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 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.
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
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
Best practices for quality assessment in the clinical phase of undergraduate medical training
(University of the Free State, 2020-08) Brits, Hanneke; Bezuidenhout, J.; Van der Merwe, L. J.
Medical universities have a responsibility to ensure quality assessment of clinical competence when they certify that they produce competent medical practitioners who can integrate knowledge, skills and attitudes. The assessment of clinical competence is complex, and can be characterised by tension between validity, reliability and fairness, due to the assessment on the “does” level. The defined problem that was addressed is that assessment in the clinical phase of the undergraduate medical programme (MBChB) at the University of the Free State has not been reviewed critically or benchmarked against local and international standards. This thesis intended to benchmark clinical assessment practices against an assessment framework and then propose an action plan on how to bridge the gap between theory and practice when assessing clinical competence. A pragmatic approach was followed to address the practical problems of uncertainty regarding the quality of assessment. From a theoretical perspective, an abductive approach was used to achieve inference. An explanatory sequential mixed method research design was used. During triangulation, alignment of and gaps between theory and practice were identified and solutions recommended. A proposal with an action plan was drafted to enhance the quality of clinical assessment in the undergraduate medical programme. Firstly, an assessment framework to benchmark clinical assessment in undergraduate medical training was compiled. A rapid literature review of local, national and international official regulations and policies, supported by best evidence practices, were used to compile this assessment framework. In this framework, the three components of quality assessment, namely, accreditation, assessment and quality assurance, were addressed. In the second part of the study, current assessment practices were reviewed through data collected from three sources, namely, students, lecturers and student marks, to ensure that different aspects were included in the review. A questionnaire with open and closed-ended questions was completed by clinical students in the undergraduate medical programme, to get the students’ perspectives on assessment. More than half the students were of the opinion that current assessments were not fair, and >90% complained about the lack of formal feedback after assessments. Secondly, the teaching and learning coordinators and module leaders of all the clinical departments involved in undergraduate medical training completed questionnaires on the assessment methods used in their departments. They also made recommendations for ways to improve current assessment practices. Using multiple choice questions and objective structured clinical evaluations were standard practice in most disciplines. Workplace-based assessment (WBA) was not well established and was only used in 30.1% of disciplines. The overemphasis on summative assessment was identified as an area for improvement. Thirdly, current assessment practices were evaluated for reliability. The decision reliability between end-of-block assessment and summative assessment was excellent, with a G-index of agreement of between 0.86 and 0.98. Using unobserved long cases during summative assessment was shown to be unreliable and questionable. During a formal focus group interview, answers were sought on how to bridge the gap between theoretical principles of quality assessment and current assessment practices. Finally, the researcher compiled a proposal with an action plan on how to enhance quality assessment in the clinical phase of the undergraduate medical programme. Most of the practices that compromise the quality of assessment can be addressed on an operational level, and will not be costly to implement. This includes training of assessors, implementation of WBA, effective feedback to students and blueprinting and moderating all assessments. Assessor training will improve the quality of assessments, and will also contribute to the professional development of assessors. Continuous WBA will have the ultimate effect of improving validity and reliability, which will benefit all stakeholders.
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
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
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
Core competencies in critical care for general medical practitioners in South Africa
(University of the Free State, 2024) Maasdorp, Shaun Donnovin; Van Der Merwe, L. J.; Paruk, F.
