Institutional factors that affect black South African students' perceptions of Early Childhood Teacher Education

M G Steyn email@example.com
Department of Early Childhood Education
University of Pretoria
South Africa

Teresa Harris
Department of Early Childhood Education
James Madison University
USA

C G Hartell
Department of Early Childhood Education
University of Pretoria
South Africa

Institutional factors that affect black South African students' perceptions of Early Childhood Teacher Education
C9BBF7B0968135BE859C3CB9F4B2A6DEbarriers to learningearly childhoodEarly Childhood Educationenrolmentminority groupsperceptionsrecruitmentteacher education
Black students account for over 72% of enrolments in higher education, but only a small percentage of them choose Early Childhood Education (ECE) as a field of study and complete the qualification.The purpose of this study was to examine, from the perspective of black ECE students, why so few of them enrol in this particular programme at a historically white university.Through a qualitative, case study approach the reasons for the low enrolment and completion rates were investigated.Participants mentioned that recruitment for this programme, particularly in rural areas should be improved.They also pointed out the higher prestige of other career options, the linguistic challenges they face, the cost of university education and early teacher education in particular, as well as access to transport and resources as barriers to recruitment and retention.Their recommendations for higher enrolment rates included the use of black students to recruit in rural and in township areas, increased funding for bursaries, and more culturally sensitive pedagogies in early childhood teacher education.

Introduction

Following 46 years under an apartheid government, South Africa underwent transformation in 1994 to become a democratic state (De Bruijn, Van der Voort, Dicke, De Jong & Veeneman, 2005).From then on educational reformers attempted to "…provide a system of education that builds democracy, human dignity, equality and social justice" (Department of Education, 2001:4).The primary aim of the reforms was to broaden participation in higher education so as to reduce the highly stratified race and class structure of the country (Fraser & Killen, 2005).Consequently higher education institutions in South Africa went through changes in structuring, funding and student numbers due to government's policy to transform higher education in South Africa, as well as globalisation and internationalisation (Gbadamosi & De Jager, 2009).The changes in structuring are reflected in the National Plan for Higher Education (NPHE) which included a new language and funding policy, a framework for quality assurance, and proposals for the restructuring of higher education through mergers and incorporations.

Tertiary institutions in South Africa also experienced an impressive growth in student numbers and historically white universities experienced a dramatic shift in demographics.This widened access resulted in an increased enrolment of black students which now account for over 72% of enrolments in higher education 1 (Brüssow, 2007) while Smith (2011) estimates the percentage closer to 68%.However, the number of these students who successfully complete their courses is alarmingly low.Letseka and Breier (2008) comment that the average graduation rate for white students is more than double that of black students.Similarly the National Planning Commission (NPC, 2011:16) reports that, "Race remains a major determinant of graduation rates in our higher education institutions".Furthermore the completion rate for black students is less than half of the completion rate of white students and the figures are particularly low where first generation students are involved; only one in five graduated in the required time (NPC, 2011).

In part this low throughput rate may be attributed to a difference in life experiences as a result of students' social, educational, cultural and economic backgrounds, which manifests in unequal levels of readiness for studies in higher education.In South Africa a small group of privileged learners attend well-resourced and previously advantaged state schools or private schools where they receive good to excellent education.The majority of learners (about 80%) are however dependent on rural and township schools which are under-resourced and may be coined as dysfunctional (Van der Berg, 2008).Another reason for the low completion rates can be ascribed to institutional factors.Overt or covert practices in university programmes on the part of lecturers may unintentionally or overtly exclude these students.Although universities in South Africa went to great lengths structurally to accommodate and include black students in terms of access to higher education, there remains evidence that these changes were insufficient to address educational disadvantages (Hannaway, 2012;Steyn, Harris & Hartell, 2011).

In the late 1980s, however, another discourse emerged between government and higher education institutions which constructed problems related to access very differently.In terms of this discourse, successful access to higher education was not dependent on black students addressing the deficiencies they brought with them to tertiary study, but rather on higher education institutions examining their curricula, assessment practices and teaching methodologies in order to consider the extent to which they impeded or facilitated access to an African majority (Ellis, 2012).The responsibility for 'disadvantage' was thus shifted from individuals (deemed to carry this burden with them from their socio-cultural backgrounds in 'homeland' or township schools) to the institutions, which were seen to construct that disadvantage through a reliance on curricula, assessment practices and teaching methodologies that had their origins in highly developed societies elsewhere (Gay, 2010).To summarize this discourse, the achievement of equity regarding access to higher education was an issue of institutional and systemic transformation rather than individual remediation.

The evolution of universities from the late 1990s to the present (which has coincided with the hegemony of the African National Congress in South Africa) has been impelled by the larger developments in world economics.Gunasekara (2006: 101) says of universities: "Where once universities largely focused on teaching and research within a universal community of knowledge creating institutions, universities are adopting a third role in regional economic development".Universities' participation in the economy creates the expectation that students will necessarily get a well-paid job once they leave university.

