Introduction: Occupational injuries in medical students are concerning, especially in countries with a high prevalence of bloodborne infections. With more HIV-infected patients on antiretroviral treatment, appropriate post-exposure prophylaxis (PEP) depends on knowledge of source patients' infection status and treatment response. This study determined the number and type of exposure incidents, reporting practices, and PEP use among medical students at the University of Pretoria, South Africa. Methodology: Data were collected from an anonymous voluntary questionnaire completed by medical students from years 1 to 6 of study as well as from incident records archived at the Department of Family Medicine. Data were described and tests of association performed in Stata 11. Results: Thirteen percent of students overall and 21% of senior students reported an incident in the preceding year. The majority of incidents occurred during phlebotomy, with fatigue and work pressure found to be major contributing factors. Underreporting was common and many students displayed a lack of risk awareness and a preference for managing the incident privately. Although 59% knew the HIV-status of the source patient, less than a third knew the viral load and only 16.9% the regimen. Side-effects on antiretroviral treatment used for PEP were common and only about three-quarters of the students completed the course. Conclusions: We recommend targeted training, especially in the senior years, together with improving the work environment through attention to working hours, sharps disposal and ready availability of safety devices, improved reporting systems, individualised PEP, and possibly the implementation of an occupational injury support line.

Background:The role and scope of general practitioners in semi-urban and rural areas is poorly understood and documented. An absence of specialist support results in generalists being called to perform surgical procedures. It is imperative that they competently and confidently perform specific surgical procedures. Method: This cross-sectional study identified a list of agreed surgical procedures in which generalists should be competent. Enquires were made about generalists' competence in performing such skills and training junior doctors how to use these them. Interns were asked about the quality of their exposure to and their perceived competence in the skills. A questionnaire was given to interns who completed their internship in 2008 in Mpumalanga and Gauteng, and another to generalists affiliated to the University of Pretoria. Data were analysed descriptively using Microsoft® Excel®. Results: The response rate was 31% and 21% for the interns and generalists, respectively. There was agreement on specific core skills in training. Most generalists (81%) lacked the competence to provide training on some of the specific core skills needed for independent practice. Most of the internships were completed in semi-urban areas (62%). The majority of the interns perceived themselves to be competent in Caesarean sections, the excision of lumps and bumps, and abscess drainage. Interns from urban areas rated themselves as being incompetent in the core surgical skills. Interns who worked in semi-urban regions felt competent in core surgical skills. Conclusion:The training of interns should be supervised by senior doctors in in-service training settings. Basic surgical skills and in-service training can be taught during family medicine rotation internships by surgically skilled family physicians and generalists in semi-urban areas and district hospitals.

The risks associated with infection of healthcare workers and students with blood-borne pathogens, specifically HIV, hepatitis B virus and hepatitis C virus, are often neglected. South Africa (SA) currently has no official policies or guidelines in place for the prevention and management of these infections. This article reviews the available data and international guidelines with regard to infected healthcare practitioners and makes minimum recommendations for the SA setting.

Background: Incorporating the teaching and assessment of professionalism in an undergraduate medical curriculum is a challenging process. There are two components that require attention: the cognitive and the experiential. This article outlines how the School of Medicine at the University of Pretoria (UP), South Africa is addressing the teaching and assessment of professionalism. Aims: To embed teaching and assessment of professionalism in a revised six-year undergraduate medical curriculum. Method: This is a descriptive paper of a curriculum process that has stretched over a number of years. The eight principles regarding teaching professionalism provided by Cruess & Cruess (2006) are used to reflect on the current strengths and weaknesses of teaching and assessing professionalism in the UP undergraduate medical curriculum.The cognitive component of the curriculum has been addressed by introducing a series of stage appropriate, contextualized assignments in each year of the curriculum. Faculty committee structures supported the development and implementation of this component. Students' responses to an assignment on the influence of role models provided insight into how the experiential component impacts on their professional development. Results: The teaching and assessment of the cognitive component were relatively easy to put in place. The challenge is to maintain this component. The experiential component appears to be much the same as it was prior to revision. Conclusions: Our way forward is to expand the teaching and assessment of professionalism in the experiential component. We want to facilitate faculty to develop a charter on professionalism. The principles and commitments of the charter will underlie a white coat ceremony for undergraduates. These principles will also provide guidelines for role models in their supervision of experiential learning and can inform criteria for assessment. An assessment strategy to assess professionalism in the experiential component needs to be developed and implemented.

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