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

Compliance efficacy and patient satisfaction with two litre polyethylene glycol ascorbic acid for colonoscopy preparation in a outreach rural setting

Background: Annual surveillance of Lynch Syndrome patients from the rural Northern Cape Province of South Africa is conducted with a mobile colonoscopic unit. Excellent preparation of the colon is essential to detect small right sided lesions. We wished to evaluate a two litre polyethylene glycol (PEG) electrolyte solution containing ascorbic acid and sodium ascorbate Moviprep® as preparation for colonoscopy in this cohort. Methods: Six weeks prior to the colonoscopy surveillance week, a team travelled to the area to prepare the patients for colonoscopy. Patients were individually counselled on the importance of bowel cleansing and the use of Moviprep®. Prior to their colonoscopy, subjects completed a product acceptability questionnaire. At the procedure, the quality of bowel preparation was assessed by a single individual (DJdV) using the Harefield cleansing scale grades; grades A or B were defined as good preparation and grades C or D as poor preparation. Results: Sixty four of the 71 subjects seen on the preparation trip completed the questionnaire and took their Moviprep®. The questionnaire responses showed that 53 (83%) had used other colon preparations previously and 57 (89%) would prefer Moviprep® for their next colonoscopy. Eighteen patients did not undergo colonoscopy due to time constraints. Forty-one of the 46 subjects (89%) who underwent colonoscopy had successful colonic preparation 7 of whom received an extra litre of Moviprep due to stool based nursing assessment prior to colonoscopy. Side effects of nausea and hunger were occasionally troublesome but did not affect compliance. Conclusion: When patients are pre-councelled, Moviprep® provides adequate colonic cleansing in 73% with the standard regimen and 89 % after additional prep in subjects undergoing surveillance colonoscopy in a rural setting. Moviprep was tolerated well and 88% of subjects would choose the same preparation for their next colonoscopy

SSR genetic diversity assessment of popular pigeonpea varieties in Malawi reveals unique fingerprints

Background: Pigeonpea (Cajanus cajan (L.) Millsp.) is a drought tolerant legume of the Fabaceae family and the only cultivated species in the genus Cajanus. It is mainly cultivated in the semi-arid tropics of Asia and Oceania, Africa and America. In Malawi, it is grown as a source of food and income and for soil improvement in intercropping systems. However, varietal contamination due to natural outcrossing causes significant quality reduction and yield losses. In this study, 48 polymorphic SSR markers were used to assess the diversity among all pigeonpea varieties cultivated in Malawi to determine if a genetic fingerprint could be identified to distinguish the popular varieties. Results: A total of 212 alleles were observed with an average of 5.58 alleles per marker and a maximum of 14 alleles produced by CCttc019 (Marker 40). Polymorphic information content (PIC), ranged from 0.03 to 0.89 with an average of 0.30. A neighbor-joining tree produced 4 clusters. The most commonly cultivated varieties, which include released varieties and cultivated land races, were well-spread across all the clusters observed, indicating that they generally represented the genetic diversity available in Malawi, although substantial variation was evident that can still be exploited through further breeding. Conclusion: Screening of the allelic data associated with the five most popular cultivated varieties, revealed 6 markers - CCB1, CCB7, Ccac035, CCttc003, Ccac026 and CCttc019 - which displayed unique allelic profiles for each of the five varieties. This genetic fingerprint can potentially be applied for seed certification to confirm the genetic purity of seeds that are delivered to Malawi farmers.

The Effects of Iron Deficiency and Anaemia on Primary School Learners' Scholastic Performance

Background. Iron deficiency anaemia (IDA) is a preventable cause of cognitive impairment and other negative effects on the academic potential of learners. Objectives. To determine the local prevalence of IDA among grade 2 learners in a resource-poor community and to evaluate the association between IDA and the learners' scholastic performance. Methods. This was a case-control observational design study. Data were collected using a stadiometer and an electronic scale; HemoCue Hb 201+ system and official grade 1 school reports. Results. The point prevalence of IDA was found to be 9.8% (n=19); with a higher prevalence among girls (58%). There was no statistically significant difference between the performances of the two groups (p=0.511) in mathematics. There was a statistically significant difference for life skills (p=0.00017); and the difference between the groups in literacy or languages approached statistical significance (p=0.071). Conclusions. The results of this study suggest that IDA is prevalent and may have negative effects on learners' scholastic performances. Such negative effects warrant early preventive measures so as to avoid the possibilities of school failure; drop-out and poor productivity in adulthood

