Evaluating the effect of the Practical Approach to Care Kit on teaching medical students primary care: Quasi-experimental study

BACKGROUND: South Africa is committed to health reforms that strengthen primary health care. Preparing future doctors to work in primary care teams with other professionals is a priority, and medical schools have shifted towards community-based and decentralised training of medical students. AIM: To evaluate the effect on student performance of the Practical Approach to Care Kit (PACK) (an integrated decision-making tool for adult primary care) during the final phase of medical student training at Stellenbosch University. SETTING: Clinical rotations in family medicine at clinics in the Western Cape. METHODS: Mixed methods involving a quasi-experimental study and focus group interviews. Student examination performance was compared between groups with and without exposure to the PACK during their clinical training. Student groups exposed to PACK were interviewed at the end of their rotations. RESULTS: Student performance in examinations was significantly better in those exposed to the PACK. Students varied from using the PACK overtly or covertly during the consultation to checking up on decisions made after the consultation. Some felt that the PACK was more suitable for nurses or more junior students. Although tutors openly endorsed PACK, very few modelled the use of PACK in their clinical practice. CONCLUSION: The use of PACK in the final phase of undergraduate medical education improved their performance in primary care. Students might be more accepting and find the tool more useful in the earlier clinical rotations. Supervisors should be trained further in how to incorporate the use of the PACK in their practice and educational conversations.