Reflections on the development of family medicine in the Western Cape: a 15-year review

Mash, Robert

doi:10.1080/20786204.2011.10874152

Cited by 38 publications

(62 citation statements)

References 4 publications

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“…Training in skills of listening and giving feedback, awareness of self and others, peer support, being recognized and rewarded, protected time, and assessment are all important [59]. As most supervisors are not employed by the university their ability to perform these training and teaching roles relies on collaboration with the Department of Health and a commitment from them to enable and support these roles [42]. …”

Section: Discussionmentioning

confidence: 99%

“…Ten clinical domains are covered, including mental health, general adult medicine, child health, women’s health, HIV/AIDS and infectious diseases, ear/nose/throat/eyes/skin, general surgery, emergencies, anaesthetics, and orthopaedics. Important principles and competencies are also addressed, including consultation and communication skills, ethics, professionalism and human rights, evidence-based practice, family-orientated care, personal and human growth and development, community-orientated care, chronic care, health promotion and disease prevention, management and administration, teaching, education and research [42]. …”

Section: Introductionmentioning

confidence: 99%

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The national portfolio for postgraduate family medicine training in South Africa: a descriptive study of acceptability, educational impact, and usefulness for assessment

2013

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BackgroundSince 2007 a portfolio of learning has become a requirement for assessment of postgraduate family medicine training by the Colleges of Medicine of South Africa. A uniform portfolio of learning has been developed and content validity established among the eight postgraduate programmes. The aim of this study was to investigate the portfolio’s acceptability, educational impact, and perceived usefulness for assessment of competence.MethodsTwo structured questionnaires of 35 closed and open-ended questions were delivered to 53 family physician supervisors and 48 registrars who had used the portfolio. Categorical and nominal/ordinal data were analysed using simple descriptive statistics. The open-ended questions were analysed with ATLAS.ti software.ResultsHalf of registrars did not find the portfolio clear, practical or feasible. Workshops on portfolio use, learning, and supervision were supported, and brief dedicated time daily for reflection and writing. Most supervisors felt the portfolio reflected an accurate picture of learning, but just over half of registrars agreed. While the portfolio helped with reflection on learning, participants were less convinced about how it helped them plan further learning. Supervisors graded most rotations, suggesting understanding the summative aspect, while only 61% of registrars reflected on rotations, suggesting the formative aspects are not yet optimally utilised. Poor feedback, the need for protected academic time, and pressure of service delivery impacting negatively on learning.ConclusionThis first introduction of a national portfolio for postgraduate training in family medicine in South Africa faces challenges similar to those in other countries. Acceptability of the portfolio relates to a clear purpose and guide, flexible format with tools available in the workplace, and appreciating the changing educational environment from university-based to national assessments. The role of the supervisor in direct observations of the registrar and dedicated educational meetings, giving feedback and support, cannot be overemphasized.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The national portfolio for postgraduate family medicine training in South Africa: a descriptive study of acceptability, educational impact, and usefulness for assessment

2013

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“…The role of the family physician may be important in assisting with the clinical care of these patients through consultations, mentoring of nurses/nurse practitioners, and clinical governance activities. [23] Family physicians may offer a more patient-centred and biopsychosocial approach, as a result of their generalist training.…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity in non-communicable diseases in South African primary healthcare

Lalkhen

Mash

2015

S Afr Med J

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Corresponding author : R Mash (rm@sun.ac.za) Background. Multimorbidity in non-communicable diseases (NCDs) is a complex global healthcare challenge that is becoming increasingly prevalent. In Africa, comorbidity of communicable diseases and NCDs is also increasing. Objectives. To evaluate the extent of multimorbidity among patients with NCDs in South African (SA) primary healthcare (PHC). Methods. A dataset obtained from a previous morbidity survey of SA ambulatory PHC was analysed. Data on conditions considered active and ongoing at consultations by PHC providers were obtained. Results. Altogether 18 856 consultations were included in the dataset and generated 31 451 reasons for encounter and 24 561 diagnoses. Hypertension was the commonest NCD diagnosis encountered (13.1%), followed by type 2 diabetes (3.9%), osteoarthritis (2.2%), asthma (2.0%), epilepsy (1.9%) and chronic obstructive pulmonary disease (COPD) (0.6%). The majority of patients (66.9%) consulted a nurse and 33.1% a doctor. Overall 48.4% of patients had comorbidity and 14.4% multimorbidity. Multimorbidity (two or more conditions) was present in 36.4% of patients with COPD, 23.7% with osteoarthritis, 16.3% with diabetes, 15.3% with asthma, 12.0% with hypertension and 6.7% with epilepsy. Only 1.1% also had HIV, 1.0% TB, 0.4% depression and 0.04% anxiety disorders. Conclusion. About half of the patients with NCDs had comorbidity, and multimorbidity was most common in patients with COPD and osteoarthritis. However, levels of multimorbidity were substantially lower than reported in high-income countries. Future clinical guidelines, training of PHC nurses and involvement of doctors in the continuum of care should address the complexity of patients with NCDs and multimorbidity.

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“…In some provinces, such as the Western Cape, the goal is to place at least one such family physician at each district hospital, where they will increase the surgical output and improve operative capacity. [5] The new mid-level doctor, known as the associate clinician, has also been specifically trained to work at the district hospital, and these graduates are now entering the system.…”

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confidence: 99%

Well-trained generalists can help improve surgical capacity at district hospitals

2014

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Reflections on the development of family medicine in the Western Cape: a 15-year review

Cited by 38 publications

References 4 publications

The national portfolio for postgraduate family medicine training in South Africa: a descriptive study of acceptability, educational impact, and usefulness for assessment

The national portfolio for postgraduate family medicine training in South Africa: a descriptive study of acceptability, educational impact, and usefulness for assessment

Multimorbidity in non-communicable diseases in South African primary healthcare

Well-trained generalists can help improve surgical capacity at district hospitals

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