehensively discussed and recommendations are made to transform the teaching-learning relationship by repositioning the participants (both students and clinical educators) in order to enhance the quality of the clinical learning experience within the physiotherapy clinical environment. / AFRIKAANSE OPSOMMING: Die onderrig-leerproses-verhouding tussen die kliniese dosent en die student vorm die kern van kliniese onderrig, ondersteun deur en op grond van die verduidelikende teorieë van sosiale konstruktivisme, leerervaring en posisionering, vir verwante gesondheidsberoepe. Die onderrigleerproses- verhouding word daarom beskou as die grondslag vir die sukses van leergeleenthede, aangesien die kwalitiet van die verhouding deurslagggewend is om studente se leerproses in die kliniese omgewing te ondersteun. Kliniese dosente speel ‘n dubbele rol as mentors en assessore vir studente. Die doel van die studie is om studente en kliniese dosente se sienings van die dubbele rol van ‘n kliniese dosent van studente binne die kliniese onderrigveld van fisioterapie in die kliniese omgewing te ondersoek, asook hoe die persepsies van albei partye die onderigleerproses- verhouding beinvloed. Die data word verkry van fokusgroepe en individuele onderhoude deur ‘n fenomenologiese kwalitatiewe navorsingsbenadering met ‘n interpreterende paradigma te volg. Die data is ontleed volgens ‘n kontekstuele interpreterende inhoudsontledingsproses. Die persepsies van die deelnemers aan die onderrig-leerprosesverhouding, hul spesifieke verwagtinge, uitdagings en voorkeure as drie breë temas van hierdie tesis, weerspieël hul ervarings en word weergegee in die bevindings van die studie. Die navorsing bespreek hierdie bevindings en doen regstellende aanbevelings oor die bevindings. Hierdeur kan die onderrig-leerproses-verhouding, deur herposisionering van albei partye (studente sowel as kliniese dosente), getransformeer word en die gehalte van die kliniese leerervaring in die fisioterapeutiese kliniese omgewing verbeter word.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: There is no dearth of evidence of the importance of facilitation for the effectiveness of small-group teaching. However, there is hardly any local literature on the knowledge of untrained facilitators and how they apply this knowledge to develop generic skills in students. Needs identified through this study have provided an insight into the areas requiring formal training that could be useful for developing nursing-faculty development programmes.

Thesis(MA)--Stellenbosch University, 2014. / ENGLISH ABSTRACT; In order for the transformation objectives of racial and gender diversity to be adequately reflected in the South African medical profession, it is crucial to understand how Black medical registrars experience the training environment. This qualitative study presents the experience of ten Black African medical specialists who completed their registrar training in the Western Cape in the past five years. Using both thematic and discourse analysis the study aimed to identify and describe the interpersonal, structural and institutional factors that may impede or promote Black advancement during registrar training. Participant experiences where contextualised in relation to discourses around the medical profession as a site of cultural reproduction that has been historically constructed as the exclusive domain of the White male. The analysis unearths experiences of systemic racism where the organisational culture of training institutions is experienced as alienating and unwelcoming to Black professionals. The findings raise the need for a more thorough evaluation of how transformations efforts are being received in specialist medical education. Key Words: Black doctors, Transformation in Higher Education, Systemic Racism, Medical training / AFRIKAANSE OPSOMMING: Met die oog op die realisering van die transformasiedoelwitte rakende ras- en geslagsdiversiteit in die Suid-Afrikaanse mediese professie, is dit deurslaggewend om te verstaan hoe Swart mediese spesialis studente die opleidingsomgewing ervaar. Hierdie kwalitatiewe studie gee die ervaring weer van tien Swart Suid-Afrikaanse mediese spesialiste wat die afgelope vyf jaar hulle opleiding in die Wes-Kaap voltooi het. Deur gebruik te maak van beide tematiese- en diskoersanalise, poog die studie daarin om die interpersoonlike, strukturele en institusionele faktore wat Swart bevordering tydens professionele opleiding kan belemmer of bevorder, te identifiseer en te beskryf. Deelnemers se ervarings is gekontekstualiseer in verhouding tot die diskoerse rondom die mediese professie as terrein van kulturele voortsetting van wat histories as eksklusiewe domein van Wit mans gegeld het. Die studie ontbloot ervaringe van sistemiese rassisme, waarin Swart professionele beroepspersone vervreem en onwelkom voel in die organisasiekultuur van opleidingsinstansies.Die bevindinge beklemtoon die behoefte aan ‘n meer diepgaande evaluasie van hoe transformasie-pogings ontvang word in mediese spesialis opleiding. Sleutelwoorde: Swart dokters, transformasie in tersiêre opleiding, sistemiese rassisme, mediese opleiding