To prevent death or disability, critically ill patients require timeous life-sustaining interventions by competent healthcare providers. These patients often require management within an intensive care unit (ICU), although the initial resuscitation and stabilisation may happen outside of an ICU setting. Currently, there is a global shortage of intensivists or intensive care specialists. The majority of intensivists are employed at tertiary hospitals in major cities. At district and regional hospitals in South Africa, which are generally located outside major cities, critical care services are often provided by medical practitioners who are not intensivists. The problem is that the undergraduate medical curriculum does not provide dedicated critical care training and, therefore, there is uncertainty regarding the competency of non-intensivist medical practitioners to provide critical care services. In order to address the problem stated, three research questions are addressed in this thesis: 𝘪. 𝘞𝘩𝘢𝘵 𝘪𝘴 𝘵𝘩𝘦 𝘤𝘶𝘳𝘳𝘦𝘯𝘵 𝘴𝘵𝘢𝘵𝘦 𝘰𝘧 𝘤𝘳𝘪𝘵𝘪𝘤𝘢𝘭 𝘤𝘢𝘳𝘦 𝘴𝘦𝘳𝘷𝘪𝘤𝘦 𝘱𝘳𝘰𝘷𝘪𝘴𝘪𝘰𝘯 𝘢𝘵 𝘥𝘪𝘴𝘵𝘳𝘪𝘤𝘵 𝘢𝘯𝘥 𝘳𝘦𝘨𝘪𝘰𝘯𝘢𝘭 𝘱𝘶𝘣𝘭𝘪𝘤 𝘴𝘦𝘤𝘵𝘰𝘳 𝘩𝘰𝘴𝘱𝘪𝘵𝘢𝘭𝘴 𝘪𝘯 𝘵𝘩𝘦 𝘍𝘳𝘦𝘦 𝘚𝘵𝘢𝘵𝘦 𝘱𝘳𝘰𝘷𝘪𝘯𝘤𝘦 𝘰𝘧 𝘚𝘰𝘶𝘵𝘩 𝘈𝘧𝘳𝘪𝘤𝘢? 𝘪𝘪. 𝘞𝘩𝘢𝘵 𝘪𝘴 𝘵𝘩𝘦 𝘬𝘯𝘰𝘸𝘭𝘦𝘥𝘨𝘦, 𝘢𝘵𝘵𝘪𝘵𝘶𝘥𝘦𝘴 𝘢𝘯𝘥 𝘱𝘳𝘢𝘤𝘵𝘪𝘤𝘦𝘴 𝘰𝘧 𝘮𝘦𝘥𝘪𝘤𝘢𝘭 𝘥𝘰𝘤𝘵𝘰𝘳𝘴 𝘸𝘩𝘰 𝘱𝘳𝘰𝘷𝘪𝘥𝘦 𝘤𝘳𝘪𝘵𝘪𝘤𝘢𝘭 𝘤𝘢𝘳𝘦 𝘢𝘵 𝘥𝘪𝘴𝘵𝘳𝘪𝘤𝘵 𝘢𝘯𝘥 𝘳𝘦𝘨𝘪𝘰𝘯𝘢𝘭 𝘱𝘶𝘣𝘭𝘪𝘤 𝘴𝘦𝘤𝘵𝘰𝘳 𝘩𝘰𝘴𝘱𝘪𝘵𝘢𝘭𝘴 𝘪𝘯 𝘵𝘩𝘦 𝘍𝘳𝘦𝘦 𝘚𝘵𝘢𝘵𝘦 𝘱𝘳𝘰𝘷𝘪𝘯𝘤𝘦 𝘰𝘧 𝘚𝘰𝘶𝘵𝘩 𝘈𝘧𝘳𝘪𝘤𝘢? 𝘪𝘪𝘪. 𝘞𝘩𝘢𝘵 𝘢𝘳𝘦 𝘵𝘩𝘦 𝘤𝘰𝘳𝘦 𝘤𝘰𝘮𝘱𝘦𝘵𝘦𝘯𝘤𝘪𝘦𝘴 𝘦𝘹𝘱𝘦𝘤𝘵𝘦𝘥 𝘰𝘧 𝘨𝘦𝘯𝘦𝘳𝘢𝘭 𝘮𝘦𝘥𝘪𝘤𝘢𝘭 𝘱𝘳𝘢𝘤𝘵𝘪𝘵𝘪𝘰𝘯𝘦𝘳𝘴 𝘸𝘩𝘰 𝘱𝘳𝘰𝘷𝘪𝘥𝘦 𝘤𝘳𝘪𝘵𝘪𝘤𝘢𝘭 𝘤𝘢𝘳𝘦 𝘢𝘵 𝘢 𝘯𝘰𝘯𝘴𝘱𝘦𝘤𝘪𝘢𝘭𝘪𝘴𝘵 𝘭𝘦𝘷𝘦𝘭 𝘰𝘧 𝘩𝘦𝘢𝘭𝘵𝘩𝘤𝘢𝘳𝘦 𝘪𝘯 𝘚𝘰𝘶𝘵𝘩 𝘈𝘧𝘳𝘪𝘤𝘢? The aim of the study was to identify deficiencies in the competency of general medical practitioners who provide critical care services to patients at the district and regional levels of healthcare in South Africa, and the overall goal was to establish which core competencies are required of general medical practitioners if they are to provide critical care to patients in South Africa. The study was conducted in three phases, with each phase addressing one of the research questions. During phase 1, the objective was to gain deeper insight into the current state of critical care service provision in the public healthcare sector, specifically at district and regional hospitals in the Free State province of South Africa. The objective was achieved by means of a literature review and questionnaire survey among designated personnel at public sector hospitals who were knowledgeable about critical care service delivery in their respective hospitals in the Free State province and who were able to provide the required information. The findings are reported in the first draft manuscript (Title: A survey of critical care resources at district and regional public sector hospitals in the Free State province of South Africa), which describes a critical shortage of available ICU beds at regional hospitals, and reports that none of the ICUs had intensivists available. During phase 2 of the study, the objective was to determine the knowledge, attitudes and practices of medical doctors who provide care to critically ill patients at district and regional public hospitals in the Free State province of South Africa. A survey was conducted among medical practitioners and the results indicate that medical practitioners had a severe deficiency in critical care knowledge and were of the opinion that their undergraduate medical training had not prepared them adequately to manage critically ill patients. The majority responded that additional training is required. These findings are reported in the second draft manuscript (Title: A survey of the knowledge, attitudes and practices pertaining critical care medicine among medical practitioners at district and regional hospitals in South Africa). During phase 3 of the study, the objective was to establish core competencies expected of medical practitioners working in critical care settings or providing critical care services. A list of suggested core competencies was compiled, after which a Delphi study among international and national experts in the field of critical care medicine was conducted. The results of the Delphi study provide consensus recommendations on core competencies in critical care medicine and are reported in the third draft manuscript (Title: Core competencies in critical care for general medical practitioners in South Africa: A Delphi study). The thesis concludes with recommendations with regard to a curriculum for a postgraduate diploma in critical care training programme, intended for medical practitioners already employed at hospitals where critically ill patients are managed. The training programme was compiled based on the findings of the three phases of the study. Such a training programme is suggested as a feasible solution to improve the critical care competencies of medical practitioners and, thereby, mitigate the challenges posed by the shortage of intensivists at district and regional hospitals in South Africa.
