SciELO - Scientific Electronic Library Online

vol.13 número1Facilitating factors and barriers to kangaroo mother care utilisation in low- and middle-income countries: A scoping reviewGeneral medicine, first-line medicine in Morocco: How is it perceived by medical students and how to enhance their interest in this career? índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados



Links relacionados

  • En proceso de indezaciónCitado por Google
  • En proceso de indezaciónSimilares en Google


African Journal of Primary Health Care & Family Medicine

versión On-line ISSN 2071-2936
versión impresa ISSN 2071-2928

Afr. j. prim. health care fam. med. (Online) vol.13 no.1 Cape Town  2021 



Re-imagining health professions education in the coronavirus disease 2019 era: Perspectives from South Africa



Anna M.S. SchmutzI; Louis S. JenkinsII, III, IV; Francois CoetzeeV; Hofmeyr ConradieV; James IrlamIII; Elizabeth M. JoubertV, VI; Dianne MatthewsVII; Susan C. van SchalkwykVIII

IDivision of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
IIDepartment of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
IIIDirectorate of Primary Health Care, University of Cape Town, Cape Town, South Africa
IVDepartment of Family and Emergency Medicine, Western Cape Department of Health, George Regional Hospital, George, South Africa
VUkwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
VIDivision of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
VIIDivision of Family Medicine, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
VIIICentre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa





BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic hit South Africa in March 2020, severely disrupting health services and health education. This fundamentally impacted the training of future health professionals and catalysed a significant response from across the health education sector. In 2020, the South African Association of Health Educationalists requested members to submit reflections on different aspects of their COVID-19 related educational responses
RESPONDING TO THE PANDEMIC: Seven vignettes focused specifically on clinical training in the context of primary care and family medicine. This short report highlights the key insights that emerged from these vignettes, considering what has been learnt in terms of health professions education and what we need to take forward. These insights include building on what was already in place, the student role, technology in the clinical learning context, taking workshops online, vulnerability and presence and the way going forward.
DISCUSSION AND CONCLUSION: The contributions emphasised the value of existing relationships between the health services and training institutions, collaboration and transparent communication between stakeholders when navigating a crisis, responsiveness to the changed platform and dynamic environment and aligning teaching with healthcare needs. It is more important than ever to set explicit goals, have clarity of purpose when designing learning opportunities and to provide support to students. Some of these learning points may be appropriate for similar contexts in Africa. How we inculcate what we have learned into the post-pandemic period will bear testimony to the extent to which this crisis has enabled us to re-imagine health professions education.

Keywords: COVID-19; health professions education; primary health; responsiveness; remote teaching; clinical training.




The coronavirus disease 2019 (COVID-19) pandemic hit South Africa (SA) in March 2020 and subsequently more than 1.6 million people contracted the virus.1 Lockdown restrictions led to the closing of tertiary educational institutions and forced people to work and learn from home. In health professions education, the disruption fundamentally impacted the training of future health professionals and catalysed a significant response from across the education sector. Those responsible for clinical training had to think creatively and swiftly to navigate the ever-changing situation. Whilst the pandemic continues to wreak havoc, it has created opportunities for reviewing existing practices and approaches to the training of students on clinical platforms. The clinical learning environment, where health professional students work and learn, is foundational to health professions education.2 The forced shift to online learning has been extensively documented since the start of the pandemic.3,4 Whilst the work that has gone into refurbishing traditional 'theory' modules for online engagement cannot be underestimated, sustaining clinical training has provided unique challenges across most health professions.