Thesis (DPhil)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: This dissertation aims to establish the reasons underlying possible gendered attrition trends in the South African medical profession between 1996 and 2005. Noting the international trend of the increasing feminisation of medical education and the profession, the dissertation illustrates that this is also a reality in our national context, and frames this phenomenon as being plagued by difficulties very similar to those encountered in other traditionally male-dominated fields. The particular relevance for further research and debate is illustrated through the noticed discrepancy between women’s representation in enrolment and graduation at medical schools in South Africa, and their representation in the profession itself. The decision to approach this investigation from a feministorganisational perspective was based on the fact that this would not only be a novel, but indeed also an appropriate, research approach to the study of gendered trends in medical education and the profession within the South African context. The research project thus sets out three main objectives relevant to this investigation. Objective 1 aims to establish the sex composition of the cohort of medical graduates that have not entered, or decided to exit, the medical profession. In terms of this objective, findings show an increasing rate of progression of men into the profession, accompanied by a decreasing rate of progression of women into the profession. Objective 2 attempts to establish the reasons behind sex trends in South African medical schools and in the profession. Thus, in an effort to comprehensively investigate the issues underlying attrition, I employ a mixed-methods approach to the primary data collection and analysis. Firstly, the findings show, through a quantitative analysis of the interview data, that this sample of women felt that both institutional and societal factors influenced a women doctor’s propensity to remain in the profession. Secondly, it is established that whether these respondents felt that they had appropriate role models in the profession was the most important factor in terms of their identification with, and propensity to stay in, the profession. Thirdly, it was also found that the respondents felt strongly that the culture of the medical profession impacts negatively on a woman doctor’s propensity to stay in the profession, but similar to the findings of other studies, this does not bring us closer to an understanding of what that culture constitutes. Thus, lastly, through a qualitative analysis of the interview data I find that the respondents clearly recognise the presence of a gendered substructure in medicine in the South African context, and identify some elements of this structure as most commonly linked to attrition. Objective 3, based on the outcomes of the previous objectives, aims to provide recommendations for the retention of medical doctors in general, and women doctors specifically, in the South African context. It concludes that flexibility1 in the medical profession is paramount to the retention of doctors, and women doctors specifically. This is a difficult challenge to overcome, as central values such as the importance of continuity of care in the medical profession would suggest that providing increased flexibility to medical doctors would impact negatively on patient care. However, it appears that there is increasing recognition amongst scholars, policy makers and medical practitioners themselves of the importance of acknowledging alternative work patterns. On the basis of the outcomes of my research, it is clear that the national gender attrition trends are a cause for concern in terms of resourcing the National Health System against the backdrop of a widely acknowledged shortage of doctors in South Africa and elsewhere. If women doctors do not progress effectively into the system, but form the majority of graduates, this is a tragic loss, as well as a waste of resources during training. This aspect also has policy implications, because it appears that the government, in trying to retain doctors, has increasingly turned to measures that are restrictive (compulsory community service, restrictions on foreign doctors), rather than focusing on ways in which to make doctors want to stay. The dissertation thus