Doctoral Degrees (Office of the Dean: Health Sciences)

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Open Access
Antibiotic resistance in anaerobic bacteria
(University of the Free State, 2000) Theron, Maria Magdelena; Chalkley, Lynda; Van Rensburg, Nolan
English: Anaerobic bacteria are important human pathogens capable of causing serious debilitating infections ranging from abscesses to life threatening infections and warrant more attention than they are currently receiving. Anaerobes are often present in mixed infections in association with other anaerobes/facultative anaerobes and aerobic bacteria and it is imperative to administer correct antimicrobial therapy ab initio. Antibiotic resistance development in anaerobic bacteria has a tremendous impact on selection of effective antimicrobial agents for empiric therapy. β-Lactam antibiotics are frequently used and have for many years been the first choice in the treatment and prophylaxis of anaerobic and mixed aerobic/anaerobic infections. Current knowledge of β-lactam resistance progression and resistance mechanisms in anaerobic bacteria is, however, limited. Metronidazole is often used empirically against suspected anaerobic infections, but anaerobes can no longer be considered to be universally susceptible as resistance has been noted in strains of Bacteroides fragilis, clostridia and peptostreptococci. The objectives of the study were to: 1) assess antibiotic susceptibilities of anaerobic bacteria isolated in the Bloemfontein area to antimicrobial agents currently employed in empiric treatment, 2) compare the in vitro activity of currently employed antibiotics with new antimicrobial agents, and 3) conduct studies on antibiotic resistance development. Anaerobic bacteria were isolated from clinically significant infections from April 1996 to March 1997 from the Universitas and Pelonomi Hospitals, Bloemfontein. Infection sites traced for 302 of 378 of the isolates, were from blood, brain abscesses, liver abscesses, lung infection/abscesses, eustachian infection/sepsis, neoplasms, bone fracture/infection, post-operative/amputation sepsis, gunsho/stab wound infection/ sepsis, genital tract isolates, general abscesses, and intestinal tract infections. Isolates were identified in the routine diagnostic laboratory by presumptive and preliminary methods and results confirmed by the Rapid ID32A identification system. Minimum inhibitory concentrations (MICs) were determined by the National Committee for Clinical laboratory Standards (NCCLS) agar dilution method for the following 18 antimicrobial agents: six β-lactams (amoxicillin, ampicillin, penicillin, piperacillin, cefoxitin, cefepime and cefpirome), two carbapenems (imipenem and meropenem), metronidazole, clindamycin, chloramphenicol, ciprofloxacin, trovafloxacin, vancomycin, dalfopristin/quinupristin, linezolid and loracarbef. Screening for β-lactamase production was performed by employing nitrocefin and inhibition of β-lactamases determined using amoxicillin/clavulanic acid combination. For detection of carbapenernase/metallo-β-lactarnase production a biological assay was performed; cell extracts and imipenem being added to agar seeded with E. coli ATCC 25922. Detection of metallo-β-lactamase genes was undertaken with primers directed to cfiA, cphA and blalMP genes. PBP profiles and penicillin affinities were determined by labelling with [3H]penicillin, separation of proteins by SOS-PAGE and visualisation after fluorography. In PBP competition studies whole cell samples were initially preincubated with rupenern, piperacillin or ampicillin at different concentrations and post-labelled with [3H]penicillin, followed by SOS-PAGE and fluorography. Metronidazole MICs of 64 isolates were correlated with inhibitory concentrations (ICs) obtained with two batches of Etest strips (range 0.006 - 32 µg/ml and 0.016 - 256 µg/ml). Membrane proteins of parental and metronidazole mutant strains of a VeilIonelIa sp. and Peptostreptococcus prevotii were separated by SOS-PAGE and profiles compared. The prevalence of rdxA genes was investigated in 16 anaerobic/ facultative anaerobic bacteria with metronidazole MICs 1 µg/ml employing two sets of primers and fragments of approximately 937 bp and 491 bp sequenced. The prevalence of nim genes were investigated in 64 anaerobic/facultative anaerobic isolates with metronidazole MICs 0.5 µg/ml using a pair of universal mm gene primers. Amplification was performed at two annealing temperatures (52°C & 62°C) and fragments at approximately 458 bp recorded as presumptive positives and sequenced. Positive strains were subjected to plasmid extraction. MICs indicated overall susceptibility of Gram-positive anaerobic isolates to be higher than for the Gram-negative isolates. Reduced susceptibility to penicillin (MICs ≥1 µg/ml) was found in 20 Peptostreptococcus strains and seven non-perfringens Clostridium spp. β-Lactamases hydrolysing both penicillins and cephalosporins were demonstrated in all Bacteroides and Prevotella isolates with ampicillin MICs> 4 Iµg/ml. Only 8% Peptostreptococcus spp. were resistant to piperacillin in contrast to 41% Bacteroides spp. and 68% Veillonella spp. Veillonella spp. exhibited selective β- Iactam resistance to piperacillin. Cefoxitin showed excellent activity against both Gram-positive and Gram-negative isolates, except for Bacteroides and Fusobacterium species. The majority of Gram-positive isolates were susceptible to cefepime and cefpirome, whereas < 50% Bacteroides spp. and < 70% Prevotella spp. were susceptible. High-level resistance to imipenem/meropenem (MICs> 128 µg/ml) was seen for 13/37 Fusobacterium spp. Two P. magnus isolates were resistant to metronidazole (MIC >128 µg/ml), three C. perfringens strains showed reduced susceptibility (MICs 4-8 µg/ml), while two Prevotella spp. had metronidazole MICs of 32 µg/ml. Eighty five percent of all isolates were susceptible to clindamycin. Oalfopristin/quinupristin exhibited excellent activity throughout the Gram-positive bacterial spectrum with only one Peptostreptococcus sp. showing reduced susceptibility (MIC 8 µg/ml), but poor activity against B. tragiIis group isolates. Trovafloxacin was effective against all the Gram-positive anaerobes except for two P. anaerobius strains (MICs 8 µg/ml), and demonstrated superior activity to ciprofloxacin against the Gram-negative isolates. Overall, chloramphenicol was the most effective antibiotic, with only two Clostridium spp. being resistant (MICs 16 µg/ml). PCR products of predicted size of cfiA genes were found in two strains of B. vulgatus, a B. capillosus and a P. loescheii strain and of cphA genes in three B. tragi/is strains and a strain of P. loescheii. None of the PCR products on sequencing, however, were seen to be positive for ctiA or cphA genes. No bla/MPgenes were amplified. PBP profiles were analysed with respect to identification based on the API Rapid ID 32A system. Seven major groups of fusobacteria PBPs could be identified, but although PBP profile/API agreement was evident for the majority of F. mortiterum strains, the API system did not lend itself to reliable identification of fusobacteria. PBP profiles were seen to distinguish species/subspecies of Clostridium species other than C. perfringens, while comparison with the API identification method showed some correlation, but not with most of the species investigated. Comparing PBP profiles of nine Veillonella spp. assigned three groups of species/subspecies. Commercial identification systems appeared not to be as reliable as promoted. The differentiation of anaerobic bacterial species by PBP profiling could certainly assist in situations of therapeutic failure. For F. mortiterum the PBP with the lowest affinity for penicillin and imipenem was the highest-molecular-weight PBP, 74 kDa. The PBP profile of an imipenem-resistant variant of F. varium (MIC >128 µg/ml) demonstrated an additional PBP (±69 kDa) when compared to that of the parental strain (apparent MIC 0.5 µg/ml). In two C. tertium strains, a C. sporogenes and a C. bitermentans strain low-molecularweight< 50 kDa) PBPs exhibited reduced affinity towards penicillin. In Veillonella isolates a PBP (66 kDa) that possessed the highest affinity for penicillin, was seen to exhibit the lowest affinity for piperacillin. Regression analysis revealed good correlation between metronidazole agar dilution MIC and Etest IC values. In the clinical setting, metronidazole Etests provide an important role in the susceptibility testing of anaerobes. Inducing metronidazole resistance in a P. prevotii and a VeilIonelIa strain produced mutants with only a twofold increase in metronidazole MICs increase, yet alterations to several membrane proteins were apparent. Such findings, as were also found with PBP analysis conducted in this study, complexes interpretation as to how antibiotic resistance has developed in anaerobic bacteria. Nim genes were demonstrated in 14/64 strains (MICs ≥ 0.5 µg/ml) and identified as NimA genes in five propionibacteria, a P. bivia, a C. bitermentans and an A. odonto/yticus strain, with nimB genes identified in five isolates of B. tragi/is and a P. magnus strain. Sequence divergence was < 4% from the respective documented nimA and nimB gene sequences. Although the origin of nim genes is unknown, predominance of nimA genes in facultative anaerobes, propionibacteria, may indicate a transferable nimA gene source in anaerobic environments. To avert the clinical problem of untreatable anaerobic infections, it is necessary to continuously monitor for the emergence of antibiotic-resistant strains, conduct investigations into how resistance has developed, and understand conditions that foster inter- and intra-dissemination of resistance genes among anaerobic bacteria.
Open Access
An assessment model in outcomes-based education and training for health sciences and technology
(University of the Free State, 2003-12) Friedrich-Nel, Hester Sophia; Nel, M. M.; De Jager, L.
