ABSTRACT
Background: While international experience suggests that well-trained primary care physicians improve the quality and cost effectiveness of health care, family medicine (FM) as the discipline of the specialist primary care physician appears to not be an attractive career for medical graduates in South Africa (SA). The aim of this study was to establish final-year medical students' knowledge about FM and its relevance to the healthcare system, explore their perceptions of the discipline's relevance, and identify their specialty preference.Methods: This was a descriptive study conducted amongst final-year medical students at the University of KwaZulu-Natal (UKZN) in 2017 attheconclusion of their seven-week FM module. Data were collected using a self-administered questionnaire and results were analysed descriptively.Results: The response rate of completed questionnaires was 80.2% (157/196). Students reported limited exposure to FM in their early undergraduate years and low levels of awareness about essential public health programmes. Students showed good awareness of the six roles of family physicians (FPs), but FM was only the sixth most popular choice for specialisation. Conclusions: In general, students had favourable views concerning FM and its role in the future of healthcare delivery in SA,although their knowledge of essential health programmes was poor. The majority of students had limited interest in pursuing a career in FM. A key recommendation to address these issues is to introduce FM into the curriculum earlier, to cover the key roles of the FP, and provide teaching that highlights the relevance of FM to health system programmes
Subject(s)
Family Practice , Health Knowledge, Attitudes, Practice , South Africa , Students, MedicalABSTRACT
Background: South Africa has 7.06 million people who are HIV-positive, with those having a low CD4 count being susceptible to cryptococcal meningitis (CCM), which has an estimated mortality of 3050%. This study aimed to establish the outcome of patients admitted with CCM to a regional hospital in Durban between June 2015 and May 2016, and the extent to which the National Department of Health (NDoH) protocol was adhered to in managing their condition. Method: This retrospective observational descriptive study reviewed the records of patients ⥠12 years old admitted with CCM between June 2015 and May 2016, from which their demographic and medical data were extracted.Results: Seventy-six complete records were found of which 49 were men and 27 were women. The average CD4 count was 55.9 cells/mm3, 85.5% were treated with intravenous amphotericin B and high-dose oral fluconazole, 6.7% received only amphotericin B and 5.2% received only fluconazole. There was an in-hospital mortality of 31.6%, and the NDoH protocol was adhered to in 72.4% (55/76) of patients. There was, however, no significant difference in outcome between those who were and were not managed as per the protocol (p = 0.177).Discussion and conclusion: In-hospital mortality for CCM continues to be significant despite high rates of adherence to the NDoH protocol in the majority of patients. For this to be addressed, early diagnosis of HIV and initiation of ART to prevent the profound immunosuppression is essential
Subject(s)
Cryptococcus , Meningitis , South AfricaABSTRACT
Background. There is a dire need for medical schools in South Africa to train medical doctors who have the capacity and willingness to work in primary healthcare facilities; particularly in rural areas. Objectives. To assess the effect of students' gender; race; place of birth and place of high school completion on their choice of training site location and to assess the extent to which the training programme enhanced students' learning experiences relevant to primary care across training sites. Methods. A survey design involving six cohorts of 4th-year undergraduate medical students (N=187) who were part of the 2013 Family Medicine rotation at the Nelson R Mandela School of Medicine. Self-administered questionnaires were completed by students at the end of each rotation. Data analyses involved descriptive computations and inferential statistical tests; including non-parametric tests for group comparison and generalised polynomial logistic regression. Results. Students believed that their knowledge and skills relevant to primary care increased after the rotation (p0.0001). There were statistically significant differences between rural and urban sites on certain measures of perceived programme effectiveness. Male students were less likely to choose urban sites. Black students were less likely to choose rural sites compared with their white and Indian counterparts; as were students who attended rural high schools (odds ratio (OR) 9.3; p0.001). Students from a rural upbringing were also less likely to choose rural sites (OR 14; p0.001). Conclusion. Based on the findings; an objective approach for student allocation that considers students' background and individual-level characteristics is recommended to maximise learning experiences
Subject(s)
Health Facilities , Primary Health Care/education , Rural Health , South Africa , StudentsABSTRACT
Background: Provision of surgical services at district hospitals (DHS) is cost effective and important. The District Hospital Service Package for South Africa (package of services) specifies the services that a district hospital should provide. The aim of this study was to document the surgical services provided at two DHS in KwaZulu-Natal and to compare this with the recommendations in the package of services. Methods: In a retrospective quantitative study; data from 2008 were collected from the theatre register at two DHS. Data were analysed and results compared with the norms and standards in the package of services. Results were presented to staff at the hospitals; who then commented on the challenges of providing surgical services at DHS. Results: Only 60and 30respectively of procedures listed in the package of services were being carried out at the two hospitals. In total; 3 900 procedures were carried out over the year. Dundee Hospital offered a broader range of surgical procedures and anaesthetics than the Church of Scotland Hospital (COSH). COSH has a large obstetric burden; with 3 666 deliveries each year. A large number of procedures were being carried out by a single operator. Conclusions: Many surgical procedures are being carried out even though neither hospital provides the full complement of surgical services as specified in the package of services. The wide variation between the surgical services offered reflects the surgical and anaesthetic skills at the respective hospitals. Potential medico-legal hazards that require urgent attention were identified. A review of the package of services is essential to identify core procedures that must be provided at DHS