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
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
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
Development of guidelines for team-based learning in an undergraduate pharmacy curriculum: a case study
(University of the Free State, 2017-01) Eksteen, M. J.; Swart, S. B.; Reitsma, G. M.
English: An in-depth study was done with a view to develop guidelines for the implementation of team-based learning (TBL) in an undergraduate pharmacy curriculum. The research was initiated in response to the identification of a gap in the knowledge regarding the usage of TBL in a management module within a BPharm curriculum in South Africa. TBL is an active, small group-based teaching strategy where students are actively engaged with one another and the module content to solve real-life problems they might encounter in future. This structured, student-centred strategy allows minimal time for traditional lecture methods. Instead, students are required to acquire knowledge independently prior to class. This opens up time during class for students to work together in teams on an issue, similar to what will be expected of pharmacists as part of the health professions team. The aim of this study was to develop guidelines on how to effectively implement TBL in pharmacy education to enhance student learning. It was attained by means of the following six objectives: to conceptualise and contextualise TBL as a teaching strategy in higher education; to determine the experiences of the pharmacy students regarding team work in the pharmacy profession before they were exposed to TBL; to determine pharmacy students’ learning experience of TBL in the management module of the BPharm curriculum after they were exposed to TBL; to identify whether TBL as a teaching strategy increase pharmacy students’ understanding of the theoretical work (curriculum) presented in the module; to determine whether TBL allows students to develop generic skills such as time management, team work, communication, change, innovation, problem solving and precision, as required for pharmacists on a NQF level 8; and to develop guidelines on how to effectively implement TBL in pharmacy education to enhance student learning. A case-study research design was followed because a single phenomenon of interest in one fourth-year pharmacy group was investigated. A mixed-method research approach was followed including both qualitative and quantitative methods. During the first phase of the study in the beginning of the semester, data were collected via written narratives as part of the exploratory design of mixed method research. This was followed by focus group interviews to further explore the themes identified and to establish the initial experiences of pharmacy students regarding team work in the pharmacy profession before exposure to TBL. At the end of the semester, after student exposure to TBL, a questionnaire was used to collect both quantitative and qualitative data on students’ learning experiences with TBL in comparison with traditional lecture methods, whether TBL fostered the development of a deeper approach to learning, and to investigate the possible development of generic skills essential to the health profession team. From the results of the first phase, it was clear that students had some exposure to being part of the health care team. The focus group interviews pointed out that pharmacy students could identify several contributions a pharmacist can make to the health profession team, which competencies they will need and how university training should prepare them to effectively contribute to the health professions team. The results of the questionnaire indicated that TBL provided students with an enjoyable learning experience and that they prefer TBL over traditional lecture methods. TBL also promoted deeper learning and understanding of course content and fostered the development of essential generic skills commonly referred to as graduate attributes or employability skills. The findings of the study were used to develop guidelines for health professions educators to implement TBL in undergraduate pharmacy education. These evidencebased conclusions can be used to optimise the teaching and learning of pharmacy students in South African higher education.
