The contribution of family physicians to district health services in South Africa: A national position paper by the South African Academy of Family Physicians

Registrars' experience with research in family medicine training programmes in South Africa

BACKGROUND

 Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes.

METHODS

 An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software.

RESULTS

 The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging.

CONCLUSION

 Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time.Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country.

From the President's Desk: Part 1, 2024

No abstract available.

A national training course for clinical trainers in family medicine

Quality vocational training is important to ensure that family physicians can strengthen the district health system. Competent clinical trainers and supervisors, with the necessary educational knowledge and skills, are required for this job. In 2014, a formal Train the Clinical Trainer (TCT) course was introduced in South Africa as a collaborative effort between the Royal College of General Practitioners (RCGP) and the South African Academy of Family Physicians (SAAFPs). To make the training relevant, the course was aligned with the National Unit Standards for Family Medicine, as these defined the learning outcomes for registrars. The aim of the TCT course was to equip workplace-based clinical trainers with an essential set of educational skills, which could be further developed through mentoring and support. Accredited trainers present the face-to-face course yearly to two family physicians from each of the nine departments of family medicine in South Africa. The TCT course is built around the educational principles of learner-centredness and andragogy. During these 5 days of training the roles and responsibilities of trainers and learners, the learning environment, alignment with the curriculum, assessment for and of learning, and leadership are covered. Recently online assessment, the e-portfolio and the use of entrustable professional activities were added to the course content. In the future we would like to accredit more clinical trainers through a process of workplace-based self-evaluation and 360-degree feedback from peers and students. Lastly, we want to expand the training course in the African region.Contribution: The Train the Clinical Trainer (TCT) course, established in 2014 through RCGP and SAAFP collaboration in South Africa, ensures family physicians have essential educational skills. Aligned with national standards, the course embraces learner-centered principles. Ongoing enhancements include online assessments and future plans involve accrediting more trainers through self-evaluation and expanding across the African region.

Allopathic Medicine Practitioners' perspectives on facilitating disclosure of traditional medicine use in Gauteng, South Africa: a qualitative study

BACKGROUND

Traditional medicine (TM) plays a key role in maintaining health in many societies. Given the requirement for TM disclosure, Allopathic Medicine Practitioners (AMPs) must encourage open communication with patients to persuade those who use TM to disclose. Addressing patient non-disclosure of TM requires this dialogue to be facilitated. We sought to understand and describe how South African AMPs facilitate disclosure of TM use during a consultation with patients who use both TM and allopathic medicine (AM) and how it influences the patients' willingness to disclose TM use.

METHODS

This qualitative exploratory descriptive study on AMPs at Gauteng district public hospitals in South Africa was conducted between 2021 and 2022. Non-probability purposive sampling was employed to select a sample of 14 AMPs. Individual participants were encouraged to share their unique experiences and interpretations of the phenomenon concerning TM use disclosure. The raw transcribed textual data were processed using ATLAS.ti, and inductive content analysis was undertaken following the coding of the content to identify categories.

RESULTS

The data revealed four major categories: 'providing a suitable atmosphere for disclosure,' 'encouraging patients to disclose TM usage to AMPs,' 'patient autonomy,' and 'AMP training'. During a consultation with patients who use both TM and AM, participants expressed their experiences and perceptions of TM nondisclosure. They also discussed several methods for encouraging patients to disclose their TM usage, particularly when TM is used concurrently with AM.

CONCLUSION

This study expands on previously reported findings by describing how South African AMPs facilitate the disclosure of TM use during consultation. Many AMPs struggle to initiate TM conversations with their patients which results in non-disclosure. This study revealed that integrating TM into AM training programmes, promoting cross-practice, and creating a safe environment is necessary for the development and application of the most appropriate approaches that would assist in facilitating disclosure.

Strategies to enhance the approach to prostate cancer screening of South African black men in the Free State: a Delphi study

Background

The incidence and mortality rates of prostate cancer (PCa) are disproportionately on the increase among South African black men. Recent studies show a greater net benefit of prostate-specific antigen screening of black men compared with the general population. There are, however, knowledge, attitude, and practice (KAP) gaps among primary healthcare providers (HCPs) and users (black men) on PCa screening. Likewise, there is a scarcity of research on strategies to address these gaps.

