Masters Degrees (Office of the Dean: Health Sciences)

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Open Access
The lived experiences of emergency care graduates as they transition from college to professional workplace
(University of the Free State, 2021) Malgas, Arthur Mbuyiselo; Adefuye, A.; Vincent-Lambert, C.
Central to every formal education qualification offered by any education and training institution is the aim to produce well-rounded graduates who have gained new knowledge, skills and professional attributes. Emergency medical care education and training programmes are no exception to this desire to produce highly skilled and well-trained graduates. Emergency Medical Services (EMS) workers are generally referred to as paramedics by members of the public; however, there are different levels in which they are categorised, depending on the level of training obtained and professional registration with the regulatory body. Currently, emergency care education and training in South Africa have finalised alignment with higher education after the National Emergency Care Education and Training (NECET) policy was promulgated by the minister of health. The need to review and realign EMS education and training was necessitated by the South African Qualifications Authority (SAQA) and the Higher Education Act. This review resulted in the development of a two-year, 240-credit National Certificate in Emergency Care Technician (ECT). The previous qualification, at National Qualifications Framework (NQF) Level 5, was phased out as per the revised Higher Education Qualifications Sub-framework (HEQSF) and was replaced by a Diploma NQF Level 6 qualification. The NQF Level 5 qualification produced graduates who were eligible to register in the professional category of advanced life support (ALS) with the Health Professions Council of South Africa (HPCSA). Graduates from the ECT programme reported being confronted by negative attitudes from experienced members of the profession and did not feel that they were being accepted during clinical practice shifts at EMS stations, especially in areas where other ALS paramedics were working. Some paramedics who had progressed to the ALS category through short courses expressed their lack of trust and confidence in ECT graduates and their capabilities. The ECT scope of practice was released by the Professional Board for Emergency Care (PBEC) and was also heavily criticised. The scope of practice allows ECTs to perform several advanced and invasive, life-saving procedures, including the administration of potent medication. Most of the resistance and criticism seemed to be based on opinions and emanated from a lack of understanding of what the training programme entailed and how it was delivered. To date, no research has been conducted to investigate the perceptions and lived experiences of ECTs trained paramedics in South Africa. This study investigated the lived experiences of ECT graduates in the North West Department of Health at the time that they made the transition into practice and their ability to practise their scope of expertise. In addition, this study formulated implementable recommendations that can be used to support graduate paramedics as they transition to the workplace. This mini-dissertation sets out the research study, which was done through focus group interviews with ECTs who were trained at the North West EMS College. A review of literature available on EMS education and ECT training, and an analysis of the clinical competencies attributed to ECTs, assisted the researcher in designing an interview schedule that was followed when conducting the semi-structured interviews. The findings of this investigation contribute to the current body of knowledge depicting how the ECTs trained in the North West Department of Health experienced their transition into practice.
Open Access
A view on assessment: MBCHB 3 clinical skills module at the University of Limpopo
(University of the Free State, 2021-11) Maphophe, T. S.; Hattingh, M. G. M.
Abstract not available
Open Access
Critical-thinking skills of undergraduate allied health professions students in the clinical rotation years at the University of the Free State
(University of the Free State, 2020-01) Louw, M.; Van Wyk, C.
In the health professional’s world, decisions have to be made in an instant, and because these decisions influence the lives of the patients that health care professionals treat – wrong decisions can be fatal. These decisions need to be based on solid knowledge and have to be adapted to the patients or the situations and, in order to make unique, knowledge-based decisions, the health care professional must apply critical reasoning. Decision-making is dependent on inductive and deductive reasoning processes, and critical thinking (CT) has been found to be one part of the clinical reasoning process (Vendrely 2005:55). Watson and Glaser (2011:3) define CT as “the ability to identify and analyse problems, as well as seek and evaluate relevant information in order to reach the appropriate conclusion”. By entrusting allied health professions (AHP) students with higher-order thinking skills and the ability to make sound clinical decisions, students are provided with the tools they need to be successful in their careers. CT forms part of the exit-level requirements for AHP, for example, physiotherapists need to work autonomously and in interdisciplinary teams, and have to demonstrate accountability. In turn, occupational therapists should be able to use basic science, social science and arts, as well as information technology, effectively and critically (Velde, Wittman & Vos 2006:49). A curriculum usually combines didactic learning and clinical placements, to ensure a competent practitioner that applies CT skills (Reed 2014:1). However, no CT skills tests are currently administered at the University of the Free State (UFS) to test the actual level of critical thinking of undergraduate AHP students. Worldwide, a few tests exist that test CT skills at different levels of education, from school to postgraduate level. The only research articles that could be found in relation to testing CT skills in AHP used the California Critical-thinking skills Test (CCTST), the California Critical Thinking Disposition Inventory (CCTDI), the Health Sciences Reasoning Test (HSRT) and the Watson-Glaser™ Critical Thinking Appraisal (W-GCTA). Most of these tests only test the CT skills of Master’s and PhD-level students, with a select few including undergraduate students. The research that was found did not indicate that one test was superior, but suggests that a test of which the questions could be adjusted to a particular health profession would give a better indication of CT skills (Ennis 1996:174; Velde et al. 2006:58). These CT skills tests are all quite costly to apply, and this led the researcher to search for alternative CT tests, and to investigate whether any other