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Open Access
A support framework to facilitate social learning and integration skills of first-year undergraduate medical students
(South African Medical Association, 2024/07/31) Tlalajoe-Mokhatla, N.; van der Merwe, L. J.; Jama, M. P.
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱. Limited research exists on medical students’ coping and adjustment skills, especially in the South African context. Stakeholders planning medical curricula need to be aware of emotional and communication skills that allow students to cope and adjust to stress associated with transitioning to medical studies. 𝗢𝗯𝗷𝗲𝗰𝘁𝗶𝘃𝗲. To design a support framework to facilitate first-year undergraduate medical students’ social learning and integration skills. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀. This descriptive qualitative case study used multiple data collection methods, nominal group meetings and Delphi questionnaires to explore and understand undergraduate medical students’ challenges with social learning and integration factors. These insights were then used to develop the support framework. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀. The support framework articulates levels of engagement and actions required to address social learning and integrated factors, namely under- preparedness, peer support, confidence, self-management, alienation and academic advice. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻. Implementing the proposed support framework on social learning and integration could facilitate the successful transition of first-year undergraduate medical students from high school to university. This framework aids students in dealing with social learning and integrated factors, such as under-preparedness, peer support, confidence, self-management and alienation as well as academic advice using contextualised and appropriate skills and tools.
Open Access
The analysis of the needs of Free State emergency care practitioners with regard to continuous professional development
(University of the Free State, 2016-01) Sookram, Bradley Paul; Van Wyk, C.
English: The Health Professions Council of South Africa (HPCSA) recognises and endorses continuing professional development as a means of ensuring best possible practice to the public. The lack of literature regarding continuing professional development for emergency medical care practitioners and the number of non-compliant emergency medical care practitioners, provided evidence for the need to investigate the possible needs faced by emergency medical care practitioners to be compliant to the HPCSA guidelines for continuing professional development in South Africa. The overall goal of the study was to conduct an analysis of the needs of Free State emergency medical care practitioners with regard to continuous professional development. A literature study was done to gain a deeper understanding of continuous professional development with reference to health professionals and specifically emergency medical care practitioners. A questionnaire was compiled considering some barriers that were identified which affected compliance with continuous professional development regulations. The questionnaire was compiled electronically and printed in a hard copy using the Evasys system. The target population was emergency medical care practitioners in the Free State province that were active and registered with the HPCSA. The study revealed that resources, improved communication and access to continuous professional development activities were the main needs of emergency medical care practitioners. Although there were some limitations during this study, it was evident that continuous professional development accreditors, and continuous professional development service providers need to plan, organise and provide information in advance for emergency medical care practitioners to be able to attend continuous professional development activities. Addressing the needs of emergency medical care practitioners with regard to continuous professional development will contribute positively not only towards the workplace but to the community at large.
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
Assessment of current student selection criteria as performance predictors for academic success in entry level radiography education at the Central University of Technology
(University of the Free State, 2014-06) Kridiotis, Carol-Anne; Bezuidenhout, J.
The numbers of students enrolled in the Radiography programme at the Central University of Technology (CUT) are increasing each year, and selectors are therefore faced with critical admission decisions when selecting prospective students for a programme with limited spaces. This research study was undertaken to assess current student selection criteria in Radiography education, by retrospectively analysing the degree to which these criteria predicted actual academic performance over a three-year period amongst entry-level students enrolled in a three-year National Diploma in Radiography. The rationale behind the interest in student selection in Radiography education was the fact that the South African Qualification Authority (SAQA) has approved and registered a professional Bachelor’s degree in Radiography (480 credits), with a new curriculum and altered exit-level outcomes, including research skills. The transition from a diploma-level to a degree-level qualification in Radiography in South Africa indicated that a review and an assessment of current diploma-level student selection criteria could provide a benchmark for selecting students for degree-level education. An extensive literature study and document analysis provided background information and perspectives related to student admission criteria and selection tests in the health sciences, both nationally and internationally. The research design and methodology included a retrospective quantitative study and document analysis. In the research process, data were collected for each student, including biographical data, prior tertiary education, matriculation or National Senior Certificate (NSC) subject marks and a total Admission Points Score (APS) as calculated from each matriculation certificate. The CUT selection test results for each student were also documented, and included a General Scholastic Aptitude Test (GSAT) score, an English Proficiency Test score and a Self-Directed Search Questionnaire score. By using the above selection scores, a total CUT Rating Score was calculated, and a statistical correlation procedure compared all of the above variables with the marks of all entry-level Radiography modules, for each first-year student in the study group. A further correlation procedure compared selection criteria with whether the student had achieved the first year exit-level outcomes, or whether they had not achieved these exit-level outcomes. The main findings of the statistical analysis indicated that certain selection criteria are valid and can be used as academic performance predictors. This retrospective research study presents data which shows success rates for entry-level Radiography students in diploma-level Radiography education at the CUT over a three-year period were at a level of 71.53%. Recommendations for the future degree-level student selection process were made, which included increasing NSC achievement level admission requirements, using the current tests of merit and implementing methods to help students make valid and informed decisions about their career choice. The goal of optimising the student selection process would evolve over a number of years, and degree-level Radiography education has already been implemented at certain institutions since January 2014. The aim of this study was fulfilled by assessing current selection criteria as performance predictors for academic success.
