Review Article

Transformation of medical education through Decentralised Training Platforms: a scoping review


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Motlatso Mlambo1
PhD, Senior Researcher *

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Abigail Dreyer2
MPH, Lecturer

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Rainy Dube3
MBBCh, Lecturer

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Nontsikelelo Mapukata4
ND & BTech Med Tech; MSc Health Care Management; MSc Med (Bioethics and Law), Lecturer

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Ian Couper5
MBBCh; MFamMed; FCFP(SA), Director

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Richard Cooke6
MBChB, MMed Family Medicine, Director Centre for Rural Health and Acting head of department


1, 2, 3, 4, 6 Centre for Rural Health, Faculty of Health Sciences, Witwatersrand University, South Africa

5 Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

ACCEPTED: 12 July 2017

early abstract:

Introduction: Medical education in South Africa is facing a major paradigm shift. The urgency to increase the number of suitable, qualified and socially accountable health sciences graduates has brought to the fore the need to identify alternative training platforms and learning environments, often in rural areas. Subsequently, the focus has now shifted towards strengthening primary health care and community based health services. This scoping review presents a synopsis of the existing literature on decentralised training platform (DTP) strategies for medical education internationally, outlining existing models within it and its impact.
Methods: This scoping review followed Arksey and O'Malley's framework outlining five stages: i) identification of a research question, ii) identification of relevant studies, iii) study selection criteria, iv) data charting, and v) collating, summarizing and reporting results. The literature for the scoping review was found using online databases, reference lists and hand searched journals. Data were charted and sorted inductively according to key themes.
Results: A final review included 59 articles ranging over the years 1987-2015 with the largest group of studies falling between the periods of 2011-2015 (47.5%). Studies mostly employed quantitative (32.2%), qualitative (20.3%), systematic/literature review (18.6%) and mixed methods research approaches (11.9%). The scoping review highlighted a range of DTP strategies for transforming medical education. These include training for rural workforce, addressing context specific competencies to promote social accountability, promoting community engagement, and medical education partnerships. Viable models of DTP include community-based education, distributed community engaged learning, discipline-based clinical rotations, longitudinal clerkships and dedicated tracks focusing on rural issues; shorter rural placements and supplemental rural tracks are also described.
Conclusion: This scoping review showed a considerable amount of literature on decentralised training platforms that highlight the necessary adaptations needed for transforming medical education. The rural context is critical for many of these. Further studies are required to address the impact of DTPs on health service outcomes and human resource outcomes.