English: The promulgation of the SAQA Act No. 58 of 1995, following the new democracy in South Africa, is regarded as the impetus for change in higher education. It was consequently recommended that higher education institutions should implement the Outcomes-based education and training (OBET) approach. The literature review conducted in this study emphasised the move towards assessment in the OBET approach in medical and health care education. Assessment in higher education has therefore become an essential issue to deal with. Likewise, the need for educators in Health Sciences and Technology to become empowered with the principles of assessment in the OBET approach was identified. A study was conducted to revisit current assessment practices in Health Sciences and Technology at the Technikon Free State and the University of the Free State, with the OBET approach as background. The aim of the study was to compile an assessment model in OBET for Health Sciences and Technology. With the assessment model, the change to assessment in the new approach in higher education in Health Sciences and Technology could be facilitated. A questionnaire for the structured interviews was designed, based on essential elements of assessment identified in literature on assessment and the OBET approach. The structured interviews were conducted with 16 headhunted academics from Health Sciences, Technology and higher education studies from the University of the Free State and the Technikon Free State respectively from July to August 2002. The information from the structured interviews, supported and supplemented by the literature on assessment and the OBET approach, was subsequently used to compile a proposed assessment model. The statements of the proposed assessment model were fed into the questionnaire for the Delphi process. A three-round modified Delphi process, conducted from February to August 2003, was applied to rate the statements of the proposed assessment model according to essential, useful or unnecessary statements of an assessment model. The aim was to attain consensus on the ratings of the statements, with consensus defined as 80 percent of the Delphi panel in agreement. Additionally, the Delphi panel could rephrase and/or comment on the statements of the proposed assessment model. The Delphi panel, consisting of 10 members, represented five different areas in higher education and assessment. Findings of the Delphi process and the literature on assessment and the OBET approach were used to compile the final assessment model in OBET for Health Sciences and Technology. The findings of the structured interviews indicated that the participants in the study were knowledgeable about the range of innovative (performance) assessment methods. However, the participants pointed out that they lacked the knowledge and skills to optimally make use of these innovative assessment methods. This was evident from the fact that fewer than 50 percent of the participants used an appropriate range of innovative assessment methods in the questionnaire. However, it should be noted that the OBET approach had not been implemented in the relevant programmes at the participating institutions at the time of the interviews. Even so, the information obtained from the structured interviews was adequate to compile the proposed assessment model in OBET for Health Sciences and Technology. The outcome after three rounds of the modified Delphi process used in the study, was that consensus on 60 percent of the statements of the proposed assessment model had been attained. The statements were all rated as essential elements of an assessment model, with the majority of the statements achieving consensus between rounds I and II of the Delphi process. The final assessment model was presented as 65 essential and six useful statements in seven categories. With the exception of two statements, all the statements rated by the Delphi panel were included in the final assessment model. This was based on the ratings of the statements of the assessment model by the Delphi panel and verified by literature on assessment in the OBET approach. The willingness of the participants in the study to share information on successes and failures experienced in assessment practices contributed positively to the design of the assessment model. This assessment model in OBET for Health Sciences and Technology was developed, designed and compiled to perform integrated and quality assessment in the programme. The generic assessment model should provide a programme with direction to practise meaningful and holistic assessment in the OBET approach. In addition, using the assessment model in OBET for Health Sciences and Technology should add value to learning. Likewise, by means of the assessment model, assessment should be repositioned at the centre of learning activities in higher education. The information from the structured interviews proved useful to compile and develop the proposed assessment model. The three-round modified Delphi process was an effective research methodology to validate and benchmark the statements of the proposed assessment model. In addition, the assessment model could become a valuable educational tool with which assessment in Health Sciences and Technology could be repositioned as a process that matters to academics, learners, the institution, accrediting bodies, as well as current and future employers.
Open Access
Developing model for group work in phase I and II of the M.B.,Ch.B.-learning programme at the University of the Free State
(University of the Free State, 2003-12) Raubenheimer, Daleen; Nel, M. M.; Petersen, S. A.
English: Drastic changes in the guidelines for medical education have taken place over the past few years which have resulted in the adjustment of undergraduate medical learning programmes of medical schools. One of the prerequisites for being regarded as competent medical practitioners is the ability to function effectively in a health care team. This implies that group work needs to be incorporated as an instructional learning method in undergraduate medical education. The Faculty of Health Sciences, University of the Free State (UFS) implemented a transformed M.B.,Ch.B.-Iearning programme in 2000, consisting of a hybrid curriculum with lectures, group work and directed self-study as the main components of instruction. However, group work was implemented without guidelines and it currently appears not to be reaching the objectives it was intended to. This study was conducted in an attempt to provide guidelines for the implementation and practice of group work through an appropriate model. An opinion survey was conducted amongst the students and staff involved in Phases I and II of the M.B.,Ch.B.- learning programme at the UFS, so as to determine the importance of various indicators for a group-work model, using the literature as a basis for the compiling of suitable questionnaires. The opinions of national and international experts in group work and medical education were also obtained through a Delphi study in an attempt to reach consensus amongst the experts on the importance of the indicators for the group-work model. The model was eventually designed by considering the literature and the results from these two investigations in order to determine its structure. The group, consisting of students, forms the centre of the model, whereas the roleplayers (i.e., students, lecturers and facilitators) are united through group-work sessions. The important input factors which could influence the effectiveness of group work include training, support and resources for group work. All aspects of group work need to be evaluated for various reasons: Not only should the group process and -task be evaluated and assessed, for students to receive marks and thus progress in their studies, but all the elements of group work should be reviewed as part of assuring the quality of group work. However, quality assurance also entails reflecting and reacting on the evaluations in order to ensure that the outcome of group work (i.e., learning in terms of knowledge, skills and attitudes) is reached. The organisation (in this instance, the Faculty of Health Sciences, UFS) needs to provide a suitable environment and academic climate for group work to take place in. This study may therefore contribute to the quality of the undergraduate medical education at the UFS, assisting students to develop the skills necessary to function as competent health care professionals.
Open Access
A management model for heads of department in the medical school, University of the Free State
(University of the Free State, 2004-06) Van Zyl, Gert Jacobus; Nel, M. M.
English: The research study was undertaken to determine the needs of Heads of Department in the School of Medicine, UFS; management models available to them; and the factors impacting on their academic environment. The rationale for the study can be found in the need expressed by Heads of Department to manage their departments in the new academic setting. The aim of the study was to create and establish a management model for experienced as well as new Heads of Department in the School of Medicine, measured against the background of good management practices. This aim was achieved by performing a literature study regarding the needs of Heads of Department; factors influencing their academic environment, and the composition of available management and leadership models that could apply to Heads of Department in the School of Medicine. Heads of Department are appointed in the academic environment with the primary focus on their educational achievements. Throughout the process it was demonstrated that this is still relevant and needs to be part of the appointment process of Heads of Department in the School of Medicine. It was also indicated throughout this study that there is an increasing expectation from Heads of Department to take on sole responsibility for the management of their departments. In the light of these developments, it was important to consider solving this problem for them, and also to establish a management model for Heads of Department, thus empowering them to manage their departments in the future. The research took the form of a descriptive, explanatory survey comprising a literature review, a questionnaire survey and a Delphi process. The literature study covered a few aspects, including assessing the possible needs of Heads of Department, exploring factors impacting on their environment, as well as the difference between management and leadership, and the difference between various management models that may be applicable to management in an academic setting such as a Medical School. The second part of the empirical study was a Delphi process, which involved six experts from the areas of management, health management, and education. The overall goal and objective was to make a significant contribution to the managerial needs of Heads of Department, and to establish a management model, thus empowering Heads of Department to manage their departments in the future. A quantitative approach with open-ended questions was followed. The Delphi technique also focussed on these areas through statements in order to measure the experts' feelings about these areas. As part of the Delphi process, the experts had to participate in two rounds. The main findings from the questionnaire to Heads of Department, the Delphi technique, and information obtained via the literature study enabled the researcher to make a recommendation on a management model for Heads of Department, UFS. The management model had to be flexible, individualized, relevant, and adaptable. It had to include the seven main areas of management, namely strategic management; office administration, postgraduate education and training; undergraduate teaching research, academic administration, and service delivery. The recommendations on the clinical management model were extensively detailed, as these will also form the basis of an implementation plan for implementing the management model in the School of Medicine, UFS. In summary, the researcher is of the opinion that the overall goal and objectives of the study were addressed and realised, and that meaningful recommendations were made. The PRIME model was established as a management model for Heads of Department, School of Medicine, UFS, offering an ultimate solution to the managerial problems of Heads of Department. The management model is in line with the needs of the Heads of Department, legislation, and the policy documents referred to in earlier chapters. In addition, recommendations were also made on future research; the possible implementation in other Medical Schools; and the use of the PRIME model. The researcher realises the limitations of the study, which are discussed in detail. Although a number of limitations were listed, the majority of these could be seen as minor limitations and they do not have an impact on the final outcome of the study. It is recommended that the study be followed by a research process and the possibility of utilising certain principles of the PRIME model in other Medical Schools in South Africa in order to assist them with the managerial problems they might be experiencing. The aim of the model is not to address all the issues in detail, but to provide a model for academic management of departments based on the needs indicated, and the academic management models available for such management. It is the researcher’s opinion that the PRIME model for the management of academic departments will contribute significantly to the overall management of academic health, the best possible utilisation of resources, and the improvement of health services at large. Furthermore, the researcher believes that this study has achieved all these aspects. It is in line with the current trend to improve quality within health services, and it is ultimately about improving the lives of Heads of Department in the academic sphere. The thesis also provides an extensive and comprehensive reference source for Heads of Department on leadership, management, needs, management models available; and factors that have an impact on the academic environment. As a management model, the PRIME model aims to create a win-win situation for the Heads of Department, their departments, and management and authorities. With this PRIME model, we can reach for the stars!
