Practice intentions of clinical associate students at the University of Pretoria, South Africa

Abstract

INTRODUCTION : Like those in so many other countries, the South African health system faces a human resources crisis with rural areas most affected. The clinical associate program was initiated to develop a mid-level medical worker specifically for district health in underserved areas in South Africa. The University of Pretoria (UP) started its three-year Bachelor of Clinical Medical Practice (BCMP) degree program in 2009 using a practice-based authentic learning approach in 20 urban and rural district and secondary hospitals. With the first cohort at the brink of graduation, the objectives of this study were to determine the practice intentions, practice preferences and factors associated with the practice intentions of clinical associate students at the University of Pretoria. METHODS : This was a cross-sectional study of first-, second- and third-year clinical associate students studying at UP. The measurement tool was a self-administered electronic questionnaire. The majority of questions were closed-ended and these were of different types including multiple choice and Likert scale. The dependent variable of interest in the study was urban–rural practice intention. Bivariate and multivariate analysis was conducted using Stata v12. RESULTS : A total of 149 of the 216 registered BCMP students at UP participated in the study. Amongst the 146 participants that provided a response regarding their practice intentions directly after graduating, 87 (59.6%) intended to practise in a rural area. Intention to practise in a rural area was found to be significantly associated with self-description of having lived most of one’s life in a rural area (p=0.002). If given complete freedom of choice, 53.4% of participants indicated a preference to practise in a rural area and 46.6% had an urban preference. Only one participant intended to emigrate within 5 years of graduating. If the BCMP degree was internationally recognised, 25.0% of participants would prefer to practise abroad. At some point following completion of the BCMP degree, 93.9% of participants intended to undertake further studies, with medical degrees and postgraduate clinical associate qualifications being the most popular choices. CONCLUSIONS : As a substantial proportion of clinical associate students intend to practise in rural areas in South Africa, they could be a potential solution to the critical shortage of health professionals in rural settings in South Africa. Universities should continue their drive to recruit clinical associate students from rural areas