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19 October 2021 | Story André Damons | Photo Charl Devenish
Dr Champion Nyoni and Dr Annali Fichardt, together with Prof Yvonne Botma (not on the picture), from the School of Nursing at the University of the Free State (UFS) came in second for their research paper on this innovative educational strategy at the recent Faculty of Health Sciences’ Faculty Research Forum.

When South Africa went into hard lockdown due to the outbreak of the COVID-19 pandemic, the School of Nursing at the University of the Free State (UFS) adopted the conventional boot camp as an innovative way to continue learning and teaching clinical skills for its students.

School of Nursing leadership adopting an innovative educational strategy

The COVID-19 pandemic, specifically the hard lockdown of 2020, challenged the leadership of the School of Nursing to adopt  innovative educational strategies to continue learning and teaching, especially for undergraduate nursing students. Adapting theory classes to the online space appeared easier due to the various enabling modalities in the university such as Blackboard, but the same could not be said about learning clinical skills. It is near impossible to learn clinical skills at home. The School of Nursing had to devise ways to facilitate learning of clinical skills in campus during the pandemic. Underpinned by the theory of deliberate practice, they used the boot camp as an innovative educational strategy to continue the learning and teaching of clinical skills. 

Dr Champion Nyoni, Dr Annali Fichardt and Prof Yvonne Botma, who did research on this innovative educational strategy, came in second place at the recent Faculty of Health Sciences’ Faculty Research Forum. They also won the Kerneels Nel medal for best educational research paper in 2020. 

Manuscript already accepted

The manuscript about their research has already been accepted by The African Journal of Health Professions Education and will be published next year. 

“Deliberate practice is understood as a type of purposeful and systematic learning of skills requiring focused attention and is conducted to improve performance. Boot camps are synonymous with conventional training camps, such as used in the military, where specific skills are learnt, and the School of Nursing adopted the practice for this particular situation,” wrote the researchers in the manuscript. 

According to them, the boot camps had the dual aim of developing foundational clinical skills for undergraduate nursing students, including sessions missed during the higher levels of lockdown, and preparing them for the ‘new’ workplace environment. 

Educational institutions were compelled to adapt their education strategies during the pandemic and the innovation of the use of boot camps as a strategy for learning and teaching clinical skills is an example of what the School of Nursing applied immediately after the hard lockdown. 

How the boot camps worked 

Each student year group was allocated a week at the simulation laboratory. Each year group was then split into smaller groups to attend their boot camp on specific days of the week. The module outcomes determined the nature and number of clinical skills to be taught per camp. 

All the students received a video recording of the clinical skills and associated learning material prior to the boot camp to prepare for the session. On the day of the camp, the group was further split into smaller manageable groups, which were stationed in smaller venues of the simulation laboratory with a preceptor. 

Equipment and materials related to the clinical skills for the day were made available in all the venues. A central venue hosted the leading session facilitator, who provided foundational information about the clinical skill before a demonstration while being live-streamed to the other smaller venues. Students in smaller venues watched the leading facilitator via live streaming after which they had opportunities for clarification from their preceptor. All the students in the small groups then demonstrated the taught skills to the preceptor who immediately provided feedback. 
This intervention commenced after the hard lockdown and continued for the whole of the year 2020.

Outcomes of the strategy 

The boot camps appeared to have influenced the learning and teaching of clinical skills positively, but the strategy is an emergency solution only in response to COVID-19 and is not regarded as suitable for long-term educational purposes. Students’ clinical outcomes appear to have improved compared to previous years and they appreciated the efforts taken by their educators in facilitating the learning of clinical skills and re-integrating them into the clinical environment. 
“We always encourage our students to be innovative in their own practice, – the boot camps were an exceptional demonstration of practising what we preach,” says Dr Nyoni.

The infrastructure, the educators, and the leadership of the School of Nursing appeared to be enablers for the effective influence of this strategy. The boot camps were located at the state-of-the-art simulation facilities at the school that have multiple venues and facilities for live streaming. Teamwork among the educators in each year group drove the process through reflecting on their own practice. 

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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