Open Access
'n Raamwerk vir 'n voorgraadse onderwys- en opleidingsprogram vir spraakterapie en oudiologie
(University of the Free State, 2006-01) Van Pletzen, Helena Catheriena; Bezuidenhout, M. J.; Nel, M. M.
English: Health care workers are finding themselves in an era of change with regard to service rendering. Health care workers need to be prepared for these changes during their training. The most important change in the transformation process of health care is the focus on primary health care and associated community-orientated and community-based services. To ensure that the training of prospective speech therapists and audiologists (the health care workers) is applicable with regard to preparing for service, the curriculum must be such that the expected outcome will be achieved through the education and training students receive. There are, however, also changes with regard to training in the policies and regulations of higher education that must be adhered to. In order to adapt to all the changes in health care service and the changes in policies and regulations for training, it is necessary to change and adapt the strategies for training too. Training and service rendering can only be effective if it meets with the requirements of the relevant professional board, health care bodies and the regulating bodies of higher education. The requirements of health care and education and the associated changes, however, necessitate a review of curricula for education and training programmes. When a new curriculum has to be developed or an existing curriculum is reviewed, the process is to be conducted according to specific steps and various factors need to be attended to. If these steps are defined and the factors that influence the education and training together with the requirements regarding content, the education and training process and the desired outcomes are described, it is called a framework for the programme. The research problem defined, was that no guidelines or framework existed according to which a curriculum for a training programme for speech therapy and audiology could be adapted, revised or developed. This led to the formulation of the research question, namely: What should be included in a framework for an undergraduate education and training programme to ensure that the training programme meets the requirements of the above mentioned bodies? The main purpose of this study was to make a contribution to health care in South Africa by making a contribution to the education and training of a group of health care workers. The goal was to compile a framework for undergraduate education and training programmes for speech therapy and audiology. In order to achieve the goal, a comprehensive literature study was conducted to study curriculum development, existing curricula and the requirements of relevant bodies. A concept framework was developed and verified by an empirical study through the application of the Delphi technique. The data were processed and analysed and the final product, a framework for the training programme for undergraduate speech therapy and audiology, was established. The literature study served as the basis of this investigation. The Delphi technique was applied to verify the concept framework that had been developed on the basis of the literature study. The concept framework initially consisted of 183 statements, describing aspects and elements of the curriculum design process and content of the curriculum. Each statement was to be judged according to a three-point rating scale, namely essential, desirable and irrelevant. The criterion for reaching consensus was predetermined, namely 75% of the number of ratings on any of the items in the questionnaire had to correspond. The panel of experts (eight) that took part in the Delphi process included heads of departments of the various training institutions in South Africa, an educational expert and an expert representative of the Professional Board for Speech, Language and Hearing Therapy. A pilot study to determine the validity and reliability of the research instrument (the questionnaire) had been conducted before the research instrument was sent to the participants in the Delphi process. With the completion of round three, consensus on the items in the Delphi questionnaire was on 96.77%. Stability was also reached in round three, as the items on which consensus was not reached, showed the same responses with regard to rating since round one. The Delphi process was therefore ended after round three and the final framework was compiled based on the results of the Delphi investigation, in other words, the responses of the participants. The framework is of great value for programme development, as professionspecific information and requirements of stakeholders are contained within the framework, thereby facilitating the task of experts in educational development involved with programme development for speech therapy and audiology. It is recommended that the programme be used by institutions as a guideline for the development of innovative undergraduate training programmes for speech therapy and audiology. It can also be used for revising and/or evaluating existing training programmes, as well as for the accreditation of a training programme. The content elements of the framework may be adapted and changed, if and when the requirements of the relevant professional board and the requirements of health care services and education change, as well as according to changes in the needs of students and needs of the community.
Open Access
A model to manage continuous professional development for the alumni of a private higher education institution
(University of the Free State, 2007-05) Castleman, E. M.; Nel, M. M.
Health services in a country are affected by many factors, one of which is the human resources that render those services. One of the dimensions of human resources that will impact on the effectiveness of the health services is their competence. There are three phases of health education, namely basic health professions education; postgraduate health professions education; and continuous professional development. This study will focus on the third phase of continuous professional development of health professionals. The purpose of continuous professional development is defined in this study as high quality patient care and the outcomes to improve, maintain and further develop competencies regarding skills, knowledge and attitude in order to meet the changing needs of both patients and the health care delivery system. Globally there is more emphasis on the role of higher education institutions in continuous professional development. It was evident from the literature that higher education institutions should have a strategy as continuous professional development providers in order to be effective and efficient in contributing to attaining the outcomes of continuous professional development. The question that has arisen was, “How should the model to manage continuous professional development for alumni of a private higher education institution (PHEI) be composed in order to be conducive to the outcomes of continuous professional development, which are improved competencies of health professionals?” Given the situation the problem that was addressed was that there was no model to be implemented by the Foundation for Professional Development [a Provisionally Accredited Private Higher Education Institution in terms of section 54(3) of Act No. 101 of 1997 (RSA 1997)] focusing in the health sector to enable it to take accountability to plan, organise, lead and control continuous professional development for its alumni which will support attainment of the purpose of continuous professional development. The aim of this study was to develop a model to manage continuous professional development for alumni of private higher education institutions in an effective and efficient manner. In the attempt to attain the aim the objectives pursued were a literature study to develop a framework of the model to manage continuous professional development inclusive of the most effective and efficient components of continuous professional development, while a questionnaire survey followed to identify the most preferred components of a model to manage continuous professional development for alumni of a PHEI to ensure effective implementation of the model. This was done by means of a custom designed questionnaire. The final objective in attainment of the aim was the triangulation of the information from the literature study, the results of the questionnaire survey, and conclusions to develop a model to manage continuous professional development. An empirical, non-experimental research design was followed in this quantitative study. A cross-sectional survey was employed because the respondents were approached only once to complete questionnaires and it was possible to make comparisons between subgroups and look at relationships between variables. Descriptive and inferential statistics were calculated and used to answer the research questions. The custom designed self-administered questionnaires collected information on respondents’ personal profiles, professional profiles, employment backgrounds, geographical profiles, communication preferences in an alumni network, alumni network interaction preferences, accreditation preferences by an alumni network, educational product needs in an alumni network, areas of expertise and interest, alumni network membership needs, and the alumni patient profile. The sample population for the current study was defined as: “Learners at the Foundation for Professional Development during August 2006 to November 2006”. On completion of their training these learners would become alumni of the Foundation for Professional Development and would become eligible for inclusion in a continuous development alumni programme. This population were therefore best positioned to test certain assumptions about a continuous professional development alumni network and start the building of a model to manage continuous professional development. A total number of 1968 learners attended workshops during this period and the entire population were presented with an opportunity to participate in the study. No sampling technique was therefore required. The objective of the literature review was to gather information to develop a framework for the model to manage continuous professional development. Continuous professional development with specific attention to the origin and the purpose of continuous professional development was reviewed. Then the purpose was defined, the process was reviewed and subsequently the trend of regulation of continuous professional development globally. The concept of credentialling was reviewed in relation to continuous professional development and integrated to assessment in continuous professional development. To gain a global perspective a review on international and South African trends in providers of continuous professional development and coordination of the function was provided. It was also necessary to review adults’ learning preferences, needs assessment, and continuous professional development learning methods as part of identifying best practices in composing the framework for managing continuous professional development for alumni of a PHEI. For the same reason learning networks, mentoring and personal continuous professional development plans were reviewed. The model to manage continuous professional development for the alumni of a PHEI is a triangulation of the literature study, the research results and conclusions. Application of the model will ensure fulfilment of the continuous professional development functions of a PHEI in their responsibility towards their alumni in a planned and coordinated manner. It is supportive of continuous professional development in a cyclic and continuous manner, applying the principles of adult learning and credentialling. Assessment is an integral part of the quality assurance on the various levels. It is based on a network principle in that it utilises existing infrastructure and expertise in a decentralised manner to make continuous professional development convenient and relevant to learners. Integrated in the model is managed communication with alumni based on the research results. Information to plan, organise, implement and evaluate continuous professional development is another integral component of the model. According to the level of assessment alumni will be accredited in the network on five levels with associated benefits to promote continuous professional development and nurture a culture of lifelong learning with an emphasis on planned learning and improvement of practice. The researcher is of the opinion that PHEIs shall be capacitated by the model developed and through implementation of the model to manage continuous professional development for alumni of a PHEI, the overall goal, aim and objectives of the study to facilitate continuous professional development in South Africa will contribute to the optimisation of health care in South Africa. The researcher did not imply that this model should be implemented in its original form, but that the intention is that each HEI should customise the model according to its own unique situation and alumni needs and expectations. However, the process followed and components of the model could be repeated without reinventing the wheel. The implementation plan could therefore be utilised as a useful guideline. The researcher is of the opinion that components of this contribution could also facilitate the management of continuous professional development in public HEIs in South Africa. Furthermore the researcher is also of the opinion that components of the contribution could be implemented internationally by HEIs. Therefore the overall goal, aim and objectives of the study were reached.
