Where are they working? A case study of twenty Cuban-trained South African doctors

Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study

BACKGROUND

South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period. While such schemes are used widely and are funded by substantial public funds, their exact makeup differs across jurisdictions, and little is known about why these differences have emerged or how they influence their effectiveness or impact on the health system. We aimed to fill these gaps through an analysis of the origins, architecture, and evolution of RoS schemes in South Africa.

METHODS

A multimethod research study including a policy review, a literature review, and semi-structured interviews of policymakers was undertaken between October 2020 and August 2022. The included policy documents and literature were analysed using the Walt and Gilson framework and narrative synthesis. Qualitative data were analysed using inductive, thematic analysis in NVIVO 12.

RESULTS

RoS schemes are used as a recruitment and retention strategy and a mechanism to address equity in access to medical education. Whilst there is evidence of RoS schemes existing in 1950, no evidence of beneficiaries was found in databases until 1989. The impact of these schemes is likely being limited by sub-optimal institutional arrangements and poor transparency in their design and implementation.

CONCLUSION

Despite rigorous research methods, the origins of RoS policies in South Africa could not be established due to poor preservation of institutional memory. Opportunities to monitor the value of public investment into RoS programs are being missed and often the underlying objective of the programs has not been well-specified. Policies were found to have been developed and operate in isolation from other health workforce planning activities and thus may not be maximising their impact as a retention and training tool.

Professional experiences in the transition of Cuban-trained South African medical graduates

BACKGROUND

Medical educators have been tasked to provide Cuban-trained Foreign Medical Graduates (FMGs) with adequate learning exposures to become integrated into the South African healthcare workforce. International research suggests that FMGs face multiple challenges during the transition from practising medicine in countries other than where they had been trained. The transitional experiences of international FMGs are well documented, but little is known about the challenges faced by Cuban-trained graduates upon reintegration into South Africa. An improved understanding of the challenges will provide insight into how medical educators can best support Cuban trained graduates in their final phase of training in the South African context.This study explored the challenges experienced during the professional transition of Cuban-trained FMGs with reference to Schlossberg's transitional theory.

METHODS

A qualitative case study was used to interview a purposive sample of 20 Cuban-trained FMGs who studied between January 1997 and December 2007. Data were collected through audio-recorded, semi-structured interviews, which were analysed thematically.

RESULTS

The findings indicate that FMGs' experienced educational and social stress, which was linked to the transitional situation itself. Challenges during reintegration included bias and discrimination, language, educational differences, and becoming familiar with patients from diverse educational and cultural backgrounds. They drew on peer and institutional support that was mainly informal and varied across disciplines and the medical schools.

CONCLUSION

Recommendations include a national multidisciplinary consolidated approach to provide personal and professional support at national, institutional, and departmental levels. The creation of mentoring networks will optimise Cuban-trained FMGs' transitional experiences for returning students.

J, Bosongo S, Dossou JP, Waweru E, Apers L, Zannou M, Criel B. The expanding movement of primary care physicians operating at the first line of healthcare delivery systems in sub-Saharan Africa: A scoping review

INTRODUCTION

In sub-Saharan Africa (SSA), the physicians' ratio is increasing. There are clear indications that many of them have opted to work at the first-line of healthcare delivery systems, i.e. providing primary care. This constitutes an important change in African healthcare systems where the first line has been under the responsibility of nurse-practitioners for decades. Previous reviews on primary care physicians (PCPs) in SSA focused on the specific case of family physicians in English-speaking countries. This scoping review provides a broader mapping of the PCPs' practices in SSA, beyond family physicians and including francophone Africa. For this study, we defined PCPs as medical doctors who work at the first-line of healthcare delivery and provide generalist healthcare.

METHODS

We searched five databases and identified additional sources through purposively selected websites, expert recommendations, and citation tracking. Two reviewers independently selected studies and extracted and coded the data. The findings were presented to a range of stakeholders.

FINDINGS

We included 81 papers, mostly related to the Republic of South Africa. Three categories of PCPs are proposed: family physicians, "médecins généralistes communautaires", and general practitioners. We analysed the functioning of each along four dimensions that emerged from the data analysis: professional identity, governance, roles and activities, and output/outcome. Our analysis highlighted several challenges about the PCPs' governance that could threaten their effective contribution to primary care. More research is needed to investigate better the precise nature and performance of the PCPs' activities. Evidence is particularly needed for PCPs classified in the category of GPs and, more generally, PCPs in African countries other than the Republic of South Africa.

CONCLUSIONS

This review sheds more light on the institutional, organisational and operational realities of PCPs in SSA. It also highlighted persisting gaps that remain in our understanding of the functioning and the potential of African PCPs.

Assessment practices in undergraduate clinical medicine training: What do we do and how we can improve?

Background

Assessment should form an integral part of curriculum design in higher education and should be robust enough to ensure clinical competence.

Aim

This article reports on current assessment practices and makes recommendations to improve clinical assessment in the undergraduate medical programme at the University of the Free State.

Methods

A descriptive cross-sectional study design was used. Qualitative and quantitative data were gathered by means of open- and closed-ended questions in a self-administered questionnaire, which was completed by teaching and learning coordinators in 13 disciplines.

Results

All disciplines in the undergraduate medical programme are represented. They used different assessment methods to assess the competencies required of entry-level healthcare professionals. Workplace-based assessment was performed by 30.1% of disciplines, while multiple-choice questions (MCQs) (76.9%) and objective structured clinical examinations (OSCEs) (53.6%) were the main methods used during formative assessment. Not all assessors were well prepared for assessment, with 38.5% never having received any formal training on assessment. Few disciplines (15.4%) made use of post-assessment moderation as a standard practice, and few disciplines always gave feedback after assessments.

Conclusion

The current assessment practices for clinical students in the undergraduate medical programme at the University of the Free State cover the spectrum that is necessary to assess all the different competencies required. Multiple-choice questions and OSCEs, which are valid and reliable assessment methods, are used frequently. Poor feedback and moderation practices should be addressed. More formative assessments, and less emphasis on summative assessment, should be considered. Workplace-based and continuous assessments may be good ways to assess clinical competence.