Browsing by Author "Chauke, Lawrence"

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An assessment of the hospital learning environment within the Univesity of Witwatersrand obstetrics and gynaecolgy registrar training programme
(University of the Witwatersrand, Johannesburg, 2023) Masukume, Rumbidzai; Chauke, Lawrence; Odell, Natalie
Background. The hospital educational environment is a critical component of a health professionals’ education. It influences clinicians’ professional development, well-being, academic success and ability to provide high-quality healthcare services. There is limited data on the postgraduate clinical learning environment (CLE) in obstetrics and gynaecology (Obgyn) in South Africa. Research objectives. (1) to evaluate obstetrics and gynaecology registrars’ perceptions of their CLE utilising the modified Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire, (2) to assess factors influencing these perceptions; (3) to evaluate the impact of the learning environment on academic outcomes, and (4) to use the results to recommend targeted improvements of the registrar training programme in Obgyn at the University of Witwatersrand (WITS). Methods. A prospective cross-sectional study involving a convenience sample of doctors enrolled for the four-year Obgyn training programme at WITS. The modified PHEEM questionnaire was electronically sent to 80 participants between January and April 2022. Categorical variables were described using frequencies and percentages. Continuous variables were summarised by measures of central tendency. Factors associated with the PHEEM scores were evaluated using the Student’s t-test and analysis of variance (ANOVA) tests. A p-value of <0.05 was considered statistically significant. Results. Of the 80 participants, 46 (57.5%) responded to the questionnaire. The mean total modified PHEEM score (SD) was 74.9 (16.4) out of a possible 160. The mean scores in this study were as follows: perception of autonomy 27.4/56 (5.3), perception of teaching 30.2/60 (4.0), and perception of social support 17.3/44 (7.1). The overall perceptions of the educational environment were influenced by sex (p<0.001), supernumerary status (p= 0.0036), and marital status (p=0.001). Only two individuals did not complete the four-year training programme. A total of 81.8% of those who completed the four-year training programme passed their Fellowship of the College of Obstetricians and Gynaecologists (FCOG) of South Africa qualifying exams (FCOG 2) on their first exam attempt, however, 34.1% wrote the FCOG 2 exams after completing the four-year training. Conclusion. During the study period, the educational environment within the Obgyn WITS circuit was perceived to be more negative than positive, indicating that all three domains of the modified PHEEM require attention to enhance the educational environment.
Critical incidents in gynaecology: audit at Charlotte Maxeke, Johannesburg Academic Hospital
(University of the Witwatersrand, Johannesburg, 2023-07) Chikwiri, Christopher; Chauke, Lawrence
Background: Critical incidents are among the ten leading causes of death and disability worldwide. Improving patient safety has become a global priority and one way to reach this goal is to report and analyse critical incidents. Objectives: To describe the epidemiology, patient outcomes and avoidable factors associated with critical incidents in gynaecology department at Charlotte Maxeke Johannesburg Academic Hospital (CJMAH). Methods: This research was a retrospective descriptive analysis of critical incidents in patients admitted to gynaecology wards at CMJAH from 1st January 2019 to 31st December 2019. All medical records of patients identified to have experienced critical incidents were reviewed and demographic information, timing of admission, critical incident markers and avoidable factors were extracted for analysis. Results: In total there were 257 critical incidents (CI) in 2082 gynaecology admissions during the one-year study period, which gives a critical incidence of 12.3%. A total of 158 patients experienced at least one or more critical incidents. The mean age (SD) of patients was 41.1 (14.8) years. The median (IQR) duration of admission was 6 days (3-10). Reasons for admission were emergencies 60 (38.0%), elective 54 (34.2%), oncology 44 (27.8%). Majority of the critical incident events were omission of procedures (n=45, 17.5%), deaths (n=34, 13.2%), massive transfusion (n=30, 11.7%), repeat laparotomies (n=29,11.3%) and fistula/organ damage (n=19, 7.4%). Avoidable critical incidents were (n=87, 55.1%). Most critical incidents were associated with no harmful outcomes to the patients (50, 31.5%), death (34, 22.8%) (mainly as a result on oncology admissions), moderate disability (29,17.9%), minimal disability (26, 16,1%), permanent/severe disability (14, 8.6%) and in (5,3.1%) harm could not be specified. Critical incidents forms were only filled out in 39 patients, that is a reporting rate of 24.7%. Conclusions: Critical incidents are a major cause of unnecessary harm in gynaecology at CMJAH. Half of these critical incidents are avoidable and therefore corrective measures can be undertaken to eliminate them in order to improve patient safety. Underreporting of critical incidents is still a major problem. There is need for precise definitions of critical incidents terms and modification of critical incident reporting system (including electronic) to promote patient safety culture in gynaecology.