Open Access
Association between deformity correction and clinical outcome post total knee arthroplasty
(University of the Free State, 2020-06) Hartzenberg, F.; Van der Merwe, J. F.
Background: The aim of this study was to establish if the degree of deformity correction during total knee arthroplasty (TKA) has an influence on post-operative patient satisfaction. Patient and methods: This was a retrospective, descriptive analytical study of 180 patients that underwent an elective TKA using computer assisted software. Patients were divided into two groups according to the degree of deformity correction required to obtain a neutral mechanical axis: 3-degrees-andmore or less-than-3-degrees. Knee injury and Osteoarthritis Outcome Scores (KOOS) were collected at the pre-operative, 6 week and 1 year post-operative intervals. The mean KOOS scores were compared at each interval and the difference between mean KOOS scores were compared for the following intervals: pre-operative to 6 weeks postoperative; pre-operative to 1 year postoperative; 6 weeks to 1 year postoperative. Results: The pre-operative mean KOOS scores for the group of patients that required a 3-degree-andmore deformity correction were statistically higher than the group requiring less-than-3-degreedeformity correction. At 6 week and 1 year follow ups there was no statistical difference between the two comparison groups. With respect to mean KOOS score improvement between intervals, the group that required less than 3 degrees of deformity correction showed statistically significant improvement in symptoms for the pre-operative to 1 year follow up period. Conclusion: Results of the study showed that patients requiring a lesser correction of their malalignment do better after TKA.
Open Access
Bedside teaching in optometry: a millennial view on an ancient teaching and learning method
(AOSIS, 2023) Kempen, Elzana; Labuschagne, Mathys J.; Jama, Mpho P.
Background: Bedside teaching is a key component of a positive learning environment where non-technical skills and professional attributes can be taught. It is also one of the few ways to transfer professionalism: a core competency in a health science curriculum. This study investigated the experiences and perceptions of optometry students on bedside teaching to improve its effectiveness, and tailor it to the needs of the millennial generation students. Aim: This study aimed to determine the experiences and perceptions of optometry students on bedside teaching (apprenticeship) during an ocular pathology clinic. Setting: The study was done at the Department of Optometry at the University of the Free State, South Africa. Methods: A qualitative case study was undertaken. All 17 final-year optometry students (N = 17) were invited to participate. Data were collected using an open-ended questionnaire. Content analysis was used to analyse the experiences and perceptions of the participants. Results: Bedside teaching is a generally well-perceived experience from the student’s perspective. The role of the supervisor was mentioned as the critical factor that facilitated learning, specifically learning by observing the application of theory and handling and treatment of the patient. Conclusion: This study showed that millennial students perceived bedside teaching positively and provided valuable insights into this teaching and learning method in an undergraduate optometry clinical education setting. Experiential learning benefited these millennial students who prefer learning by observation. Contribution: A blueprint for the learning triad in bedside teaching is provided for optometry educators to apply this teaching and learning method successfully according to the needs of the current generation of students.
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 (CBE) - the MED 113 Expo as case study
(University of the Free State, 2004-11) Prinsloo, Engela Adriana Margrietha; Joubert, G.; Du Toit, G. F.