In this study a historically white university in South Africa was identified in order to develop an understanding of the institutional background and challenges.At this particular university the Faculty of Education has made concerted efforts to transform and become more representative of the whole South African population.This is evident in changes in policy and increasing attempts to recruit black staff and students.However, the relative lack of black academic staff at this particular university continues to be a significant factor contributing to the perception of the institution to be white.In the Department of Early Childhood Education at this institution only 20% of the 2 lecturing staff are black and there is a particular concern about the few black students enrolled in the Early Childhood Teacher Education Programme -in 2010 a mere 7.92% of the student population in the Early Childhood Education Department were black (Faculty of Education, 2010).Data obtained from Green (2010) through a survey of early childhood teacher production at higher education institutions in South Africa in 2009 highlighted the urgent need for black teachers speaking one of the nine official languages of the black population.The survey revealed that only 1.5% (2 out of 135) black students at the research institution were expected to progress to the final (fourth) year of study.Furthermore, the survey highlighted that only 13% (168 out of 1275) of all early childhood education teachers produced in South Africa in 2009 were black which starkly contrasts with an estimated need to replace 3275 black early childhood education teachers which the education system would lose through attrition in that same year.

This study is the second in a project exploring the possible reasons why black students do not register in the Department of Early Childhood Education at this particular university, but rather opt instead for other phases such as Intermediate, Senior or Further Education and Training.In view of the fact that the greatest shortage of teachers is experienced in rural areas and townships where the concentrations of black learners are highest (Crosser, 2009) and that learners are most successful when taught by teachers who reflect their home cultures (National Education Association (NEA), 2002), researchers from the Department of Early Childhood Education initiated a research project to determine whether institutional factors may be contributing to the low enrolment of black students for ECE.The "intellectual puzzle" for this research was thus to determine whether and to what extent institutional factors affect black South African students' perceptions of Early Childhood teacher education.

Black students' experiences at white universities

In South Africa students gain university entrance based on their matriculation results which are assumed to be reliable in-3 dicators of their readiness for tertiary studies.Although research indicates that pre-tertiary academic achievement strongly and consistently correlates with the probability of attending tertiary institutions (Thomas, 2000), Fraser and Killen (2005) maintain that these results cannot predict student success in higher education.Despite the desegregation of the South African education system and the more equitable allocation of resources, traditional black schools are still to a great extent disadvantaged and are therefore failing in preparing students sufficiently for tertiary demands (Griffin & Allen, 2006).

With their prior experiences as successful learners with acceptable matriculation scores, black students approach their university studies with the same expectations and academic behaviours which they exhibited in secondary school (Griffin, 2006).However, once they engage in their studies they often experience the transition from school to university as daunting since they are faced with increasing linguistic demands, more rigorous performance requirements and diverse cultural environments which may conflict with their personal values and beliefs.In this regard Sedlacek (1999) maintains that in addition to the usual institutional pressures to adapt successfully to academic life, a black student must typically cope with cultural biases and consequently learn how to link his or her black culture to the prevailing one at the historically white university.Van Wyk (2008:171) elucidates the clear link between learning and culture and affirms in this regard that "… globalisation and its imperatives have resulted in that a large part of South African curricula are geared towards Western forms of knowledge …".Similarly Sennett, Finchilescu, Gibson and Strauss (2003) identify some potential transitions facing many black students entering university for the first time, such as adaptations from a traditional African to a modern Western culture, from a rural to an urban environment, and from an identity as "the high achiever in a small community" to only one of many such students in a larger, more diverse setting.They indicate that "…a further dimension to the challenges facing black African students adjusting to university can be understood to be related to the characteristics of the institution itself" (Sennett et al., 2003:108).In their study on the experiences of university life by black students at a predominately white university, Davis, Dias-Bowie, Greenberg, Klukken, Pollio, and Thomas and Thompson (2004) cite institutional alienation as their most significant experience.This isolation denotes a barrier that black students need to overcome in order to achieve academic success.

Some students develop personal behaviours and strategies that allow them to successfully complete their programmes in pursuit of personal and career goals (Davis et al., 2004;Sedlacek, 1999).Others may be unable to cope with the demands of university life and consequently depart from the institution.A number may change to another programme that is more in tune with their academic abilities, cultural preferences or financial means.The latter scenario is investigated in this article and we pose the question whether the expectations of the programme offered by the Department of Early Childhood Education may be so far removed from the 'African life world' (Van Wyk, 2008), financial abilities and other factors related to the institution, that the majority of teaching students rather opt for other phases.

Transition theory

The shift from secondary to tertiary studies is generally regarded as a major developmental leap as this involves a dramatic change in the lives of young people.The Transition Theory (Schlossberg in Santiago, 2004) was deemed an appropriate theoretical and practical point of departure.Schlossberg defined a transition as " … any event, or non-event that results in changed relationships, routines, assumptions, and roles" (Santiago, 2004:3).Schlossberg's theory is appropriate since the transition to university life has an interactive effect: it impacts the experiences of students, but the strength of the impact is also determined by the individual student's coping mechanisms.

Schlossberg (in Mims, Mims & Newland, 2009) identifies four factors which impact transitions: situation, self, support and strategies.The first factor, situation, refers to the context in which the transition takes place; whether it is chosen or forced and whether it is experienced as welcoming or traumatic (Santiago, 2004).The second factor, self, refers to the intrapersonal characteristics of the student, namely their self-esteem, strengths, weaknesses, resilience and other elements that may "push or pull" the student in the transition process (Mims et al., 2009:593).Support refers to the strategies that are in place to assist the student to overcome barriers and it moreover involves the support from family, friends, the community and the university.The last factor, strategies, suggests equipping mechanisms that the student uses to steer through this transition in order to achieve the goal of successfully completing his studies.

