​An innovative new clinical training plan has enabled fifth-year medical students at Stellenbosch University's Faculty of Medicine and Health Sciences (FMHS) to navigate the restrictions placed on the training platform due to the Covid-19 pandemic.

Were it not for the IDEAL (Integrated Distributed Engagement to Advanced Learning) plan, fifth-year medical students would have been hard pressed to catch up with the current year's clinical rotation before graduating at the end of 2021. Clinical rotation is the practical part of medicine and health sciences students' training that can only be performed in a clinical setting, such as a hospital, clinic or care home.

The IDEAL rotation enables students to return to a uniquely constructed learning platform where students are accommodated amidst limited placement opportunities.

Under non-pandemic conditions, the fifth-year students' clinical rotation would have commenced at Tygerberg Hospital and other training facilities at the beginning of August. However, with these sites, and especially Tygerberg Hospital under immense pressure due to Covid-19, the strategic decision was made by the FMHS management team and the Department of Health to prioritise the final-year medical students and to delay the other more junior years' return to the clinical platform.

A bilateral agreement, recently signed between Stellenbosch University and the Western Cape Government Department of Health, enabled these two entities to engage as partners to consider the possibilities. A key consideration was how the students could be part of the clinical teams and learn while also delivering assistance in the clinical setting.

A team of colleagues, led by Dr Therese Fish, FMHS Vice Dean: Clinical Service and Social Impact, Dr Kobus Viljoen from the Rural Clinical School in Worcester and Prof Michael Pather with the Division of Family Medicine and Primary Care contacted the leadership at public sector hospitals in the Western and Northern Cape to determine how many places are available on the clinical platform.

Viljoen was asked by the FMHS Vice Dean: Learning and Teaching, Prof Julia Blitz, to lead the IDEAL rotation team. A design team, including two fifth-year medical students, Luné Smith (class leader) and Ntsako Mtileni (the exiting Tygerberg Student Council Chairperson) developed the strategy for the IDEAL rotation.

With 160 clinical places available for 256 students, it was important to think creatively. The end result was the IDEAL rotation, which entails everyone being placed but students having to spend one day on site in the clinical environment and the next day away from the clinical setting engaged in learning.

The students were placed in groups of between two and forty. “Some of the large groups are in the metro, as well as further away in Worcester and Paarl," says Viljoen. Smaller groups have been posted to places like De Aar, Calvinia and Springbok in the Northern Cape or Hermanus and Bredasdorp in the Overberg, and other Western Cape sites. In all, 18 different sites are being utilised.

In less than a month the logistics for accommodation, transport and information and communication technology for 256 students had to be finalised. “The SUNLOC team lead, by Georginia Stam and Nicole Crow pulled off a miracle to make this happen," says Fish.

During the new rotation, which began on August 24 and ends on November 13, students are making use of two apps. One is the already existing Vula Mobile, which has been adapted so that students can learn in a very specific format, and the other one is My Clinical Logbook, created in house by the FMHS experts.

The self-directed learning approach differs significantly from earlier in that the interaction with the patient drives the student's learning experience and there is no structured curriculum. “You go to the patient and find out quickly how something works or what you are unsure about," Viljoen explains.

Students are assigned to learning facilitators in groups of five to eight. These facilitators communicate with the students through the apps and give advice on the learning process and clinical reasoning.

Over a two-week period a student will alternately be on site on a Monday, Wednesday and Friday or a Tuesday and Thursday. On each of these days a patient has to be logged on to Vula Mobile. If the student is unsure about a specific treatment, this is what he will focus on the next day (off site).

SUNLearn also has a forum for all the different clinical disciplines. Students can post questions there and the assigned lecturers will answer or explain by means of an article, podcast or YouTube video. 

IDEAL covers all eleven major disciplines that the students would have covered in their sixth year.

“It's a bit like a test run for greater integration of all the disciplines and a fun way to gain experience and learn," says Viljoen.

Because of the new learning experience, there is other support besides the facilitators, with the site clinician the first level of support. Various staff members, called the well-being supporters, engage with students – groups of ten students are allocated to each wellbeing supporter.

According to Viljoen IDEAL stands on two legs: Service and learning. “We endeavour to create a learning opportunity, but also consider at how we can support the health system. The idea is that the students become part of the local clinical team and declare themselves willing to do things that do not necessarily come across as academic, but through which they will learn a lot."

“None of this would be possible without the staff of the health facilities where students are placed, the patients who attend those facilities, the many university staff and the leadership of the Western Cape Government: Health and the Northern Cape Health Department," says Fish.

Caption: FMHS students receiving training on the clinical platform. Photo by Stefan Els.