Description of study participants: The mean age of the students was 23±1.5 years. Four out of the six supervisors were orthopedic officers while the remaining two were principal orthopedic officers, four out of the six had a university degree while the other two were diploma holders.
Orthopaedic students and supervisor perceptions about practice-based learning: Analysis of data resulted into 4 major themes namely: 1) Hands on skills, 2) Unconducive learning environment, 3) Best form of learning and 4) Undefined training structure. These themes are further explained along with supportive participant quotations.
Hands on skills
Students perceived practice-based learning as a very good method of learning that provides skills, a chance to practice what is taught and gain confidence to manage patients. Some students explained;
“It's a very good method of learning because it gives us experience about how to handle patients, basically in our course we need hands on.” (IDI/10)
another one explained;
“I get that chance of doing what I am supposed to do as far as my course is concerned, I get that kind of exposure and practice.” (IDI/07)
while the other student explained;
“If you practice something over and over again you get more experienced and confident.” (IDI/06)
Unconducive learning environment
A large number of students reported to have encountered instances of inadequate training while on wards and being stressed during the training. This was enlightened by the interviews as some students perceived their supervisors to be harsh, they faced problems of overcrowding on ward, inadequate placement time and lack of materials and equipment to use. They explained;
“…the area is so small, in that sometimes you are sent a number of people and the area is so small so all of you cannot see, may not see what is being done.” (IDI/01)
another one explained;
“…. we face a challenge of inadequate supervision those who manage to come are busy.” (IDI/03)
he continued to explain;
“.. some supervisors are rude, instead of teaching us they condemn you in case something is mistakenly done.”
About the inadequate materials and equipment, some students explained;
“They should also provide enough equipment on the ward because we risk our lives a lot like acquiring infections due to absence of gloves.” (IDI/04)
another one explained;
“… most of the time the facilities are not enough for emergency patients like medicine which isn’t enough compared to the patients we receive, gloves aren’t enough, and orthopedic facilities are also not enough.” (IDI/06)
Best form of learning
Interviews with the supervisors helped to reveal why most of them thought students are not gaining adequate skills and why most students express anxiety or stress during the training. The supervisors perceived practice-based learning as being advantageous, best form of learning that provides experiences to students. They explained;
“… this it’s the best form of learning because these jobs are practical and they help a lot of students except for a few who aren’t interested because they do exist.” (IDI/T04) he continued to explain;
“…. practice based learning is knowledge and skills you gain with hands on, when a student is both working and learning at the same time, it involves picking up experience, the student work and we recess them.”
Another supervisor explained;
“it carries the biggest part in fact it is very advantageous much as theory is vital but theory alone cannot teach a student, so the practical skills they get especially here on wards is what carries the biggest part of their learning it is very vital to me that is it.” (IDI/T01)
Undefined training structure
Amongst the student supervisors, practice-based learning was faced with challenges of inadequate materials for the students, overcrowding, short placement time which affects the learning environment and skills acquisition for the students. The supervisors explained;
“… the students come in big numbers and end up not attended to but if they come in small numbers it won’t be an only advantage to the supervisor because he will attend to them with close supervision but also the students will have a chance of having practical work and utilizing the few materials and infrastructures available.” (IDI/T03)
another one explained;
“The hospital is being flooded by students from other private students from different parts of the world, they can be so many and the teaching become hard for us and we aren’t catered for.” (IDI/T04)
About the materials and equipment, one supervisor explained;
“.. challenges the students face sometimes they are cases to manage but they are no materials to use so you find a patient has been kept on the ward for two days before he has been worked on so in that case if a student was going to participate in management of that condition he misses out.” (IDI/T02)
Another supervisor explained’
“Sometimes materials are limited we may not have certain working to use so we end up improvising much as we would have wanted them to know how to use what type of appliance.” (IDI/T03)
And about the short placement period, one supervisor explained;
“…. to me these programs it’s like they are sent to the ward when teachers are busy doing other things then they say go to the ward but we don’t see them much as this is three years post they finish three years and you have never seen them yet am in a vital unit of accident and emergency so the time I think it’s not enough or them I can’t be exact but they stay for two weeks at most.” (IDI/T01)