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Introducción: la educación centrada en la comunidad es un componente esencial del diseño curricular de la carrera de Medicina. En el segundo año, los estudiantes permanecen durante tres semanas en hospitales rurales y desde ellos van a las clínicas, centros de salud comunitaria y a las casas de la comunidad. Objetivos: identificar evidencias del cumplimiento de los objetivos de aprendizaje de esta actividad en los diarios de campo de los participantes. Métodos: se hizo el análisis cuali-cuantitativo del contenido de los diarios de 58 estudiantes. La información se agrupó de acuerdo a los tres escenarios de aprendizaje, y en un segundo análisis emergieron las siguientes categorías: determinantes que afectan la salud de la población, enfermedades que provocaron que los usuarios acudan a los centros de salud, así como información sobre el funcionamiento de estas instituciones. Resultados: la pobreza, el desempleo, el hábito de fumar y el alcoholismo fueron los determinantes de la salud que los estudiantes mencionaron con más frecuencia. Mientras que la malnutrición, el VIH/SIDA, el embarazo precoz y abandonar el tratamiento fueron las causas que obligaron a los usuarios a solicitar servicios de atención tanto en el nivel primario como en el secundario. Destacaron también el protagonismo del personal de enfermería en los servicios que ofrecen los centros de salud, así como el rol de todos los departamentos (médicos y no médicos) en el funcionamiento del hospital. Conclusiones: las categorías que emergieron de los diarios reflejan que los objetivos educacionales se cumplieron y que fue una experiencia rica en relaciones sociales y oportunidades para aprender(AU)

Introduction: Community-centered education is an essential component of curricular design for the medical major. In the second academic year, students stay for three weeks in rural hospitals, from which they go to clinics, community health centers and community houses. Objectives: To identify evidence of compliance with the learning objectives of this activity in the home visits plans of the participants. Methods: The qualitative and quantitative analysis of the content was carried out of the home visits plan of 58 students. The information was grouped according to the three learning settings, and a second analysis derived in the following categories: determinants that affect the health of the population, diseases that caused users to go to health centers, as well as information about the functioning of these institutions. Results: Poverty, unemployment, smoking and alcoholism were the health determinants that the students mentioned most frequently. While malnutrition, HIV/AIDS, early pregnancy and abandoning treatment were the causes that forced users to request care services at both the primary and secondary levels of healthcare. They also highlighted the role of the nursing staff in the services offered by health centers, as well as the role of all departments (doctors and non-doctors) in the running of the hospital. Conclusions: The categories derived from the home visits plan reflect that the educational objectives were fulfilled and that the experience was a fruitful regarding the social relations and opportunities to learn(AU)

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Introducción: la educación centrada en la comunidad es un componente esencial del diseño curricular de la carrera de Medicina. En el segundo año, los estudiantes permanecen durante tres semanas en hospitales rurales y desde ellos van a las clínicas, centros de salud comunitaria y a las casas de la comunidad. Objetivos: identificar evidencias del cumplimiento de los objetivos de aprendizaje de esta actividad en los diarios de campo de los participantes. Métodos: se hizo el análisis cuali-cuantitativo del contenido de los diarios de 58 estudiantes. La información se agrupó de acuerdo a los tres escenarios de aprendizaje, y en un segundo análisis emergieron las siguientes categorías: determinantes que afectan la salud de la población, enfermedades que provocaron que los usuarios acudan a los centros de salud, así como información sobre el funcionamiento de estas instituciones. Resultados: la pobreza, el desempleo, el hábito de fumar y el alcoholismo fueron los determinantes de la salud que los estudiantes mencionaron con más frecuencia. Mientras que la malnutrición, el VIH/SIDA, el embarazo precoz y abandonar el tratamiento fueron las causas que obligaron a los usuarios a solicitar servicios de atención tanto en el nivel primario como en el secundario. Destacaron también el protagonismo del personal de enfermería en los servicios que ofrecen los centros de salud, así como el rol de todos los departamentos (médicos y no médicos) en el funcionamiento del hospital. Conclusiones: las categorías que emergieron de los diarios reflejan que los objetivos educacionales se cumplieron y que fue una experiencia rica en relaciones sociales y oportunidades para aprender(AU)

Introduction: Community-centered education is an essential component of curricular design for the medical major. In the second academic year, students stay for three weeks in rural hospitals, from which they go to clinics, community health centers and community houses. Objectives: To identify evidence of compliance with the learning objectives of this activity in the home visits plans of the participants. Methods: The qualitative and quantitative analysis of the content was carried out of the home visits plan of 58 students. The information was grouped according to the three learning settings, and a second analysis derived in the following categories: determinants that affect the health of the population, diseases that caused users to go to health centers, as well as information about the functioning of these institutions. Results: Poverty, unemployment, smoking and alcoholism were the health determinants that the students mentioned most frequently. While malnutrition, HIV/AIDS, early pregnancy and abandoning treatment were the causes that forced users to request care services at both the primary and secondary levels of healthcare. They also highlighted the role of the nursing staff in the services offered by health centers, as well as the role of all departments (doctors and non-doctors) in the running of the hospital. Conclusions: The categories derived from the home visits plan reflect that the educational objectives were fulfilled and that the experience was a fruitful regarding the social relations and opportunities to learn(AU)

