title: 'Going rural': driving change through a rural medical education innovation.
abstract: BACKGROUND
  Medical education across the globe is in a state of flux influenced by a number of drivers for change. In response, institutions are seeking to re-align their curricula to address the prevailing imperatives. Against this backdrop, the training of practitioners for practice in rural communities was identified as an educational priority, and led to the establishment of a rural clinical school (RCS) within a Faculty of Medicine and Health Sciences in South Africa in 2011. This article describes the students' experiences in the first year that this innovative educational model was implemented and explores the extent to which it influenced their thinking and practice.
  
  
  METHODS
  A qualitative, formative evaluation study of the first year of implementation was undertaken. Data was generated from in-depth interviews. This article focuses on individual interviews conducted with the eight students at the RCS, which explored their experiences during a year-long clerkship. Transcripts of interviews were thematically analysed.
  
  
  RESULTS
  Four themes emerged from the analysis: a learning experience that differed from what was experienced at the tertiary training hospital, an enabling clinical environment in the district and regional hospital, the positive role played by the specialists, and the influence of the community immersion. Underlying all of the responses was the building of relationships over time both with supervisors and with patients. Evident from the responses was that students' confidence in their clinical skills and decision-making abilities was heightened while their approaches to their own learning were enhanced.
  
  
  CONCLUSIONS
  To respond to the call for educational reform and a heightened awareness of social realities, innovative approaches to the training of medical students, such as those adopted at the RCS, are indicated. It is argued that the learning facilitated by these rural medical education models has the potential to offer learning experiences that can lead to transformation through a change in practice and attitude among the students, and ultimately also enable curricular renewal at the institutional core.
authors.affiliation: Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. scvs@sun.ac.za.
authors.forename: S C
authors.initials: SC
authors.lastname: Van Schalkwyk
authors.affiliation: Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. jbez@sun.ac.za.
authors.forename: J
authors.initials: J
authors.lastname: Bezuidenhout
authors.affiliation: Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. hoffie@sun.ac.za.
authors.forename: H H
authors.initials: HH
authors.lastname: Conradie
authors.affiliation: Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. tfish@sun.ac.za.
authors.forename: T
authors.initials: T
authors.lastname: Fish
authors.affiliation: Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. nkok@sun.ac.za.
authors.forename: N J
authors.initials: NJ
authors.lastname: Kok
authors.affiliation: Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. bbvh@sun.ac.za.
authors.forename: B H
authors.initials: BH
authors.lastname: Van Heerden
authors.affiliation: Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. mrdv@sun.ac.za.
authors.forename: M R
authors.initials: MR
authors.lastname: de Villiers
mesh_terms: D002982:Clinical Clerkship / Q000458:organization & administration*; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D006801:Humans; D017145:Models, Educational; D018794:Problem-Based Learning; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D013019:South Africa; D013038:Specialization