Browsing by Author "Erumeda, Neetha Joe"

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Evaluation of the postgraduate family medicine decentralised training programme at the university of Witwatersrand, South Africa, using the logic model
(University of the Witwatersrand, Johannesburg, 2024) Erumeda, Neetha Joe; George, Ann Zeta
Postgraduate family medicine decentralised training programmes were implemented in South Africa about 15 years ago, but the University of the Witwatersrand’s programme has not been comprehensively evaluated. This study evaluated the programme using a complex programme evaluation logic model based on linearity theory. This theory assumes ideal inputs and processes produce good programmatic outputs and outcomes. Resources and support were evaluated as inputs, postgraduate supervision and workplace-based learning as processes, supervisory feedback as outputs and workplace-based assessments as outcomes. A parallel convergent mixed-methods instrumental case study was conducted with purposively-sampled family physicians (n=11) and trainees (n=11) from five decentralised training sites. Semi-structured interviews were audio recorded, transcribed verbatim, and analysed inductively using MAXQDA 2020 software. Descriptive statistical analysis was conducted on components of registrars’ learning portfolios (scores, supervisory feedback, and skills competence) and examination results using Stata 14.2 software. An integrative analysis involving transforming the quantitative results to qualitative findings and drawing meta-inferences was conducted. The integrated findings were used to modify the initial logic model and identify key recommendations to optimise the programme. The integrative analysis identified the need for more material and human resources, university and district management support, and standardised resources, supervision, and learning practices. Supervisors’ knowledge, skills, and behaviours varied across sites and their feedback was insufficient regarding soft skills like clinical reasoning and patient negotiation. Workplace-based assessments did not meet the required standards across training years and districts. Interpersonal interactions with patients, peers, supervisors and other professionals, engagement in district activities, promoted learning. Registrars’ professionalism and self-learning need improvement. The key recommendations include more explicit national guidelines, sufficient support from the provincial department, university, and district management, well maintained infrastructure, sufficient skilled supervisors, more professional development training for supervisors, protected time for registrar learning, and better use of self-learning and reflection. Emulating successful contextual adaptations while addressing challenges across sites contributes to thriving decentralised training programmes in district health systems. An improved understanding of the concepts and their interrelationships in training programmes could be translated to similar decentralised training platforms across medical disciplines of sub-Saharan Africa or low-middle income countries
A self assessment study of procedural skills in medical officers at District Hospitals in Region B Gauteng Province South Africa
(2012-01-19) Erumeda, Neetha Joe
Background The role of district hospital doctors in South Africa includes providing effective and efficient primary health care and referral of patients to more specialist care when needed. The doctors who work in these district hospitals have varying levels of clinical and procedural skills. Much research has been done on this topic in rural areas of South Africa; however there is insufficient information on the skills of doctors in urban district hospitals. The aim of this study was therefore to conduct a self-assessment study of procedural skills of medical officers in three district hospitals in Region B, Gauteng Province, which is mostly an urban area. It is hoped that the results of this study can be used to influence the development of appropriate training programs which will capacitate Medical officers to function effectively within the district hospitals. Methodology The study was a descriptive cross sectional study of all the doctors in all the three district hospitals in the region during the period of October 2009-November 2009 using a self-administered questionnaire. Doctors assessed themselves on 71 procedures considered to be required at district hospital level. Results The results show that there was varying level of self-reported competence in procedural skills among doctors, ranging from some procedures being performed independently to some performed with support, and to some where there was even unfamiliarity with certain procedures. There was some association between perceived overall competence in procedural skills with factors such as age, gender and years of experience, but no association with place of under graduate study, discipline and Family Medicine training. There was statistically significant association between age and overall anaesthetic competence (p=0.03), gender and overall competence in surgery (p=0.03), orthopaedics (p=0.02), urology (p=0.005), years of experience and overall competence in dermatology skills (p=0.02). Junior doctors reported higher competence in anaesthesia, whilst male doctors reported higher competence in surgical, orthopaedic and urology procedures. The organizational and management structure of the hospital where the doctors are currently working was also identified as a significant factor which affected the overall reported competence. Conclusion The study demonstrates that there are varying level of self-reported competence in procedural skills amongst doctors in urban district hospitals. This research study identifies the need for training in the procedural skills that the doctors have identified themselves as not competent to perform. Greater clarity regarding skills required of doctors in district hospitals is needed.