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Item 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.Item Open Access Towards the development of a capacity development framework for research ethics administrators: lessons from South Africa(University of the Free State, 2021) Mulondo, Mutshidzi Abigail; Tsoka-Gwegweni, Joyce; LenkaBula, Puleng; Chikobvu, Perpetual𝑬𝒏𝒈𝒍𝒊𝒔𝒉 𝗜𝗻𝘁𝗿𝗼𝗱𝘂𝗰𝘁𝗶𝗼𝗻: Currently, research ethics capacity development is limited to research ethics committee (REC) members, and little research has been done on research ethics administrators, leading to lack of standardised requirements for this role, its responsibilities, and training requirements for fulfilling the supportive role for RECs. Although the role is administrative, research ethics administrators’ duties exceed those of just simple administration, and include complex demands such as preparing for audits. This study proposed and validated a capacity development framework for research ethics administrators in South Africa. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: A scoping review was done to gain deeper insight into the history and current status of REC administration, with a specific focus on capacity development programs available for research ethics administrators. A questionnaire was then distributed to 36 research ethics administrators to determine the current responsibilities, training requirements and needs of the role, focusing on the local situation of REC capacity development. The first draft of the capacity development framework was developed through triangulating findings from the scoping review and questionnaire. A Delphi survey of the designed framework, completed by 13 experts from South Africa and abroad, was then conducted until consensus was reached. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: From the 22 studies synthesised in the scoping review, two reported that there had been two capacity development efforts for administrators in Africa, namely the African Conference for Administrators of Research Ethics Committees, and the West African Bioethics Training Program. Thirty-six (36) administrators from National Health Research Ethics Council-registered ethics committees in South Africa participated in the online cross- sectional survey. Nearly 49% of the participants indicated that they had only received informal research-ethics-related training – not targeted formal training. Of the 23 research ethics experts approached, 13 participated in the Delphi Survey, and results show that 67% of them confirmed that research ethics administrators require basic, entry-level training at the level of a Bachelor’s degree to be able to fulfil their duties. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Research ethics administrators need to have a Bachelor’s degree and be capacitated in ways comparable to the training received by research ethics committee members. The world of research is evolving fast and requires every role player in the research ethics committee to be adequately capacitated. ___________________________________________________________________Item Open Access The role of a sustainable integrated systems approach to high-technology clinical simulation in South Africa(University of the Free State, 2020-11) Van Wyk, Riaan; Labuschagne, M. J.; Joubert, G.Simulation-based health education is used as a training and feedback method, and its modalities can broadly be divided into two, namely low-technology and hightechnology. Due to its higher complexity, high-technology simulation has some added challenges for implementation and day-to-day operations. The aim of the study was to illustrate the role of and determine how to achieve a sustainable integrated systems approach in supporting and enhancing hightechnology clinical simulation in South Africa in order to ensure long-term success. To achieve the aim of the study, a sequential approach was followed to pursue the objectives. • The objectives were: To conceptualise the various operational subsystems of high-technology clinical simulation and determine the best practices and challenges to high-technology clinical simulation and this was achieved with a literature review. • To establish the current operational approach to and challenges regarding hightechnology clinical simulation experienced by the simulation facilities of South African public, accredited health professions training institutions. • To reach consensus amongst simulation experts on best practices for a sustainable integrated systems approach to high-technology clinical simulation in South Africa. • To explain and illustrate the integration of the operational subsystems with each other and to set out recommendations and guidelines needed to achieve a sustainable integrated systems approach in supporting and enhancing hightechnology clinical simulation in South Africa. A quantitative descriptive study was performed. Data were collected using an online, web questionnaire (Education Survey Automation Suite (EvaSys)) with representatives of public, South African simulation facilities. Forty-two health professions training institutions, representing 12 health professions were identified and approached for the survey. The questionnaire was completed for 17 facilities, of which 14 utilised high-technology simulation. Challenges were identified through the quantitative data and comments in each subsystem across the facilities. The approaches followed by