Open Access
A guide for accreditation reviews aimed at quality assurance in South African undergraduate medical education and training
(University of the Free State, 2008-06-18) Bezuidenhout, Maria Johanna; Nel, M. M.; Van Zyl, G. J.; Van Der Westhuizen, L. J.
Quality assurance is not something new to higher education, but recent years have seen an increase in the interest in the quality of education, mainly due to demands for accountability. This study was conducted to investigate the phenomenon of quality assurance in higher education with special reference to accreditation as quality assurance measure in undergraduate medical education, and to develop a guide for accreditation reviews. Quality assurance as it manifests in a number of higher education systems in different countries was studied. It was found that social and economic demands, an increase in and a changed student population have contributed to a renewed emphasis on quality, that is, effectiveness and efficiency, in higher education. Medical education could not escape the demands for quality assurance. Recent publications on medical education stress the necessity for change and innovation in medical education, and a concomitant need for measures to ensure that the education and training students receive are of a high standard.In many higher education systems accreditation is used as a quality assurance mechanism. Accreditation is defined as a process of external quality review used to scrutinise institutions and their programmes to ensure quality in the offerings and to encourage quality improvement. The process of accreditation usually entails a selfassessment by the institution (internal evaluation), followed by an external review conducted by a panel of peers with a view to verifying the findings of the internal assessment. Accreditation usually also has a dual goal, namely to ensure quality and to promote quality. In South Africa the Health Professions Council through the Sub-committee for Undergraduate Education and Training (UET) of the Medical and Dental Professions Board is the professional body responsible for quality assurance in medical education and this is brought into effect through a process of accreditation of medical education programmes. The first accreditation reviews took place in 2001, and by the end of 2004 all medical faculties/schools had been subjected to at least one accreditation review visit. The process was based on sound studies and apparently served its purpose well. As different panels comprise different members, however, there is no comparability in the accreditation reviews. Each member, it is perceived, approaches the process from his/her own frame of reference, as no fixed set of standards exists to ground the evaluations. Although panel members are experienced and experts in their disciplines, they are not necessarily experts in the field of modern medical education, and may hold disparate views on what quality in education entails. Therefore, specific standards in terms of which a quality appraisal can be done are required in an accreditation process.Involvement of the researcher in the accreditation process of the UET led to the research problem being identified, namely a lack of a review guide that might be used in the appraisal of medical education programmes and the institutions that offer them. In this study it was assumed that a guide for accreditation reviews, containing standards with rubrics and criteria to use as a measurement tool, would serve well to render the accreditation process more objective and structured, thereby contributing to ensuring quality in medical education in South Africa. Such a guide, it was presumed, would also be useful in the planning processes of medical schools/faculties, especially with a view to quality improvement as well as in the internal self-evaluation, and would contribute to better preparation for the external accreditation review. As background to the study an extensive literature review was conducted to investigate the phenomenon of quality assurance. Quality assurance in higher education perse and in medical education specifically was studied; accreditation as quality assurance mechanism and the role standards have to play in quality assurance mechanisms were attended to, and tools used in quality assurance processes were put to scrutiny. The standards that apply in various quality assurance systems in higher and medical education received special attention during this phase of the study, as these were used as point of departure when the draft guide for accreditation reviews was compiled. The accreditation process of the MDPB of the HPCSA, as implemented by the UET was studied in detail to gain a complete picture of the process as it manifests in South Africa. A qualitative research design was employed and a phenomenological descriptive and exploratory approach was followed. The methods employed for data collection included participant observation, individual interviews and a focus group interview, while a literature study provided the required grounding and background. As the researcher has been involved in the quality assurance process since its inception, participant observation and emanating field notes played an important part in the study. This was amplified with information collected from literature. A draft guide for accreditation reviews in undergraduate medical education in South Africa was compiled based on the information collected. In this guide it is proposed that medical schools/faculties in South Africa should compile a portfolio to serve as evidence of the quality of their teaching and training. The portfolio, it is recommended, should be a (mainly) computer-based document with links to appropriate sites, and should comprise two parts: (i) an overview of and background information on the school/faculty, and (ii) an indication of the extent to which the school/faculty satisfies the standards in the Standards for accreditation part of the guide, supplemented by a list of materials (links) to substantiate the response. The proposed use of the guide by medical schools/faculties and the accreditation review panels is described, and the remainder of the document consists of a set of standards for undergraduate medical education with rubrics and rating scales for use by the medical school/faculty and the accreditation panel. The rubrics are set out in three levels, namely a minimum level, higher level and highest level, requiring the evaluator to indicate for each standard the level at which the school/faculty is in compliance with the standard. It is recommended that each school/faculty in the self-evaluation rates itself in terms of the rubrics. This rating together with the completed portfolio and evidence cited is then submitted to the accreditation review panel, and each panel member rates the school/faculty/ programme individually. The individual ratings and that of the institution are used to structure the subsequent on-site visit. During the visit the panel then verifies the self-evaluation response, and brings out a joint rating of compliance with the standards, together with a report containing recommendations and comments. The draft Guide for accreditation reviews was used as research instrument in the empirical study. Individual interviews were conducted with six deans/heads of medical schools or their representatives and four former members of accreditation review panels to gauge their views and opinions on the draft guide and to gain their perspectives of the phenomenon under study. Following the individual interviews a focus group interview was conducted with seven members of the UET to collect their opinions and perspectives. The interviews were conducted in a positive spirit and the interviewees were enthusiastic about the possibility of using the proposed guide for accreditation reviews. The data collected during the interviews were analysed in terms of a data analysis spiral for use in qualitative studies. The data provided the researcher with a clear view of the respondents’ perspective of the phenomenon and their opinions on the draft guide. Based on the findings, the draft guide was adapted to incorporate recommendations made by the respondents. The findings were compared to the findings of the literature review in a literature control. In the final analysis it was found that the participants regarded the current accreditation process as unstructured and rather subjective, and supported the idea of the use of the proposed guide for accreditation reviews, as well as for planning and quality enhancement purposes in medical schools/faculties. The assumption thus could be accepted on the basis of the opinions of the participants in the study, namely that a guide for accreditation reviews would address the research problem, that is, a lack of a tool or mechanism to use in accreditation review evaluations. The use of this guide, it was found, has the potential to render accreditation reviews more structured and more objective, as panel members would no longer conduct evaluations based on their individual frames of reference or background, but on a common set of standards and criteria as set out in the rubrics. This will bring comparability to the accreditation process. The guide will also satisfy the second goal of accreditation, namely improvement of quality, as schools/faculties will be encouraged to strive for higher levels in the evaluations. It is hoped that this proposed Guide for accreditation reviews will receive attention from medical educators, planners and the accreditation body, that the information and perspectives on quality assurance and accreditation presented in the study will contribute to a better understanding of the phenomenon of quality assurance in education, and that the information and newly constructed knowledge in the study will be applied to the benefit of quality assurance in medical education in South Africa. As final outcome of the study a Guide for accreditation reviews is presented, with the recommendation that it be brought to the attention of the accreditation body for South African undergraduate medical education and training, with a view to implementation as part of the accreditation process. It is also recommended that it be considered for use as planning guideline for medical education programmes, as it has the potential to enhance innovation and improvement in medical education and to be used as benchmarking instrument.
Open Access
A model for the academic development and implementation of a postgraduate diploma in Transfusion Medicine in the Shool of Medicine at the University of the Free State
(University of the Free State, 2010-11) Louw, Vernon Johan; Nel, M. M.; Hay, J. F.
