Medical students' attitudes towards the primary health care approach: what are they, how do they change and where are they from?

Abstract

Background: The context of the research presented in this article is the new MBChB curriculum at the University of Cape Town (UCT) that has been running since 2002. This new curriculum is PHC-driven and has an emphasis on the integration of the biological and psychosocial. This context of curriculum reform at UCT can be placed within the wider South African context in which the South African Department of Health has committed to the primary health care (PHC) approach. The aim of this research was to provide an understanding of medical students’ attitudes towards the (PHC) approach. The findings presented in this article form part of a broader set of findings for a PhD research study that aimed to qualitatively explore medical students’ attitudes towards and perceptions of the PHC. Methods: A qualitative approach was taken and focus groups and interviews were conducted with second, third and fourth-year medical students from UCT. A total of eighty-two students were purposively selected to participate in this research. A content analytic approach was used to analyse the focus group and interview data. Results: Students have a generally positive attitude towards the PHC approach and were positive about UCT’s choice to promote this approach. Some however were concerned about the international relevance and status of their degree, and concerns were also raised about the contrast between the theory and reality of the approach, many labelling PHC as idealistic. Students’ responses indicate that attitudes towards the PHC approach are open to change through the course of their academic career and are influenced by a range of factors. Some of these factors were related to the medical school environment, such as the PHC approach itself, how PHC was taught, and the views of other students and staff at UCT. Other factors that were not related to the university included personality, students’ background and exposure to health facilities, and clinical exposure outside UCT. Conclusions: These findings raise the question of whether students are able to think and feel positively about the PHC approach but not actually internalise the philosophy of the PHC approach. Students’ struggle with the incongruence between what is perceived as the idealistic theory of PHC and the reality of health care in South Africa is also an issue that needs to be acknowledged. These issues are particularly significant in South Africa where a commitment has been made by the South African Department of Health to the PHC approach, and where doctors are set to play a vital role in the implementation and success of this approach.