Integrating Primary Health Care principles in clinical teaching
Primary Health Care (PHC) was adopted as a lead theme for curriculum transformation by the Health Sciences Faculty of the University of Cape Town in 1994. However, integration of PHC in clinical teaching remains limited at the secondary and tertiary levels of care.
Prior to embarking on this project, recent experience and data from the department of Medicine suggest that clinicians at all levels of the health care system can apply these principles in clinical teaching if they are familiar with them. The established Clinician Education Course (CEC) provided an ideal opportunity to modify a module to focus on teaching the PHC principles as relevant to clinical teaching.
Why the idea was necessary
Different strategies to integrate the PHC principles in all clinical teaching are necessary for holistic individual and community health care. The CEC was chosen as one approach to provide clinicians with an approach, and the skills and knowledge needed to impart to students the importance and application of the principles of PHC in clinical care.
What was done
A module of the CEC was re-designed and introduced in 2010. An in-depth qualitative study was conducted with 8/15 (53%) of the participants who completed the module. Participants completed a pre- and post-module questionnaire on their knowledge of PHC and their perceptions of integrating PHC principles in their own clinical practice and teaching. This was followed by observation of their clinical teaching and an in-depth semi-structured interview. The data related to pre and post module knowledge of PHC were analysed using basic tools of discourse analysis. The rest of the data from the questionnaires, in-depth interviews, and observations were triangulated and analysed according to the impact of the course on different levels using Freeth et al’s modification of Kirkpatrick’s model for evaluation of educational outcomes at different levels.
Results and impact
Participants’ post module knowledge shifted from disorganised, point form, concrete examples to a more coherent understanding of PHC and the PHC principles. 7 participants, 3 each from Family Medicine and speech therapy and audiology and one from psychiatry, claimed to already be using the PHC principles in their clinical teaching prior to the course. This was corroborated by observation of their clinical teaching and/or further explanation in the semi-structured interview. The aspect that all identified as needing further attention, and where greater insight was gained, related to equity of care and violation of human rights within the health care system. The last participant from a tertiary speciality was finding it more difficult to incorporate the PHC principles. All eight had identified areas of action for individual and organisational change in the future.
“…it’s about changing the country and I’m saying to them can we make a difference to healing the nation. So they’ll be laughing about it because it is lofty ideals, but PHC is about that, it is about lofty ideals. It’s about healing the nation” P3.
Ethics Approval REC REF 152/2010 granted 12/04/2010
Melanie Alperstein, University of Cape Town
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Date published: 2011-06-17
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