In July 2020, the SA Association of Health Educationalists (SAAHE) requested members to submit reflections on different aspects of their COVID-19 related educational responses.5 Seven of these submissions focused on clinical training in the context of primary health care (PHC) and family medicine (FM). Strategies to strengthen PHC during the global COVID-19 disruption have included service delivery models that promote integrated services, workforce strengthening and use of digital technologies.6 In a recent systematic review, Komashie and colleagues point to a diversity of challenges facing healthcare, such as multimorbidity, the complex nature of healthcare delivery and a range of organisational and cultural concerns.7 In response, they argue for the adoption of a systems approach to strengthen the quality and delivery of healthcare. Such an approach acknowledges the interconnectedness that exists between all components within the healthcare sector, whilst emphasising the value of adopting adaptive iterative implementation of interventions. Such thinking holds implications for clinical training as well, particularly at a time when the pandemic has exponentially heightened the burden on our healthcare system. We would argue that adopting a systems approach that draws on established relationships with stakeholders, across the health sector, whilst acknowledging cultural and organisational challenges has the potential to effect the adaptive responses that are required at this time.7 This short report presents a series of vignettes that describe a range of such adaptive responses; highlighting the key insights that emerged, considering what has been learnt and what needs to be taken forward and reflecting on how, collectively, they represent a systems approach, contributing to strengthening the healthcare in this time of disruption.


Responding to the pandemic: Seven vignettes

The different contexts, the adaptive iterative implementations during the COVID-19 disruptions and the key insights that were gained are summarised as a series of vignettes in Table 1.



Clinical training should always be responsive to local healthcare needs to promote learning and complement service delivery.15 The restrictions and protocols implemented as a result of COVID-19 were undeniably a catalyst for rethinking the potential use and opportunities afforded through different technological processes and applications. The key health professions education lessons learnt during the COVID-19 pandemic are summarised in Table 2. Although this rethinking came about in pressurised circumstances and often amounted to 'emergency remote teaching', we have presented some examples of innovations and lessons learnt that came about during the COVID-19 pandemic, which may provide solutions for others involved in health professions education in the post-COVID era.

Existing relationships between health institutions and the clinical service platform that have developed over many years have been invaluable in rapidly adapting the clinical environment to the global pandemic.16 This emphasises the need for health professions education to continue training in practical settings at grassroots level, close to people and communities. These new circumstances have highlighted the value of providing opportunities for students to be exposed to practical integrated healthcare and to engage with a much broader scope of platforms offered by, for example, non-governmental organisations (NGOs) and community-based organisations (CBOs). It can be argued that the COVID-19 disruption has enabled adaptive iterative implementation of previously less-utilised digital technologies, such as electronic learning portfolios (e-portfolios), Zoom© and Vula©, which have now become essential to connect within supervisor-learner relationships over large distances in rural areas.17 In addition, the pandemic has provided an opportunity for a more student-centred approach that sees the teacher-student relationship as a partnership of co-learning and risk taking - one that welcomes self-disclosure, and acknowledging uncertainty and failure as pathways to enrich learning.14 The pandemic is 'an opportunity to not only rethink online digital pedagogies but also to reimagine education ' where creating new, intersecting relationships, new forms of learning and a new respect for different modes of knowledge is valued to create more equitable, humane and just societies.18,19



Over the past year, clinical educators across SA have collectively demonstrated their ability to adapt using innovative approaches whilst drawing on established, pre-existing relationships and whilst navigating the complex healthcare system. Much of what has happened has been influenced by technology. Online meetings have allowed participants (students, educators and clinicians) from far and wide to engage, without barriers of cost, travel or losing travel time. This has become a new way of collaborating, enabling participation across geographical borders, exposure to leaders in the field and disciplinary experts engaging one another. Whilst there previously might have been a reluctance by many clinical educators to move teaching and learning activities into the online learning environment, the combination of existing online activities and the pressures to increase their use that came with the COVID-19 pandemic allowed for a rapid adoption of these new modes of teaching. The COVID-19 crisis has emphasised the value of collaboration and communication between stakeholders in adapting to a changed clinical and learning platform and aligning teaching with community healthcare needs.



The authors would like to acknowledge the support from their various colleagues and departments.

Competing interests

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Authors' contributions

A.M.S.S., S.v.S. and L.J. conceptualised the article and wrote the first draft. All the authors submitted individual paragraphs, which contributed to subsequent drafts. All the authors reviewed and approved the final article.

Ethical considerations

No ethical approval was deemed necessary for this article, as no research on human or animal subjects was carried out.

Funding information

This article was funded by the Centre for Health Professions Education, Stellenbosch University.

Data availability

Data sharing is not applicable to this article, as no new data were created or analysed in this study.


The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.