universities, in South Africa and beyond, use CT skills tests. The University of Cambridge developed the Thinking Skills Assessment (TSA) test for admission testing of CT and problem-solving skills, to assess the applicants’ suitability for their chosen course (Admission Testing Services 2016:2). Other universities that use the same test for admission are Oxford University and University College London. A free online TSA specimen test is available, for applicants to complete to prepare for the TSA test. The TSA tests the following abilities: Summarising the main conclusion, drawing a conclusion, identifying an assumption, assessing the impact of additional evidence, detecting reasoning errors, matching arguments and applying principles. The aim of this study was to determine the CT skills that undergraduate AHP students at the UFS, possess in their clinical rotation years, and to determine if these skills change over a period of one clinical rotation year of study. Secondly, the type of activities that lecturers in the different departments in the School for Allied Health Professions (SAHP), excluding the Department of Exercise and Sport Science, use to develop CT skills in their undergraduate students was investigated in this study. This study was conducted in the field of health professions education. The study is interdisciplinary, as it forms a bridge between health professions education and allied health education. This study consisted of two parts. Part 1 was a quantitative research study that was experimental in nature, with a one-group pretest-posttest design. A literature study was done to conceptualise and contextualise CT skills and determine the CT skills in undergraduate AHP students. A CT skills test (TSA-Modified) was used to test the CT skills of undergraduate AHP students who were at the point of completing their third and fourth years of study in 2018. The TSA-Modified was completed at the beginning and end of one year, to determine if changes had taken place in CT skills over this period. Part 2 was a descriptive study, using a self-constructed questionnaire to investigate the types of teaching activities lecturers in the different departments of the SAHP employed to develop CT skills in their students. The data gathered in this study can be used for further research by the researcher to determine the need for and feasibility of a CT skills test for undergraduate AHP students at the UFS. Part 1 included a target population of 227 undergraduate allied health professions students at the University of the Free State, of whom 136 completed the pretest, but only 106 completed the pretest and posttest, and who were consequently included in the study (55,5% and 43,3% response rates respectively). This study found no statistically significant development ofoverall CT skills over the study period. Interestingly, occupational therapy students showed a statistically significant difference in median test scores compared to the other groups, though this finding needs further investigation. This study highlights the need for more extensive research on the CT skills of different health care professionals, to build a stronger foundation regarding thinking, and to improve clinical reasoning skills, which could lead to better patient care Part 2 of this study include lecturers in four of the departments (Physiotherapy, Occupational Therapy, Nutrition and Dietetics, and Optometry) of the SAHP at the UFS completed a self-designed questionnaire, to determine which strategies they used to develop students’ CT skills. A response rate of 60% of the target population was achieved. Lecturers indicated problem-based learning and experiential learning as the teaching strategies applied most often to develop CT skills. This study identified how these strategies were scaffolded in 2018 in the four curricula of the different allied health professions disciplines to develop well-rounded graduates who engage in CT. This research study will provide feedback to the SAHP about the CT skills of its undergraduate AHP students in their clinical rotation years, and make recommendations, if necessary, about incorporating CT skills in the different departments’ teaching methods, to improve the level of CT skills in undergraduate students. This dissertation contains information about the research study, including the research design and methodology.
Open Access
A student review of doctor-patient communication skills training in the UFS undergraduate medical programme
(University of the Free State, 2020-01) Swinfen, Dirkie; Labuschagne, M. J.; Joubert, G.
Open Access
Evaluation of the cerclage cable force
(University of the Free State, 2020-12) Mofokeng, Jabulani Ephraim; Van der Merwe, J.
INTRODUCTION: Cerclage cable systems are manufactured by different companies to assist in fracture reduction and fixation; their usefulness extends to various specialties, including trauma, tumour surgery and arthroplasty, especially in revision total hip replacements. Two types of systems exist, namely, monofilament and multifilament systems. Multifilament cables grip systems are reported to have good outcomes; however, these attractive fixation devices are not without complications, with a reported failure rate that ranges from 27% to 44%. Loosening is one the modes of failure that can occur intraoperatively, after clamp fixation, or postoperatively because of micro motion and displacement caused by soft tissue interposition and bone resorption. The aim of this study is to determine whether the initial force that is applied to the cylindrical structure reflects the value of the force indicated by the manufacturer of the tensioning device. METHOD: This is a descriptive study that was undertaken during January 2020 at the University of the Free State, Universitas Academic Hospital’s Department of Orthopaedics. A measuring device was manufactured to measure the true force exerted by the cable systems. The researcher used five different cerclage cable systems from different companies in order to evaluate the forces exerted by these systems. The measuring device had a cylindrical structure to which these forces we applied at four different sites. The force applied was measured and compared to the forces indicated by the manufacturer of the tensioning device. These values were recorded on the data collection sheet.RESULTS: Out of the five cable systems evaluated, only one cable system indicated the correct force at all four different sites. However the other four cable systems reflected higher forces on the tensioning device when the true measured forces were lower. Retensioning the cables more than twice caused fraying of the cables. CONCLUSION: The force applied to the bone by the cerclage cable system is not a true reflection of the force indicated by the manufacturer of the tensioning device. Cables should not be retensioned more than twice as this may cause fraying and lead to failure of the implant.