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BACKGROUND: Verbal interactions are paramount to develop cognitive and social skills of students taught using problem based learning in small group tutorials. Responses to a questionnaire showed that 27% of second year medical students did not feel free to participate in their groups AIM: To explore if these students may have different perceptions respect to their peers, regarding the functioning of their tutorials. MATERIAL AND METHODS: The answer to the item "feel free to participate" was the criterion to allocate students in two groups, study (n = 25) and control (n = 66). The means of the perceptions were compared between groups in the 15 items' questionnaire. RESULTS: Students in the study group had different perceptions in eight of the items. These students enjoyed and considered interesting the topics addressed in the tutorials less frequently. Also they did not study all learning issues, did not always understand the case and foresaw less opportunities to participate in their groups. CONCLUSIONS: Quiet students perceived tutorials different than their more active peers. Those differences concerned motivation and a mixture of cognitive (individual) and social (rest of the group) strategies that were not conducive to build a suitable learning environment for those students in their respective tutorial groups.

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INTRODUCTION Problem-based learning harmonized with education in and for the community is the cornerstone of the curriculum for the undergraduate medical degree at Walter Sisulu University, Mthatha, South Africa. In tutorials, students construct knowledge and learn to work collaboratively while interacting with one another in their search for solutions to a pedagogically modeled health issue based on a patient. Problems cover students' needs defined by the learning cycle of the second year medical curriculum, organized into four learning blocks. OBJECTIVES Determine student perspectives on which factors affect tutorial group functioning and detect the reported presence of these factors in the four learning blocks comprising the second year of medical studies at Walter Sisulu University. METHODS Twenty second-year medical students were chosen by stratified random sampling and assigned to two focus groups. One group discussed factors that foster smooth functioning of the tutorial group; the other focused on factors hindering effective group work. Later, in a joint session, 17 items previously identified by both groups were selected and included in a survey given to all 97 students at the end of second year. The survey assessed presence of each item in 0, 1, 2, 3 or 4 of the learning blocks. RESULTS Survey response was 93.8%. Mean reported presence of factors that influenced tutorials in the four learning blocks was 2.71 (SD 0.31) for the social dimension, 3.02 for motivational (SD 0.02), 3.00 for cognitive (SD 0.42), and 2.22 for self-directed learning (SD 0.79). CONCLUSIONS Tutorial group performance at Walter Sisulu University is positively influenced more by motivational and cognitive factors than by social and self-directed learning factors. Social dimensions should be prioritized when training tutors and self-directed learning stressed for students. The poor productivity of extra-tutorial group discussions suggests the need for a critical evaluation of this activity. KEYWORDS Problem-based learning, problem-based curriculum, active learning, medical education, tutorial groups, South Africa.

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Introduction The South African health system has disturbing inequalities, namely few black doctors, a wide divide between urban and rural sectors, and also between private and public services. Most medical training programs in the country consider only applicants with higher-grade preparation in mathematics and physical science, while most secondary schools in black communities have limited capacity to teach these subjects and offer them at standard grade level. The Faculty of Health Sciences at Walter Sisulu University (WSU) was established in 1985 to help address these inequities and to produce physicians capable of providing quality health care in rural South African communities. Intervention Access to the physician training program was broadened by admitting students who obtained at least Grade C (60%) in mathematics and physical science at standard grade, and who demonstrated appropriate personal attributes. An innovative curriculum, combining problem-based learning with community-based education (PBL/CBE) in small tutorial group settings, was also adopted. This approach was aimed at educating and graduating a broader cohort of students, while training future doctors to identify, analyze, and treat health problems in the rural South African context. Outcomes To date, 745 doctors (72% black Africans) have graduated from the program, and 511 students (83% black Africans) are currently enrolled. After the PBL/CBE curriculum was adopted, the attrition rate for black students dropped from 23% to <10%. The progression rate rose from 67% to >80%, and the proportion of students graduating within the minimum period rose from 55% to >70%. Many graduates are still completing internships or post-graduate training, but preliminary research shows that 36% percent of graduates practice in small towns and rural settings. Further research is underway to evaluate the impact of their training on health services in rural Eastern Cape Province and elsewhere in South Africa. Conclusions The WSU program increased access to medical education for black students who lacked opportunities to take advanced math and science courses prior to enrolling in medical school. Innovative admission requirements and adoption of a PBL/CBE curriculum have made the WSU program one of the top training programs for black African doctors in South Africa.