Optimising the learning environment for undergraduate students in the department of family medicine at sefako makgatho health sciences university

Background: An important determinant of a medical student's behaviour and performance is the department's teaching and learning environment. Evaluation of such an environment can explore methods to improve educational curricula and optimise the academic learning environment.Aim: The aim is to evaluate the educational environment of undergraduate students in the Department of Family Medicine as perceived by students.Setting: This descriptive quantitative study was conducted with one group of final-year students (n = 41) enrolled in 2018, with a response rate of 93% (n = 39). Students were in different training sites at SMU.Methods: Data were collected using the Dundee Ready Educational Environmental Measure (DREEM) questionnaire. Total and mean scores for all questions were calculated.Results: The learning environment was given a mean score of 142/200 by the students. Individual subscales show that 'academic self-perception' was rated the highest (25/32), while 'social self-perception' had the lowest score (13/24). Positive perception aspects of the academic climate included: student competence and confidence; student participation in class; constructive criticism provided; empathy in medical profession; and friendships created. Areas for improvement included: provision of good support systems for students; social life improvement; course coordinators being less authoritarian and more approachable; student-centred curriculum with less emphasis on factual learning and factual recall.Conclusion: Students' perceptions of their learning environment were more positive than negative. The areas of improvement will be used to draw lessons to optimise the curriculum and learning environment, improve administrative processes and develop student support mechanisms in order to improve students' academic experience

The changing landscape of infective endocarditis in South Africa

Background. Little is known about the current clinical profile and outcomes of patients with infective endocarditis (IE) in South Africa (SA). Objectives. To provide a contemporary and descriptive overview of IE in a representative SA tertiary centre. Methods. We conducted a retrospective review of the records of patients admitted to Groote Schuur Hospital, Cape Town, between 2009 and 2016 fulfilling universal criteria for definite or possible IE, in search of demographic, clinical, microbiological, echocardiographic, treatment and outcome information. Results. A total of 105 patients fulfilled the modified Duke criteria for IE. The median age of the cohort was 39 years (interquartile range (IQR) 29 - 51), with a male preponderance (61.9%). The majority of the patients (72.4%) had left-sided native valve endocarditis, 14.3% had right-sided disease, and 13.3% had prosthetic valve endocarditis. A third of the cohort had rheumatic heart disease. Although 41.1% of patients with left-sided disease had negative blood cultures, the three most common organisms cultured in this subgroup were Staphylococcus aureus (18.9%), Streptococcus spp. (16.7%) and Enterococcus spp. (6.7%). Participants with right-sided endocarditis were younger (29 years, IQR 27 - 37) and were mainly intravenous drug users (73.3%), and the majority cultured positive for S. aureus (73.3%) with frequent septic pulmonary complications (40.0%). The overall in-hospital mortality was 16.2%, with no deaths in the group with right-sided endocarditis. Predictors of death in our patients were heart failure (odds ratio (OR) 8.16, 95% confidence interval (CI) 1.77 - 37.70; p=0.007) and age >45 years (OR 4.73, 95% CI 1.11 - 20.14; p=0.036). Valve surgery was associated with a reduction in mortality (OR 0.09, 95% CI 0.02 - 0.43; p=0.001). Conclusions. IE remains an important clinical problem in a typical teaching tertiary care centre in SA. In this setting, it continues to affect mainly young people with post-inflammatory valve disease and congenital heart disease. The in-hospital mortality associated with IE remains high. Intravenous drug-associated endocarditis caused by S. aureus is an important IE subset, comprising ~10% of all cases, which was not reported 15 years ago, and culture-negative endocarditis remains highly prevalent. Heart failure in IE carries a significant risk of death and needs a more intensive level of care in hospital. Finally, cardiac surgery was associated with reduced mortality, with the largest impact in patients with heart failure

A comparison of Clinical Communication Skills between Two Groups of Final Year Medical Students with Different Levels of Communication Skills Training