English: In this research, an in-depth study was done to construct a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine in the School of Medicine at the University of the Free State. Transfusion medicine as a discipline has experienced major advances over the past few decades with an emphasis on increased blood safety and the improvement of systems, technology and administrative processes. Unfortunately, attention has largely been focused on laboratory aspects and clinical transfusion medicine has lagged behind. This has resulted in the present situation where clinical transfusion medicine has become totally underrepresented in medical curricula, despite the fact that many doctors are involved in administering blood and blood products. This has led to a number of studies and publications on the increasing rate of preventable transfusionassociated deaths resulting from errors on the part of medical personnel. Many researchers have made the link between these errors and the inadequate education and training received by doctors in respect of transfusion medicine. This begs the question as to how this gap in the knowledge market can adequately be bridged and further what a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine should look like. Against this background, the problem that was addressed in this study was the absence of such a model. As far as the researcher could ascertain, no such model existed prior to his embarking upon this research. The goal of the research was thus to develop a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine – specific to the South African context – with a view to contributing to safer and more cost-effective transfusion practice by clinicians. A further aim of the study was to develop this model specifically in the School of Medicine at the University of the Free State. Both qualitative and semi-quantitative research methods were employed and used in a complementary fashion. The methods used included a study of the literature, semi-structured questionnaires and a Delphi survey. The literature review provided insights into the current status of education in transfusion medicine with special reference to the changing arena of transfusion practice. Also, a perspective was provided on some of the key issues that should be taken into account during the development and implementation of a model for a Postgraduate Diploma in Transfusion Medicine. Semi-structured interviews were conducted with experts in transfusion medicine from all over the world. Open-ended questions were asked, which allowed for an interactive discussion between the researcher and the interviewees. Prior to the interviews, a letter of request and explanation was provided to the participants and formal, informed consent obtained. The purpose was to collect information on a number of issues related to clinical transfusion medicine practice. As well as wanting to determine the nature of the challenges with which clinicians are faced, the researcher set out to delineate their scope of practice. Questions dealt with the roles, tasks, functions, skills, deficiencies, areas of clinical knowledge and competences practised by doctors involved in transfusion medicine. An attempt was furthermore made to determine not only the relevant outcomes of a Postgraduate Diploma in Transfusion Medicine but also the relevant academic, educational and sustainability factors. The results of the semi-structured interviews were analysed and collated in tables. These, combined with the findings from the literature review, formed the basis of the statements used in compiling the Delphi survey. The Delphi survey was used to test the criteria derived from both the literature review and the semi-structured interviews qualitatively and semiquantitatively. The Delphi questionnaire was provided to South African doctors with appropriate experience in transfusion medicine and medical education subsequent to their receiving an information letter and giving informed consent. The Delphi questionnaire was divided into sections corresponding to the main themes in the semi-structured interviews. After analysis by the researcher, the findings of the Delphi survey were presented in the form of a description of the findings, a discussion and recommendations. Aspects discussed in the model comprised the premises for the development of the model, the points of departure, the key internal and external role players who could potentially influence the model and the different elements that should be included and/or addressed in the model. Perspectives were provided on the model and its implementation, including some thoughts on procedural, policy and management issues. The researcher proposed that, before anything else, a situational analysis had to be done to identify the needs, deficiencies and challenges related to transfusion medicine practice and education. This needed to be done in consultation with all the relevant role players. Subsequently, the educational, academic and sustainability factors relevant to the programme had to be identified. Careful planning was required within the context of a qualified and motivated team. Once the structure, programme content, timeframe, target audience and funding streams had been identified, and the appropriate approvals for the programme obtained, the programme would have to be marketed. Cooperation and networking with all role players through continuous dialogue would allow for the linkage of resources and lay the foundation for long-term collaborative relationships. Finally, continuous feedback from role players, including students would be required to determine whether goals had been achieved and if not, to use this as the basis for continuous improvement. In that the stated problem was addressed and the goal and objectives of the research were met, this study makes a unique contribution to transfusionmedicine education by providing a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine. Final conclusions were drawn and the limitations and recommendations of the study were highlighted. It is hoped that this study will make a contribution to the better education of clinicians in the clinical aspects of transfusion medicine and that this will, in turn, translate into patients’ receiving better and safer transfusions.
Open Access
A critical appraisal of selection criteria and academic progression of first and second year medical students at the University of the Free State
(University of the Free State, 2011-05) De Klerk, Brenda; Cliff, A.; Nel, P. P. C.; Moja, L. M.
English: The changing of the evaluation systems used for Grade 12 scholars in South African schools and the transformation principles of the Department of Education, compelled the University of the Free State (UFS) to start looking into alternative criteria for the selection process of medical students. One of the alternative criteria explored is the Health Science Placement Tests (HSPTs). The overall aim of this study was to assess the relationship between the HSPTs, school performance and other factors and academic performance during the first two years of study at the UFS. The specific objectives of the study were to conceptualise and contextualise the problem of selection of medical students at the UFS and to identify factors in different regions of the world that play a role in the selection of medical students by means of a thorough literature survey, but also to assess the influence of the current selection criteria and additional criteria on the performance of first and second year medical students at the UFS. A quantitative research approach was followed. The study population comprised of the first year medical students of 2004 and 2005 and second year medical students during 2005 and 2006 at the UFS. The demographic information of the students, their HSPTs results, school performance and academic performance results during first two years of study were statistically analysed to detect associations. Data for the study was obtained from the several databases of the University of the Free State and was collated by the researcher. The data management and analysis in this study was conducted by the staff of Statistical Consulting Service, Department of Statistical Sciences, University of Cape Town, using a variety of available statistical techniques. The correlation between all the numeric and categorical variables and the outcome variable were checked. These results showed the degree to which the variables changed together and allowed the researcher to indicate those with a predictive relationship. Strong to moderate correlations were found to be present between the averages of the first two years of study and English, Mathematics, Science and Biology of the Grade 12 marks, the PTEEP, MACH, MCOM and SRT of the HSPTs and the M-score. A weak negative correlation was found between the age of the student and whether or not they had any tertiary education and both the first and second year averages. By using the simple linear regression technique of analysis, the researcher evaluated the effect that each of the individual variables had on the first and second year averages. The following variables had a significant influence on the first two year‘s average marks: English, Mathematics, Science and Biology average mark, School Poverty Quintile Index, M-score and the HSPTs average. By using a multiple regression analysis, the predictors of dependent variables upon the outcome variable were tested, while the independent variables were held fixed. After following a step-wise regression analysis, the best fit model was the model evaluating the relationship between the first and second year average marks independently and the age of the student, the English, Mathematics, Science and Biology scores of Grade 12 and the PTEEP, MACH, MCOM and SRT tests of the HSPTs and the School Poverty Quintile Index. This model explained 50% variance of score in the first year and 70% variation of score in the second year as a result of the combination of these variables. Although some of the variables were not statistically significant, they were still of conceptual significance. From this analysis it was clear that the more variables that were included, the more reliable or predictive the model was to determine how a student would perform academically at the end of the first two years of study. The conclusion of this study was that the application of different statistical approaches presents a case for the complimentarity of data for use in selection models and approaches. Through the exploration of different models of regression and association, a particular model was found acceptable as an indicator for good performance during the first two years of study. This choice was based on the fact that the multiple regression model was able to predict the effect that a variable would have on the outcome and the size of the effect. It was able to explain 50% variance of score in the first year and 70% variation of score in the second year and also took into account the effects of other confounding variables. This study and similar future studies will identify reliable and valid selection criteria for medical students who will perform well academically within the M.B.,Ch.B. tertiary education programme.
Open Access
A framework for articulation between the emergency care technician certificate and the emergency medical care professional degree
(University of the Free State, 2011-11) Vincent-Lambert, Craig; Bezuidenhout, J.; Jansen van Vuuren, M. V.
English: The need to comply with the requirements of the SAQA Act necessitated a review of emergency care education and training in South Africa. The review and restructuring led to the creation of a formal two-year, 240-credit NQF level 5 Emergency Medical Care Technician (ECT) Qualification. The NDoH views the ECT programme as the "Mid-Level Worker" equivalent for the Emergency Care Profession. At the Higher Education level, the existing three-year National Diploma and one-year B Tech Programmes were collapsed to form a single four-year, 480-credit, NQF level 8 Professional Bachelor of Health Sciences Degree in Emergency Medical Care (B EMC). After the establishment of the two-year ECTand four-year B EMCprogrammes, the next challenge faced by the HPCSA,educators and educational providers within the emergency care field became that of facilitating articulation between the two qualifications. This study aimed to critically analyse and compare the two-year ECT qualification with the four-year professional B EMC degree in order to design a framework and bridging programme that may support and guide articulation between the two qualifications. An expository, retrospective analysis of existing documentation was followed by a focus group discussion with educators in the field in order to identify and explore potential obstacles and challenges with regard to articulation between the ECTand the B EMCqualifications. Finally, a detailed Delphi Questionnaire was sent to selected expert panel members. The study highlights a strong desire for articulation and academic progression within the emergency care profession. Similarities and substantial differences were identified in the scope, level and depth of knowledge of the ECT and B EMC qualifications. A framework was designed that includes a bridging programme to provide ECTgraduates with the necessary knowledge, skills and insights required to enter directly into the third year of the Emergency Medical Care Degree.
Open Access
A framework for articulation between the emergency care technician certificate and the emergency medical care professional degree
(University of the Free State, 2011-11-15) Vincent-Lambert, Craig; Bezuidenhout, J.; Jansen van Vuuren, M. V.
English: The need to comply with the requirements of the SAQA Act necessitated a review of emergency care education and training in South Africa. The review and restructuring led to the creation of a formal two-year, 240-credit NQF level 5 Emergency Medical Care Technician (ECT) Qualification. The NDoH views the ECT programme as the “Mid-Level Worker” equivalent for the Emergency Care Profession. At the Higher Education level, the existing three-year National Diploma and one-year B Tech Programmes were collapsed to form a single four-year, 480-credit, NQF level 8 Professional Bachelor of Health Sciences Degree in Emergency Medical Care (B EMC). After the establishment of the two-year ECT and four-year B EMC programmes, the next challenge faced by the HPCSA, educators and educational providers within the emergency care field became that of facilitating articulation between the two qualifications. This study aimed to critically analyse and compare the two-year ECT qualification with the four-year professional B EMC degree in order to design a framework and bridging programme that may support and guide articulation between the two qualifications. An expository, retrospective analysis of existing documentation was followed by a focus group discussion with educators in the field in order to identify and explore potential obstacles and challenges with regard to articulation between the ECT and the B EMC qualifications. Finally, a detailed Delphi Questionnaire was sent to selected expert panel members. The study highlights a strong desire for articulation and academic progression within the emergency care profession. Similarities and substantial differences were identified in the scope, level and depth of knowledge of the ECT and B EMC qualifications. A framework was designed that includes a bridging programme to provide ECT graduates with the necessary knowledge, skills and insights required to enter directly into the third year of the Emergency Medical Care Degree.
Open Access
Clinical simulation to enhance undergraduate medical education and training at the University of the Free State
(University of the Free State, 2012-01) Labuschagne, Mathys Jacobus; Nel, M. M.; Nel, P. P. C.; Van Zyl, G. J.
