Assessing clinical associate students’ views on learning opportunities and involvement during primary health care placements : a mixed methods study in Tshwane

Abstract

BACKGROUND : The training model for Clinical Associates (Clin-As), initially centered on district hospitals, has increasingly involved primary healthcare (PHC) facilities over the past few years. This study explore and compare the perceptions and experiences of Clin-A students regarding learning opportunities and involvement during hospital and clinic rotations. METHODOLOGY : This cross-sectional mixed-methods study involved two primary data collection techniques: the administration of the validated medical education instructional questionnaire (MedIQ) questionnaire and the facilitation of focus group discussions. RESULTS : A total of 74 Clin-A students participated in the quantitative study, including 20 s-year students from 2022, 35 s-year students from 2023, and 19 third-year students from 2023. The only statistically significant difference was noted in follow-up care, where student involvement was significantly higher in clinics (M = 3.39) compared to hospitals (M = 2.96), with a t-value of 2.933 (p = 0.002). For learning opportunities, the highest mean difference was observed in ‘participation in patient education’, where clinics (M = 4.38) had a higher mean than hospitals (M = 3.96), but without statistically significance (t = 1.715, p = 0.089). Students perceived better learning diversity and proficiency development in clinics (M: 3.91, SD: 1.31; M: 4.18, SD: 1.203) compared to hospitals (M: 4.00, SD: 1.489; M: 3.97, SD: 1.385). Clinics generally outscored hospitals, especially in involvement in patient education, chronic illness, and procedures. Ten students attended two focus group discussion: one with 2023 third-years (n = 5) and one with 2023 s-years (n = 5). Students valued clinics for skill development and patient journey exposure but faced challenges such as feeling like employees, disrupted learning from frequent rotations, patient overcrowding, and poor communication between the program and healthcare staff. CONCLUSION : This study underscores the importance of primary healthcare settings in Clin-A training, demonstrating that clinics provide learning opportunities and involvement in patient care comparable to hospitals. To address challenges such as high workload areas where students feel like employees, insufficient teaching, lack of staff awareness, limited learning in low-volume clinics, and disrupted rotations requires, structured rotations, enhanced preceptor training, and improved communication between programs and clinical sites are essential.