Open Access
Development of quality assurance and educational guidelines for an emergency medical care preparation programme in south Africa
(University of the Free State, 2021-07) Nell, Eduard Nico; Jama, M. P.; Du Plessis, J.
An in-depth investigation was conducted to develop quality assurance and educational guidelines for an Emergency Medical Preparatory Programme in South Africa. With the recent shift from vocational-based training to higher education in paramedic education, a dire need exists to assist in-service Emergency Medical Care personnel with career progression and prepare them for the rigour of higher education, and ultimately be successful with their studies. It is critical for Emergency Medical Care personnel to maintain a high standard of education and training in furthering their paramedic careers. Most, in-service Emergency Medical Care personnel do not meet the admission requirements for higher education. To support the further development of Emergency Medical Care personnel, access to the National Qualifications Framework-aligned formal Emergency Medical Care qualifications is required. Consequently, the Emergency Medical Preparatory Programme was developed to adequately prepare Emergency Medical Care in-service personnel for the rigour of higher education Emergency Medical Care programmes by focusing on Academic Communication and Literacy, Basic Computer Literacy, Life Sciences, Physical Sciences, Mathematics and Numeracy, and Physical Preparedness. This study sought to bridge the gap created by the absence of quality assurance and educational guidelines for curriculum for an Emergency Medical Preparatory Programme in South Africa. The following research question was thus formulated: Which quality assurance and educational guidelines can be used to enhance quality in an Emergency Medical Preparatory Programme in South Africa? The study’s overall goal was to conduct an in-depth investigation that could provide quality assurance and educational guidelines for an Emergency Medical Preparatory Programme to enhance quality training of Emergency Medical Care personnel and possibly Emergency Medical Care education and training programmes and short learning programmes. Subsequently, this investigation expanded the limited literature on the Emergency Medical Preparatory Programme and contributed to quality assurance in Emergency Medical Care education in South Africa. This study aimed to develop quality assurance and educational guidelines for an Emergency Medical Preparatory Programme in South Africa. A qualitative case study design was used in this study. To achieve the aim of this study, four objectives were pursued by employing a literature review, document analysis, Delphi survey, and an expert panel discussion. The literature review provided context to the research problem and justified the research position in the existing body of knowledge. Furthermore, the document analysis of the Emergency Medical Preparatory Programme documentation determined alignment with the guidelines and criteria set out by the literature review and assisted in identifying themes that were, together with the literature review, the basis for the Delphi survey questionnaire. Data were collected employing a Delphi survey with lecturers involved with training at higher education institutions presenting Emergency Medical Care educational programmes. The reason for utilising the Delphi method in this study was to achieve general agreement or convergence of opinion around a particular content statement generated in the literature review and document analysis on the topic of the research study. An expert panel discussion was conducted with heads of departments at higher education institutions presenting Emergency Medical Care educational programmes, an expert involved with quality assurance in higher education, and a Professional Board of Emergency Care member. The expert panel discussion finalised the quality assurance and educational guidelines for an Emergency Medical Preparatory Programme. Moreover, the thorough research approach and methodology ensured credibility, transferability, dependability, and confirmability of the study. The completed research can form the basis for further research undertaking. A valuable contribution was made to the body of knowledge by providing quality assurance and educational guidelines for an Emergency Medical Preparatory Programme in South Africa. Additionally, the study assisted in increasing the limited literature currently available on Emergency Medical Care-specific preparation programmes and Emergency Medical Care education quality assurance programmes in South Africa. Hopefully, these guidelines can aid the Emergency Medical Preparatory Programme in aligning with Emergency Medical Care education and providing quality education to personnel.