Open Access
Investigating curriculum based training on patient handover within higher education institutions
(University of the Free State, 2021-05) Muller, George Frederick; Brits, H.
Background: Communication between healthcare providers (HCPs) is crucial for holistic patient care and conformance to the continuum of care. Patient handover is viewed as an essential element for aligning this continuum of care in the healthcare environment. The education of HCPs notoriously neglects the topic of patient handover through various healthcare programmes with minimal interprofessional education taking place. The South African Qualifications Authority (SAQA) and quality councils (Council on Higher Education, Umalusi, and Quality Council of Trades and Occupations), guided by the various professional healthcare boards, which provides the benchmark for healthcare education outcomes, fails to incorporate patient handover as a topic of interest into most healthcare programmes curricula. Programme-specific outcomes appear not to reflect patient handover as a priority in healthcare. Poor interprofessional communication is linked to one-quarter of all adverse medical events and prolonged patient admission, with massive cost implications related to the duplication of diagnostic testing. Interprofessional power gradients have been indicated to directly influence how patient handover is conducted. Aims and objectives: The aim of this study was to investigate the current status of patient handover from a theoretical and practical perspective. The objectives followed to achieve the aim included reviewing the curricula of healthcare programmes published by SAQA. A rapid literature review was conducted to ascertain what national and international recommendations can be made regarding patient handover protocols. An HCP questionnaire was constructed and disseminated to hospital healthcare providers (H-HCPs) and prehospital healthcare providers (P-HCPs) to determine their perceptions of current standards related to patient handover. Methodology: A sequential mixed-methods design was employed, following a more qualitative approach to data collection. Methods: A curriculum content review was conducted on the SAQA-published healthcare programme curricula, followed by a rapid literature review. The data from these phases were utilised to construct an HCP questionnaire, to incorporate both H-HCPs’ and P-HCPs’ responses. Results: The various methods in this study indicated that patient handover is minimally implemented throughout the various healthcare programmes’ curricula. Simulation-based medical education (SBME) was highlighted as the best method to incorporate patient handover education and to assess the topic. The various healthcare programmes indicated minimal structure during theoretical education, with emphasis on informal learning by higher education institutions (HEIs). P-HCPs indicated the most experience with internationally recognised handover acronyms, while H-HCPs indicated minimal experience on the same topic. There appears to be a large gap between what H-HCPs deem important information during patient handover and the information that P-HCPs hand over. None of the HCPs indicated satisfaction with how current handover practices are done, but most HCPs felt confident with handing over a patient holistically. Conclusions: The World Health Organization’s recommendation to incorporate patient handover into all HCP programmes is highly neglected. Even though patient handover is superficially covered in theory lectures, educational limitations still exist regarding how to incorporate patient handover into teaching and learning. Informal education forms a significant part of this academic topic, with no standard approach adopted in current healthcare systems by either H-HCPs or P-HCPs. Formal assessment on patient handover is not incorporated. SBME encourages the ideal platform for educating, assessing, and providing constructive feedback on patient handover. The theory-practice gap between HEIs and healthcare facilities expands daily. Little interprofessional education is incorporated into healthcare, which directly influences the gap between a unified healthcare system. The less time that is spent on interprofessional education, the greater this gap becomes. Recommendations: Interprofessional collaboration is required between the various healthcare programmes. Educational institution and HCP collaboration is necessary to increase healthcare programme curricula, while simultaneously adapting to both industry and patient needs.
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
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
Low dislocation rates achieved when using dual mobility cup hip implants for femur neck fractures
(University of the Free State, 2020-06) Erasmus, Lourens Jacobus; Van der Merwe, J. F.
Background: Total hip replacements (THA) done for intracapsular neck of femur fractures (NOF) have a dislocation rate of up to 14%. This is seven times higher than in THA done for osteoarthritis. Using a dual mobility cup (DMC) has been shown to be effective in addressing dislocation in elective THA. Our hypothesis is that the use of DMC in NOF will do the same. This study aims to determine the incidence proportion of dislocation of DMCs one year after surgery in patients who received THA for NOF and to compare it to dislocation rates as documented in existing studies. Methods: A retrospective study was done on 86 patients treated with DMC-THA for an intracapsular NOF fracture from 2012 until 2016. A minimum one-year follow-up period was required for inclusion into the study. The number of dislocations at one year after surgery were noted. Results: Forty-one patients with a mean age of 60,7 years were included (26 females and 15 males). All patients were operated via the posterior approach. None of the patients had dislocated after one year. Conclusion: Low dislocation rates can be achieved using DMC THA in the management of intracapsular NOF fractures. Our one-year dislocation rate of 0% compares favourably to conventional THA and is comparable to similar DMC studies done outside of South Africa.