Methodology

The study employed a qualitative, case study approach with the aim of gaining insight into the world of student teachers as encountered from their perspective (Wilmot, 2005).Although numerous studies report on the experiences of black students at predominantly white institutions, few present the voices of these students.With this article, we want to break this silence.In qualitative research, the inquirer asks participants in the study to share ideas and build general themes based on those ideas (Creswell, 2008).By utilizing qualitative inquiry, the context, views of participants and phenomenon could be explored (Ary, Jacobs, Razavieh & Sorensen, 2006).In this study, the subjective experiences and perceptions of black student teachers enrolled in the ECE Programme at the university under study were investigated.The aim was to determine how higher education institutions, that formerly catered only for white students, can accommodate the social, economic, cultural and educational needs of black students.This study is part of an EU-DHET funded project which focuses on the recruitment and retention of black students in the Foundation Phase.For the purpose of this project, several data collection instruments were used such as questionnaires, interviews, the photo-voice method and focus group interviews.Ethical clearance has been obtained from the University of Pretoria (UP11/04/02).In this study the in-depth analyses of the 'bounded system' of the university consisting of black ECE student teachers provided a deeper understanding of the topic under study and significant data was collected by means of the focus group interviews that were conducted.

The Sample and Research Site

Since a qualitative approach was followed in this study and there was a need to target a particular group for the case study, the sampling method chosen was non-probability.To be more specific, since there were no more than six black students in each year of the four-year programme, eventually 12 black ECE student teachers at the university under study participated in this study.This method of sampling is used in special situations where the sampling is done with a specific purpose in mind (Maree, 2007).

Data collection

Four focus group interviews (one per year group) with the ECE students were conducted by researchers from the Department of Early Childhood Education at the university under study.As this study is part of a larger project, questionnaires, individual interviews as well as focus group interviews were conducted.For the purpose of this article, where information-rich and verbatim data was needed, the authors decided to concentrate on data collected via focus group interviews.All interviews were recorded and transcribed for analysis.The study employed a qualitative design using Grounded Theory.The Grounded Theory method is a systematic methodology involving the discovery of theory through the analysis of data.The first step is data collection.From the data collected, the key points are marked with a series of codes which are extracted from the text.The codes are then grouped in similar concepts in order to make them workable (Charmaz, 2006).In this study transcripts were read and coded line by line by each researcher.The researchers agreed on codes, matched them to the research literature and then refined them to identify emerging themes which guided the findings.

Findings

In this section the most prominent themes and findings that emerged from the study are discussed.

Choosing an Institution of Higher Education

The university under study follows national mandates for accepting black students and has policies and practices to actively recruit students.Policy implementation is conducted at departmental level and is supported through the Recruitment Office and Office of Student Services.The researchers wanted to learn why students selected the university under study as opposed to other universities.The gathered responses were consistent with the findings of Gbadamosi and De Jager (2009) who cited the reasons for selecting a university as, first, the reputation of the institution, and second, the geographical location.For example, some students indicated that their choice of this particular university was based on its national reputation as a prestigious institution.

Because it's the most well-known university and you get opportunities to go outside the country and do whatever you have studied here.The university's reputation also appeared to capture the interest of students and their families.Policies that make the university accessible such as acceptance rates for black students, were also considered important.

The Application Process

Application information on processes and procedures is typically provided through the career guidance modules which are taught by life orientation teachers.However, the students interviewed mentioned that their secondary schools and communities were ignorant about the processes for making applications at universities as well as for accessing the available resources such as bursaries and financial assistance.The students added that the university did not attend their schools' career days which subsequently affected their knowledge regarding ECE teacher training.Furthermore, many students admitted that they were unaware about ECE as an area of study during their initial selection of a programme.

No, we didn't.Actually there was this other lecturer who was working here.Who was it?Her name was Doreen.So she had a relative who was in Mpumalanga, our teacher, and she told us there are bursaries.They are offered so help us collect students, learners who are studying in the school to come and study.And we were interested when she told us about it, and then we came.And especially they were looking for few black students doing education because when there is a career exhibition day, people are telling us do engineering, medicine, they are not introducing us to education, especially Early Childhood Education.No one is introducing it and its like people choose to do medicine and all that.While the research interviews were conducted the university held an open day for prospective students.Even though the ECE Department hosted a table on the education campus there was not enough support on the main campus to direct potentially interested students to the Faculty of Education which is located only a short distance from the main campus.Students were of the opinion that the university needed to be more strategic in marketing the ECE Programme.

Students mentioned that the choice of studying Education and ECE was merely a backup plan for many of the students in the programme.

I applied for Criminology, and then I was advised to put education as my fall back plan, so I did.But then the university answered me for my education application.So then, a week later they answered me for Criminology and said I didn't get space due to the fact that the Humanities Faculties is full.Instead of staying at home for a year, I'll just take this for a year or a single semester.