Open Access
Essential surgical skills in rural hospitals: a CPD programme
(University of the Free State, 2016-12) Porter, D. C.; Bezuidenhout, J.; Du Toit, R. S.
English: General practitioners have to deal with a variety of conditions, challenges and diseases. Currently there is little known about surgical practice and the surgical skills required to deal with it in rural South Africa. The aim of this study was to acquire an understanding of the current surgical practice of general practitioners in rural areas and identify the essential surgical skills needed for rural South Africa. The purpose of the study was to determine the contents of a Short Learning Programme in Essential Surgical Skills in Rural South Africa. The research consisted of a relevant literature search and document analysis to ascertain the current national and international scope of rural surgery, available programmes and the essential contents and outcomes thereof. Attention was also given to curriculum design, HPCSA guidelines for CPD points, learning tools and situations to acquire surgical skills and the development of short learning programmes. The current GP surgical practice for practitioners in rural areas was evaluated through the use of a Likert-type questionnaire, this was also employed to determine the essential content and outcomes for a short learning programme. The results of the research was applied to design a Short Learning Programme for Essential Surgical Skills in Rural South Africa. It is my recommendation that this programme is rolled out in the second part of 2017 at the University of the Free State. I trust it will contribute to surgical care not only in South Africa, but internationally as well.
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
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 employability skills of consumer science graduates
(University of the Free State, 2017-07) Du Preez, Minnet; Van der Merwe, L. J.; Swart, S. B.
English: With the high graduate unemployment rate in South Africa, universities are realising the importance of delivering students with employability skills to attain employment and succeed in the work environment. A gap in the literature was identified, since no framework could be found that described the employability skills that consumer science employers require from employees. Hence, this study aims to construct a framework regarding the employability skills of consumer science graduates, including the teaching and learning strategies and assessment methods which can be used to ensure that graduates have mastered the needed skills. In order to reach the aim of this study, a mixed methods approach was followed. During the first phase of the study, questionnaire surveys were completed by consumer science employers, graduates, lecturers and students to determine which skills consumer science graduates need when entering the workplace. During this phase, 11 essential employability skills of consumer science graduates were identified and investigated. The second phase of the study comprised of focus group discussions with consumer science lecturers to determine the teaching and learning strategies that must be used to enhance the identified employability skills, as well as the assessment methods which must be used to ensure students have obtained the required skills. It was found that a variety of strategies can enhance the attainment of employability skills. The gap in literature was filled by constructing a framework of employability skills for consumer science graduates. This framework can be implemented by consumer science lecturers aiming to enhance the employability skills of consumer science graduates. This outcome can be beneficial for the university delivering more employable graduates as well as the industry who will receive more skilled employees.
Open Access
A framework for integrated emergency care education in South African undergraduate medical programmes
(University of the Free State, 2021-02) Hagemeister, Dirk Thomas; Labuschagne, M. J.
Competence to manage emergencies is expected from medical practitioners and should be acquired during undergraduate medical training. Since the causes of emergencies can originate from many different systems, both physiological and psychological, a variety of clinical specialities is involved in the teaching of the diagnosis and treatment of emergencies. Bringing various different people and approaches together in undergraduate medical education constitutes a challenge. The lack of an integrated approach to undergraduate medical education in emergency care was identified as a relevant gap worth investigating in this PhD project. This study was undertaken with the aim to provide a framework for the integration of undergraduate medical education in emergency care with the intention to contribute to the steady improvement of undergraduate medical education and, through this, ultimately, to better health outcomes. Specific objectives of the research included the identification of international and national trends in the field and of current education practices at the medical schools in South Africa, including outcomes, objectives, education strategies and ways of assessment. A constructivist approach was followed in the sense that the mostly qualitative insights from the different methods are regarded as contributions towards a larger overall framework, but without the epistemological claim to discover an ultimate truth behind the subjective facts. As methods, an extensive review of published literature on emergency care training and of the regulatory environment for undergraduate medical training provided an international background of recent developments and a local context for South Africa. Semistructured in-depth interviews were held with key people in the established undergraduate medical programmes in South Africa and this promoted a multi-facetted insight into current education practices in the country, into challenges and successes. A three-staged nominal group technique was applied as the second empirical method, to evaluate the current education practice in the undergraduate