Open Access
A feasible diabetes management guideline for primary health care practitioners in the Free State for workplace learning
(University of the Free State, 2020-08) Rossouw, Maria Magdalena; Adefuye, A. O.; Reid, M.
There is overwhelming proof that the management that patients with diabetes mellitus (DM) receive in the primary health care (PHC) settings is not adequate, causing poor control of DM and resultant complications. This poor PHC setting management of DM occurs in spite of the existence of multiple guidelines produced both nationally and internationally, and which is specifically aimed at DM management. The aim of this study was to develop a feasible, primary care DM management guideline for the Free State in order to bridge the knowledge gap of PHC practitioners and consequently improve DM management. The four objectives of this study were thus defined as doing a comparative study of current national and international DM management guidelines and trends; analysing the Adult Primary Care 2016/2017 (APC 2016/2017) its quality; studying the elements of what equates to a feasible PHC setting management guideline; and finally developing a feasible, new DM guideline by synthesizing all of the collected and analysed data. The study was designed as a desktop study with four distinct phases, each linked to a study objective. Phase I encompassed the comparative analysis of the major, referenced national and international DM management guidelines with the APC 2016/2017. Phase II entailed the evaluation of the quality of the APC 2016/2017 two tools as applied by four independent assessors. Phase III consisted of a literature review to contextualise the qualities and characteristics inherent in feasible PHC setting guidelines. In Phase IV of the study, the new management guideline was developed by synthesizing all of the data gathered in the first phases. The newly developed DM management guideline improved on the content of the APC 2016/2017 international and national DM guidelines. A concerted effort was made to enhance the feasibility of the new guideline by incorporating the features inherent in feasible guidelines, especially in terms of ease of use, incorporation of multi-morbid conditions, and clarity of presentation. The end-product of this study is a new DM management guideline, aimed at patients in the PHC setting in the Free State, which contains the features that should enhance its feasibility in this setting. Due to the known application of guidelines as tools for workplace learning, this new guideline was designed to be used as an educational tool during workplace learning and training sessions. Uptake of the new guideline in the PHC setting by means of a pilot study and implementation will improve the knowledge and confidence of PHC practitioners in the Free State. This improvement in DM knowledge will, in turn, have a positive impact on the management and general health of patients with DM in the Free State PHC setting.
Open Access
Training for interpersonal communication skills relevant to neurological practice in South Africa
(University of the Free State, 2020-09) Moodley, Anandan A.; Bezuidenhout, J.; Van Aswegen, A.
Training in proper communication between doctor and patient is not a requirement for the training of neurologists in South Africa. This is not the case in neurology training in countries such as Canada, the United Kingdom and Australia, where communication is taught and tested in the final neurology examination. The aim of this study was to assess how qualified neurologists and neurology doctors in training (registrars) view their ability to communicate with patients, and how they view such communication as an item in the neurology-training syllabus. The researcher conducted a survey to investigate the opinions of neurology doctors by using a questionnaire completed either via the internet or on printed forms. The target groups were neurology registrars and qualified neurologists working in private practice, public and academic hospitals. The results of this study will be made available to the seven neurology-training units in South Africa, as well as the College of Neurology, which is the neurology examining body of the College of Medicine of South Africa. The study found that neurology registrars and qualified neurologists are not adequately skilled in communication and, therefore, the study will motivate for the introduction of proper training and testing of communication in the objectively structured clinical examination of the final neurology exam. After all, if students are not tested in doctor-patient communication, it is unlikely that they will possess the required skills in doctor-patient communication.
Open Access
An evaluative case study for undergraduate community service-learning in physiotherapy
(University of the Free State, 2020-09) Saaiman, Christolene Mary Berenice; Botha, R. W.; Janse van Vuuren, E. C.