Identification of groundnut (Arachis hypogaea) SSR markers suitable for multiple resistance traits QTL mapping in African germplasm

Background This study aimed to identify and select informative Simple Sequence Repeat (SSR) markers that may be linked to resistance to important groundnut diseases such as Early Leaf Spot, Groundnut Rosette Disease, rust and aflatoxin contamination. To this end, 799 markers were screened across 16 farmer preferred and other cultivated African groundnut varieties that are routinely used in groundnut improvement, some with known resistance traits. Results The SSR markers amplified 817 loci and were graded on a scale of 1 to 4 according to successful amplification and ease of scoring of amplified alleles. Of these, 376 markers exhibited Polymorphic Information Content (PIC) values ranging from 0.06 to 0.86, with 1476 alleles detected at an average of 3.7 alleles per locus. The remaining 423 markers were either monomorphic or did not work well. The best performing polymorphic markers were subsequently used to construct a dissimilarity matrix that indicated the relatedness of the varieties in order to aid selection of appropriately diverse parents for groundnut improvement. The closest related varieties were MGV5 and ICGV-SM 90704 and most distant were Chalimbana and 47-10. The mean dissimilarity value was 0.51, ranging from 0.34 to 0.66. Discussion Of the 376 informative markers identified in this study, 139 (37%) have previously been mapped to the Arachis genome and can now be employed in Quantitative Trait Loci (QTL) mapping and the additional 237 markers identified can be used to improve the efficiency of introgression of resistance to multiple important biotic constraints into farmer-preferred varieties of Sub-Saharan Africa.

Compilation of an informative microsatellite set for genetic characterisation of East African finger millet (Eleusine coracana)

Background Genetic diversity of finger millet (Eleusine coracana), a nutritious neglected staple cereal in Africa and South Asia is largely uncharacterized. This study analysed 82 published SSR markers for finger millet across 10 diverse accessions to compile an informative set for genetic characterisation. Extensive optimization compared single samples with bulked leaf or bulked DNA samples for capturing within accession genetic diversity. The markers were evaluated to determine (1) how efficiently they amplified target loci during high-throughput genotyping with a generic PCR protocol, (2) ease of scoring PCR products and (3) polymorphism and ability to discern genetic diversity within the tested finger millet germplasm. Results Across 88 samples, the 52 markers that worked well amplified 274 alleles, ranging from 2 to 14 per locus with a mean of 4.89. Major allele frequency ranged from 0.18 to 0.93 with a mean of 0.57. Polymorphic Information Content (PIC) ranged from 0.13 to 0.88 with a mean of 0.5 and availability varied between 64 and 100% with a mean of 92.8%. Heterozygosity ranged from 0 to 1.0, with a mean of 0.26. Discussion Five individual samples from an accession captured the largest number of alleles per locus compared to the four different bulked sampling strategies but this difference was not significant. The identified set comprised 20 markers: UGEP24, UGEP53, UGEP84, UGEP27, UGEP98, UGEP95, UGEP64, UGEP33, UGEP67, UGEP106, UGEP110, UGEP57, UGEP96, UGEP66, UGEP46, UGEP79, UGEP20, UGEP12, UGEP73 and UGEP5 and was since used to assess East African finger millet genetic diversity in two separate studies.

In search of an effective teaching approach for skill acquisition and retention: teaching manual defibrillation to junior medical students

Introduction: Although overloaded curricula; the increasing student to educator ratio; limited resources; insufficient curriculum alignment and the unpredictable clinical learning environment contribute to the decay of clinical skill competency; the problem of poor skill retention often lies in inadequate skill acquisition which is associated with the quality of the instruction. The aim of the study was to investigate the influence of three different instructional approaches on the acquisition and retention of skills in order to determine which method would be best suited for teaching in simulation in a resource-constrained environment. Methods : A randomised controlled trial design was used to compare the efficacy of the traditional; Peyton's four-stage; and a modified five-step method. Regarding the latter; George and Doto's five-step method was altered to include peer teaching and feedback with a tutor in a supervisory role. Groups of first year students were taught 'manual defibrillation'. Subsequent to the teaching session as well as at two months later; students' skills were tested. Additional qualitative data regarding students' perceptions of the different teaching strategies they were exposed to were obtained by means of questionnaires. Results: None of the three instructional approaches proved to be superior in acquisition or retention. Previous studies reported similar findings. The lack of differentiation between the three teaching methods might be attributed to the fact that all three methods included practice with feedback in one form or another. Numerous studies have identified these as critical components leading to effective learning in a simulation-based learning environment. Conclusion: Considering that the three instructional approaches were similar in terms of skill acquisition and retention; incorporating peer teaching and feedback is a feasible strategy in a resource-limited environment

