1. This presentation has been supported by the President’s Emergency Plan for AIDS relief (PEPFAR) through HRSA under the terms of T84HA21652 Website: http://surmepi.sun.ac.za SURMEPI Stellenbosch University Rural Medical Education Partnership Initiative Community-based education – Development and implementation of a CBE strategy. A story through time M de Villiers, H Conradie, S Snyman, S van Schalkwyk, B van Heerden 2013 MEPI Symposium, Kampala, 6-8 August 2013

2. 1956-1982

3. 1982-1992 General practice Family Medicine Community practice Postgraduate CME course in Family Medicine 12 lectures in undergraduate medical programme

4. 1992-2001

6. 2001 - a new king (dean)

7. MB,ChB curriculum map

8. Early (weeks) Middle (weeks) Late (weeks) TOTAL (weeks) Internal Medicine46717 Paediatrics and Child Health46616 Obstetrics and Gynaecology44614 Surgery (General)44513 Family Medicine / Community Health / Rehabilitation 42511 Psychiatry 4711 Orthopaedic Surgery 55 Anaesthesiology 33 Otorhinolaryngology 33 Ophthalmology 33 Urology 33 Dermatology 2 2 Forensic Medicine 2 2 Imaging and Radiation 1 1 Pathology 1 1 203253105

9. 2001-2008

10. Cake 1: 2001-2004 Concept paper, with definitiondefinition Situation analysis of training sites, needs, and resources required Database mapping the status of and future needs for CBE Standing committee

11. Cake 2: 2004-2006 Safety guidelines Comprehensive CBE databaseCBE database Code of conduct for students and staff Code of conduct Repository of route maps Student transport policy Framework for CBE strategy

12. Cake 3: 2006-2007 Strategic project Workshops Recommendations for IPE (2006) Service learning short course (capacity building) Guidelines on Community-oriented education (COE) Recommendations for COE Faculty board 2007

13. Aspects covered by policy Alignment of programmes Curricula fit for CBE Community partnerships Co-ordination IPE facilitators Clinical supervisors Consolidation of sites Logistics Monitoring and evaluation

14. 2008 - 2013 PlatformPlatform planningplanning Rural Clinical School IPE strategy Graduate Attributes

15. CBE – our evolving concept Leaning in, with, from and for the community; focus on reciprocity, sustainability and social accountability Meaningful, relevant and mutually agreed upon service, addressing community needs and learning outcomes Personal growth and developing relevant competencies through reflection Promoting active citizenship and social responsibility

16. Time Team Tenacity Relationships Service providers Community Family Medicine Management Mainstream Interprofesional Recording Programme renewal Lessons learnt

17. Did they all lived happily ever after ? SURMEPI is supported by the President’s Emergency Plan for AIDS relief (PEPFAR) through HRSA under the terms of T84HA21652

19. Our initial definition “The educational implications of community-based education depend on what one understands by the concept. Magzoub and Schmidt (2000) state that CBE is not a unitary concept but rather a complex set of actions to improve life of a community. Borrowing from the WHO and other sources, Richards (2001), citing Hamad (2000) states that CBE occurs when learning occurs in the community. If one sees the “community base” simply as a training ground for learners, this holds one set of implications. If one sees oneself entering partnerships with community-based facilities and their communities, this holds a more extensive set of implications.”

21. Database

25. Student accommodation at the Ukwanda Rural Clinical School in Worcester, South Africa.

26. The IPE strategy for the Faculty of Medicine and Health Sciences at Stellenbosch University

27. The key and enabling competencies for a health professional at SU FMHS (adopted from the CanMEDS roles)

28. Lessons learnt Developing and implementing CBE strategy takes time Team of role players, change agents and champions Never give up Family Medicine as a catalyst Interprofessional approach Sustained support from the dean and management Close collaboration with health service providers Mainstream CBE decision-making structures and processes Thorough record keeping Use CBE strategy for curriculum reform and renewal Constant attention to relationship building