The application of two capability models to support fourth year medical students' learning.

Abstract

Background:

The Longitudinal Clinic attachment program for students (L-CAS) offers opportunities for students to visit complex and diverse learning sites in primary care settings where they can acquire and practice consultation skills. The three-stage assessment and plan were used as an objective indicator of the development of a number of competencies over the course of a year. Problem statement and research question:

The aim of this study has been to explore and better understand learning related to L-CAS activities, so that the L-CAS curriculum can be planned and executed to specifically support learning with the question: How does the application of the two capability models support fourth-year medical student learning during and after L-CAS visits?

Theoretical underpinning:

Two models, namely the Medical Education Model of Capability and the Department of Family Medicine University of Pretoria (DoFMUP) Capability Approach to Learning, were identified, with capability as the theoretical basis, to describe the learning process.

The Medical Education model provides a framework for planning and evaluating curricula. This model was used to identify and understand students’ aspirations and capability sets, their perceptions of enabling and hindering factors and the attainment of aspirations.

The DoFMUP Capability Approach to Learning is a practical way of understanding the process of learning in a complex world. This model was used to determine the development of students’ competence to perform a three-stage assessment and management plan (3SAP) for patients encountered in various primary healthcare settings over one year, and scaffolding deemed necessary to support learning.

Methods:

Qualitative and quantitative methods were employed.

Content analysis and grounded theory underpinned the qualitative analysis. Data from the questionnaire, focus groups and interviews was used to explain and understand students’ perceptions about their own development and learning in L-CAS, enabling and hindering factors, and how learning can be optimized.

Quantitative analysis was used to report on students’ aspirations and their perceptions of attainment of those aspirations. Patient case reports were analysed to asses change in competencies over one year.

Results:

It is clear that L-CAS offers students ample opportunities to learn, but because of all the challenges they face, most students did not choose to address their learning needs personally but responded with being demotivated. Students were able to identify significant resources that can enable them but failed to use these in dealing with their challenges. Most students perceived growth, and reported learning, but unfortunately this was not evident in their patient cases.

It is clear that the aspirations students set for themselves are different from what we expect of them.

Discussions and Conclusions:

A novel model is derived from both the capability models and aspires to support and enable the learning process before, during and after L-CAS visits. Better planning of the timing of L-CAS sessions and weighting of the credits are suggested as well as better preparation and empowerment of students using the “CHILL” acronym with focus on the resources available at the sites, like peers, community healthcare workers (CHWs) and electronic devices.

The research question has been answered in that both the models highlighted challenges and potential areas of improvement of the L-CAS curriculum that could be addressed by the implementation of the novel model.