Adjusting to University Culture

Once admitted to the university, students must make the transition from their home communities to life as a university student.This adjustment is challenging for most young people, but in particular for those who are members of a 'majority culture' and who need to become members of a more diverse, predominantly white culture with English and Afrikaans as the languages of instruction (Sennett et al., 2003).Some universities and departments have implemented policies and programmes to assist students in making this transition by offering mentoring programmes, special orientation sessions, additional study periods, and/or bridging courses.According to the participating students entering ECE, these options were not supportive enough at the time of admission and black students consequently developed a support system among themselves.

We are so fortunate because when we came here, we applied, we shared the same room and at the school we were also together, the three of us and then one passed away and so there are two of us.And all along we have been together that way.We like it because we're sharing everything -the same clothes and when we apply we get the same thing.The English language expectations of the university posed a significant challenge to students.For students who attended schools in rural areas or predominantly black urban areas, English was a second or third additional language.Van Wyk (2008) mentions in this regard that language and the acquisition of knowledge go hand in hand which puts black students at a definite disadvantage when receiving instruction in English.Currently Government is advocating African languages as medium of instruction at universities in order to cater for the needs of black students.While instruction in the higher grades at school may have been provided in English it was often of dubious quality (Kamper & Steyn, 2011).However, students who attended model C schools (multiracial schools that received both government funding and had higher schools fees) generally received far better quality English instruction.The students interviewed frequently mentioned that black students are not adequately proficient in English which resulted in academic difficulties as well as a widening communication gap between black and white students.

But with most black students it's the language barrier because you know when we're doing our research, the information, the English, is of a higher standard and the people have trouble with that.And you have to go through an article of 50 pages and understand all the words...yeah academic writing, people struggle with that.

The Cost of University Education

The main concern of many university students around the world is related to finances.University studies are generally very expensive as they involve the acquisition of study materials, participation in student activities and procurement of accommodation.It is not surprising that Knight and Yorke (2003) identified financial difficulties as one of the primary causes of withdrawal among full-time students.Similar findings were documented by Botha, Du Plessis and Menkveld (2007);Stanton-Salazar, Vasquez and Mehan (2000) and Gregory and Otis (2000).

All of the participating students interviewed for this study received some form of financial aid albeit in varying amounts.A few of the students had loans that must be repaid after graduation.One student explained her financial challenges as follows:

…my mom because she's a single parent and she didn't have money for me to go to school because she's a domestic worker… .So the challenge that I'm facing is sometimes I think Early Childhood Education needs us to have money for laminating, for activities we do, we have to buy stuff, we have to do all that, so that's one challenge that I have because they don't have money.I have to go home for holidays and work and then it's hard for me to study then for exams.When I'm working, I don't have time to study.When I'm here I have a lot of work like studying so that is one of the challenges, but I'm trying to produce.Considering the challenges, the bursaries were critical for providing the financial support needed for students to pursue tertiary studies.A monthly allowance was provided for resi-dence and tuition, however, the bursaries did not always sufficiently cover the expenses typically associated with university studies.A frequent complaint was the limited amount of money provided for textbooks.

It's not enough for all the books, but at least we can buy some of the books.We made copies with the chapters that they want because I can't afford the books.Several students reported that after completion of their first year of study they had found ways to make ends meet.However, the financial concerns raised by students stretched beyond normal living expenses and included the costs associated with the modules per se.First-year students had to create learning resources themselves in certain modules.

The causal relationship between finances and academic success cannot be underestimated.The majority of the participants related a lack of finances to lower academic achievement.They therefore associated the cost of the learning materials they had to create with the marks they earned for those assignments.

The thing is, if you try to use your own creativity, there are people who are going to come up with their assignments looking extremely beautiful.You want to get 90 and you put effort into everything you can, you try to take this and this and mix, but if you didn't have the money to buy those things to make your assignment look really good, then you're not going to get that good mark.However, they also offered suggestions for making the costs more equitable so that some students would not be advantaged by their ability to buy materials that were inaccessible to others.

I would strongly suggest that the amount that they charge for each module, they should at least try to provide some material…

Retention in the programme

The research revealed that a positive correlation exists between a student's interests and aspirations.The programme of study and membership of the university community can promote the successful completion of studies.The attrition rates of black students may in part be attributed to the fact that students were not accepted into their first choice degree programmes hence chose ECE as a last resort.

Analysis and Discussion

The low enrolment, completion rates and institutional factors that influence black students' academic progress in the ECE programme at a former white university were investigated and described in the literature review and empirical study, and two major themes were identified, namely student recruitment into the university and student experiences related to ECE.The transition from school to university, especially for black students, requires major personal adjustment and the four factors as identified by Schlossberg (in Santiago, 2004) namely, situation, self, support and strategies, impact on this transition.The students interviewed were already enrolled in the ECE Programme of the university under study.The fact that these students enrolled into a programme that was unknown to them and which has an apparent low status in the black community, reflects on the self.The self refers to the intrapersonal characteristics of the student, that is their self-esteem, strengths, weaknesses, resilience and other elements that may "push or pull" the student in the transition process (Mims et al., 2009: 593).The participants in the study successfully completed their secondary school studies, made the decision to study at a reputable university, which is a new context, and left their families and culture behind in search of a better future.The situation refers to the context in which the transition takes place, whether it is chosen or forced and whether it is experienced as pleasant or traumatic (Santiago, 2004).The students experienced challenges with regard to support and they had to adopt strategies to overcome financial constraints and unfamiliar academic demands at the university under study.Support refers to the strategies that are in place to assist the student to overcome barriers, and it moreover involves the support from family, friends, the community and the university.The strategies referred to suggest mechanisms that the students use to manage this transition so as to reach their goal of successfully completing their studies.