English: Background: Societal complaints that health professionals do not address their needs, the ratio of specialist to primary health care professionals and that human resources in health services are concentrated in the private sector, urged new methods of teaching and learning to be explored. Community-based Education (CBE) is one of the educational approaches that could address these concerns. Aim: The aim of this study was to determine if community-based activities could help students to integrate theory and practice, and influence attitude and behaviour towards the community. In addition it aimed to determine if community exposure motivated students and stimulated their enthusiasm towards CBE. These aims were achieved by determining student opinion on the learning process, experience and assessment as well as determining whether the community and services benefited in any way. The final aim was to refine the community-based education model in module MED113 to serve as future reference for development of CBE approach in other modules. Method: It was a quantitative study including a literature study and the completion of questionnaires by first year medical students, learners, community health care workers and representatives of institutions participating in CBE activities. Results: The results yielded a 75.7% positive response with regards the integration of theory and practice and a 77.9% positive response regarding change in attitudes towards the community. 93.6% of respondents' enthusiasm towards CBE activities improved. 94.3% and 54.1 % of respondents were positive regarding the experience and method of assessment respectively. There was a 100% positive response by learners, community health workers and representatives of institutions with regards the learning experience and value for the institutions respectively. Conclusion: Recommendations regarding changes to the CBE activities of MED 113 were made to use it as model in other CBE modules.
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
Community-based electrocardiography teaching and learning in semesters four and five of the UFS M.B.Ch.B. programme
(University of the Free State, 2014-01-31) Larson, Carol Olivia; Bezuidenhout, J.; Van der Merwe, L. J.
English: The current global emphasis on appropriate standards for medical education and greater civic engagement by higher educational institutions, and the value of electrocardiography as diagnostic aid stimulated the researcher to perform this study. Globally electrocardiography is an essential exit-level core competency of undergraduate medical programmes. Although an outcome-based curriculum was introduced by the UFS School of Medicine in 2000, certain aspects of competencybased education (such as the registration and interpretation of an electrocardiogram) can be adapted and included in outcome-based curricula. Prior to the commencement of this study, a preliminary literature review revealed that little research had been performed with regard to the use of electrocardiography as a learning task in community settings in the preclinical phase of medical curricula. The overall goal of the study was to facilitate the transition between electrocardiography teaching and learning in the preclinical and clinical phases of the UFS medical curriculum. The problem that initiated the research was that more information was required regarding the practicability of implementing electrocardiography teaching and learning in community settings during semesters four and five of the UFS undergraduate M.B.,Ch.B. curriculum. To address the problem, two research questions were formulated concerning the generic, context-specific and task-specific issues that inform decisions regarding community-based electrocardiography learning during semesters four and/or five of the UFS undergraduate medical curriculum and the attitudes and opinions of a purposive sample of Faculty members regarding community-based electrocardiography learning in semesters four and/or five. To answer the research questions, two research objectives were pursued regarding the identification of the principal issues and challenges that inform decisions regarding the feasibility of introducing community-based tasks in the preclinical phase of a South African undergraduate M.B.,Ch.B. curriculum and the collection of quantitative and qualitative information from a purposive sample of personnel employed at the UFS Faculty of Health Sciences. The first part of the study consisted of a comprehensive literature review, which assisted the researcher to identify applicable key aspects for inclusion in the interview schedule used for the empirical study. The survey was performed with a view to later formulating an effective strategy to facilitate the transition between the electrocardiography learning provided in the preclinical and clinical phases of the UFS M.B.,Ch.B. curriculum and possibly incorporate four additional hours of community-based learning in phase II of the curriculum. Ninety-two (92) per cent of the persons in the sample consented to participate in the study and a pilot study was conducted, to improve the reliability, validity and trustworthiness of the study. The data collected from the interviews was analysed and a description and discussion of the research findings were documented. Based on the literature review and the responses of the interviewees, several prominent conclusions were reached. Important faculty-related and communityrelated key issues and challenges were identified, and interviewees’ favourable responses regarding CBL, task-based CBL and CB ECG learning in the UFS undergraduate medical curriculum indicated that further related research is justified. Interviewees’ responses with regard to the practicability of implementing CB ECG learning in the preclinical phase were moderately favourable and useful recommendations were made. Of significance to the planning of future research studies was that twenty-six per cent more respondents supported the implementation of CB electrocardiography learning during the clinical phase of the curriculum than was the case for the preclinical phase. These research findings can assist with decisions as to whether future (more comprehensive and potentially more costly) research projects are justified. The appropriate implementation of electrocardiography, as community-based learning task during the preclinical and/or clinical phases, can contribute to a greater degree of community engagement and an improvement in the quality of electrocardiography learning in the UFS undergraduate curriculum. This should therefore benefit all the 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
Computer-assisted learning: a web-based application in histology
(University of the Free State, 2003-11) Hugo, Alwyn Pieter; Buys, J.; Nel, M. M.