medical programme at the University of the Free State and to identify needs and make suggestions for improvements. This process collected prioritised statements on strengths and weaknesses from recent graduates and, informed by these contributions by members, prioritised suggestions by the members of the education team, which were then discussed with academic programme managers. Results of the methods are presented as five publishable manuscripts, with one manuscript each reporting the findings from a rapid review of the international and national regulatory environment, one on a scoping review of peer-reviewed publications on undergraduate medical education in emergency care over the last decade, one on in-depth interviews conducted at South African medical schools and the nominal group technique at the University of the Free State, with the fifth manuscript suggesting a framework for the training. Key findings from the regulatory review show that many international bodies explicitly include emergency competencies in their exit outcome objectives, and that the latest trend is towards expressing those objectives in entrustable professional activities. This trend was confirmed in the literature review, which also found that there is, internationally, a growing role being played by emergency medicine, that training is increasingly based on online resources and simulation, and that experiential training typically happens in emergency rooms. The routine standard use of ultrasound in emergency care and the broad integration of ultrasound teaching in undergraduate training was equally significant. The in-depth interviews provided information on an array of issues, with different medical schools sharing the challenges of integrating emergency skills training across modules, reviewing the outcome objectives for curricular renewal, and trying to map such objectives effectively. Increasing student load against a constrained staff basis, complicated further by joint appointment status, interprofessional teaching and the role of emergency medicine, were found to be relevant. From the nominal group technique conducted at the University of the Free State, the importance of short courses in skills training, the need for integrated and well managed coverage of emergency care, for more in-situ clinical experiential learning opportunities, and for appropriate staff development in the field of health professions education, was re-emphasised. The proposed framework illustrates the complex interaction between the key factors of high-quality clinical practice, best current educational practice, and the institutional culture, with each of the three factors dependent on additional factors. In conclusion, the researcher recommends further research to formulate a national set of entrustable professional activities and enabling competencies, and to achieve a comparative mapping of outcome objectives between different medical schools.
Open Access
A framework for service-learning in the undergraduate radiography programme in the Mangaung area
(University of the Free State, 2016-03-02) Botha, René Walter; Bezuidenhout, J.
In this research project, an in-depth study was done by the researcher with a view to compiling a framework for Service-Learning (SL) in the undergraduate Radiography programme in the Mangaung area. SL is “a credit-bearing educational experience in which students participate in an organised service activity that meets identified community needs and reflect on the service activity in such a way as to gain further understanding of course content” (Bringle & Hatcher 1995: 212). Currently no framework for SL in resource-based disciples such as Radiography exists in South Africa. The objectives of the study were: • To establish whether the community benefits from Radiography SL; • To establish whether SL cultivates social responsiveness in students; • To investigate the effectiveness of SL in enabling students to achieve the generic skills; • To establish specifically whether SL cultivates critical thinking in students; and • To analyse whether reciprocity is achievable when doing SL in Radiography. A mixed method research approach was used to gather data consisting of both qualitative and quantitative data. Third-year Radiography students prepared and executed dramatised presentations, and Grade 12 learners, contact persons at the five schools involved and the Radiography facilitator evaluated the presentations using different rubrics. The Radiography students completed a structured reflection adapted from Zlotkowski et al. (2005) and the Watson-Glaser Critical Thinking Appraisal tool. Radiography academics participated in a semi-structured interview during the study. Data was also gathered from delegates at the 42th ISELT conference. The data sets were merged, connected and embedded to facilitate triangulated discussion and conclusions. Grade 12 learners, contact persons and academics who participated (42nd ISELT conference UJ, TUT and CPUT) indicated that communities benefitted from the SL intervention. From students‟ reflective comments it can be concluded that students became more socially responsive. This conclusion was confirmed by the academics who participated. From feedback by Grade 12 learners and contact persons and other academics involved, it can be concluded that SL enables students to attain generic attribute skills. The collective results of the Watson-Glaser Critical Thinking Appraisal tool of the third visit increased from the second visit. Facilitators from the ISELT conference, UJ, TUT and CPUT confirmed that SL assists in developing critical thinking skills in students. Academic reciprocity was made possible by incorporation of additional sources of information, through doing research and by having a practical approach to simplifying information. From the conclusions it is clear that SL activities benefit students and communities. The general approach to structuring the framework allows other academic fields to make use of this framework. The framework has an action-research format: activities and goals of the intervention are reflected on constantly.