Student Recruitment into the University

Consistent with findings from Gbadamosi and De Jager (2009), students and their families initially selected universities based on their reputations and geographical location.Many of the students in this study initially chose this historically white university based on its national and international reputation.

The students interviewed recognised the value of marketing the ECE programme to students in rural and urban areas beyond the province.It would seem that marketing strategies which from the outset targeted the students are important in creating an awareness of both the institution and the Teacher Education Programmes.Since the experiences of the students at this historically white university were positive in terms of the quality of the programme, but realistic in terms of the actual costs associated with living expenses, materials fees and bursaries as well as access to transport and resources, they could very well serve as effective ambassadors for the ECE programme.

Only one of the black students interviewed initially chose this university for its ECE programme, even though the university considers the programme to be widely known throughout South Africa.It therefore seems that education faculties should examine their current practices of identifying and retaining black students.Based on the responses from the students in this study, three factors stood out clearly.Students needed:

• access to practical information on the ECE programme • access to information on the application process and financial aid • support for academic success within the programme.

Student Experiences Related to Retention in Early Childhood Education

Since academic success often evades students from poor backgrounds, Dass-Brailsford (2005:575) chose academic achievement as an indicator of resilience amongst black students because "… it is easily measurable and increasingly sought by poor families in South Africa."Whilst other societies may regard academic success as an ordinary developmental task, it is difficult to attain academic success in a country such as South Africa where the majority of black students come from economically deprived backgrounds in terms of resources and quality education.Black students in the ECE programme distinguished mainly three inhibiting factors on their academic success: their limited English abilities which adversely affects the marks they are able to earn on projects, their lack of finances to purchase the materials that make their projects worthy of high marks, and finally, their lack of prior experience with the early childhood models that are familiar to their more economically privileged peers.

Despite the fact that English is the mother-tongue of less than 10 percent of the South African population it remains the language of instruction.With limited use of English outside the classroom (Howie, 2003), students have little opportunity to develop language proficiency and their lack of English language skills compounds their academic difficulties.As a result, students read slowly and often do not comprehend study material.Their competence in reasoning skills, organising skills and mathematical skills is compromised when they cannot understand what their instructors are explaining (Zulu, 2008).Students in this study also pointed out the linguistic challenges that they faced.Although it is national policy for secondary schools to use English as the language of instruction, many black students remain unable to adapt to the fast pace of university instruction and the heavy demands for reading in English.Hence they appeared to be less competent than their peers who had more exposure to English in the classroom and outside.At the university under study which is a bilingual Afrikaans and English institution, it appears that both white and black students who attended model C schools were more language proficient than their black peers.

Another inhibiting factor was the cost of materials needed for assignments.According to the students, assignments which evidently used expensive material were awarded higher marks than assignments that seemed less costly to produce.Another factor compounding the quality of assignments was the prior experiences that students brought into the classroom which form the basis for designing new learning resources.Although many black students may have attended preschools in their home communities, they had limited access to and experience with materials that were common in well-resourced private early childhood centres and private schools.

Conclusion and recommendations

The South African Department of Education has noted that 4147 ECE teachers are needed annually to meet the growing enrolment of children, however only 1275 graduates were expected in 2009.Of these expected graduates, only 168 were African Language speaking students which emphasises the acute shortage of teachers in predominantly black areas (Green, 2010).Recruitment is a national priority, yet this article has identified several institutional factors (for instance financial, cultural and language issues) that impact negatively on the low enrolment and throughput rate of black students.Given the national priority for preparing ECE teachers to meet the growing teacher demand in under-served areas, South African universities must critically examine the factors that influence students' decisions to pursue teaching as a career and use that information to design marketing strategies that will attract more students to the field.In addition, given the challenges that black students face in terms of financial costs and adjustment to new academic demands, universities need to identify and develop support programmes so that students are able to complete their studies successfully.

As a result of the study, we recommend that Higher Education Institutions (HEIs) should critically consider the following questions related to the institutional factors that support and challenge the recruitment and retention of black students in ECE teacher education: • What are the university's assumptions about its own reputation and the students it wants to recruit? • Does the university have concerns about the financial and academic resources needed to provide support for black students to be successful?Is there a focus on the 'bottom line' costs?Or is there perhaps a preference to invest in blacks whose academic performance and profile is more similar to those of white students?• What is the role of the university in supporting the integration of all students in the academic community of scholars and the social-emotional community of young adults?• Why are so few recruitment and retention efforts extended to rural and township communities?To meet financial needs, lecturers should ensure that course materials are affordable to all students.Teacher education faculties should take cognisance of the stressors and challenges that many black students experience (e.g.limited financial resources, family demands to return home in cases of family illness and death, violence within the community) (Hobson-Horton & Owens, 2004) and should consider incorporating the costs of learning materials into the module costs.To further extend support to students, universities may adopt policies that allow study materials to be purchased at reduced or wholesale prices.

