Internship training adequately prepares South African medical graduates for community service – with exceptions

Abstract

Background. The 2-year internship period for medical graduates began in South Africa in 2005 and has never been formally evaluated. Objective. This study assessed the perceptions of community service medical officers (COSMOs) working at district hospitals (DHs) in KwaZulu-Natal (KZN) to determine whether the 2-year internship programme had adequately prepared them for community service (CS). Method. A cross-sectional descriptive study was conducted regarding the perceptions of COSMOs working at 22 district hospitals in KZN. Data were collected in July 2012, using a questionnaire based on the core skills and knowledge detailed in the Health Professions Council of South Africa intern log book. All eight domains were self-assessed and a score of 4 out of 5 indicated an ability to work independently. Results. Of the COSMOs, 78% (60 out of 89) completed the questionnaire. Most felt well-prepared for CS in all disciplines, but critical gaps in knowledge and skills were identified in paediatrics, orthopaedics, anaesthetics and obstetrics. In addition, 75% of respondents (45 out of 60) expressed a need for additional training in the disciplines of ear, nose and throat (ENT), urology, ophthalmology and dermatology. Conclusion. The 2-year internship has provided the basis for independent medical practice in DHs. However, certain critical skill gaps need urgent attention, particularly in obstetrics and anaesthesia. Areas of weakness in ENT, urology, ophthalmology and dermatology could be addressed by including these specialities as a compulsory rotation in surgery, medicine or family medicine during internship training.

The state of South African internships: A national survey against HPCSA guidelines

“…As SA doctors are able to practise in an unsupervised environment after their CSO year (or even during this year in many rural settings), other provisions should be made to ensure that internship provides a protected working space to exercise clinical skills under supervision (with feedback) to ensure that patients are treated in a safe and appropriate manner. Although the majority of respondents felt prepared for their CSO year, which is in keeping with other research, [11] a largely unsupervised internship turning into a completely unsupervised CSO year will promote a cycle of confident incompetence [12] in medical decision making and compromise patient safety further.…”

A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

“…This failure of referring clinicians to appreciate the unstable condition of their patient reflects the lack of confidence and competencies in the ability to care for critically ill children at a district facility. These concerns have been cited in the South African study by Nkabinda et al, [18] who reviewed community service medical officers' experience of working in district hospitals in KwaZulu-Natal and identified paediatric resuscitation and intubation as a skill domain in which confidence was lacking. We propose interventions to improve resuscitation and intubation skills in the periphery.…”

Comparing international and South African work-based assessment of medical interns’ practice

“…SA studies indicated the suboptimal performance of interns in paediatric resuscitation, obstetric practice, anaesthesia, orthopedics, intubation, circumcision and appendectomies. [9,15,23,24] The emphasis on procedural skills in acute emergencies possibly reflects the narrow interpretation of the role SA interns are expected to play within institutional hierarchical systems, and disregard for assessing their competence in knowledge, attitudes and non-clinical functions. This lack of studies on non-procedural skills in SA identifies clear gaps in the assessment methods of interns in SA.…”