The Use of the Road to Health Card in Monitoring Child Health

Objectives: The Road to Health Chart (RTHC) provides a simple; cheap; practical and convenient method of monitoring child health. The RTHC could assist with vaccine compliance and early identification of growth faltering; to improve general health. The purpose of the study was to assess whether the RTHCs were adequately completed and interpreted at primary; secondary and tertiary care levels in South Africa.Methods: The study was carried out at a primary; secondary and tertiary care centre. A questionnaire was administered to 100 subjects from each; seeking demographic information; whether the RTHC was brought along; and if not why it was not brought.Results: Most children were brought by their mothers. The RTHC was not brought to 48 of the consultations; of those; about 72 thought that bringing the RTHC along was not necessary. Health workers seldom asked to see the RTHC at the primary and secondary care settings; but 50 of them did so at Ga-Rankuwa Hospital (p = 0;002). In only 8 cases overall were the children below the 3rd percentile of weight-for-age. Approximately 20 had incomplete immunisations.Conclusions: Many parents believe that the RTHC is only required for Well-baby-clinic visits; not for consultations. The RTHC is not often asked for at consultations; the fact that this is more often done at the tertiary care centre may be that much of the service is supplied by paediatricians-in-training. Health workers should ask to see the RTHC; in order for mothers to understand the importance of the information. The study showed that the RTHC is not used to its full potential

Occupational Exposure to Bloodborne Viruses amongst Medical Practitioners in Bloemfontein; South Africa

Background : The possibility of occupational exposure to bloodborne viruses such as HIV; hepatitis B virus (HBV) and hepatitis C virus (HCV) is an everyday reality to health care workers. This study reports on doctors' extent and outcome of exposure to bloodborne viruses in Bloemfontein. Methods : descriptive study was done. Doctors (n=441) actively involved in public and/or private medical practice were requested to anonymously complete a questionnaire regarding occupational exposure to bloodborne viruses (HIV; HBV; and HCV). Results : A response rate of 51.7 was obtained. More than half (54.2; 95 CI [ 47.7 ; 60.5 ]) of respondents were exposed to bloodborne viruses; 48.3 occurring with HIV positive patients and 4.3with known HBV positive patients; and no positive HCV patients. After exposure occurred; 68.9 of patients were tested for HIV; 10.9 for HBV and only 4.2 for HCV infection. The frequency of serological testing for doctors immediately after exposure was 65.3 for HIV; 21.7 for HBV and 8.2 for HCV. No seroconversion to HIV or HCV was reported; while two seroconversions to HBV were reported. Most exposures occurred as a result of needle stick injury (85) and occurred in the operating theatre during . The majority (59.8procedures 59.3)of exposed doctors did not take any prophylactic treatment and those who did; did not always complete the treatmentConclusion : The risk of seroconversion to HIV after occupational exposure was as expected; while seroconversion to HBV was less than expected. The lack of adequate follow up serological testing after occupational exposure is alarming. It is the responsibility of the occupationally exposed doctor to adequately comply with prophylactic measures and undergo serological testing to ensure the least possible risk of contracting infection from a bloodborne virus

Emergency Care Provision for; and Psychological Distress in; Survivors of Domestic Violence

"Background : This study aimed (i) to ascertain the number of treatment referrals and information about protection orders given to survivors of domestic violence presenting for emergency trauma care; as reported at the one-month visit; (ii) to obtain a profile of violent incidents and injuries; and (iii) to assess self-esteem and posttraumatic and depressive symptomatology in the aftermath of injury.Methods : A survey of 62 participants presenting in the acute aftermath of domestic violence (as defined by the Domestic Violence Act of 1998) was conducted over 12 weeks at the Trauma and Resuscitation Unit of a Level One trauma centre in an urban public hospital in South Africa.1 Following informed consent; face-to-face structured interviews were conducted during admission and a month later. The following instruments were administered at baseline: a Demographic and Injury Questionnaire; the Beck Depression and Rosenberg Self-Esteem Inventories; and the Davidson Trauma Scale. A psychosocial questionnaire was administered at the one-month follow-up. Results : Fifty-eight per cent of the participants were female and 42 were male. Seventy-four per cent of the perpetrators were male. Ninety-five per cent of the participants said that no health professional had informed them about where or how they could find help. Although all were seriously injured; 76 of the participants said only the researcher had asked about their experience. Sixty-six per cent of the cases of domestic violence were related to intimate partner violence. Overall; subjects displayed high levels of depressive and post-traumatic stress symptomatology that had neither been treated nor adequately referred. Conclusion Even though domestic violence poses significant health threats and costs to the health system; it appears to be a neglected area of South African health care. Health professionals should at least be able to identify and intervene within the ""open window"" period when psychosocial opportunities are pivotal."