Subject(s)
Anesthesia Department, Hospital , Hospitals , Standard of CareABSTRACT
This study assesses the retention of core knowledge and skills among healthcare providers (HCPs) who attended a Basic Life Support (BLS) course. The format for teaching this course changed in 2006 and a review of the effectiveness and acceptability of the new course was considered vital. Studies indicate that early and effective cardiopulmonary resuscitation improves the chances of survival in cardiac arrest victims; however; the knowledge and skills of HCPs in basic life support vary. International recommendations on the BLS course were that HCPs repeat the course every two years. However; no studies have been conducted in South Africa to determine the ideal time when HCPs should be re-evaluated to ensure that they retain adequate knowledge and skills. This study was conducted at a training centre in a hospital in KwaZulu-Natal; where a new format for training was introduced in 2006. Participants were HCPs who had completed a BLS course. The sample was taken sequentially from half of the annual intake of a BLS course three months after completion of the course. Data were collected using the accredited American Heart Association written test and the Critical Skills Checklist; and a further questionnaire was developed to collect variables such as demography and profession. Results indicate that skills retention was good and; although there was some fall-off in skills and knowledge; there was no significant difference between the scores at the end of the course and retest scores. Staff working in accident and emergency departments had more practical experience and their knowledge and skills retention was better than that of staff working in other areas of the hospital. Nurses performed nearly as well as doctors and are an important skills resource in the management of patients who need to be resuscitated. All participants were satisfied with the new format and had no suggestions on how to improve it
Subject(s)
Attitude , Cardiopulmonary Resuscitation , Health Literacy , Health Personnel , Retention, PsychologyABSTRACT
Background: Community service (CS) is an effective recruitment strategy for underserved areas; using legislation as the driver; however it is not a retention strategy. By the end of each year; most CS officers working in district hospitals (DH) are skilled; valued and valuable members of the health team; able to cope with the demands of working in the public health service within the resources available at DHs. Their exodus at the end of each annual cycle represents a net loss of valuable skills and experience by the public service; measured by the time and effort required to orientate and induct the following cohort of CS officers. This in turn has a negative effect on the level of service delivery and the quality of patient care. This study sought to understand the motivations of CS officers to continue working at the same DH for a subsequent year after their obligatory year was over. The objectives were to determine the number of CS officers who actually remained at the same DH after completing their CS in 2002; the major factors that influenced them to remain; and factors that would encourage the 2003 cohort of CS officers to remain for an additional year at the same DH. Methods: A descriptive cross- sectional study design was employed using qualitative methods with the cohort of CS officers who had completed their compulsory CS year in 2002 and who were still working at the same DH in July 2003. This was followed by a quantitative survey of CS officers doing their CS at DHs in KwaZulu-Natal (KZN); Eastern Cape (EC) and Limpopo Province (LP) in November 2003. Results: 22/278 (8) of the 2002 cohort of CS officers in KZN; EC and LP remained at the same DH in the year following their CS. The reasons given; in order of decreasing priority; were that they were close to home; had been allocated as part of their CS; were personally recruited; had bursary commitments; had heard about the hospital from friends; had visited the hospital prior to starting community service; and had visited as a medical student. Four others did not specify reasons. In the larger quantitative study 150 / 221 questionnaires were returned. More than 80of the respondents felt that there had been opportunities to develop confidence in their own ability to make independent decisions; that they had had good relations with the hospital staff; and that they had been able to make a difference in health care delivery. Between 67and 76of respondents felt that they were providing a good standard of care; that there were learning opportunities; that they were doing worthwhile work and saw CS as excellent work experience. However only 52of respondents felt that there had been opportunities for personal growth; 38felt that appropriate equipment was available; 37had a supportive mentor figure and 29felt that there were adequate levels of staffing at the hospital. In total 24 (16) of the 150 who responded to the questionnaire indicated a willingness to remain at the same DH after completion of their year of CS. The intention to continue for a further year was statistically significantly associated with the following factors: ethnic group; province; rural origin; allocation priority and bursary commitment. Conclusions: The retention in the same DH of only 8of the CS officer cohort in 3 rural provinces indicates a serious loss of skills on a recurrent annual basis. Local hospital management can do much to strengthen the factors that would attract CS officers to stay on by improving orientation; mentoring; teamwork; professional development opportunities; medical equipment and accommodation