1. Perceptions and attitudes of fifth year medical students of Stellenbosch University regarding the Rural Clinical School in Worcester.

2.  The scarcity of healthcare professionals in rural communities is a global concern that causes a serious challenge to equitable healthcare delivery.  Rural Clinical Schools (RCS) are being implemented in some countries to promote awareness of rural health career and to expand clinical placement networks.  The most important factors leading graduates to consider rural practice are rural origin and positive training experiences in rural platforms.

3.  Therefore, the university has extended their clinical exposure to rural medicine by establishing a RCS for teaching of undergraduate medical students in the rural areas of the Cape Winelands and the Overberg District  Selected senior students will spend their entire clinical year in a rural platform.  The RCS is expected to support and secure the rural education and training network to increase the availability and viability of rural health services in the long term.

4. The plan is to allocate 30 medical students to the RCS every year, where most students will be placed in Worcester Regional Hospital and some students distributed to the District Hospitals. For the first placement in 2011, 8 medical students were allocated to the RCS. 6 students placed in Worcester Hospital and 2 students in Ceres Hospitals. Specialities included in the curriculum for the Rural Clinical School are: Internal medicine, Surgery, Orthopaedics, Paediatrics, Obstetrics & Gynaecology, Family medicine and Psychiatry

6. Rationale – continued  To ensure the success of the RCS program, it is necessary to understand:  why students would/would not choose a rural placement.  Explore their views and understanding of rural health issues.  Explore the relevance of rural clinical school placement to their learning. Research Question What factors do students perceive as contributors to them selecting the RCS and barriers that students think can prevent them from selecting the Rural Clinical School for placement?

7. Aims To gaining a deeper understanding of the fifth year medical students’ perceived factors that can lead to them choosing the RCS and barriers that can prevent them from selecting the RCS. Objectives The objectives were to:  Identify the barriers that may have prevented students from choosing a RCS placement.  Identify factors that may have influenced medical students to choose a RCS placement.

8. An exploratory study design Quantitative: A survey was distributed to all fifth year MB,ChB students either manually or electronically. Items in the questionnaire were taken from the FRAME Questionnaire (Krahe, McColl, Pallant, Cunningham & DeWitt, 2010). The questionnaire focused on the following areas: demographic information; demographic information; students’ preference for clinical practice; students’ preference for clinical practice; factors important to students when choosing a clinical school for training factors important to students when choosing a clinical school for training suggested ways to make the RCS more attractive. suggested ways to make the RCS more attractive. Qualitative: Structured Focus Group Interviews.

9. Participants Quantitative Survey: All fifth year medical students Structured focus group interviews: Purposive sampling: all students going for RCS placement. Convenient sampling: Students who did not select RCS for placement. Analysis Quantitative: Data was captured on SPSS and analysed using descriptive statistics. Qualitative: Audio taped interviews were transcribed and analysed using categories and clusters.

10. 80/176 questionnaires issued were returned giving us a 45% response rate 80/176 questionnaires issued were returned giving us a 45% response rate 26 students were part of the structured focus group interviews 26 students were part of the structured focus group interviews Group 1 = 7 students (students who selected RCS placement) Group 1 = 7 students (students who selected RCS placement) Group 2 = 19 students (students remaining at Tygerberg campus) Group 2 = 19 students (students remaining at Tygerberg campus)

11. Demographic information of students Gender: Males 43.8% Gender: Males 43.8% Females 56.2% Females 56.2% Age: 22 – 25 92.5% Age: 22 – 25 92.5% 26 – 29 7.5% 26 – 29 7.5% Marital Status: Single 93.7% Marital Status: Single 93.7% Living with partner 6.3% Living with partner 6.3% Background: Rural 40% Background: Rural 40% Urban 57.2% Urban 57.2% Preferred place of future practice: Urban area in RSA 33.8% Preferred place of future practice: Urban area in RSA 33.8% Rural area in RSA 52.5% Outside RSA 8.8%

13. Quantitative – responses from open ended questions Other factors important to selecting the RCS: Not being well prepared for exams Not being well prepared for exams Uncertainty of teaching in rural areas Uncertainty of teaching in rural areas Suggested ways of making the RCS more attractive: Positive report of previous students Positive report of previous students More consultations and tutorials with doctors More consultations and tutorials with doctors More teaching and learning opportunities More teaching and learning opportunities More information and good planning of the RCS More information and good planning of the RCS Safe accommodations with meals and internet access Safe accommodations with meals and internet access

14. Quantitative – responses from open ended questions Positive comments about the RCS Rural settings have good doctors Rural settings have good doctors It is a great learning opportunity and to learn practical skills It is a great learning opportunity and to learn practical skills Good for preparing students for the hardship of internship. Good for preparing students for the hardship of internship.

15. Quantitative – responses from open ended questions Concerns about the RCS Being well prepared for exams Being well prepared for exams Worried district doctors won’t give good teaching Worried district doctors won’t give good teaching Not much academic input in rural hospitals Not much academic input in rural hospitals Patients in rural hospitals are less complex as compared Tygerberg Hospital Patients in rural hospitals are less complex as compared Tygerberg Hospital Concern that they will be equipped to pass final exam Concern that they will be equipped to pass final exam Enough time to study in the RCS Enough time to study in the RCS

16. CategoryClusters In-depth hands on training experience.  Training experience  Opportunities University preparing medical students for rural practice.  Good exposure Rural Clinical School  Expectations  Future  Rural learning opportunities  Fear of the unknown  Work environment  New environment  Application procedure and selection criteria  Accommodation environment Qualitative data:

17. Positive experience in rural hospitals does have an effect on students choices of choosing rural practice. There are existing barriers that could prevent students from selecting the RCS placement As well as factors that could influence students to select the RCS placement It is evident from the findings that with good planning and more exposure to RCS, a great future for the RCS is possible. It is therefore recommended that RCS should be introduced to students at an earlier academic level. More information regarding the RCS placement should be made available to students in order for them to make more informed decisions of being placed in such a setting.