Social and educational transformation was needed in post-Apartheid South Africa (SA) to address numerous social problems that the country was experiencing. Higher educational institutions were identified as vehicles to bring about transformational change to addressing inequalities in the South African society. As such, Education White Paper 3 laid the foundation for making community service, community engagement and service-learning integral to higher education. Building on national directives, the University of the Free State (UFS) established community engagement and community service-learning (CSL) to bring about transformational change. The Department of Physiotherapy at the UFS adheres to the Higher Education Quality Committee directive that CSL in South African educational programmes is used to enhance social transformation. Physiotherapy departments need to ensure that their CSL offerings remain relevant to educational directives and changes in the profession, the higher education environment as well as communities by way of continuous evaluation. The aim of this evaluative case study was to evaluate the undergraduate Physiotherapy CSL module at the UFS. This evaluation involved engaging with relevant literature, including national and institutional policies and guidelines as well as with all stakeholders involved in the named UFS CSL module. The key concepts identified by the different authors in the literature review closely corresponded with the Good Practice Guide for managing the quality of CSL. Key concepts included partnerships, planning, teamwork/collaboration, management of the CSL process (including orientation, assessment and sustainability), recognition and celebration, evaluation of the impact and/or monitoring as well as expansion and/or termination and teamwork/collaboration. The Good Practice Guide was identified as a tool to evaluate the undergraduate physiotherapy CSL module as it encapsulates all the important aspects of CSL. The researcher used three different data collection methods, namely focus groups with UFS CSL experts and physiotherapy academics, semi-structured interviews with service providers and questionnaires with community members and physiotherapy students. The limited quantitative data collected through a questionnaire survey was mainly analyzed as descriptive statistics to describe the profile of the study participants. For the qualitative data analysis, the researcher used thematic analysis by identifying and summarizing data from the transcripts and questionnaires. A wide variety of themes were extracted from the data such as communication, collaboration, equality, social responsibility, graduate attributes, assessment strategies, sustainability, as well as the quality and impact of the module. In building sustainable partnerships, acknowledgement of community elders at first contact is cardinal. The importance of student and community preparation before commencing a community project also arose as critical in this study. The community voice that plays an integral role, even in the planning of a CSL module, was emphasized. Another important aspect was to monitor the impact of a CSL project on the different stakeholders. It also came to light that CSL programmes should continuously be evaluated against abovementioned concepts, policy directives and stakeholders’ expectations for adherence. In terms of the undergraduate physiotherapy CSL module at the UFS, recommendations included that informal connections and relationships be formalized, interaction be effective and a reciprocal participatory approach to development initiatives be followed that engages community members/leaders in fostering equality in the triad partnership. Celebration with all partners is recommended as this helps acknowledge and appreciate all partners playing a part in the CSL module and serves as motivation for future partnerships. In addition, constructive alignment and scaffolding of information must be applied consistently to outcomes and assessment strategies in the CSL module. The study’s value lies in that it provides comprehensive (i.e. multi-stakeholder) insight into the current CSL undergraduate physiotherapy module at the UFS and may influence changes to the module in terms of teaching and learning, and equal and inclusive partnerships. Inter-professional collaboration to expand and incorporate more stakeholders was suggested to improve the impact of CSL and possibly reduce the fragmentation of CSL. This study also serves to encourage more and extensive research in the field of CSL in physiotherapy education on a national level. This could be facilitated by the Good Practice Guide and Self - evaluation Instruments for Managing Quality of SL as it proved to be a very valuable tool in creating a comparable space for CSL offerings in HEIs and, more specifically, physiotherapy.
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
Integrated clinical simulation assessment criteria for emergency care education programmes in South Africa
(University of the Free State, 2015-07) Campbell, Roderick Grant; Labuschagne, M. J.; Bezuidenhout, J.
English: An in-depth study was done into integrated clinical simulation with a view to identifying assessment criteria and case types in order to employ integrated clinical simulation as an instrument for summative assessment of learners by ALS emergency-care-education programmes in South Africa. Clinical simulation is mandated by the Health Professions Council of South Africa, Professional Board for Emergency Care (HPCSA: PBEC), for use by emergency-care-education programmes as a summative assessment instrument. The Higher Education Quality Committee (HEQC) calls for integrated assessment as a suitable test of applied competence reflecting the key purpose of a qualification. The South African Qualifications Authority (SAQA), using the outcomes-based education and training paradigm, provides a clear definition of “assessment criteria” and “integrated assessment” for employment when assessment of applied competence occurs (SAQA 2001:11, 21). These definitions were used to frame and focus the study. This study sought to bridge the gap created by the absence of guidelines by PBEC for assessment criteria and case types or scenarios for use with integrated clinical simulation summative assessment. In this study the elements of assessment criteria, as defined by SAQA, relevant to integrated clinical simulation were explored. In tandem with assessment criteria, case types or scenarios appropriate to integrated clinical simulation were extrapolated. This study is situated in the field of Health Professions Education and focused on the profession of Emergency Medical Care. The research methods comprised analysis of documents that contextualise the mandate and use of clinical simulation for assessment by emergency-care-education programmes in South Africa. A review of scholarship provided a conceptual framework for understanding healthcare simulation as an educational methodology and valid assessment instrument for assessing applied competence in an authentic situation. A conceptual understanding of the prerequisites for using healthcare simulation that ensures an authentic situation for meaningful student engagement was discoursed. Perspectives from literature that address assessment criteria and case types relevant to ALS paramedic practice were discovered. An embedded, single-case study design was employed and focus-group interviews were used as the method of data collection for the empirical phase of the study. Data from focus-group interviews with experienced ALS paramedics was analysed