1. National Department of Health. Covid-19 online resource and news portal [homepage on the Internet]. 2021 [cited 2021 May 25]. Available from:        [ Links ]

2. Nordquist J, Hall J, Caverzagie K, Snell L, et al. The clinical learning environment. Med Teach. 2019;41(4):366-372.        [ Links ]

3. Al-Balas M, Al-Balas HI, Jaber HM, et al. Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: Current situation, challenges, and perspectives. BMC Med Educ. 2020;20(1):1-7.        [ Links ]

4. Dhawan S. Online learning: A panacea in the time of COVID-19 crisis. J Educ Technol Syst. 2020;49(1):5-22.        [ Links ]

5. The South African Association of Health Educationalists [homepage on the Internet]. Reflections on a pandemic. 2020 [cited 2021 May 25]. Available from:        [ Links ]

6. Peiris D, Sharma M, Praveen D, et al. Strengthening primary health care in the COVID-19 era: A review of best practices to inform health system responses in low- and middle-income countries. WHO South East Asia J Public Health. 2021;10(Suppl S1):6-25.        [ Links ]

7. Komashie A, Ward J, Bashford T, et al. Systems approach to health service design, delivery and improvement: A systematic review and meta-analysis. BMJ Open. 2021;11:e037667.        [ Links ]

8. Van Schalkwyk SC, Bezuidenhout J, Conradie HH, et al. 'Going rural': Driving change through a rural medical education innovation. Rural Remote Health. 2014;14(2):38.        [ Links ]

9. Van Schalkwyk S, Blitz J, Couper I, et al. Consequences, conditions and caveats: A qualitative exploration of the influence of undergraduate health professions students at distributed clinical training sites. BMC Med Educ. 2018;18(1):1-9.        [ Links ]

10. Wilkinson TJ, Smith JD, Margolis SA, Gupta TS, Prideaux DJ. Structured assessment using multiple patient scenarios by videoconference in rural settings. Medical Educ. 2008;42(5):480-487.        [ Links ]

11. Irlam J, Pienaar L, Reid S. On being agents of change: A qualitative study of elective experiences of medical students at the Faculty of Health Sciences, University of Cape Town, South Africa. Afr J Health Prof Educ. 2016;8(1):41-44.        [ Links ]

12. Biggs J. What the student does: Teaching for enhanced learning. High Educ Res Dev. 2012;31(1):39-55.        [ Links ]

13. Reid M, Suleman F, De Villiers M. The SARS-CoV-2 pandemic: An urgent need to relook at the training of the African health workforce. SAMJ: S Afr Med J. 2020;110(4):261.        [ Links ]

14. Brantmeier EJ. Pedagogy of vulnerability: Definitions, assumptions, and applications. In: Lin J, Oxford R, Brantmeier EJ, editors. Re-envisioning higher education: Embodied pathways to wisdom and transformation. 2013; p. 95-106.         [ Links ]

15. Lombardi MM. Authentic learning for the 21st century: An overview. Educause Learning Initiative. Charlotte, NC: Information Age, 2007; p. 1-2.         [ Links ]

16. Mash B, Edwards J. Creating a learning environment in your practice or facility. S Afr Fam Pract. 2020;62(1):a5166.        [ Links ]

17. De Swardt M, Jenkins LS, Von Pressentin KB, Mash R. Implementing and evaluating an e-portfolio for postgraduate family medicine training in the Western Cape, South Africa. BMC Med Educ. 2019;19:251.        [ Links ]

18. Mbembe A. Decolonizing knowledge and the question of the archive. Public lecture [homepage on the Internet]. Wits Institute for Social and Economic Research; 2015 [cited 2021 May 26]. Available from:        [ Links ]

19. Peters MA, Rizvi F, Mcculloch G, et al. Reimagining the new pedagogical possibilities for universities post-Covid-19: An EPAT collective project. Educ. Philos. Theory. 2020; 1-44.        [ Links ]



Anna Schmutz

Received: 19 Feb. 2021
Accepted: 31 May 2021
Published: 10 Aug. 2021

Creative Commons License Todo el contenido de esta revista, excepto dónde está identificado, está bajo una Licencia Creative Commons