the facilities are in line with the recommended approach in the literature. The challenges faced by the facilities are typically the challenges described in the literature. An electronic Delphi survey was also conducted with simulation experts. The data from the questionnaire survey were used to inform the Delphi survey. The Delphi survey was conducted with eight simulation experts over three rounds. Four hundred and one statements emerged from the Delphi survey, and on 230 (57.4%) of these, consensus was reached. The results from the questionnaire survey and the Delphi survey were used to identify challenges and provide recommendations to address these challenges. Guidelines were drafted to illustrate how the recommendations could be achieved, and how multiple subsystems overlap and are integrated with each other. The conclusion was that high-technology simulation consists of various operational subsystems that integrate with each other to ensure long-term sustainability. These subsystems are management, funding, staff and staff development, curriculum integration, physical environment, and research. Utilising an integrated systems approach can lead to sustainable, high-technology simulation in South Africa.Item Open Access Development of quality assurance and educational guidelines for an emergency medical care preparation programme in south Africa(University of the Free State, 2021-07) Nell, Eduard Nico; Jama, M. P.; Du Plessis, J.An in-depth investigation was conducted to develop quality assurance and educational guidelines for an Emergency Medical Preparatory Programme in South Africa. With the recent shift from vocational-based training to higher education in paramedic education, a dire need exists to assist in-service Emergency Medical Care personnel with career progression and prepare them for the rigour of higher education, and ultimately be successful with their studies. It is critical for Emergency Medical Care personnel to maintain a high standard of education and training in furthering their paramedic careers. Most, in-service Emergency Medical Care personnel do not meet the admission requirements for higher education. To support the further development of Emergency Medical Care personnel, access to the National Qualifications Framework-aligned formal Emergency Medical Care qualifications is required. Consequently, the Emergency Medical Preparatory Programme was developed to adequately prepare Emergency Medical Care in-service personnel for the rigour of higher education Emergency Medical Care programmes by focusing on Academic Communication and Literacy, Basic Computer Literacy, Life Sciences, Physical Sciences, Mathematics and Numeracy, and Physical Preparedness. This study sought to bridge the gap created by the absence of quality assurance and educational guidelines for curriculum for an Emergency Medical Preparatory Programme in South Africa. The following research question was thus formulated: Which quality assurance and educational guidelines can be used to enhance quality in an Emergency Medical Preparatory Programme in South Africa? The study’s overall goal was to conduct an in-depth investigation that could provide quality assurance and educational guidelines for an Emergency Medical Preparatory Programme to enhance quality training of Emergency Medical Care personnel and possibly Emergency Medical Care education and training programmes and short learning programmes. Subsequently, this investigation expanded the limited literature on the Emergency Medical Preparatory Programme and contributed to quality assurance in Emergency Medical Care education in South Africa. This study aimed to develop quality assurance and educational guidelines for an Emergency Medical Preparatory Programme in South Africa. A qualitative case study design was used in this study. To achieve the aim of this study, four objectives were pursued by employing a literature review, document analysis, Delphi survey, and an expert panel discussion. The literature review provided context to the research problem and justified the research position in the existing body of knowledge. Furthermore, the document analysis of the Emergency Medical Preparatory Programme documentation determined alignment with the guidelines and criteria set out by the literature review and assisted in identifying themes that were, together with the literature review, the basis for the Delphi survey questionnaire. Data were collected employing a Delphi survey with lecturers involved with training at higher education institutions presenting Emergency Medical Care educational programmes. The reason for utilising the Delphi method in this study was to achieve general agreement or convergence of opinion around a particular content statement generated in the literature review and document analysis on the topic of the research study. An expert panel discussion was conducted with heads of departments at higher education institutions presenting Emergency Medical Care educational programmes, an expert involved with quality assurance in higher education, and a Professional Board of Emergency Care member. The expert panel discussion finalised the quality assurance and educational guidelines for an Emergency Medical Preparatory Programme. Moreover, the thorough research approach and methodology ensured credibility, transferability, dependability, and confirmability of the study. The completed research can form the basis for further