closes by suggesting two main areas within which these findings and recommendations would be employed most usefully: 1) medical schools/ training/education, and 2) the medical profession/culture. / AFRIKAANSE OPSOMMING: Hierdie proefskrif het ten doel om die redes onderliggende aan geslagsverskille in die verlies van vroue uit die Suid-Afrikaanse mediese beroep tussen 1996 en 2005 vas te stel. Die internasionale tendens van die toenemende vervrouliking van mediese opleiding en die mediese beroep wys dat dit ook ‘n realiteit in die Suid-Afrikaanse nasionale konteks is. Hierdie verskynsel word veroorsaak deur probleme soortgelyk aan dié wat in ander, tradisioneel manlik gedomineerde beroepe ondervind word. Die spesifieke relevansie vir verdere navorsing en debat word geïllustreer deur die aangetoonde proporsionele verskil tussen vroue se inskrywing en graduering in mediese skole in Suid-Afrika, en hul verteenwoordiging in die beroep self. Die besluit om hierdie ondersoek uit ‘n feministies-organisatoriese perspektief te benader, is nie net omdat dit ‘n oorspronklike benadering sou wees nie, maar ook gepas vir ‘n studie van geslagstendense in die mediese onderwys en professie binne die Suid- Afrikaans konteks. Die navorsingsprojek bevestig dus drie hoofdoelstellings wat relevant tot hierdie ondersoek is. Doelstelling een probeer om die geslagsamestelling van die kohort van mediese gegradueerdes wat nie tot die beroep toegetree het nie, of dié wat besluit het om die beroep te verlaat, te bepaal. Daar is bevind dat daar ‘n verhoogde koers van vordering van mans tot die beroep is, gepaardgaande met ‘n verlaagde koers van vordering van vroue tot die beroep. Doelstelling twee probeer om die redes onderliggende aan die geslagstendense in die mediese skool en die beroep vas te stel. Dus, om ‘n omvattende ondersoek te doen om uit te vind wat onderliggend aan die verlies is, het ek van ‘n gemengde metode benadering tot data insameling en analise gebruik gemaak. Die resultate van die onderhoud data wys dat hierdie vroue voel dat beide institusionele en sosiale faktore ‘n vroulike dokter se besluit om in die beroep te bly, beïnvloed. Tweedens is daar vasgestel dat geskikte rolmodelle in die beroep die belangrikste faktor is in vroue se identifikasie met die beroep, en hulle besluit om in die beroep te bly. Derdens is gevind dat die respondente baie sterk voel dat die kultuur van die mediese beroep ’n negatiewe impak het op ‘n vroulike dokter se besluit om in die beroep te bly, maar soos ook in ander studies bevind is, bring dit ons nie nader aan ‘n begrip van die aard van die kultuur nie. Ten slotte is daar dus met die onderhoud data gevind dat die respondente duidelik bewus is van die teenwoordigheid van ‘n geslagsubstruktuur in die mediese beroep in Suid-Afrika. Ek identifiseer ook sekere elemente van hierdie struktuur wat bydra tot die verlies van vroulike dokters uit die mediese beroep. Doelstelling drie, gebaseer op die uitkomste van die vorige doelstellings, probeer om aanbevelings te maak vir die behoud van mediese dokters in die algemeen, en vroulike dokters spesifiek. Die gevolgtrekking is dat buigsaamheid in die werkskultuur van die mediese beroep van kardinale belang is vir die behoud van dokters in die algemeen, en vroulike dokters meer spesifiek. Dit is ‘n moeilike uitdaging om te oorkom omdat sentrale waardes, soos die belang van kontinuïteit van versorging in die beroep, persepsies laat ontstaan dat meer buigsaamheid in werksomstandighede ‘n negatiewe impak op die versorging van pasiënte sou hê. Dit blyk egter ook dat daar ‘n toenemende erkenning is deur akademici, beleidsontwerpers en mediese praktisyns self van die belang van alternatiewe werkspatrone. Gebaseer op die resultate van die ondersoek is dit duidelik dat die nasionale geslagsverliestendense ‘n rede tot kommer vir die verskaffing van menslike hulpbronne vir die nasionale gesondheidstelsel is, veral teen die agtergrond van ‘n algemeen erkende tekort aan dokters in Suid-Afrika. As vroulike dokters nie effektief in die stelsel opgeneem word nie, hoewel hulle die meerderheid van gegradueerdes is, is dit ‘n tragiese verlies en vermorsing van hulpbronne wat vir opleiding gebruik is. Dit het ook implikasies vir beleid omdat dit blyk dat die Suid-Afrikaanse regering, in sy pogings om dokters te behou, meermale maatreëls gebruik wat perke stel (verpligte gemeenskapsdiens, beperkings vir buitelandse dokters, ens.), waar hulle eerder behoort te fokus op maniere om dokters in Suid-Afrika te hou. Ten slotte stel die proefskrif twee hoofareas voor waarin hierdie bevindings en aanbevelings aangewend kan word: 1) mediese skole/opleiding/onderwys, en 2) die mediese beroep/kultuur.

published_or_final_version / Education / Master / Master of Education