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Background Asthma is the most common chronic respiratory disease among children and adolescents worldwide. However, the burden of severe asthma is highest in Sub-Saharan Africa. This study aimed to explore teachers' perceptions of asthma care across six African countries. Methods We conducted focus group discussions (FGDs) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. FGDs were conducted in Accra (Ghana), Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda), and Harare (Zimbabwe) between 01 November 2020 and 30 June 2021. Results We identified two key themes related to asthma care: (1) barriers to asthma care and (2) suggestions to improve the care of asthma learners. Teachers reported a lack of knowledge and skills among themselves, learners, and caregivers. Some teachers believed that myths about asthma and restrictions on themselves administering care exacerbated challenges faced by learners with asthma. Most teachers identified a need for all-inclusive asthma training programmes for teachers, learners and caregivers, focusing on acute episodes and mitigating triggers. Utilising teachers with personal experiences with asthma to advocate and support these initiatives was suggested. Recommendations were made for annual screening to enable early identification of learners with asthma and clarity on restricting teachers administering asthma medications. Conclusions Teachers across African schools identify multiple barriers to asthma care. Structured school education programs and annual asthma screening are key to addressing some barriers to care.

Veena S Singaram,1 Kimesh L Naidoo,2 Shenuka Singh3 1Clinical and Professional Practice, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; 2Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; 3Discipline of Dentistry, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaCorrespondence: Veena S Singaram Email singaram@ukzn.ac.zaPurpose: Self-directed learning (SDL) has been advocated for effective training of final-year health professions students. COVID-19 challenges conventional teaching, learning, and assessment in the clinical environment. This study aimed to identify and explore enablers and barriers to SDL among final-year health professions students training during the COVID-19 pandemic.Methods: Adopting the SWOT (strengths, weaknesses, opportunities and threats) framework, this study explored the clinical learning and training experiences of final-year health professions students during the pandemic. A survey was conducted via online platforms. Data from 155 respondents were thematically analyzed.Results: Personal attributes such as reflection, self-determination, motivation, resilience, and positive learning behaviors and skills were identified as SDL enablers. Collaborative learning networks and online learning platforms facilitate learning needs and goals. Fear and anxiety, untrusted learning sites, uncertainty about graduation, financial issues and challenges in the learning environments were the major themes related to barriers to SDL.Conclusion: The importance of SDL as a skill for uncertain times warrants further investigation in the training of future healthcare professionals. Inclusive planning and engagement with final-year health professions students to address identified stressors, as well as the creation of shared platforms where students are part of the decision-making processes for clinical learning and training are recommended. Responsive curricula that optimize unpredictable disruptions in clinical training are needed to equip students to diagnose their own learning needs and implement appropriate learning strategies.Keywords: undergraduate medical students, learning environment, clinical training, medical curriculum, self-directed learning, COVID-19, health professions students

Background Newly qualified medical practitioners (interns) in South Africa (SA) are part of the frontline healthcare workers who face Africa’s most severe COVID-19 pandemic within an environment already burdened with tuberculosis, HIV and trauma epidemics. The experiences of interns during the pandemic reflect SA’s preparedness to respond in a crisis and inform strategies that could be adopted to balance training and service in resource-challenged contexts. This study explored the strengths, weaknesses, opportunities and threats posed by the COVID-19 pandemic as reflected on by interns within clinical training platforms in SA.Methods An online survey tool consisting of ten open-ended questions based on the SWOT framework related to personal and professional perspectives to clinical training during the COVID-19 pandemic was developed using SurveyMonkey. Due to lockdown restrictions, all data were collected remotely with the survey instrument being distributed via the social media platform WhatsApp. Three coders thematically analysed data until consensus was reached.Results Forty-six first- and second-year interns reflected on personal and systemic challenges as the major threats and weaknesses in intern training during the COVID-19 pandemic. Extrapolating on strengths and opportunities, there were three overarching learnings interns reflected on. These related to being a medical professional, being in a learning environment, and specific learnings realised. Existing challenges in the environment exacerbated the threats posed by COVID-19 and innovative strategies related to improving support, feedback and broadening the intern curriculum were identified. In addition, the use of online training around holistic care and intern evaluation was mooted as an innovation to develop out of this pandemic.Conclusion Although the clinical environment where interns learn and work is often stressful and overpowered by high service burdens, there are unique opportunities to enhance self-directed learning and graduate competencies, even in the midst of the COVID-19 pandemic.