Educational resources

Higgins, Reading and Taylor (1996, pp80-81) described the use of resources to match the learning styles of students. Where PBL suits the student with a holistic approach, serialist learners cope better with more traditional didactic teaching. Their perspective appeared to be from librarians and included traditional resources such as reading lists, library access, the internet, conferencing and multimedia. Readers consisting of copyright material approved for copying and lecture notes made available electronically saving students time and the need to duplicate resources such as text books were also listed.

Physical facilities listed were lecture theatres, libraries and recreational facilities. With the move towards CBE and evidence based learning, information technology (IT) can ensure that information including assessment results are available to students both on campus and at distant sites (Mash, Marais, Van Der Walt, et al, 2005). Undergraduate students, although they may differ in computer skills and preferred method of learning, were generally familiar with computer technology, however staff may need to be appropriately trained and technical support must be available to both groups (Hugo, 2007).

IT is steadily taking its place in undergraduate medical education (Barzansky & Etzel, 2005). E-learning incorporates online delivery of course content and interactive chat rooms and bulletin boards as well as offline CDs and DVDs (Davies, 2005). Treadwell, de Witt and Grobler (2002) described the use of an interactive multimedia programme on CD- ROM together with a supervised skills laboratory session in teaching neonatology skills. Although this could not replace attitudinal experiences and soft skill development as can be obtained for example in an interdisciplinary team experience, this approach could be considered to teach designated knowledge and skills within a rehabilitation training

programme. This SA study based in Pretoria was borne out of staff shortages and the need for repeated teaching to small groups. Although students preferred direct patient contact, advantages such as availability of programmes in relevant languages, cost- effectiveness, and availability of material in preparation for clinical rotations and for revision, both which encourage self directed learning, were sited.

The CRS has experience of internet based post graduate teaching programmes which allow for long distance learning and accommodates for staff shortages (Hugo, 2007). Video tapes and slide shows have been used in the previous US Rehabilitation programme and could be adapted for present day use with modern technology as described in the Preventative Pulmonary Academic Award (PPAA) programme (1993).

In contrast to didactic teaching experiential learning makes use of projects and laboratories with PBL requiring the availability of clinical sites and suitable patients. Although public services are traditionally used, private facilities should also be investigated as discussed under the clinical contextual environment. Exposure to specialised and generalised, community and institutional platforms should be considered to give students an opportunity to apply knowledge and skills in various contexts.

The involvement of the patient as a resource in all these settings can take various forms. A traditional model where the student sits in on a doctor-patient consultation varies vastly from a model where patients contribute to programme delivery (Byron & Dieppe, 2001; Coleman & Murray, 2002). Patients with chronic illness are considered to be experts regarding the role of contextual factors on health and can teach students from their various experiences of the health system ranging from challenging diagnostic to treatment issues (Stacy & Spencer, 1999; Wells, Byron, McMullen & Birchall, 2002). Although not medical experts, they are in the ideal position to educate students as to their perspective as to how medical care could be delivered and to the functional and social implications of disability. Ideal patients demonstrate responsibility for their health and are typically older and have many years experience of being disabled (Shapiro, Mosqueda & Botros, 2003). Patients and students should be prepared for this type of interaction, be it observed or direct consultations, formal lecturing or informal socialisation. Although some patients expect financial rewards most stated that the altruistic benefits of contributing to the health system, personal gain in knowledge and socialisation were benefit enough (Coleman & Murray, 2002). Patients should thus give input into programme development and

evaluation (Crotty, Finucane & Ahren, 2000; Byron & Dieppe, 2001). No such examples of patient involvement in rehabilitation programmes could be found in the literature searched.

Training programmes can be enriched through exchange with other departments and universities and these can be considered as resources. Experience can be drawn from training programmes in rehabilitation and related fields. As the US programme is unique in SA international collaboration can be sought. Differences between SA and international medical training programmes as explained in the introductory chapter of this study need to be taken into account.

The development of the field of rehabilitation in various parts of the world also differs. In North America rehabilitation originated in the 1930’s after the World Wars and Polio epidemics (De Lisa, Leonard, Smith & Kirshblum, 1995; American Academy of Physical Medicine and Rehabilitation website accessed 20/04/2007). PM&R was established as a speciality with the first graduate of the American Board of PM&R qualifying in 1947 (University of Pennsylvania website accessed 20/04/2007). In 2004, Vlak, Boban, Franulovic-Golja and Eldar reported that 60% of USA medical schools were teaching PM&R. In the UK, the British Society for Rehabilitation Medicine was established in 1984 (Frank, 1998). The existence of PM&R departments and undergraduate training was reported in the eastern countries, however, the details were scanty. Iran for example has an undergraduate rehabilitation training programme as of 1966 (Raissi, Vahdatpour, Ashraf & Mansouri, 2006). Standards for clinical practice and specialisation in European countries which are consistent with practices in America, were published in the Whitebook on Physical and Rehabilitation Medicine in Europe as recently as 2007 (Gutenbrunner, Ward, Chamberlain, 2007).

Although PM&R departments are established at most North American, Australian and UK universities, undergraduate rehabilitation programmes are only taught in about half of these medical schools (Lane, 1983, Kahtan, Inman, Haines & Holland, 1994), many only on an elective basis. Although the need is recognised in Europe (GMC, 2003 website accessed 24/08/2007; American Medical Student Association website accessed 24/08/2007), rehabilitation is seldom included in undergraduate training programmes. Even where it is, PM&R is poorly acknowledged by medical peers (Greenwood, 2001) and not a popular undergraduate subject (Ward, 1992).

Except for one description of a training ward that was created in Sweden (Ponzer, Hylin, Kusoffsky, et al, 2004) most of the rehabilitation and related programmes provided isolated activities ranging from didactic lectures to patient interactions and discussion groups as listed in 2.3.2.4 above. These programmes covered core contents as described in the Whitebook. Programmes varied from around 15 hours to four weeks and offered single to multiple exposures, at various stages of the curriculum.

Most programmes described were challenged by the fact that rehabilitation is a young speciality but having stand alone departments of rehabilitation seemed to be of benefit in establishing and maintaining these programmes. Insufficient staffing and teaching time were recurring issues with integration into other specialities being a recommended solution (Marshall & Haines, 1990; Claxton, 1994; Khatan, Inman, Haines & Holland, 1994; Crotty, Finucane & Ahern, 2000).