English: An in-depth study was carried out with a view t compile recommendations for the use of clinical simulation as enhancement of undergraduate medical education and training at the University of the Free State. Clinical simulation plays an important role in the development of clinical skills and competence, and in creating a safe environment where students can learn without harm to patients while improving clinical reasoning and multidisciplinary training. Clinical simulation must be fully integrated with the curriculum, so that students can move between theory, simulation- and clinical training continuously. Assessment of skills and competence is a key component in clinical simulation-enhanced teaching and learning. In this study, the potential of clinical simulation was investigated as enhancement of undergraduate medical education and training. The extent to which clinical simulation could address the problems related to a decreasing clinical training platform, change in case mix and the demand for more health care professionals was investigated. Clinical simulation was considered as a complementary asset to enhance teaching and learning at the School of Medicine, UFS. The research methods comprised literature reviews, semi-structured interviews, focus group interviews, and observations during international visits. The literature review provided a background for a conceptual framework and contextualised the problem against related theory and research. Data were collected by means of semi-structured interviews with international experts to gain expert opinions on the use of simulation as teaching and learning tool, simulation-based assessment and the establishment of a simulation centre. Focus group interviews with lecturers and heads of departments at the UFS were conducted with the intent to evaluate the personal opinions and attitudes of the participants on these issues. The compilation of recommendations for the use of clinical simulation to enhance undergraduate medical education and training at the UFS and the planning and implementation of a simulation centre was achieved with the aid of the data collected. The premises, points of departure and role players were examined in order to make recommendations in this regard. The study originated from the recognition that a gap exists in the use of clinical simulation in the education and training of medical students at the UFS, but also in South Africa and the rest of Africa. To bridge the gap, the researcher compiled educational recommendations for the integration of clinical simulation as a required component and enhancement of the current curriculum. The development and implementation of a new simulation centre for the UFS School of Medicine was discussed in order to reach the goal of clinical simulation teaching and learning. A valuable contribution to knowledge was made by providing recommendations for developing and implementing a simulation centre for the School of Medicine, UFS. By developing the strategy, the identified gap is bridged, in that it can aid in integrating clinical simulation with current curricula, show how skills development and competence of medical students can improve and provide pointers for simulation-based assessment of medical students. Recommendations in this regard were made. The sound research approach and methodology ensured quality, reliability and validity. The completed research can form the basis for a further research undertaking.
Open Access
A critical analysis and strategic framework for research in sport and exercise medicine at the University of the Free State
(University of the Free State, 2012-06) Holtzhausen, Louis Johannes; Van Zyl, G. J.; Nel, M. M.
English: This research comprises an in-depth study to construct a strategic framework for research in Sport and Exercise Medicine at the University of the Free State in Bloemfontein, South Africa. Sport and Exercise Medicine (SEM) is a young academic discipline in South Africa. Internationally, the status, training, research and level of service delivery in SEM are spread out over a broad spectrum, from a well established and highly specialised medical specialty in certain countries, down to relative obscurity with lack of recognition in mainstream medicine and without specialty status in others. Research is the ideal focus area which will advance the status and recognition of SEM in South Africa and elsewhere, as well as increase the evidence base for SEM, both locally and internationally. A need for relevant research in SEM in South Africa has been recognized. The University of the Free State (UFS) has a young SEM programme, which needs to grow and gain local, national and, eventually, international recognition to make a meaningful contribution to the discipline of SEM. Furthermore, the UFS has embarked on a journey to increase its research outputs and status considerably over the next five to ten years. These conditions provide a golden opportunity to establish a research programme of excellence in SEM at the UFS. Against this background, the problem that was addressed is a lack of co-ordinated, publishable research in the Sport and Exercise Medicine (SEM) disciplines at the UFS, despite many opportunities that are presented. In addition, a relative need for strategic research planning in sport sciences in South Africa and internationally has been recognized. The overall goal of the study was therefore to facilitate high quality, published research in SEM with the view to improve the scientific grounding of the discipline. In order to achieve this goal, the specific aim of the study was to do a critical situation-based analysis of Sport and Exercise Medicine and relevant factors in research and research management, with the view to compile a strategic framework for the development of a research programme in SEM at the UFS. Both qualitative and quantitative research methods were utilised in the study and used in complementary fashion. The methods comprised a literature review, semi-structured interviews and a Delphi survey to determine the key components of the eventual strategic framework. All respondents in the empirical part of the study gave informed consent to participate. Pre-testing of the interview guide and the Delphi questionnaire were done by means of pilot studies. These processes were followed to ensure scientific validity, reliability and trustworthiness of the study. The literature review provided relevant insights into aspects of SEM and SEM research; leadership, management and strategic planning; academic research management; principles of research; as well as strategies and policies influencing research at the UFS. With the literature review as foundation, semi-structured interviews were conducted with current academic role players in SEM at the UFS, as well as with research managers at the UFS, to investigate the practical applications of theory and policy in research at the UFS, to identify challenges in research at the UFS, and to obtain the views of current role players on aspects of a multidisciplinary research framework in SEM at the UFS. Thirteen participants were selected for the semi-structured interviews by means of purposive and sequential sampling methods. The questions in the semi-structured interviews comprised seven categories, namely the status, role and place of SEM at the UFS; stakeholders in SEM research; research strategy; challenges in research; skills, knowledge and status of researchers and research leaders; suggested components of a strategic framework in SEM research; and an open category which invited any further relevant comments. Due to their semi-structured nature, the data obtained from interviews were mostly qualitative, but with quantitative elements. The results of the semi-structured interviews were categorised, analysed and collated in tables. These results were used in the context of the literature review, to construct a Delphi questionnaire which was used in a Delphi process with a panel of national and international experts in SEM research and in research management. The Delphi technique is a method for the collection of opinion on a particular topic, particularly the opinions of experts on the topic at hand. It was therefore chosen as an appropriate tool to test the results of interviews with local experts as interpreted according to the literature, on a panel of experts. The participants in the Delphi process were carefully selected to include national and international experts in SEM education and research, as well as policy-makers, leaders and managers in research. The selected international experts were globally representative. The panel consisted of ten experts. The Delphi questionnaire was constructed in accordance with the semi-structured interviews, but categorised in the sequence of the program logic model of the W.K. Kellogg Foundation, on which the final strategic framework was developed. The categories comprised strategic foundations of a research framework in SEM; the role, place and character of research in SEM at a university; inputs and processes required, challenges expected and outputs envisaged; as well as the expected impact or significance of a research programme in SEM at the UFS and possible ways to measure the progress of the programme. The results of the Delphi survey were analysed and the findings presented and discussed. The final outcome of the study, a strategic framework for research in SEM at the UFS, was created by triangulation of the critical analysis of SEM research and other relevant themes in the literature review, the results of the semi-structured interviews, and the results of the Delphi survey. In the final product, the premises, principles, points of departure and required resources for the development of a strategic framework for a research programme in SEM at the UFS were presented. Detailed formulations of inputs, processes and outputs of the programme were put forward, to culminate in a sustainable research programme. In conclusion of the study, final conclusions were drawn, limitations of the study addressed and recommendations made. The researcher believes that this study will make a unique contribution to the research, further development, and ultimately the status of Sport and Exercise Medicine at the University of the Free State and in South Africa. The challenges identified in the study and the complexities of research development have not gone unnoticed. These challenges will be addressed with passion and determination towards the attainment of the ultimate goal which inspired the study.
Open Access
An assessment model for the training of medical postgraduate students in urology
(University of the Free State, 2012-11) Wentzel, Schalk Willem; Van Zyl, G. J.; Nel, M. M.
English: The researcher realised that there was a need to revisit assessment of postgraduate students in Urology and therefore decided to conduct a study on the current assessment model in Urology. The aim of the study was to develop an assessment model for postgraduate students in Urology that would comply with the principles of Higher Education (HE) and also be acceptable and advantageous to both the postgraduate students and assessors in Urology. A study was undertaken to identify the changes that have taken place in assessment as well as the different principles of assessment that should be included in a sound assessment model. The study investigated the role of formative and summative assessment, feedback in assessment and quality assurance as part of assessment. The research included an investigation of the assessment methods that will be most suitable for the assessment of postgraduate students in Urology. The research undertaken in this study followed a quantitative approach with some elements of qualitative research. The researcher made use of a literature review, a questionnaire survey among Urologists in South Africa and a Delphi process that included experts in the fields of Urology and HE. In the questionnaire survey the participants were asked to answer questions about the changes in HE and the assessment methods available to assess postgraduate students in Urology. The questions in the questionnaire survey were compiled by the researcher with the help of the literature review. The information gathered by the questionnaire survey supported by the literature review enabled the researcher to prepare some statements that could be included in the proposed assessment model for registrars in Urology. The statements prepared by the researcher were presented to a Delphi panel and they were asked to rate the statements as essential, useful or unnecessary parts of the assessment model. The Delphi panel consisted of ten experts in Urology and HE that were selected by the researcher and his moderators. A four-round Delphi process took place from September 2011 until January 2012. A total of 189 statements were presented to the Delphi panel in Round One of the Delphi process. At the end of the fourth round of the Delphi process consensus was reached on 163 out of a possible 189 statements (86%). The researcher approached the compilation of the assessment model in three parts. In the first part the researcher proposed that assessors of postgraduate students in Urology should have adequate knowledge about assessment in HE. In the second part of the assessment model, the researcher proposed an assessment policy for the College of Urology and described the characteristics thereof. In the final part of the assessment model the researcher proposed the assessment methods that should form the framework of formative and summative assessment of postgraduate students in Urology. The researcher stressed the importance of the dissertation as the student’s contribution towards the available literature in their field of study and included some proposals on the format of the dissertation project. The results of the study indicated that there were areas in the current assessment model of postgraduate students in Urology that could be improved. The assessment model as proposed by the researcher could be considered by the College of Urologists for future use in the assessment of postgraduate Urology students. If accepted, the assessment model can also serve as an example for the other colleges of the Colleges of Medicine of South Africa to formulate an assessment model of their own. The project attempted to make a contribution towards the improvement of assessment in urology students. The assessment model, if implemented, may assist in improvement of quality assurance in and fairness, validity and trustworthiness of assessment. It will stimulate other researchers in the field of HE to pursue other aspects of assessment that warranted further research. The assessment model can be an effective and valuable instrument to enhance student learning and produce topclass Urologists to serve the needs of the South African public.
