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This post was written by Wits University’s Ameera Hamid.

Blended learning. Hybrid learning. Flipping the classroom.  Whatever one chooses to call it, this method of learning – which integrates traditional face-to-face classroom activities with online education and other technologies – has become a game changer in universities and other educational institutes.  Not only is it a supplement to teaching and learning, but has transformed and improved the learning process.  Joining in this trend with a vision to overcome teaching hurdles, the clinical associates at Wits University launched the DICAS (Digital Integration of Clinical Associate Studies) project.  With the aid of tablet devices, students will now be able to access curricular resources at any time, wherever they are and course coordinators can now communicate with students more effectively.  More excitingly, Wits has teamed up with Dimagi to create an electronic logbook to track clinical experiences at both on- and off-campus training sites.  These clinical experiences play a vital role in compiling a portfolio mark for students, but comes with its challenges.

In the past, at the beginning of each academic year, students would be handed a paper-logbook to document their activities at their clinical training sites – mostly in rural communities around Gauteng and North West province.  Critical data on patient consultations, clinical procedures and hours spent training at the clinic or hospital would be recorded.  This was not only time consuming for students to fill in, but completing these logbooks took large amounts of time from clinical supervisors who had to review them and validate that each procedure was performed.  At the end of a 9 week rotation, coordinators would then have an opportunity to see the logbooks for the first time and waste valuable time over the next few days entering all this data onto an excel spreadsheet in order to generate a portfolio mark for each student.  Integrity and accuracy of the data entered were often concerns and students misplacing their paper-logbooks put coordinators in a predicament.  The CommCare electronic logbook built together with Dimagi, has innovatively remedied many of the challenges previously faced with the paper-logbook.  The simple click and swipe interface of the logbook allows students to rapidly enter consultation details in the wards and this in turn, is automatically sent to a database on-campus where coordinators can monitor student performance.

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Students have welcomed the logbook with great enthusiasm and have realized additional benefits that traditional paper-logbooks were not readily able to provide.  Case lists and case details allow students to monitor themselves to safeguard against poor performance, i.e. have they performed the target amount of skills, have they spent enough time at each ward.  More than a tally of hours spent in clinical training, the logbook is a sort of journal – a chronicle of students’ encounters which they can refer back to when writing up an assignment or learning for a clinical exam.

The logbook comprises of four modules; a registration module that records information about the ward rotation they are busy with; a login module that monitors their time spent at various activities at the clinical site; a skills module to document the patient consultations and procedures performed; and an evaluation module for clinical supervisors at the site to appraise students’ performances.  Integrated GPS capabilities ensures that students arrive at the correct clinical site and confirm their attendance for that rotation.  Many students at first felt that the GPS stamp was an invasion of their privacy.  However, with use, many of the students realized that this method actually takes less effort on their part and minimized time lost looking for a supervisor to sign them in for the day.  Supervisors also responded positively to this new implementation as it meant that they would spend less time reviewing the logbook and could spend more time on training.

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Coordinators too, have embraced this changed system.  All data collected from students logbooks can now easily be manipulated to output the desired reports that were previously manually generated.  The variety of reports and exports that the CommCare platform can generate are so manifold that coordinators are now able to compare clinical sites with each other based on the patient cases that are seen by students.  This information is used to identify clinical sites that are not suitable for training and more importantly to continually update curriculum content to focus teaching on what students are seeing at the hospitals and clinics, which was formerly not probable with the paper-logbooks.  Another great advantage of the electronic logbook is that coordinators can monitor student performance on a weekly basis and intervene timeously if a student is performing below par, to prevent the student from failing his/her rotation.

As project manager, one of the remarkable benefits of the CommCare logbook is we can use the data to produce research.  Clinical associates are a relatively new cadre of health worker in South Africa and many of the hospitals and clinics are not yet sure of their role in the hospital infrastructure.  These reports can now be published in a way that will highlight the skills that clinical associates are ably performing and pave a path for their role in hospitals and clinics.  Although this project is still in its infancy, we have already uncovered so many advantages with the Commcare platform and continue to explore other uses for it. For example an electronic register for classroom attendance is in the pipeline and in future a pharmacology and prescribing app for students, so watch this space!

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