Objective

This study sought to determine complementing strategies to enhance the approach to PCa screening of African men in the Free State, South Africa, from the perspectives of primary HCPs and users.

Methods

This study utilized a three-round modified Delphi survey to achieve its aim. Consensus was determined by an a priori threshold of ≥70% of agreement.

Results

The survey involved a multidisciplinary panel of 19 experts. The consensus was reached on 34 items (strategies) to enhance the approach to PCa screening in the study setting. Community health education strategies were proffered, relating to relevant topics, methods, venues of delivery, and persons to deliver the education. Continuing education topics and methods of instruction were suggested for primary HCPs.

Conclusions

In view of the existing KAP gaps in PCa screening among primary HCPs and users (black men), an expert consensus was determined, on complementing strategies to enhance the approach to PCa screening of South African black men in the study setting.

From the President's Desk - Part 1, 2023

No abstract available.

Perceptions of resources available for postgraduate family medicine training at a South African university

BACKGROUND

 Clinical training is one of the roles of family physicians (FPs) in decentralised postgraduate training. Effective training requires skilled trainers and sufficient resources. Little is known about the resources available for decentralised clinical training in district health systems in low- to middle-income countries, especially in sub-Saharan Africa.

AIM

 To explore FPs' and registrars' perceptions of the available resources in a decentralised postgraduate family medicine (FM) training programme.

SETTING

 Five decentralised training sites affiliated with the University of the Witwatersrand across two provinces in South Africa.

METHODS

 This qualitative study forms part of a broader project evaluating a FM registrar training programme using the logic model. Semistructured interviews were conducted with a purposive sample of 11 FPs and 11 registrars. The interviews were transcribed verbatim and analysed thematically.

RESULTS

 Three themes were identified: 'Impact of resource constraints', 'Family physicians' skills and knowledge could be further improved' and 'Family physicians need additional support to optimise their training role'. The additional resources needed include more FPs, equipment, infrastructure and funding. Knowledge and skills of FPs were reported variable and needed further improvement. Additional support was required from peers, the district management and the university.

CONCLUSION

 Well-resourced decentralised training environments with sufficient skilled trainers and adequate resources are needed to positively influence FP training and supervision, especially in middle-income countries like South Africa.Contribution: Clinical trainers need adequate resources and support from peers, district management and the university for effective decentralised clinical training.

Retention of medical officers in district health services, South Africa: a descriptive survey

BACKGROUND

The health workforce is critical to strengthening district health services (DHS). In the public sector of South Africa, medical officers (MOs) are essential to delivering services in primary health care (PHC) and district hospitals. Family physicians, responsible for clinical governance, identified their retention as a key issue.

AIM

To evaluate factors that influence retention of MOs in public sector DHS.

DESIGN & SETTING

A descriptive survey of MOs working in DHS, Western Cape, South Africa.

METHOD

All 125 MOs working in facilities associated with the Stellenbosch University Family Physician Research Network (SUFPREN) were included in the survey. A questionnaire measured the prevalence of key factors that might be associated with retention (staying >4 years) and included the Satisfaction of Employees in Health Care (SEHC) tool and Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Data were collected in Research Electronic Data Capture (REDCap) and analysed in the Statistical Package for Social Sciences (SPSS).

RESULTS

Ninety-five MOs completed the survey. The overall rating of the facility (P = 0.001), age (P = 0.004), seniority (P = 0.015), career plans (P<0.001), and intention to stay in the public sector (P<0.001) were associated with retention. More personal factors such as social support (P = 0.007), educational opportunities for children (P = 0.002), and staying with one's partner (P = 0.036) were also associated with retention. Sex, rural versus urban location, district hospital versus primary care facility, overtime, remuneration, and additional rural allowance were not associated with retention.

CONCLUSION

The overall rating of the facility was important and subsequent qualitative work has explored the underlying issues. These findings can guide strategies in the Western Cape and similar settings to retain MOs in the DHS.

From the President's Desk - Part 3, 2022

No abstract available.