Open Access
Community-based education and service learning: experiences of health sciences students at the University of the Free State
(University of the Free State, 2013) Kruger, Sonet Beatrice; Van Zyl, G. J.; Nel, M. M.
𝑬𝒏𝒈𝒍𝒊𝒔𝒉 In this research project, an in-depth study was done by the researcher in view of providing recommendations, based on the experiences of Health Sciences students in Community-Based Education (CBE) and Service Learning (SL), to academic staff in the Faculty of Health Sciences (FHS), University of the Free State (UFS), as well as to all internal and external role players who are planning such initiatives in the future in order to enhance the effectiveness thereof. The current challenge in the training of health professionals is that programmes should produce graduates who are prepared for work in community settings. CBE and SL are teaching approaches used in the FHS, at the UFS, in order to prepare undergraduate students for future professional work in rural and underserved communities. The research problem revolved around determining what the experiences of Health Sciences students are during CBE and SL undertaken at the UFS. The overall goal of the study was to explore the students’ views regarding CBE and SL initiatives in order to make recommendations to all stakeholders involved in these initiatives with the view to enhance the efficacy thereof for students. The aim of the study was to explore the experiences, views, attitudes and perceptions of Health Sciences students regarding CBE and SL at the UFS. An exploratory mixed-methods design was used – a design in which the results of the first method (qualitative) can help develop or inform the second method (quantitative). The methods that were used and which formed the basis of the study comprised a literature review, and – as the empirical study – nominal group discussions and a questionnaire survey. The purpose of the literature review was to provide background for the research problem, to establish the need for the research and to indicate that the researcher is knowledgeable about the area. The literature review focussed on the contextualisation and conceptualisation of CBE and SL. The purpose of the nominal group discussions was to identify themes that occurred in the questionnaire survey. The purpose of the questionnaire survey was to identify the most commonly shared perceptions and attitudes that Health Sciences students have about CBE and SL and to identify whether there are certain factors that influence their experience of CBE and SL. Recommendations were made on how to implement and manage CBE and SL within undergraduate Health Sciences programmes at the FHS in such a way that students benefit from the experience and as a result, the effectiveness thereof improve. The study was done to make a contribution to the implementation and management of CBE and SL within undergraduate Health Sciences programmes in the Faculty of Health Sciences at the UFS, through describing how students currently experience CBE and SL in the FHS. The study provides recommendations to all stakeholders in the FHS, at the UFS that are currently involved in CBE or SL and to those who are planning such initiatives in the future. A contribution is made and new knowledge is added through this study. By describing how undergraduate Health Sciences students experience CBE and SL in the FHS, at the UFS and by providing recommendations regarding the implementation and management of CBE and SL in such a way as to enhance the students’ experience thereof, the identified gap is bridged. The sound research approach and methodology ensured the quality, reliability and validity of the research. The completed research can form the basis for future research. If the recommendations are followed when implementing and managing CBE and SL initiatives within undergraduate Health Sciences programmes, the students’ experiences of these initiatives will improve, and ultimately the effectiveness of CBE and SL will improve for all stakeholders involved. ___________________________________________________________________
Open Access
Standardised training and assessment in radiation safety for diagnostic radiographers
(University of the Free State, 2014-11) van der Merwe, Belinda; Kruger, S. B.; Nel, M. M.
English: Radiographers are occupationally exposed to ionising radiation and therefore considered radiation workers. First-year radiography students are placed in clinical practice within weeks of enrolment without proof of knowledge of radiation safety requirements. The qualified radiographer may apply to be the licence holder of X-ray equipment or is often appointed as a responsible person for X-ray equipment. The third-year radiography student on the brink of graduation is thus a potential licence holder of medical X-ray equipment. The Department of Health mandates the responsibilities of radiation workers and licence holders in the Hazardous Substances Act, Regulations 1332, and guideline documents, namely the Code of practice for users of medical X-ray equipment and the Requirements for licence holders with respect to quality control tests for diagnostic X-ray imaging systems. The purpose of the regulations is to ensure the safe use of X-ray equipment so that the ionising radiation dose to the staff and the patient is kept as low as reasonably achievable. The research problem is that the regulations depict that licence holders of X-ray equipment must educate radiation workers and implement quality control tests, but nationally no standardised monitoring of radiation safety and quality control requirements education is currently in place. The purpose of this study was to develop standardised radiation safety and quality control requirement training and assessment for diagnostic radiography to address radiation safety. The methods that were utilised were a literature review that provided background in order to contextualise the research problem and to develop the criteria for the training and assessment; a Delphi survey involving a panel of experts to establish a set of criteria suitable for a basic or advanced component of the training and assessment; questionnaires for radiography students to determine the knowledge of the radiation worker before the training, and questionnaires determining the effect of training on the knowledge by means of a post-test. Results of the Delphi survey identified the content of the radiation safety and quality control requirements for training and assessment by means of the contribution of a panel of experts. The development and execution of the training and assessment statements formed part of action research that contributed to fill the gap pertaining to the education and training in the requirements for radiation safety and quality control for radiation workers and medical X-ray equipment licence holders in the higher education environment. The contribution of the research was to develop standardised training and assessment content and methods for diagnostic radiographers regarding the radiation safety and quality control requirements for radiation workers and medical X-ray equipment licence holders to be implemented in the diagnostic radiography healthcare environment. The recommendation is that this study may serve as a directive for higher education institutions, the Directorate: Radiation Control, as well as licence holders, that will benefit if evidence can be confirmed of the educational and training attainment of radiographers regarding the requirements for radiation safety and quality control. Standardised training and assessment in radiation safety and quality control requirements have the potential to enhance the safety of the first-year radiography students as beginner radiation workers, the compliance of the third-year students as potential licence holders of medical X-ray equipment, and, as a result, the safety of patients.
Open Access
Standard setting for specialist physician examinations in South Africa
(University of the Free State, 2015-01) Schoeman, Frans Hendrik Scarpa; Nel, M. M.; Burch, V. C.
English: Setting defensible and fair pass standards for high-stakes postgraduate specialist certification examinations is a critical quality assurance component of assessment. Doing so in a feasible and sustainable way, within a resource-constrained context such as South Africa, is challenging. Traditionally the 28 member Colleges of the Colleges of Medicine of South Africa (CMSA), the national specialist licensing examination body in South Africa, have used a fixed pass mark of 50%. This practice does not acknowledge the inherent variance in examination difficulty and so increases the risk of failing competent candidates (false negative outcome) and passing incompetent examinees (false positive outcome). In 2011, the College of Physicians (CoP), a large CMSA member College, addressed the matter by implementing a standard setting process for the written components of their specialist physician certification examinations. The aim of this study was twofold: i) To evaluate the knowledge, attitudes, views and perspectives of CoP examiners regarding standard setting, and ii) compare the performance and utility of the Cohen and Angoff methods to advise the CoP regarding an appropriate standard setting method in a resource-constrained setting. A literature review was done to conceptualise standard setting as it pertains to assessment in medical education. In addition, policies and regulatory systems relevant to specialist certification examinations in South Africa were reviewed to provide the context for this study. Two research components were concurrently conducted between 2012 - 2014: A prospective study evaluated the knowledge, attitudes, views and perspectives of CoP examiners regarding standard setting before and after training and 30 months of practical experience using both the Cohen and Angoff methods of standard setting. A comparative study evaluated the performance (pass marks and failure rates) and utility (according to a framework derived from the literature review) of the Cohen and Angoff methods using five cycles of examination data, including multiple choice questions (MCQ), short answer questions and short essay questions. The introduction of standard setting was successful and widely supported by the CoP examiners. The Cohen method performed well when used for test data with a reasonable number of test items (30 or more) in homogeneous exit-level cohorts of more than 50 candidates. Tests containing few test items (i.e. short essay questions) performed poorly. The performance of the Cohen method was variable for smaller cohorts (less than 100) of candidates drawn from heterogeneous populations, such as entry-level Part I MCQ test takers. The Angoff method yielded unacceptable outcomes regardless of test format. The utility comparison identified the Cohen method as the preferred standard setting method for the CoP. The findings of this study support the introduction and ongoing use of the Cohen method as a feasible and sustainable method of setting pass marks for the written components of the CoP certification examinations. Education and training in the use of standard setting methods, as part of a change management strategy, improved examiners’ understanding of the role, importance and basic methodology of standard setting and strengthened their support for the use of standard setting in certification examinations. More data are needed to evaluate the true impact of cohort size on the stability of the Cohen method for entry-level, heterogeneous cohorts of examinees. The purist Angoff strategy, used in this study due to resource limitations, performed poorly and was deemed ‘not fit for purpose’ by the CoP examiners. The usefulness of the novel standard setting utility framework developed in this study warrants further research in other examination settings such as performance–based examinations.
