Education for rural medical practice.

Abstract

In the context of a country and a continent that is largely rural, education for rural medical practice in Africa is relatively undocumented and poorly conceptualized. The arena of medical education in South Africa has been largely unchanged by the transition to democracy, despite intentions of reform. The literature reveals a lack of empirical evidence as well as theory in education for rural health, particularly in developing countries. This report presents twelve original papers on a range of key issues that represent the author’s contribution to filling this gap in South Africa. It aims to contribute to the development of a discourse in education for rural medical practice in an African context, and culminates in a theoretical paper regarding pedagogy for rural health. A conceptual framework is utilized that is based on the standard chronological steps in the initial career path of medical doctors in South Africa. Beginning with the literature that is focused around the need to recruit and retain health professionals in rural and underserved areas around the world, the report then addresses the policy context for medical education in South Africa, examining the obstacles to true reform of a transformatory nature. The selection of students of rural origin, and the curricular elements necessary to prepare graduates for rural practice are then investigated, including the actual career choices that medical graduates make in South Africa. Out in the workplace, the educational components of the year of compulsory community service are described, including organizational learning and apprenticeship as novice practitioners, placed under severe pressure in rural hospitals in the South African public health service. A community-oriented type of medical practice is described amongst exemplary individuals, indicating the aspiration towards a different kind of educational outcome. Finally the thesis as such is presented in the final paper regarding a theoretical basis for education for rural health, consisting of the combined notions of placed-based and critical pedagogy. It is argued that while the geographic elements of rural practice require a pedagogy that is situated in a particular rural context, the developmental imperatives of South Africa demand a critical analysis of health and the health care system, and the conceptual basis of this position is explained.