and interpreted in conjunction with scholarly viewpoints and experience of the researcher to examine integrated clinical simulation as a summative assessment instrument, which was the main unit of analysis, and the subunits, namely, assessment criteria and case types. From the analysis of focus-group discussions, seven themes informing the research questions were deliberated. The first theme addressed the integrated clinical simulation as an assessment instrument. The second theme spoke to the context and conditions of ALS paramedic practice that are relevant to the integrated clinical simulation. Theme three through to theme six tackled the knowledge framework together with the physical, cognitive, affective and the social-professional dimensions of ALS paramedic practice that are relevant to the integrated clinical simulation. Finally, theme seven engaged case types and scenarios for integrated clinical simulation as a summative assessment instrument. The lack of fidelity of the integrated clinical simulation perceived by focus-group participants, together with its historical use as a summative assessment instrument challenges the application of integrated clinical simulation as an authentic assessment. Using a single, once-off integrated clinical simulation to assess competence in ALS paramedic practice is contested by the range of life-threatening emergencies possible across medical disciplines. In order for the integrated clinical simulation to assess competence it must cover the range of medical disciplines, incorporate the dimensions of ALS paramedic practice, reflect the conditions, complexity and range of life-threatening emergencies presented to ALS paramedics in South Africa and elicit the appropriate response modes required in practice. Although no specific case types were identified for use in the integrated clinical simulation, characteristics of case types were identified and they provide a matrix for case-type selection. These characteristics refer to the categories of medical and trauma conditions, with a focus on life-threatening emergencies across the range of medical disciplines. The action-response mode of the ALS paramedic and life-support interventions required are determined by the nature of the presenting life-threatening emergency within the scope of practice prescribed by the PBEC. The context and conditions of ALS paramedic practice must also be represented if true competence is to be assessed. This study informs a conceptual framework of healthcare simulation for use by emergency-care-education programmes in South Africa. The study serves to frame the breadth, depth and scope of assessment criteria applicable to integrated clinical simulation for use as a summative assessment instrument. Finally, this study provides a conceptual matrix for case type and case design for clinical simulation in emergency care.
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
The impact of an interactive education strategy in radiography education
(University of the Free State, 2003-11) Brussow, S. M.; Nel, M. M.; Joubert, G.
English: Increased access to higher education to address equity is a major objective of The National Plan for Higher Education (NPHE) in South Africa. This increased access necessitated more flexible entry requirements to admit previously disadvantaged learners. These learners are, however, inadequately prepared for higher education. Higher education institutions should take this into account in teaching and learning. The rationale for this study was to address the access-success imbalance in higher education mentioned by South Africa's Minister of Education. This research study was thus undertaken to evaluate the impact of an interactive educational strategy in radiography education.The research took the form of an exploratory, descriptive and quantitative experimental study comprising of a literature review and an experimental investigation. The literature review covered mainly two aspects: The first aspect consisted of factors associated with academic achievement, namely cognitive ability, self-regulation, self-efficacy, motivation, approaches to learning, effective study skills, and learning styles. In the second place, educational strategies were reviewed in the literature, while interactive education was seen as an opportunity to foster the factors associated with effective learning. Effective learning entails encouraging self-regulation, nurturing self-efficacy, raising motivation, promoting a deep approach to learning, teaching and assessing study skills, and accommodating differences in learning styles when teaching. Since the key to effective learning is rooted in the engagement of learners in active and collaborative learning experiences, this productive interaction between learners and facilitators - which enhances educational events and promotes learning - was therefore explored. The overall goal of the study was to make a contribution towards optimising the effectiveness of education and training in the radiography programme in the School of Health Technology at the Technikon Free State. The aim was to explore the impact of an interactive education strategy in radiography education on 30 second-year learners enrolled for the modules Radiographic Practice and Clinical Radiographic Practice II (RAD 20 at and KLD 20 at) in 2002, gauged by summative assessment and learner perception. The empirical study involved a Learning Preference Inventory (LPI) which provided details on learners' learning preferences. The outcome of the LPI directed the design of the Structured Interactive Sessions (SIS), the intervention in which an attempt was made to address the learners' learning preferences. The learners were divided into three study groups, namely a formal lecture group, a self-activities group, and a self-study group. A pre-post test model was used to quantitatively evaluate the improvement in academic performance after the SIS intervention and subsequently a questionnaire survey was carried out to assess learners' perception(s) of the effectiveness of the interactive and self-directed approach to education in radiography. The results of the three measures, i.e. the LPI, the questionnaire, and the pre-post test model used in the study, shared a prevalent important component, namely the significant role of the facilitator. The LPI results demonstrated dominance in prevalence for a teacher-structured learning environment. The aforementioned fact is confirmed by the distribution of test scores in the pre-test indicating that the groups with no facilitator guidance had lower test marks than the group who received formal lectures. The learners' perception and experiences verified a preference for facilitator-guided activities in class. The researcher realises the limitations of the study, namely that the study is restricted to performance after a single intervention in a controlled test situation, while learners from one programme were used and the contribution of only interactive education on learning, rather than combinations of factors, was quantitatively explored. It is therefore recommended that both quantitative and qualitative approaches, as well as a larger and more diverse study group, would provide a more widely applicable measurement for academic improvement after an interactive intervention. The findings of the present study suggest a possible link between interactive educational strategies and academic achievement. The findings also support the literature on academic performance in which motivation through interaction between the facilitator and the learners plays an important role.