Important questions that need to be addressed in future research are the following: • Are faculty members aware of the cultural differences and context that affect the performance of black students in their classes?• How culturally sensitive are faculty members pertaining to instructional practices and culturally relevant pedagogies?Some questions relating to language issues which affect the retention of black students in ECE teacher education need to be considered: • Are language policies covertly racist in requiring English language study, to the possible detriment of other African languages?• What support services are available to students who have difficulty with English?The number of challenges facing black students in the ECE Programme is regrettable.However, the information obtained through this study can help to improve inherent policies, rules and regulations that tend to exclude black students in this programme.

Notes

1 In South Africa, people continue to self-identify by their cultural groups and racial labels (e.g., coloured, indian, black, white), and all the students who participated in this study identified themselves as black South Africans.2 For the purposes of this document, ECE refers to the education of young children from birth to nine years.In South Africa, this corresponds with what is often referred to as Early Childhood Development (ECD) for children from birth to five years old in families and early childhood institutions and for children from five to nine years old, accommodated in the ECE (Grades R-3) of schooling.3 Matric refers to the last year of schooling in South Africa and can also be referred to as grade 12.

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Male median raphe cysts: serial retrospective analysis and histopathological classification

I-Hung Shao
Tai-Di Chen
Hsiang-Te Shao
Hsiao-Wen Chen
Male median raphe cysts: serial retrospective analysis and histopathological classification
R E S E A R C H Open Access
Background: To review the clinical and pathological characteristics of median raphe cysts and to classify the lesions according to pathogenesis and histopathological findings.Methods:The medical records of patients who were diagnosed with median raphe cysts between 2001 and 2010 were reviewed to document the clinical presentation and pathological findings of the cysts. Results: Most patients were asymptomatic; however, 9 patients had inflammatory or infectious cysts that were tender or painful. Four patients who had cysts on the parameatus and distal prepuce had difficulty voiding. Hematuria and hematospermia were noted in 2 cases. Thirty-one cysts were lined with an urothelium-like epithelium, and a squamous epithelium lining was found in 3 cases. In 2 cases, a well-formed mucinous glandular structure was observed. The other 20 cysts consisted of mixed epithelia. After excision of the cysts under local or general anesthesia, an urethral fistula developed as a complication in only 1 case.Conclusions: Median raphe cysts are benign lesions formed due to tissue trapping during the development of urethral folds. The cysts can be defined into 4 types based on pathological findings: urethral, epidermoid, glandular, and mixed. The associated symptoms and signs should be taken into consideration when determining the treatment for the cysts.Virtual slides: The virtual slide(s) for this article can be found here: http//www.diagnosticpathology.diagnomx.eu/ vs/7727074877500751

classification Background Median raphe cysts can develop at any site along the midline of the ventral side of the male genital area, from the meatus to the scrotum and perineum ( Figure 1). In most patients, the cysts, which are asymptomatic or unrecognized during childhood, may progress later and become symptomatic during adolescence or adulthood. Although these cysts were first identified decades ago, only a few have been reported to date, mostly in case reports. The clinic pathological characteristics and pathogenesis of the disease are not well understood by physicians. In this study, we reviewed the medical records of patients with median raphe cysts to analyze the clinical characteristics and classify the histopathological findings.

Methods

We retrospectively reviewed the medical records, including the pathological diagnoses, of all patients with cysts on the median raphe (from the meatus to the perineum) diagnosed between 2001 and 2010 in our institution. Patients with epidermal inclusion cysts, skin tags, or cysts located anywhere other than the median raphe were excluded. Medical charts were reviewed to document the clinical presentation, characteristics of the cysts (including the occurrence site, cyst size, and histopathological findings), and patients outcomes.

This study was approved by our institutional review board in Chang Gung Memorial Hospital.

Results and discussion

A total of 69 genital cysts from 68 patients were reviewed from 2001 to 2010. Ten epidermal inclusion cysts and 3 cystic tumors were excluded. A total of 55 patients (including a 16-year-old patient with synchronous cysts) had 56 median raphe cysts. The clinical characteristics are summarized in Table 1. The mean age of the patients was 26.7 years (range from newborn to 66 years), with a bimodal distribution at approximately 1-10 and 21-40 years old ( Figure 2). Most (72.7%) of the patients were asymptomatic, whereas 9 patients (16.4%) had inflammatory or infectious cysts, that were painful or tender. Another 4 patients with cysts on the parameatal site and distal prepuce had difficulty voiding. Hematuria or hematospermia occurred in 2 cases. Cysts were predominantly found on the parameatal site and penile shaft in 19 (33.9%) and 24 cases (42.9%). Lesions were found on the glands penis in 4 cases (7.1%) and on the scrotum and prepuce in 2 (3.6%) and 7 cases (12.7%), respectively. The mean size of the cysts was 0.88 cm, ranging from 0.2 to 2.1 cm. On histopathological examination, all the cysts were centered in the dermis and were not connected with either the epidermis or urethra. They exhibited cystic dilation and were irregularly shaped with clear mucinous content. The histological findings relating to the epithelium lining were varied, as 31 (55.4%) of 56 cysts were lined entirely with a urothelium-like epithelium (Figure 3), which is composed of a layer of columnar cells overlaid with uniform small cells arranged in stratified layers (1 to >10  layers). Apart from the absence of umbrella cells, the histological features of the epithelium were similar to those of the urothelium. A pure squamous epithelium lining was found in 3 cases (5.4%; Figure 4), and a wellformed intraepithelial mucinous glandular structure was found in 2 cases (3.4%; Figure 5). Twenty cases (35.7%) were of the mixed type, that is, the epithelial lining either coexisted with squamous metaplasia or was scattered with mucinous cells. Two cases had focal ciliated cell metaplasia ( Figure 6). No surgical complications were encountered, except in 1 case where urethrocutaneous fistula formation occurred owing to long-term chronic inflammation adjacent to the urethra. Among the 55 patients, 1 underwent cyst aspiration, and recurrence was noted several months later. No signs of malignancy were found in any of the patients, either clinically or pathologically.