"Background : Training in communication skills is prominent in many undergraduate medical programmes. In South Africa; training in this highly complex skill is developing rapidly; especially against the backdrop of a multilingual and multicultural society. Little work has been done locally to evaluate which training works best in our context. In 1999; the Stellenbosch University Faculty of Health Sciences introduced a new curriculum that included considerably more communication skills training. The aim of this study was to assess and compare the communication skills used in the consultations of two groups of final-year medical students who had different levels of communication skills training in order to make recommendations on appropriate changes in this training. Results : A total of 161 interviews were analysed. Both groups performed well (mean = 1) in listening to the opening question; encouraging the patients to tell their story; and demonstrating appropriate non-verbal behaviour. However; ending the session by summarising and clarifying the plan was poorly performed (mean = 0.4). The 2004 group was statistically significantly better in structuring the consultation by using signposting (p value = 0;02). Methods : Standardised doctor-patient interviews performed by students during the final-year examinations in 2003 and 2004 were videotaped. These were assessed by two independent; blinded evaluators using an abbreviated version of the Calgary-Cambridge communication guide for skills not done (0) and done (1). The data was analysed using STATISTICA 7. Results : A total of 161 interviews were analysed. Both groups performed well (mean = 1) in listening to the opening question; encouraging the patients to tell their story; and demonstrating appropriate non-verbal behaviour. However; ending the session by summarising and clarifying the plan was poorly performed (mean = 0.4). The 2004 group was statistically significantly better in structuring the consultation by using signposting (p value = 0.02).Conclusion : There are a number of influences on the effectiveness of communication skills training; including issues around language; culture and gender; student attitudes; the significance of communication skills training in the programme and; most importantly; the integration of this training into the curriculum as a whole. Merely adding more time to communication skills training does not seem to be the answer. Incorporating a wider range of training methods is also important. The results of this impact study acted as an impetus for innovative curriculum development in our faculty; leading to the development of a comprehensive clinical model and a ""golden thread""? for communication skills in the curriculum to ensure the longitudinal integration of communication skills."

The knowledge and skills gap of medical practitioners delivering district hospital services in the Western Cape; South Africa

Introduction District (community) hospitals play an important role in the delivery of health services at community level; especially in rural areas. These hospitals provide comprehensive level-one health services to their communities; and serve as a resource for the whole health district. Most district hospitals are situated in rural areas; with medical services in these hospitals being rendered by generalist medical practitioners. The education and training of generalist practitioners for rural practice needs specific attention. Firstly; the unique nature of rural practice makes it necessary for doctors to undergo relevant and focused instruction. Rural family practice requires that doctors have the knowledge and skills to practise in settings where high technology and specialist resources are not available; while at the same time requiring that they be able to perform a wide range of advanced functions and procedures. Secondly; it is argued that appropriate education and training for rural practice can positively influence the recruitment and retention of medical practitioners in rural areas.5 The teaching of the knowledge and skills required for rural practice should take place in an appropriate setting that promotes interest in rural practice and familiarises the student with its particular challenges. There is a paucity of data in South Africa on medical practitioners staffing district hospitals; especially in terms of their knowledge and skills levels. Such information is critical if rural hospitals are to deliver equitable and quality health services; and also for guiding appropriate undergraduate; postgraduate and continuing professional education for rural practice. With this as background; health service managers in the Western Cape requested a skills audit of medical officers in district hospitals to identify a possible gap in competencies that may impact on service delivery. The aim of this study was thus to identify the knowledge and skills of medical practitioners delivering these services in the Western Cape and to compare them with service needs in order to make recommendations for education and training. This article reports on the results of the knowledge and skills gap analysis; while the results of the district hospital performance data and in-depth interviews are reported elsewhere. Method The competencies of medical practitioners working in 27 district hospitals were explored by using a self-administered questionnaire containing a competency rating of proxy markers. The data were analysed using the SAS statistical package. Variables were examined for statistically significant differences. Results A response rate of 75

The Knowledge and Skills Gap of Medical Practitioners Delivering District Hospital Services in the Western Cape; South Africa