Open Access
Factors associated with students' assessment of teaching quality in a module in the MBCHB 1 program|
(University of the Free State, 2004-08) De Klerk, Brenda; Bachmann, O. M.; Bezuidenhout, M. J.
English: In the light of a changed student body due to transformation principles coming into place and a new curriculum for undergraduate medical education introduced in 2000 in the Medical School of the University of the Free State, the obvious thing to do, was to take steps to ensure that the quality of the education and training students receive, was maintained at a high level. One way of ensuring quality was by having the modules in the program evaluated by students. However, the evaluations of modules in the M.B.,Ch.B. program that are in place (cf' Bezuidenhout 2000-2002), show big discrepancies between different classes, different language groups, different ages, etc. in their assessment of teaching and the curriculum in general. The problem addressed in this study dealt with factors coming into play when students in the M.B.,Ch.B. program evaluated a module. The following research questions were addressed: • How did the changes in the student body and the new curriculum affect the evaluation of modules? • Were there any student-related factors that might have influenced the students' way of evaluating the MED113 module's quality of instruction? • Were there specific people groups in the undergraduate medical education classes that needed special attention regarding certain aspects of teaching and training? • Were there any aspects regarding teaching or the lecturers in the MED113 module that drastically needed to be changed? The purpose of this study was to contribute to the quality of education in the M.B.,Ch.B. program of the School of Medicine, University of the Free State, and it aimed at gaining a better understanding of the results of the evaluation by students of the MED 113 module and to identify factors that might be associated with their evaluations. From students' evaluations, the weaknesses and strengths in the MED 113 module could also be established and corrected where necessary. The method of investigation entailed: • A literature study of quality assurance and the factors that could possibly play a role in students' assessments of lecture quality. • The development of a research instrument (questionnaire) for gathering data on students' perceptions of teaching quality in the MED113 (Concepts of Health and Disease) module for 2002, based on the information gathered from the literature review. These instruments were completed by each student after each session of the MED 113 module. • Factors influencing students' evaluation of teaching were identified, using the questionnaires (empirical study). • Recommendations regarding possible ways of addressing these factors that influence a student's perceptions were made. • The weaknesses and strengths, according to students' perception, in the MED 113 module, were identified by means of the questionnaire. • Recommendations to improve the teaching in the module were made, based on the findings. Information gained through this study will be used in the planning process for the MED113 module for 2004 and in future quality control strategies, with a view to improve the quality of teaching and learning in the School of Medicine at the University of the Free State.
Open Access
The facilitators' perspective of interprofessional education at the Faculty of Health Sciences, University of the Free State
(University of the Free State, 2017-01) Cairncross, J. P.; Steinberg, W. J.
English: Collaborative practice in healthcare occurs when various health workers with different areas of professional expertise work together with patients, their families and communities. The World Health Organisation (WHO) published a report that policy makers can apply to their own local context to address the local health needs and improve health outcomes through the implementation of interprofessional education programmes (IPE) that strengthen the health system. IPE can be defined as two or more professions learning “with, from and about each other” when they are brought together around a particular task. In 2014 the IPE programme was piloted at the Faculty of Health Sciences (FoHS), University of the Free State (UFS), and fourth year undergraduate students from the FoHS participated. Facilitators are staff from the different Schools of the FoHS, UFS, who assist small groups of undergraduate students to achieve the key outcomes/ competencies of the IPE programme. This study investigated the facilitators’ perspective, their opinions and attitudes, on the current and future IPE programmes at the FoHS, UFS. A quantitative cross-sectional study was designed by the researcher to investigate the facilitator’s perspective. The objectives of the study included determining the facilitator’s perspective on the current and future IPE programmes. Through the literature review the need for IPE and collaborative practice were identified. The facilitators’ perspective, students’ perspective and the delivery of an IPE programme were also identified. An online survey was emailed to all facilitators who had participated in the last IPE programme in 2015. The findings from the closed-ended questions were analysed and described. Findings from the open-ended questions were tabulated according to themes, categories and subcategories. All findings were discussed and summarised by the researcher. The study generated information on the facilitators’ perspective of the IPE programme that may be valuable in assisting programme coordinators in the development of future IPE programmes. Results indicated that not all facilitators were properly prepared for their role and the challenges they faced while conducting IPE sessions. Facilitators identified the need for additional training on the principles of IPE, conducting small group discussions and debriefing. Shortcomings of the current IPE programme, which do not allow for all students to actively participate with the specific case study, and a need to improve training of the standardised patients (SPs) were identified. Suggestions for future case studies were also made, i.e. to include the psychosocial aspects that can also affect the health of a patient. The study confirmed that key outcomes/ competencies of the IPE programme were being achieved. Facilitators were benefiting from the IPE programme not only by learning about the other healthcare professions but also in terms of their own personal growth and development. The study concludes with recommendations by the researcher to IPE programme coordinators. Undergraduate students should be better prepared regarding what is expected of them. Only facilitators who have completed a preparatory workshop should participate as a facilitator. The workshop should include the principles of IPE, facilitating small group discussions, conducting debriefing sessions and how to manage potential pitfalls that could arise during a session. SPs should be well informed regarding their role for the case study in order to deliver feedback to students. Case studies should be constructed to allow for active participation from all professions. Undergraduate psychology and social work students should be included in future IPE programmes to address the biopsychosocial model of health and illness.