Median raphe cysts develop along the median raphe of the male external genitalia, and such cysts have been described in case reports; however, serial reports of such cases are rare. In early studies, some cases were reported under varied terms including "mucoid cyst," "genitoperineal cyst," "parameatal cyst," "hydrocystoma," and "apocrine cystadenoma." [1] The cysts can occur at any site on the ventral side of the genital area, including the parameatus, glans penis, penile shaft, scrotum, or perineum. Most of the cysts are diagnosed in young patients. Although referred to as median raphe "cysts," they can also present as a cordlike or canaliform induration on the median raphe. Reports on such cases are even rarer in the literature [2]. The cysts should be differentiated from other genital lesions such as the glomus tumor, dermoid cyst, pilonidal cyst, epidermal inclusion cyst, urethral diverticulum, and steatocystoma [3]. Epidermal inclusion cysts, the most    common genital cystic lesion, can occur anywhere on the body in adult men and women. Unlike the median raphe cyst, the epithelium of the epidermal inclusion cyst is lined and filled with keratin. The median raphe cyst can be easily differentiated from other skin tumors by its clinical presentation or pathological features. Median raphe cysts mostly present at birth and may remain asymptomatic or unrecognized during childhood [3]. As the patient grows older, the cyst may also progress slowly. Later in adolescence or adulthood, the cyst may appear as a solitary and movable cystic nodule on the ventral surface of the penis. In some cases, the cyst may progress rapidly or become symptomatic owing to infections or trauma, which could make diagnosis difficult [4,5]. In contrast, some cyts may grow rapidly even in the absence of trauma or infection [6]. However, in most cases, the lesions remain asymptomatic and do not interfere with urinary or sexual function [3]. This could be the reason for the bimodal distribution of the presentation: the patients were either presented to the physicians by their parents during childhood or they visited the physician themselves later in their 20s and 30s because they developed symptoms or mostly for cosmetic reasons. We also found that 12 of 18 cysts were located in the parameatus in the groups younger than 18 years, whereas only 7 of 38 cysts were found on the parameatal site in the group older than 18 years (Figure 7). A possible reason for this is that the cysts on the parameatal site could be easily noticed or were more likely to induce symptoms such as voiding difficulty, prompting parents or patients to seek treatment earlier.

The cysts were asymptomatic in 72% of the patients, as most cysts were located on the proximal portion of the genitalia. The more distal the location of the cysts, the greater was the manifestation of symptoms, such as pain or difficulty voiding. Based on the histopathological findings of our serial review, median raphe cysts can be classified into 4 types: urethral, epidermoid, glandular, and mixed. The urethral type is composed of a urothelium-like epithelium, with a layer of columnar cells overlaid with several stratified layers of uniform small cells; this is the most common type, accounting for 55% of all cases. The epidermoid type comprises a squamous epithelium and was noted in 5% of cases. The glandular type, consisting of a well-formed intraepithelial glandular structure in the lining of the urethral epithelium, accounted for 3% of cases. The second most common type, the mixed type, consists of more than 1 type of epithelium, including the urethral epithelium with partial squamous metaplasia, urethral epithelium with scattered or isolated mucinous cells, or all 3 occurring simultaneously, and was found in 35.7% of all cases. Nagore et al [3]. stated that the histomorphological features of the median raphe cyst are related to its embryonic origin and pathogenesis. The urethra forms as a result of fusion of the urethral folds and envelopment of the urethral groove during development. "Tissue trapping" could occur at this time or at a later stage either due to defective fusion of the urethral folds or anomalous outgrowths of the epithelium after primary closure [4]. The fossa navicularis is lined by a non keratinizing squamous epithelium that is similar and continuous to the epithelium covering the glands penis. The histogenesis of this squamous epithelium is explained by either ectodermal in growth or endodermal differentiation [7]. The epithelium of the distal urethra, except the fossa navicularis, is composed of a layer of columnar cells overlying 4-15 stratified layers of uniform small cells, usually categorized as a stratified or pseudo stratified epithelium. Differing from the classical features of the transitional urothelium of the proximal urethra, the nature of the anterior urethral lining appears to be related to that of the squamous epithelium. However, another theory proposed that median raphe cysts could also be caused during  development of the ectopic periurethral glands of Littre, which have clear mucinous cytoplasms and basally compressed nuclei resembling pyloric glands of the gastrointestinal tract [8]. This theory explains the presence of intraepithelial mucus cells and glandular structures in some cases. Median raphe cysts are supposed to be formed during the fusion of the urethral folds. Any trapped tissue outside the urethral groove may lead to anomalous outgrowths, thus resulting in the formation of cyst-or canal-like lesions in the median raphe of the genitalia. If the trapped tissue contains urothelium cells, the lining of the formed cyst would contain urethral epithelium. If non keratinizing squamous epithelium cells in the distal urethra are trapped, then we can expect the cyst to consist of an epidermoid epithelium. If the trapped tissue includes the periurethral glands, then the epithelium appears to be glandular. When 2 or more tissues are trapped and develop into outgrowths, cysts with mixed epithelia are formed. Ciliated cells in median raphe cysts are a rare finding, with only 5 cases reported in the English literature. The pathogenesis is probably a metaplastic change secondary to a local irritation [9,10]. Excision followed by primary closure, which establishes hemostasis and prevents infection or cosmetic sequelae, remains the optimal treatment. Given that one of our patients developed a fistula after the operation, excision must be performed with caution when inflammation or adhesion is noted. However, spontaneous regression of the cyst has also been reported, [11] and observation can be considered for those who hesitate to undergo surgery for small and asymptomatic lesions. One patient received aspiration, and recurrence of the cyst was noted a few months later. Thus, simple aspiration alone is not recommended as a treatment for median raphe cysts. Further, marsupialization or unroofing performed in cases of deeply located large cysts, will result in a gaping sinus, which is cosmetically unsatisfactory, and these procedures should be avoided [12].