Abstract not avilable
Open Access
Condom sterility in periprosthetic joint infection management at Universitas academic hospital in Bloemfontein 2018
(University of the Free State, 2020-04) Tyumre, Ntsikelelo; Van der Merwe, Johan; Maloba, Motlatji B.
Joint replacement surgery, especially of the hip and knee, is one of the most rewarding operations for both the patient and the orthopaedic surgeon worldwide. Hip replacement has been dubbed the operation of the century. This is because these replacements improve the quality of life for the elderly population crippled with arthritis, and in recent years, due to better implants, also improves quality of life in the younger generation presenting with joint problems. It is, however, not without complications, the most important being periprosthetic joint infections. Other complications include aseptic loosening, periprosthetic fractures and dislocation. Periprosthetic joint infection is the most dreaded of the complications because of its difficulty to manage and association with significant morbidity and bone loss. We therefore began by describing and defining periprosthetic joint infection and investigated the current epidemiological data available. We have reviewed literature and looked at the diagnostic criteria from the different societies and meetings from around the world. Parvizi et al. developed an algorithm and proposed criteria that are based on the latest data and tests. This is explained in detail in the first chapter of this dissertation. The management of periprosthetic joint infection is dependent on the amount of time from the index joint surgery. An outline of the deferent management options are presented, while bearing in mind that two-stage revision surgery is the gold standard of management. Management of periprosthetic joint infection is associated with bone loss, either with the removal of infected implants or removal of the cement spacer in the second surgery of the twostage procedure. A recent unpublished study done locally in our department showed that putting a cement spacer in a condom and then placing the condom-cement spacer in the joint to allow it to set, and then taking out the condom-cement spacer after the cement had set, was associated with no bone loss. The study also showed that female condoms were stronger and more durable compared to the male condoms. The question that needed to be addressed, was whether it is safe to introduce condoms into the joint? Based on the literature, there is a 10% chance that condoms maybe contaminated. We investigated the sterility of condoms from the packaging and how to improve the sterility of the condoms. Sixty government-issued female condoms were used for the study, of which 30 were tested straight from the packaging and the other 30 were first put through hydrogen peroxide gas plasma sterilisation and then tested by means of MC&S. Similar to previously published studies, contamination of the condoms was confirmed, although in our study, the rate of contamination was 60%. We also isolated nonvirulent environmental and implant contaminants. The most important aspect of the results was that we were able to achieve 100% sterility of the condoms with hydrogen peroxide gas plasma. This was significant because we can place condoms for its intended use in the joints without introducing further infection in the joint. Once sterilised, condoms can also be used for other sterile/aseptic medical procedures, such as ultrasound probe covering and temperature probe covers.
Open Access
Continuous professional development echocardiography training in South Africa
(University of the Free State, 2017) Van Schalkwyk, Marizaan; Van Wyk, C.
English: Echocardiography is recognised as a highly valuable diagnostic tool, and a vast amount of information can be gathered using the procedure. The field of echocardiography has enjoyed rapid technological advances over the last few decades. The operatordependent nature of the technique and the comprehensive knowledge needed to perform a complete and clinically useful study requires maintenance of skills to ensure competence in performing the procedure. In South Africa, the requirements for continuous development (CPD) only specify CPD in general and not field-specific CPD, although the HPCSA recognises and endorses CPD as a means of ensuring provision of best possible practice to the public. This lack of fieldspecific CPD for echocardiography provided evidence for the need to investigate the possible prerequisites for CPD of echocardiography training in South Africa. The overall goal of the study was to determine what is needed to implement echocardiography-specific CPD, and how it can be implemented. A literature study was done to gain a deeper understanding of CPD with reference to health professionals and specifically echocardiography. A questionnaire was compiled, considering some barriers that were identified and which affect compliance with CPD regulations. The questionnaire was compiled electronically and printed in a hard copy using the Evasys system. The target population was echocardiographers who attend the annual New Horizons in Echocardiography congress during 2016, and echocardiography practitioners who were involved through reference from the attendees of the New Horizons in Echocardiography congress. The study revealed that improved communication and access to continuous professional development activities, with specific reference to practical hands-on activities, were the main needs of echocardiographers. It also revealed that formal accreditation and training needs to be monitored more closely and that most echocardiographers did not feel up to date with the latest technology and procedures in the field. Although there were some limitations during this study, it was evident that CPD accreditors, and CPD service providers need to plan, organise and provide information in advance for echocardiography practitioners to plan and be able to attend the CPD activities. Addressing the needs of echocardiography practitioners with regard to CPD will contribute positively not only towards the workplace and profession, but to the community at large.
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.