Open Access
The experiences and attitudes of students and lectures regarding peer physical examination in the Faculty of Health Sciences at the University of the Free State
(University of the Free State, 2017-01) Hattingh, Maryna Getruida Maria; Labuschagne, M. J.
English: Health professions students use peer physical examinations (PPE) for the purpose of training globally, but in many institutions no formal policy or guidelines exists. There are many benefits of the use of PPE e.g. students are readily available to practise on, students need not to be financially compensated and it has proven to increase students’ clinical skills and confidence, but some students may not want to participate in PPE for various reasons like religion, culture etc. Peer physical examination is the physical examination of a student by a fellow student to enhance his/her clinical skills. This is done under the supervision of a professional person or lecturer. Currently no policy or guidelines regarding peer physical examination exists in the Faculty of Health Sciences (FoHS) at the University of the Free State (UFS) and it is required from the students to participate in peer physical examination during their studies. An in-depth study was conducted to establish the attitudes and experiences of students and lecturers regarding the use of PPE in the FoHS using focus group interviews with students and lecturers. The content of a PPE policy for the FoHS at the UFS was explored with the second question of the focus group interviews. The study was done in the field of Health Professions Educations in the domain of management and leadership and wanted to provide a guideline that may be used to direct students and lecturers when participating in PPE and to explore what is needed to be included in the content of a PPE policy. A qualitative research design was followed with three focus group interviews as data collection method and the compilation of an extensive literature review on the topic. One focus group was with lecturers of all three schools in the FoHS of the UFS who participate in teaching students’ clinical skills and surface anatomy and the other two with students from all three Schools in the FoHS, UFS. Data were transcribed verbatim by the researcher and themes, categories and subcategories identified. Five themes were identified from the collected data. The identified themes, categories and subcategories were compared and discussed with the findings and recommendations of an extensive literature review in mind. The literature review provided a contextual and conceptual understanding of PPE and the benefits and pitfalls associated with the use of it. Perspectives on the use of PPE in different professions were discussed as well as the advantages and disadvantages of the introduction of a policy on PPE at various universities globally. The identified themes were: • Value of PPE • Ethical considerations when using PPE • Student safety • Student concerns • Miscellaneous. The majority of participants agreed that the use of PPE is beneficial to students. The participants agreed participation in PPE increase competence levels in clinical skills, improve confidence and communication skills and assist them to act professionally. Some participants were concerned about educator supervision when practising on peers and some felt that flipping the classroom will benefit students and lecturers as less time will be spent on lecturing and more on the actual practising of the various clinical skills. This study provided recommendations on the content of a PPE policy for the use of PPE from the perspective of health profession students and lecturers from the FoHS at the UFS. The results may be used as guidelines to formulate a PPE policy for the FoHS at the UFS.
Open Access
Preparation of nursing students for operating room exposure
(University of the Free State, 2017-01) Breedt, Shimone Chantel; Labuschagne, M. J.
English: The South African Nursing Council (SANC) requires that all nursing students rotate and work in the operating room. Most of these students have never been inside an operating room and feel unsure of what is expected of them due to the fact that they are not proficient in most of the skills that will assist them in their participation within this set-up. These students are unable to participate and learn on their first rotation in the operating room, leaving the students often feeling in the way and with a negativity regarding operation room nursing. Implemented preparation programmes in the United States of America and the United Kingdom, has proven that improved preparation programmes are successful. A study was conducted to establish what should be in such a preparation programme, as well as what teaching strategies would be most beneficial. The study was done in the field of Health Professions Education and lies in the domain of academic programme development, as the view was to improve the student nurse’s preparation for OR rotation. The study was interdisciplinary, as it reaches across Health Professions Education and Nursing. For this study, a descriptive qualitative inquiry was used by means of two nominal group sessions for data collection and the assimilation of a literature review on the topic. One nominal group was undertaken with third-year nursing students that had just completed their placement in the operating room and the other group comprised of personnel working in the operating room where the students were placed. The data were written verbatim on a flip board and categories were identified by the researcher. These categories were compared and discussed with regard to the findings and the recommendations of the literature review in mind. The categories identified were:  Documentation  Swab and instrument control  Maintaining of sterility  Equipment  Orientation  Theatre preparation. Preferred teaching strategies that were identified:  Formal lecture with written test  Practical group sessions  Pre-placements preparation  Simulation and demonstration  Visual learning. All of the participants agreed that the current preparation/orientation programme do not adequately prepare the students for optimal participation or learning during their placement and that a programme that ensured that the students are able to perform certain tasks from the first day of placement would be equally beneficial for personnel and students. This could improve learning of the students while improving their overall experience of the operating room. This study provides recommendations on the content for a preparation programme and the results may be used to develop an improved preparation programme.