Understanding rural clinical learning spaces: Being and becoming a doctor

Abstract

Context: Calls for health professions education that can foster transformative educational experiences have been voiced. Studies suggest that extended clinical training at rural sites potentially provides transformative learning spaces. This article explores ‘being and becoming’ as a construct for understanding the student experience at a rural clinical school (RCS).

Methods: Sixty-two in-depth interviews were conducted over a three-year period with RCS students, graduates (as interns) and intern supervisors. Thematically analysed data were mapped according to the adapted Kirkpatrick model for appraising educational interventions. Drawing on realist perspectives, findings were further analysed to discern the mechanisms influencing the being and becoming of junior doctors.

Results: Responses provided evidence of changed attitudes and behaviour, and the adoption of professional practice that was seen to influence patient outcomes. Analysis highlighted sharing of values through role modelling, engagement with preceptors, being respected as part of a team, and being trusted to assume responsibility for a patient as key mechanisms. The outcome was confident, competent and caring interns.

Discussion: Rural clinical learning spaces influence the ‘being and becoming’ of a junior doctor. Understanding this process in the context of place (rural platform), participation (community of practice) and person can inform expanded agendas for students’ clinical learning.

Acknowledgements

B. van Heerden, H. Conradie, T. Fish, N. Kok and J. Blitz are acknowledged for their contribution to the project. We also thank all the respondents who participated in this study.

Declaration of interest: The authors report that they have no declarations of interest. Funding from the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI), which is supported by the President’s Emergency Plan for AIDS relief (PEPFAR) through HRSA under the terms of T84HA21652, is gratefully acknowledged.

Notes

1. RCS13_2013 indicates RCS student (13) interview conducted in 2013. IN, Intern; IS, Intern supervisors; T, translated.