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Table 4 Essential components and their enabling factors (this is an abbreviated version, please see Additional file 1 for the unabridged version)

From: A framework for distributed health professions training: using participatory action research to build consensus

Leadership and governance influences effective DHPT, through the decision-making processes and roles and responsibilities of stakeholders.

1. Stakeholders engage in partnerships.

2. Roles and responsibilities of stakeholders are clear..

3. Management is committed to collaboration..

4. Stakeholders’ senior management demonstrate visionary leadership.

5. Champions take responsibility for distributed training.

6. Funding is made available.

7. Communication channels exist among stakeholders.

8. Monitoring, evaluation, and research are encouraged by leadership.

9. The training institution:

•implements institutional policies supporting distributed training.

•capacitates primary supervisors and other site staff.

•maintains relationships with the site.

•selects students most likely to practice in distributed areas.

•is familiar with the each site’s strengths and challenges.

The curriculum provides the scaffolding that informs the learning outcomes, content, mode of delivery, and assessment of students, and evaluation of the curriculum itself.

10. Management prioritises distributed training.

11. Learning outcomes across training institutions are consistent.

12. Learning outcomes for distributed training include a focus on:

•Social determinants of health.

•Common, undifferentiated problems in primary health care.

•An integrated spectrum of health and illness.

•Cultural awareness.

13. The curriculum for distributed training uses:

•Various teaching and learning approaches.

•A patient-centered approach to care.

•Opportunities for developing a range of competencies.

•Adaptability to the realities of the individual site.

•On-site, integrated and continuous student assessment.

14. Rotations should be of sufficient length to allow for student immersion.

15. Students provide and receive regular feedback.

16. Monitoring, review, and modification of the curriculum is performed.

The community is defined as the population that utilises the local health facility where students are trained, and is the reference point for the curriculum.

17. Community stakeholders are engaged.

18. Partnerships are maintained with community stakeholders.

19. The community shares the vision for training.

20. Students and staff are aware of community needs.

21. Learning opportunities are available in the community.

22. Students learn through being immersed in the community.

23. Stakeholders engage in celebration of accomplishments.

The training environment includes (a) people who work at the distributed training site, and in the community, contributing to the training of the students; and (b) the training site as the context and physical environment within which the distributed training takes place.

(a) People

24. A dedicated person coordinates the training at the site.

25. Staff from various professions work with students to facilitate their learning.

26. Site staff receive guidelines to support students’ learning.

27. Site staff receive recognition from the training institution.

28. Site staff provide feedback about student performance.

29. Subject specialists support distributed training through regular outreach visits.

30. At least one health professional acts as primary supervisor for students.

31. The primary supervisor:

•develops, implements, and evaluates the training at the site.

•is involved in assessment of students.

•receives the necessary support and training technologies.

•develops capacity in teaching and learning.,

(b) Place

32. The training site is selected collaboratively by stakeholders.,

33. Site selection is based on factors that facilitate relevant learning opportunities.

34. Medical equipment, appropriate to the level of care, is available.

35. Sufficient space for training activities is made available.

36. Materials to enhance learning are made available on-site.

37. Accommodation and transport for students are made available.

The students are learners enrolled for any programme in health professions at a training institution.

38. Students:

•receive orientation before they begin a rotation.

•have academic and social support available.

•provide feedback after they complete a rotation.

•have adequate arrangements for safety and security.

39. Student-staff ratios are mutually agreed upon.

40. At least two students are assigned to a site.

41. Reasonable logistical arrangements are made by the training institution.