Diabetes in the public healthcare sector of four South African provinces: A comparative analysis

The growing burden of diabetes has long been under the radar in developing countries such as South Africa (SA). In recent years, there has been an unprecedented and exponential increase in recorded and undiagnosed diabetes mellitus (DM) cases. Unreliable data collection, overburdened health systems and poor infrastructure have all proved to be barriers to achieving optimum disease management. The District Health Information System (DHIS) serves as the data collection tool for the SA public healthcare sector. It is used in all nine SA provinces to gather data without individual patient identifiers. Objective. To analyse and compare the DM data collected by the DHIS in the Western Cape (WC), Eastern Cape (EC), KwaZulu-Natal (KZN) and Gauteng provinces of SA. Methods. An audit of diabetes-related data from the DHIS for 2016 was conducted. The data were then analysed using Excel. Time-series and cross-sectional analyses were made possible using pivot tables. Graphics were designed using Thinkcell software. Results. Of the four provinces surveyed, Gauteng recorded the highest incidence of DM, 67% higher than the reported global DM incidence estimate, while the WC had the lowest incidence. A similar pattern was also noted regarding the incidence of DM in people aged <18 years, with Gauteng having the highest and WC the lowest prevalence results. When comparing the number of DM-related consultations conducted in each province, the metropolitan districts were highlighted as hotspots of activity for DM care. This study found a moderate inversely proportional relationship between the incidence of DM in all provinces and education deprivation (p<0.05). Among the provinces that collected data on screening (excluding EC), KZN recorded the highest number of diabetic screenings. Conclusion. Metropolitan areas were highlighted as areas to be targeted, further reinforcing the current connection observed between urbanisation and DM in SA. The presence and recording of screening efforts is an excellent step in the right direction for the SA public healthcare sector and the DHIS. With improved interprovincial co-ordination regarding standardisation of the criteria and specifications of data collection fields, and enhanced training for data officers and primary collection agents, good quality and rich data is a very close possibility.

Feedback as a means to improve clinical competencies: consultants' perceptions of the quality of feedback given to registrars

Background. Effective supervision by consultants in postgraduate medical education involves the process of feedback. Giving feedback may be challenging for consultants who have no formal training in this process; which may be further compounded in heterogeneous diverse settings. Objective. To explore consultants' perceptions of feedback to registrars in a multicultural; multilingual diverse academic hospital setting. Methods. Thirty-seven consultants consented to completing a questionnaire on what; when; where; how often; and how feedback was provided; as well as on the type and effect of feedback to registrars. Descriptive statistics were used to analyse the data. Differences between groups were calculated using Pearson's ?2 test for independent variables; with a p-value of 0.05 regarded as being statistically significant. Results. Only 40% of consultants reported that they provided feedback often or always and 62.2% reported that standards were not predetermined and communicated to registrars. When feedback was provided; it was based on concrete observations of performance (78.4%); it incorporated a plan for improvement (72.9%) and it supplied information on techniques performed incorrectly (72.9%). Only 40.5% of consultants provided feedback on procedures performed correctly. Moreover; only half of the consultants believed they were proficient at giving feedback. Conclusion. Consultants need to develop the art of giving feedback through appropriate training so that they are more comfortable and proficient with the various aspects of feedback; leading to a positive effect on enhancing registrar training

Exploring the relationship between demographic factors; performance and fortitude in a group of diverse 1st-year medical students

Background. The majority of 1st-year students are ill-equipped for university life. This heightens stress levels; which are accentuated by a lack of resilience and impact negatively on academic performance and personal wellbeing.Objectives. To explore; within the paradigm of positive psychology; the relationship between the self; family and support constructs of fortitude; and academic performance of 1st-year medical students.Method. First-year medical students completed a fortitude questionnaire and their academic performances in two academic modules were collated. Mann-Whitney and Kruskal-Wallis tests were employed for statistical analysis of the variables. Pearson correlation coefficients were calculated to assess the relationship between academic performance and fortitude subscales; as well as the fortitude composite score.Results. The student population was multicultural; multilingual and had different educational and residential backgrounds. The fortitude instrument was found to be reliable and correlated significantly with student academic performance. Male students had significantly higher fortitude scores than female students. Students who had attended state/government schools had significantly lower fortitude than those who had attended private and ex-Model C schools. Students with prior degrees had higher fortitude than matriculants.Conclusion. The significant; albeit moderate; positive correlation between fortitude and academic performance highlights the need for further exploration of wellbeing and holistic development of medical students. Support programmes are recommended to bridge the gap related to gender and educational background. Low and fair levels of fortitude indicate a need for corrective measures. These could include consulting relevant support networks such as student counsellors; mentors and academic development personnel

Motivated strategies for learning and their association with academic performance of a diverse group of 1st-year medical students

Background. Most instruments; including the well-known Motivated Strategies for Learning Questionnaire (MSLQ); have been designed in western homogeneous settings. Use of the MSLQ in health professions education is limited. Objective. To assess the MSLQ and its association with the academic performance of a heterogeneous group of 1st-year medical students.Methods. Eighty-three percent of 1st-year medical students consented to participate in this quantitative study. The MSLQ consisted of a motivation strategies component with six subscales; while the learning strategies component had nine subscales. Demographic and academic achievement information of the students was also collected. Stata version 13 (StataCorp LP; USA) was used for the statistical analyses of all data.Results. Female students displayed significantly higher motivational scores. Students with prior educational experience and those who attended peer-mentoring sessions had significantly higher learning strategy scores. Significant but moderate relationships were found between academic performance and the motivation strategies subsumed within the categories 'task value' and 'self-efficacy for learning performance'. In terms of the 'learning strategy component'; 'critical thinking'; and 'time and study environment'; the composite score was significantly but poorly correlated to academic performance. Conclusion. Overall; limited correlations were found between the MSLQ scores and academic performance. Further investigation of the use of the MSLQ and its association with academic achievement is recommended; with greater focus on specific learning events than on course outcomes. This study highlights the importance of evaluating an instrument in a specific context before accepting the findings of others with regard to the use of the instrument and its correlation with academic performance

Feedback as a means to improve cinical competencies: registrars' perceptions of the quality of feedback provided by consultants in an academic hospital setting

Background. The creating; maintenance and storage of patients' medical records is an important competence for the professional training of a dental student.Objective. Owing to the unsatisfactory state of dental records at the students' clinic; the objective of this study was to obtain information from; undergraduate dental students on the factors that affect this process and elicit recommendations for improvement. Methods. This qualitative cross-sectional study used focus group discussions with 4th- and 5th-year dental students for data collection. Data were captured through a written transcript and an audio recorder. The data were transcribed and analysed manually through developing themes; which were Compared with the literature and interpreted. Results. Three themes emerged: (i) Poorly designed clerking forms. The clerking forms were deemed to have a poor design with inadequate space for clinical notes. It was recommended that they be redesigned. (ii) Inadequate storage space. Space for storing patient records was deemed inadequate and a referencing system for file retrieval was lacking. It was recommended that more space be allocated for storage; with a referencing system for easy file retrieval. (iii) Poor maintenance of records. Patients' records; especially radiographs; were not well labelled and stored. It was recommended that drug envelopes be utilised to store radiographs. An electronic system was deemed the ultimate solution to this problem. Conclusion. The general perception was that the current paper-based record system at the clinic was unsatisfactory. Therefore; there is a need to improve the maintenance and storage of records; and to change to a more efficient electronic system. The students' attitude towards record keeping was found to be questionable; with a need to be addressed as part of teaching and learning in the curriculum. Lecturers were deemed to have a bigger role to play in the record-keeping process