Introduction: District (community) hospitals play an important role in the delivery of health services at community level; especially in rural areas. These hospitals provide comprehensive level-one health services to their communities; and serve as a resource for the whole health district. Most district hospitals are situated in rural areas; with medical services in these hospitals being rendered by generalist medical practitioners. The education and training of generalist practitioners for rural practice needs specific attention. Firstly; the unique nature of rural practice makes it necessary for doctors to undergo relevant and focused instruction. Rural family practice requires that doctors have the knowledge and skills to practise in settings where high technology and specialist resources are not available; while at the same time requiring that they be able to perform a wide range of advanced functions and procedures. Secondly; it is argued that appropriate education and training for rural practice can positively influence the recruitment and retention of medical practitioners in rural areas.5 The teaching of the knowledge and skills required for rural practice should take place in an appropriate setting that promotes interest in rural practice and familiarises the student with its particular challenges. There is a paucity of data in South Africa on medical practitioners staffing district hospitals; especially in terms of their knowledge and skills levels. Such information is critical if rural hospitals are to deliver equitable and quality health services; and also for guiding appropriate undergraduate; postgraduate and continuing professional education for rural practice. With this as background; health service managers in the Western Cape requested a skills audit of medical officers in district hospitals to identify a possible gap in competencies that may impact on service delivery. The aim of this study was thus to identify the knowledge and skills of medical practitioners delivering these services in the Western Cape and to compare them with service needs in order to make recommendations for education and training. This article reports on the results of the knowledge and skills gap analysis; while the results of the district hospital performance data and in-depth interviews are reported elsewhere.Method: The competencies of medical practitioners working in 27 district hospitals were explored by using a self-administered questionnaire containing a competency rating of proxy markers. The data were analysed using the SAS statistical package. Variables were examined for statistically significant differences.Results: A response rate of 75 (110/147) was achieved. Part-time (older) medical officers regarded themselves as more experienced and more competent than full-time (younger) employees in most areas; except when managing problems relating to HIV/AIDS. Termination of pregnancy was the procedure most frequently not performed despite practitioners being competent to do so. A substantial need for supervision was identified for managing less common emergency conditions; as well as for some outpatient problems; including preventative; promotive and rehabilitation activities.Conclusions: The knowledge and skills gaps varied considerably according to the individuals' education; training and experience; as well as their circumstances and working conditions. The superior competencies of the older practitioners reinforce the importance of the recruitment and retention of more experienced practitioners. The uneven skill and knowledge base in aspects of HIV/AIDS management should be addressed urgently by initiatives such as the internet-based course on HIV/AIDS developed by the Family Medicine Education Consortium (FaMEC). Departments of Family Medicine should urgently re-orientate their curricula to meet the training needs for level-one hospital practice

The Maintenance of Competence of Rural District Hospital Practitioners

Introduction: It is important for rural district hospital practitioners to maintain their competence to provide equitable health service for rural communities. The scope of their practice dictates that they must stay up-to-date with a large variety of knowledge and skills despite limited educational opportunities. Rural practitioners use continuing professional development (CPD) activities that are most accessible to them; but it is not known whether these activities are educationally sound and effective.Aim: We designed a study to investigate the content and methods used for the maintenance of competence by rural district hospital practitioners in the Western Cape Province; South Africa.Methods: Expert opinion was sought to evaluate the topics requiring up-dating and the validity of the learning methods to maintain competence in practice. This was achieved by employing the Delphi technique to reach consensus on content and methodology. Categorical data analysis and a principal factor analysis were performed. The qualitative data were developed into themes and presented as a conceptual framework.Results: Consensus was reached on the principal content areas requiring updating. Methods that were found most useful were in-service learning under supervision; structured courses; small group discussions and practical workshops. Rotations in tertiary hospitals; lectures by specialists; journal reading and Internet learning were less supported.Conclusion: This study provides a practical model for continuing instruction plus self-directed learning in context. Three content domains were established namely; commonly encountered areas of practice; identified gaps and needs specific to the practitioner and the setting. The implementation of external updating programmes must be tailored to suit the practitioners while the self-directed aspects should include reflective practice. Priority areas are identified and classified as well as educational methods which can contribute towards the maintenance of competence of rural practitioners

Provincial restructuring

At the time of the 1994 elections; public health services were largely outside of democratic control. Segregation and racial discrimination were institutionalised; services offered to marginalised groups including women; HIV patients and rural blacks were discriminatory and stagnant. This article looks at the position of the provincial health departments; sandwiched between the national Department of Health and multiple local government health departments. It also examines the challenges that are faced by these provincial health departments as they try to transform the delivery system of health services in South Africa

The Guidebook for District Hospital Managers

The North West Department of Health commissioned the Health Systems Trust (HST) to develop a supervisory manual or handbook for district hospitals. The overriding aim of developing a guidebook for district hospitals in the North West Province was to develop a practical resource tool for hospital managers which can be used to improve the daily management and supervision of district hospitals. The guidebook will guide managers on how to critically assess the functioning of the district hospital and will ultimately be instrumental in ensuring the provision of high quality district hospital services throughout the province and nationally. This Guidebook was developed for the North West Province to provide practical guidelines for managers in district hospitals with varying degrees of experience. The Guidebook can be utilised anywhere in South Africa. Although the Guidebook is primarily aimed at the district hospital management team it was also found to be useful to heads of wards; units and components of the district hospital. Provincial management can also use the guidebook to assist them in their task of assessing the functioning of district hospitals