Introduction

TEACHING

The key principles of the PHC Approach are integrated into various courses that make up the MBChB and Health and Rehabilitation Sciences curriculum. Plenaries and lectures, tutorials and seminars, case studies, service learning, and community surveys are used as methods of teaching and learning. In addition textbooks, readings, lecture notes, exercises, worksheets and survey forms are used as learning resources. Students are assessed by means of examinations, assignments, portfolios, research projects, oral presentations, and reflective journals. An annual multi-disciplinary portfolio-based exam is used to assess student understanding of how the PHC principles apply to their clinical learning.

Dr Lauraine Vivian and Ms Sarah Crawford-Browne are responsible for the PHC sub-theme of culture, psyche and illness (CPI). Students are taught a bio-psychosocial and cultural approach to patient care in the context of major South African health challenges and health system inequities. Problem-based learning facilitates reflection on patients’ cultures and rights, on students’ own cultural backgrounds, and on medical culture, in order to inform a critical analysis of patient histories in their correct context. PHC ward rounds in the 4th Year General Medicine rotation at GF Jooste/Lentegeur Hospital are facilitated by Dr Vivian, Ms Crawford-Browne and Prof Reid who join the consulting physician and lead students in tutorials to explore their insights into the bio-psychosocial history and cultural context of selected patients on the round.
The key PHC principles of equity and patient rights also feature prominently in teaching on the District Health System, on PHC and equity in health, and on advocating for the rights of patients. A four-week free choice or guided PHC Elective in the 5th year coordinated by Mr James Irlam, allows students to reflect on the validity and applicability of all PHC principles in a variety of clinical settings. Students are assessed via a written clinical report which encompasses their learning objectives, description of the placement site, a reflection on their clinical or research-based work, and reflections on the principles of PHC. The Faculty has incentivized rural electives from 2009-2013 by assisting students with their elective expenses to any rural site within South Africa and feedback from students who have done rural electives has been unanimously positive. Students have reflected that they have grown as health professionals; developed a range of knowledge and skills within a multi-disciplinary team; gained a compassionate insight into the needs and challenges faced by rural medicine; have strengthened their patient- and service-centred foci; and have been inspired to contemplate working in rural areas once they qualify.
Dr Gaunt, Dr le Roux and Prof Reid provide rural health seminars to 4^th year students on the challenges and rewards of working at the rural coalface. The seminars unpack poverty and inequality; child health indicators; access to health services; multi-disciplinary teamwork; generalist versus specialist skills; community medicine; disease prevention; and retention and recruitment of rural health workers.
The 2nd year MBChB Special Study Module (SSM) blocks have provided opportunities for students to conduct small research projects, literature reviews or researched digital stories within the auspices of the PHC, health promotion and CPI streams as well as the developing theme of arts & healthcare. Prof Reid has teamed up with Dr Patrice Repar from the University of New Mexico, Arts-in-Medicine Programme since 2011 on collaborative Music & Medicine and Arts & Healthcare SSMs.
Sarah Crawford-Browne has introduced digital storytelling as a flexible tool that can promote learning as an assignment, during lectures or as a research tool. Digital storytelling allows students to engage with concepts creatively and integrate theory with experience. Sharing the stories with peers and family facilitates further discussion, reflection and learning. Lecturers see the value of the tool for developing writing skills, critical thinking and conceptualization and Ms Crawford-Browne has facilitated 2 training courses and 4 seminars for UCT colleagues. Sarah has also contributed to the 1^st year Transitions programme.
The PHC Approach is also integrated into the 2nd year Health and Rehabilitation Sciences curriculum within the Communication Sciences, Physiotherapy and Occupational Therapy divisions through a special course entitled PHC and Disability. Topics include integration of the PHC approach into the AHS curriculum; health promotion; behaviour change theories and approaches; and planning a health promotion project. Teaching on integrated health systems in years 2 and 3 address alternative medicine perspectives; ethical issues; belief systems; bio-psychosocial and cultural issues; and relevant PHC principles.
PHC is taught in the following postgraduate courses: Masters in Medicine (research); Masters in Public Health (evidence-based health care, public health & society); Masters in Family Medicine (health & culture, community oriented primary care); MPhil in Maternal & Child Health (epidemiology, research ethics); MSc Occupational Therapy (evidence based health care, health promotion); MSc in Genetic Counselling; MPhil Social Justice, Law and Poverty; and the MEd ICTs in Education. Postgraduate diploma teaching includes the Diploma in Family Medicine (evidence based health care); Diploma Clinical Educators Course; Diploma  Community Eye Health - Vision 2020 (health promotion); Opthalmic Nursing (health promotion); and Nephrology Nursing in Primary Care Settings (health promotion).

MMed Research Methods for Registrars Workshops are conducted twice a year with the purpose of strengthening research capacity of Registrars within all departments. The two-day Saturday workshops include: Research hypotheses; selection and sampling; quality control of measurement; systematic reviews; ethical issues; case-control, cross-sectional and cohort studies; collecting and organizing data; data management; hypothesis testing; and library literature reviews.

James Irlam teaches basic epidemiology and evidence-based practice to undergraduates and postgraduates by means of a variety of methods. These include lectures and critical appraisal exercises, evidence-based journal clubs, and role-plays in primary care consultations followed by self-reflection on evidence-based learning needs. He has also become the proponent of climate change & health within the Directorate, lecturing to 4^th year students and developing an advocacy and research profile on the subject.
Students are taught the theory and practice of health promotion by Johannah Keikelame and her team of site & NGO facilitators including Tsuki Xapa, Christolene Beauzac, Mercia Arendse, Mandy Botsis and Claudia Naidu in partner communities and NGOs through years 2 to 4 of the medical curriculum. Health promotion learning equips students to deal effectively with the diverse health needs of individuals and communities, and there is ample opportunity in the 4^th year Public Health block to apply health promotion theory. Student groups undertake a variety of community-based health promotion projects at various off-campus sites where they learn about the importance of community participation and partnerships, health rights and health promotion ethics, and effective teamwork.
A postgraduate certificate course in Community Eye Health for Vision 2020 aims to introduce health promotion as an important strategy for promoting eye health. The module covers definitions of health promotion and milestones; Ottawa Charter strategies and actions; health promotion approaches; behavior change theories; ethics; health rights; community participation; and empowerment of individuals and communities at all levels of care including models for planning health promotion programmes, tools for analysing health problems, and advocacy for eye health promotion.