1. Community Based Education - UKZN Entrée Program Moïse Muzigaba University of KwaZulu-Natal

2. Overall Goal Make learning meaningful for the students Enhance formative & transformative learning Ensure that our students become change agents Rotational timing Revised curriculum 2010 - 6 years Year 1: Becoming A Professional (BAP) module – Public Health Years 2, 3 & 4: The Selectives Program – Public Health, Family Medicine, Rural Health Year 4: Decentralised teaching program – Family Medicine Year 6: Rural health attachment (7 weeks) in 2015 – Rural health, Family Medicine, Public Health Overview of CBE at UKZN

3. 32 credit module in Year 1 MBChB Learning objectives 1.To provide students with basic knowledge and skills required for being an adult learner in an institute of higher education 2.To provide the core foundational knowledge and principles of community, family, public and environmental health Becoming A Professional (BAP) Module

4. Challenge in medical education is changing the objective of learning from being “informative”  “formative”  “transformative” Students form themselves into groups of 2 to 4 (60 – 120 sites) Identify a disadvantaged community near where they are accommodated during the term e.g. Childrens’ homes, feeding the Homeless, street children's shelter, etc. Students decide themselves where they are going to perform their community service – sites are usually urban Students participate in 16 hours of community service Report to peers and faculty members on the Making a Difference activity; and Receive an assessment mark which contributes to the end of term mark BAP: ‘Making a Difference Community Service Activity’

5. Only requirement: need to do appropriate HIV and AIDS activity in this community. NO funding, other than what the students may generate themselves. Making a Difference activity is reported by each group as a descriptive poster funded by MEPI Each group peer evaluates two other groups’ posters. Trophy for the best poster Making a Diff- cont…

6. BAP Poster Day

7. Years 2, 3 & 4: builds on what is learnt during BAP Module in Y1  Selectives 01 - responsibility of the Discipline of Family Medicine;  Selectives 02 - responsibility of the Discipline of Public Health Medicine; and  Selectives 03 - responsibility of the Discipline of Rural Health. Based on a Community Oriented Primary Care approach (COPC) - principles of Social Medicine developed by Sidney & Emily Kark in mid-20th century in rural SA Selectives Programme

8. Self initiated groups of 2-4 choose their Selectives Site, ideally in the community in which they live: 60 – 120 sites across SA Each group identifies a PHC practitioner (Selectives Facilitator) - assists them in gaining access to other PHC service Allocated 4 weeks of dedicated time in their vacation to live and experience the range of PHC services in their Selectives Site. Selectives Progr. - Cont…

9. Output of Selectives 01 module (Y2): Community Diagnosis During selective 2, students identify a Research Problem which investigate further through a Community-Based Research Study in their Selective Site. Produce a research study protocol and obtain expedited ethical approval to conduct the survey. Results of the research study and the community diagnosis enable students to decide on a community- based health promotion intervention activity  which becomes the major component of the Selectives 03 module (Y4) Selectives Progr. – Cont…

10. Decentralised medical training - occurs outside academic hospitals in CHCs and clinics Training sites more reflective of societal needs. CanMEDS attributes Focuses on ambulatory care in PHC facilities (HEALTH EXPERT) Multi-disciplinary team (COLLABORATOR) Patient-centeredness (COMMUNICATOR) Exposure to decentralised training in rural, peri-urban & urban sites (HEALTH ADVOCATE) Family Medicine – 4 th year curriculum

11. 1.Curriculum development 2.Development of decentralised learning centres including the MEPI Learning Centres 3.Pedagogy for decentralised teaching 4.Implementation of decentralised training 5.Evaluation of programme 6.Currently there are 8 MLCs located in Rural, urban and Peri-urban areas across KZN prov Family Med.- Activities

12. BAP – Making a Difference Programme NGOs, FBOs & CBOs Selectives PHC providers: (General practitioners, local clinics, community health centres & the community at large Family Medicine The local PHC system - from clinics to district hospitals Defining our Community

13. Community Engagement Dependent of the students enthusiasm Currently, community involvement is limited and they are not involved in CBE design and evaluation Medical curriculum is being revised and therefore this component is strengthening each year

14. Level of community engagement Making A Difference and Decentralised Training Programme Selectives 01, 02, 03 Modules 7 week Rural attachment and Longitudinal Integrated Clerkship

15. Sustainability of Community Engagement Work in progress

16. Challenges 1.Recruitment of teachers 2.Accommodation and/or transport 3.Engagement of local stakeholders 4.Curriculum development 5.Suitable pedagogy

17. Question for Thought How best to make use of the short time allocated to CBE to engage community members in identifying their own health problems and work with health care providers towards alleviating the burden of disease in these communities

18. Discipline of Public Health Medicine and Dr Stephen Knight Discipline of Family Medicine and Dr Keshena Naidoo Acknowledgements

19. Contact Info Dr Nisha Nadesan-Reddy – Project Manager: Nadesanreddy@ukzn.ac.za Mr Moise Muzigaba, M&E Specialist: Muzigaba@ukzn.ac.za