ABSTRACT
The Technical and Vocational Education and Training (TVET) college sector in South Africa is seen as central to skills development and the revival of the economy. However, the sector remains one of the weakest in the post-school system. This chapter provides a synopsis of the evolution of the post-apartheid college sector context in South Africa, the nature of the new programme offerings for pre- and in-service training as well as increasing moves towards professionalisation of the sector. This discussion is presented against the backdrop of the broader policy context in the country, specifically considering the different needs of current TVET lecturers, who range from unqualified;academically qualified, but without workplace pedagogy;trained for the schooling sector;to the ideal—those who are both academically and professionally qualified. While this rather lopsided continuum is not unique to South Africa, the way it is being addressed is important to articulate and reflect on. The changes in the management and governance of the colleges prior to the establishment of the Department of Higher Education and Training (DHET) and the impact these changes had on lecturers’ job security and conditions of employment are key factors that we will explore in our contribution. The college sector lost lecturing staff during this time, further reducing its capacity to meet the training needs of the country. While seemingly intractable problems such as slow uptake of newly introduced qualifications for TVET lecturers and compliance oriented continuing professional development (CPD) programmes can be overcome, the impact of COVID-19 on this sector should not be underestimated. Of course, this uncertain future also offers an opportunity to make changes that may previously have been politically unpalatable. In this chapter, we try to imagine what a more explicitly conceptualised workplace pedagogy would comprise to produce a pipeline of well-trained and professionally orientated TVET lecturers. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
ABSTRACT
Purpose/Background: Pelvic exenteration (PE), or “beyond-TME” surgery has become an established treatment for locally-advanced, or recurrent colorectal cancer, with the aim of achieving a complete (R0) resection and improve survival. We have established a regional centre for the management of advanced colorectal cancer and pelvic sarcoma. Methods/Interventions: This was a retrospective, observational study using electronic health records (EHR). Patients were identified from a prospectively managed database and from multi-disciplinary team minutes. Data was gathered for 47 patients operated on by our Advanced Cancer service between November 2016 and March 2021 by four surgeons. EHR were searched for tumour and operation characteristics, complications, survival, oncological and recurrence data. During the COVID-19 pandemic, some patients had their operations at a separate, private hospital. Eligible patients were those that had pelvic exenteration (defined as removal of colon/rectum with additional organs such as bladder, prostate, vagina, sacrum, kidney), or large pelvic dissection for sarcoma. Results/Outcomes: 47 patients (23 male, 24 female) underwent operation, with a median age of 64 and ASA II. 33 (70%) patients presented with a primary tumour and 14 with a recurrent tumour. 37 (79%) had a locally advanced rectal or sigmoid cancer, 2 (4%) anal cancers, 2 gastro-intestinal stromal tumours and 6 (13%) pelvic sarcomas. One patient with recurrent rectal cancer had inoperable disease found at time of surgery so proceeded with only a palliative resection. Resection type is presented in Table 1. 43 patients had recorded status for margins, of which 33 (77%) had R0 resection and 10 (23%) R1. Mean operating time was 499 minutes (range 130-1020). Median time in critical care post-op was 2.5 days (IQR 1-6) and length of stay 13 days (IQR 13-20.5). 30-day Clavien-Dindo complications were: none (15, 32%), Grade I/II (17, 36%), Grade III (6, 13%), Grade IV (8, 17%). One patient operated on in the independent sector could not have inpatient records assessed. 10 patients had a return to theatre, the majority (5) for wound washout, 1 for each of the following indications: replacement of ureteric stent, ureteric reimplantation, revision of ischaemic colostomy, revision of flap, planned return for removal of haemostatic packs. There was no 90 day mortality. At a median of 25.6 months follow-up, 32 (68%) patients remain alive. In the 15 patients who have died, the mean time to death from procedure was 16.7 months. Recurrence was seen in 11 (23%) patients, of which 6 (13%) were distant, 3 (6%) local and 2 (4%) both. Conclusion/Discussion: This data shows that it is possible to set up a new advanced cancer unit and achieve outcomes, in terms of mortality, margin status and recurrence that are comparable with those previously published by other centres during their set-up phase. (Table Presented).