The Role of Educational Strategies to Reverse the Inverse Performance Spiral in Academically Isolated Rural Hospitals

The importance of continuous professional development for health care workers is widely acknowledged; but the identification of optimal implementation strategies remains a challenge; particularly in academically isolated rural areas. We report the results of a qualitative study that evaluated the effect of an educational intervention aimed at rural doctors in the Western Cape Province; South Africa. We also present a conceptual framework for developing best practice educational strategies to reverse the inverse performance spiral in academically isolated rural hospitals. Doctors felt that participation in relevant learning activities improved their competence; increased the levels of job satisfaction they experienced; increased their willingness to stay in a rural environment; and impacted positively on the quality of services provided. However; the success of educational strategies is heavily dependant on the local environment (context); as well as the practical applicability and clinical relevance of the activities (process). Successful educational strategies may help to reverse the inverse performance spiral previously described in academically isolated rural hospitals; however; this requires effective local leadership that creates a positive learning environment and supports clinically relevant learning activities. The study findings also indicate the need for health care providers and institutions of higher education to join forces to improve the quality of rural health care

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

Background The maintenance of competence by rural district hospital medical practitioners is a challenge faced by all countries and; most acutely; by resource-poor nations. It is a vital element in addressing the disparity between rural and urban health care in South Africa. The wide scope of rural-district hospital practice demands updating in a variety of content areas. District hospital doctorsare likely to have educational needs covering surgery; emergency and trauma; in-patient as well as out-patient care at primary service level; an understanding of the rural context and role of other health workers; public-health skills; and teamwork. Given such a broad curriculum; some prioritisation needs to be made for the content of their CPD. Rural practitioners generally use CPD activities that are most readily available to them; namely reading journals; meeting with pharmaceutical representatives and attending lectures sponsored by the pharmaceutical industry. These are not; however; the most appropriate or effective methods of acquiring the knowledge and skills that doctors define as being useful to them. Educational strategies that have been most effective in hanging clinical behaviour are: an assessment of learning needs; interactive tuition sessions with the opportunity to practice the skills learned and sequenced multifaceted activities. It is equally important to have rural practitioners engage in educational activities that can be performed within their work environment. The aim of this study was to define expert consensus on the content and methods most suitable for the maintenance of competence by rural district hospital practitioners in the Western Cape province of South Africa. The study was carried out as a follow-up to an analysis of knowledge and skills of doctors in Western Cape district hospitals. Method A study was therefore designed to investigate the content and methods used for the maintenance of competence of rural district hospital practitioners in the Western Cape province of South Africa. Expert opinion was sought to evaluate the topics requiring updating 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 also performed. The qualitative data were then 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 inservice learning under supervision; structured courses; small group discussions and practical workshops. Rotations in tertiary hospitals; specialist lectures; journal reading and internet learning were less supported. Conclusions The study provides a practical model for continuing instruction plus self-directed learning in context. Three content domainswere established; namely commonly encountered areas of practice; identified gaps; and needs specific to the practitioner and setting. It was concluded that the implementation of external updating programmes should be tailored to suit practitioners; while self-directed aspects should include reflective practice. Priority areas were identified and classified; as were educational methods that could contribute towards the maintenance of competence of rural practitioners

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

Breast Cancer: Early Detection and Screening in South African Women from the Bonteheuwel Township in the Western Cape: Knowledge; Attitudes and Practices