Open Access
A competency-based continuous assessment programme as part of a revised curriculum for postgraduate radiology training at the University of the Free State
(University of the Free State, 2015-02) Janse van Rensburg, Jacques; Nel, M. M.; Van Zyl, G. J.; De Vries, C. S.
English: Recent times have witnessed a shift in the educational philosophy of postgraduate radiology training programmes. Internationally, curricula have undergone revision, with many changes based on the principles of outcomes-based education. As such, these curricula prescribe learning outcomes and essential competencies – including generic competencies central to all competent physicians. Continuous assessment is commonplace and many curricula prescribe regular formal formative workplace-based assessments that contribute to learning and training. Comparing the University of the Free Sate (UFS) postgraduate radiology training programme with the recently revised international curricula revealed several important shortcomings such as the lack of an outcomes-based educational methodology, the absence or poor definition of learning outcomes and competencies – in specific the absence of CanMEDS (Canadian Medical Education Directives for Specialists) competencies – the absence of formative assessment that culminate in feedback and remedial action, and the neglect of behaviour and attitudes during formal assessment. These shortcomings represented a problem in terms of ensuring the quality of radiology graduates and the safety of their patients. Addressing the problem required a revision of the UFS postgraduate radiology curriculum – defining learning objectives, formulating outcomes and incorporating all required competencies – as well as the development of a formative competency-based continuous assessment programme for postgraduate radiology training. The research was therefore aimed at the development of a competency-based, continuous assessment programme that could be integrated into a revised curriculum for postgraduate radiology training at the UFS. The methods used to achieve this aim included a literature overview, Delphi survey and semi-structured interviews. The conceptualisation and contextualisation of postgraduate radiology education was accomplished through an extensive literature overview that garnered information on the concepts of competence and performancebased education, as well as essential concepts related to assessment in education. The Delphi method guides decision-making through consensus; an ideal research method for determining what should and should not be included in a revised curriculum. The content of the revised curriculum was therefore researched using a Delphi questionnaire survey. The effectiveness of assessment, and decisions about its implementation, are influenced by the views and opinions of those responsible for assessment. Qualitative methods of research collect rich, detailed and descriptive data and as such, semi-structured interviews are ideal for gaining a detailed understanding of individuals’ ideas and views of a particular topic. In this study, semi-structured interviews with pivotal role-players involved in South African postgraduate radiology education informed decisions about the proposed continuous assessment programme for radiology training at the UFS. The results of the research contributed richly to achieving the aim of the research. A combination of the information from the literature overview, the results of the Delphi survey and the findings of the semi-structured interviews informed the development of the continuous assessment programme. This assessment programme was based on formative workplace-based assessments, conducted formally and resulting in feedback and remedial action. The assessments included in the programme ensured appraisal of the entire spectrum of competencies including knowledge, skills and the generic physician competencies (communication, teamwork, professionalism, management and administrative skills, research and education, and patient support and advocacy). Recommendations about curricular changes were based on information from the literature overview and the results and conclusions from the Delphi survey. Some of the more important recommendations were the compartmentalisation of the curriculum according to levels of increasing difficulty and integration, merging competencies (knowledge and skills) according to the different levels of training, the inclusion of CanMEDS-based generic physician competencies and the insertion of a summative assessment prior to independent after-hours radiology call, and a mandatory intermediate summative examination halfway through the training period. The research culminated in the development of a performance-based formative continuous assessment programme, blueprinted on a revised postgraduate radiology curriculum – these addressed the shortcomings of the UFS postgraduate curriculum. Assessment according to the curriculum aims to guide a registrar through the different instructional periods (training levels), document the trainee’s progress and ensure the acquisition of essential competencies – all in a bid to ensure the quality of radiology graduates and the safety of the public they serve.
Open Access
A work-integrated learning education and training programme for radiography in South Africa
(University of the Free State, 2015-06) Du plessis, Jeanetta Gesina Elizabeth; Bezuidenhout, J.
English: An in-depth study was conducted to investigate current practices in the delivery of work-integrated learning (WIL) in Radiography training at selected universities in South Africa (SA) with the ultimate goal of developing an education and training programme for WIL in Radiography training. The study was prompted by a growing awareness that a gap existed in the delivery of WIL in Radiography programmes in SA. WIL is a relatively new jargon term that focuses attention on the integration of theoretical learning and learning in the workplace. Until recently the focus in many professional programmes has been on workplace learning (WPL) as a component of the training of students. Although the concept of placing students in the workplace to acquire work experience is not new, the rationale behind WIL goes beyond merely providing a physical workplace environment as a site for students to experience work or to learn from professional practice. However, to achieve success in the delivery of any WIL programme, it is important to structure the WIL component of any learning programme with regards to the diligent and constructive alignment of learning outcomes/objectives, the delivery of learning (i.e., facilitation methods), and assessment. For quality delivery of WIL, the coordination and monitoring of the learning processes, and hence of student progression, are also important. The research methods comprised a two-fold approach. First, a literature review was conducted in order to provide an appropriate background for the formulation of a conceptual framework and to contextualise the problem against related theory and research. Second, data were collected using questionnaires that generated both quantitative and qualitative data. The latter data were obtained by means of open-ended questions that allowed for comments that facilitated the gathering of information about the current status of the delivery of WIL in Radiography training. The compilation of an education and training programme for WIL for the Bachelor of Radiography in Diagnostics degree to enhance undergraduate radiography training in SA was achieved by merging the information from the literature review and the collected data. The findings on the current status of WIL, which emanated from the questionnaire survey, were compared with suggestions garnered from the literature for best practice in WIL in order to make recommendations to bridge the identified shortcomings in the delivery of WIL in Radiography training. By developing an education and training programme for WIL in Radiography and by providing recommendations towards improvements in the delivery of WIL, the study contributed significantly to the creation of new knowledge in the Radiology field and was thus successful in bridging the identified gap in the delivery of WIL. The implementation of the proposed programme for WIL can aid in the development of a curriculum for WIL that includes appropriate modules, learning units, assessment and monitoring strategies, and guidelines for the development of generic skills. The sound research approach and methodology that were employed ensured the quality, reliability and validity of the study. The completed research can form the basis for a further research undertaking.
Open Access
An appreciative self-management coaching programme to facilitate the wellness of somatology therapists
(University of the Free State, 2015-06) Henrico, Karien; Maritz, J.; Bezuidenhout, J.
English: In this research project, an in-depth study was conducted by the researcher with a view to design and develop an Appreciative Self-Management Coaching (ASMC) programme to facilitate the wellness of somatology therapists. The work of many health disciplines, such as the somatology therapist, is mentally, physically and emotionally demanding. Working with clients on a daily basis has been found to cause distress to the professional within this emotionally labour-intensive context. In recent years, the prevalence of wellness and the need to look after the wellness needs of the health professional have become important. The significance and benefits of wellness initiatives to the individual and the employer has been well-documented in the academic literature. The literature, however, fails to provide the somatologist with a cost effective and time efficient wellness programme, tailor made for the somatology clinic context, which is as unique and flexible as the individual him/herself. In light of the above challenges, the following research question arose: What should an appreciative self-management coaching programme consist of to facilitate the wellness of somatology therapists? A qualitative, design-based research design was followed, including Appreciative Inquiry as the underpinning philosophy. The research took place in three phases. In Phase 1 – Preliminary phase – a needs-and-context analysis was done. This phase was informed by (1) a previous study on the self-management needs of somatology therapists (Richter 2010), conducted by the researcher in collaboration with practitioners in the field of somatology; (2) a literature review on wellness, self-management, self-coaching and appreciative coaching in order to probe the contemporary trends in modern somatology and elsewhere; and (3) Appreciative Inquiry based, in-depth, semi-structured interviews using the GROW model of coaching with practitioners in the field of somatology. Phase 2 – Prototyping phase – extended on the above research. An iterative design was used, consisting of two micro-cycles of research concerned with formative evaluation. Through collaboration with practitioners and experts in the somatology, education and coaching field, using focus group discussions, the researcher improved and refined the proposed ASMC programme. Phase 3 – Evaluation and Reflection phase. Through semi-formative and focused discussion, the perceived soundness and feasibility of the ASMC was tested, using a two-fold Alpha test. (1) The first part of the alpha test was conducted during the focus group discussion in Phase 2, and (2) a document analysis was conducted by expert appraisal (using an expert in the field of coaching, education and health). Finally the researcher conducted both organic and structured reflection to further both the theoretical and practical goals of this study. Bracketing was used to meet the methodological, ethical and emotional challenges that arose. This study presents an ASMC programme that is holistic, unique, flexible and effective. The researcher believes that the ASMC did more than just bridge the gap identified for the somatology therapist. Wellness is important to all professional groups, and the ASMC is believed to be a novel first step in addressing the maldistribution of wellness related practices for the somatologist and Higher Educational Institutions due to its flexible and adaptive nature.