Conclusions

The histopathological features of median raphe cysts are varied and can be classified into 4 types of cell manifestations. The diversification of the epithelium may be due to a congenital anomaly of the genitalia, with remnants of embryogenesis or acquired metaplasia of the genitalia. However, no malignant potentiality was observed during long-term follow-up in our study. The associated symptoms and signs should be considered in the treatment of these cysts.

Figure 1
1Two synchronous cysts at the ventral side of the penile shaft of a 16-year-old patient.

Figure 2
2Age distribution with bimodal characteristic.

Figure 3
3Urethral type epithelium, consisted with one layer of columnar cells overlying varying stratified layers of uniform small cells (Hematoxylin and eosin stain, 400X).

Figure 4
4Squamous eputhelium in the median raphe cyst (Hematoxylin and eosin stain, 400X).

Figure 5
5A well-formed intraepithelial glandular structure in the lining of median raphe cyst, resembling Littré gland (Hematoxylin and eosin stain, 400X).

Figure 6
6Ciliated cells in median raphe cysts, probably a metaplastic change secondary to local irritation (Hematoxylin and eosin stain, 400X).

Figure 7
7Relationship between the age being diagnosed and the occurrence site.

Table 1
1General data and characteristics of patientAverage age (range)
26.7 y/o (1 y/o -66 y/o)

No. Age distribution (%)

0~10 y/o
14 (25.5)

11~20 y/o
6 (10.9)

21~30 y/o
11 (20.0)

31~40 y/o
12 (21.8)

41~50 y/o
6 (10.9)

51~60 y/o
4 (7.3)

61~70 y/o
2 (3.6)

No. symptom/total No. (%)

Pain / inflammation
9/55 (16.4)

Difficult voiding
4/55 (7.3)

Hematuria
1/55 (1.8)

Hematospermia
1/55 (1.8)

Asymptomatic
40/55 (72.7)

No. location/total (%)

Parameatus
19 (33.9)

Glans penis
4 (7.1)

Penile shaft
24 (42.9)

Scrotum
2 (3.6)

Prepuce
7 (12.7)

Average diameter of the cyst in cetimeter (range)

Parameatus
0.80 (0.2~3.0)

Glans penis
0.95 (0.6~11.3)

Penile shaft
0.79 (0.2~1.5)

Scrotum
2.0 (1.9~2.1)

Prepuce
0.92 (0.5~1.2)

No. pathological type (%)

Urethral type epithelium
31 (55.4)

Epidermoid type epithelium
3 (5.4)

Glandular type epithelium
2 (3.4)

Mixed type epithelium
20 (35.7)

No. complication / recurrence (%)

Fistula
1 (1.8)

None
54 (98.2)

http://www.diagnosticpathology.org/content/7/1/121
Competing interestsThere are no competing interests in this study.Author's contributions IHS carried out the preparation of the manuscript draft and participated in the analysis and interpretation of the data. TDC reviewed the pathological results and analyzed and interpreted the data. STS participated in the data collection. HWC participated in the revision and editing of the manuscript. IHS and TDC contributed equally to this study. All the authors read and approved the final manuscript.
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Male median raphe cysts: serial retrospective analysis and histopathological classification. Shao, Diagnostic Pathology. 121Cite this article asCite this article as: Shao et al.: Male median raphe cysts: serial retrospective analysis and histopathological classification. Diagnostic Pathology 2012 7:121.