Background: Breast cancer is one of the most common cancers; rating among the most frequent causes of mortality in women worldwide; including in South Africa. Although curative treatment is increasingly successful; early detection and intervention are critical in reducing mortality rates. Early diagnosis is facilitated via breast self-examination (BSE); clinical breast examination (CBE); and mammography. Breast cancer presentation shows an apparent racial variation; with black; coloured and Indian patients presenting at a younger age than whites. In addition; whites tend to present at earlier stages of disease severity; coloureds and Indians at more intermediate stages and blacks at later stages. Socio-economic variables impact on screening practices. One American/Canadian study showed women with higher education and incomes were more likely to receive screening. In South Africa; there is scant research on breast cancer screening. In 2001; Prof. Karl Peltzer of the University of the North did a small telephonic comparative study between black and white women that identified low frequencies of BSE in both groups. Further research is necessary. While several international studies exist; little research is available on the screening behaviour of South African women. The aim of this study; therefore; was to evaluate the knowledge; attitudes; and actual screening practices regarding breast cancer among women in the Bonteheuwel township in the Western Cape.Methods: A random sample of 100 women completed a questionnaire administered by a research assistant. A separate; selected group of nine women participated in a focus group discussion.Results: The results indicate that the majority of the participants were aware of the dangers of breast cancer; perceived as a common (87; 95 CI: 80) and serious (88; 95 CI: 82-94) disease; which; if treated early; could be cured in most cases (82; 95 CI: 74-90). Most had previously examined their breasts (65; 95 CI: 56-74) and/or had been examined by their doctors (62; 95CI: 52-72). Only a minority; however; practised regular BSE (24; 95 CI: 16) or had received a CBE in the last year (29-32 ; 95 CI: 20-38). Fear of diagnosis was identified as the main barrier to screening (87; 95 CI: 80-94). Despite their fears; the participants were keen to improve their knowledge and participate in the further education of their community. However; only 40 (95 CI: 30-50) had ever been taught BSE by a healthcare professional. Moreover; only 34 (95 CI: 25-43) of women who had consulted a GP in the preceding year had received a CBE during this period. A total of 38 (95 CI: 28-48) had never had a CBE in their lives.Conclusion: The participants were better informed and more engaged in screening than had been anticipated. Still; healthcare professionals need to play a more proactive role in breast cancer screening and education

Morbidity profile of admissions to GF Jooste Hospital; Manenberg; Cape Town

BackgroundSecondary hospitals play an important; yet overlooked; role in reflecting public health status; both locally and nationally. Relatively few reports analysing the causes of secondary hospital admissions exist; which is especially unfortunate in the case of developing countries; considering the huge numbers of admissions and people at risk. In developing countries like South Africa; the quality of records varies among institutions. Some hospitals have computerised data; while others may keep no records whatsoever. A major problem facing the quality of hospital records is the constant shortage of staff in rural and urban hospitals. Thorough documentation is essential in providing an invaluable database for researchers; but morbidity statistics are unfortunately scarce.GF Jooste Hospital in Manenberg is the busiest hospital in Cape Town - serving 1.1 million people; with 224 beds and over 12 000 admissions annually. Budgetary constraints in the South African public health sector means that providing healthcare services at higher levels than necessary is too costly. Because hospitals consume the largest share of the public healthcare budget; they have been the focus in cost cutting. In particular; the budgets of referral (tertiary or teaching) hospitals have been trimmed in order to promote primary and secondary care. It is imperative to identify those services that are required most at secondary hospitals in order to improve budgeting and; more appropriately; train doctors and medical students for the job at hand. Identifying the morbidity profile of the population for which the hospital caters can aid the optimal utilisation of the available resources; as well as focusing the continuing medical education of hospital physicians. We determined disease patterns of admissions over a three-year period (2001-2003); primarily as insight towards optimal hospital resource management.MethodsA retrospective study examined ward records; totalling 36 657 admissions; from which a random sample (N=608) was selected. A stratified sample (N=462) was constructed; considering the relative proportions admitted to the wards. The International Statistical Classification of Diseases (ICD) directed diagnosis sorting. Disease prevalence was expressed as the percentage of patients allocated to each ICD category among those admitted to the hospital and respective wards and; additionally; the percentage of diagnoses for each ICD subcategory among patients assigned to each major category.ResultsTrauma (represented by ICD categories S/T 23and V/X/Y 16); specifically assault-related; was most prevalent. This was followed by circulatory diseases (22) and infectious diseases (19); dominated by HIV (61) and associated diseases like TB (57). The age of the patients ranged from 13 to 87 (mean: 40 years); with the 20 to 30-year-olds predominating. Surgical patients were younger (mean: 35 years) than medical (mean: 45 years). In the medical wards; infectious (39in men; 38in women) and circulatory aetiologies (39and 41in men and women respectively) dominated. In the surgical wards; the trend varied according to sex: assault (43) and other injuries (61) for males; pregnancy-related (42) for females. ConclusionThe morbidity distribution reflects the ills affecting South African urban society; with young trauma admissions predominating. The hospital's budget is insufficient; considering its population's demands