research undertaking. A valuable contribution was made to the body of knowledge by providing quality assurance and educational guidelines for an Emergency Medical Preparatory Programme in South Africa. Additionally, the study assisted in increasing the limited literature currently available on Emergency Medical Care-specific preparation programmes and Emergency Medical Care education quality assurance programmes in South Africa. Hopefully, these guidelines can aid the Emergency Medical Preparatory Programme in aligning with Emergency Medical Care education and providing quality education to personnel.Item Open Access A model for the teaching of imaging informatics, a platform in biomedical informatics, in a future integrated National Health Insurance system in South Africa(University of the Free State, 2020-12) Grobler, A. D.; Bezuidenhout, J.; Botha, R.In this research project, the researcher conducted an in-depth investigation into imaging informatics, to develop a teaching model in imaging informatics, applicable to the South African context. Imaging informatics in the digital radiology department is a division of medical imaging informatics and a study level in biomedical informatics, and function on a cellular or organ system level (Huang 2014a:631). It involves Picture Archiving Communication Systems (PACS), Radiology Information Systems (RIS), radiographic digital imaging modalities and a secure network for storing, retrieving and communicating of medical information and DICOM (digital imaging and communication in medicine) images. In digital radiology departments, in private and public healthcare institutions, it is usually the IT specialists (or manager) and the PACS administrator that is responsible for ensuring a smooth exchange of health information. Currently, no registered, accredited training programme in imaging informatics is available in South Africa. The objectives of the study were: • To gather data regarding imaging informatics nationally and internationally; and • To develop a teaching model for imaging informatics, a platform in BMI, in a future integrated NHI system in South Africa. The researcher used a mainly quantitative research approach to collect quantitative and qualitative data through three structured questionnaires and a three-round Delphi technique. The target population involved radiographers, IT specialist, PACS administrators and system managers. Purposive sampling was used to select the samples from each of the different research populations. The research design was appropriate, as it assisted in answering the research questions within a pragmatist paradigm. Six summated themes regarding imaging informatics principles were derived from the first two questionnaires and incorporated into the development of the first Delphi questionnaire. The categories of the professional practices of imaging informatics professional in the third structured questionnaire were also included in the first-round Delphi questionnaire. The three-round Delphi survey resulted in consensus achieved for 142 of the 184 statements (categories). Stability was proclaimed on an additional 37 statements. Only five categories were excluded after round three. The information retrieved from the literature review during Phase 1 of the study regarding BMI platforms and training; imaging informatics principles and teaching courses; learning theories, teaching strategies and models; and the categories where consensus was reached, and stability proclaimed, were used to develop the teaching model for imaging informatics in a future integrated National Health Insurance system. From the conclusions, it is clear that the teaching model developed through this study will be useful for developing and implementing a curriculum for imaging informatics teaching and learning in South Africa.Item Open Access A support framework for social learning and integration of first-year undergraduate medical students(University of the Free State, 2021-06) Tlalajoe, Nokuthula; Jama, M. P.; Van der Merwe, L. J.𝑬𝒏𝒈𝒍𝒊𝒔𝒉 In an effort to address the absence of a social learning and integration support system that could facilitate the transition of first-year undergraduate medical students from high school to a new education environment in the School of Clinical Medicine (SoCM) in the Faculty of Health Sciences (FoHS) of the University of the Free State (UFS), an in-depth study was conducted to construct a support framework for social learning and integration of first-year undergraduate medical students. The researcher aligned literature from two theories relating to social learning (Bandura 1969:217) and social integration (Tinto 1975:107) respectively. An aligned theory, called social learning and integration, and defined as the interaction, through institutional experiences, that can influence how individuals learn from each other through observation, imitation, modelling and persistence, was used to obtain a deeper understanding of the dynamics of transitioning into a new education environment, and means of achieving successful transition. With the application of appropriately selected techniques, namely the nominal group technique and Delphi technique as methods of investigation, the researcher investigated factors that affect the social learning and integration of medical students at the SoCM in the FoHS at the UFS, when they transition from high school into university. During the nominal group meetings, the medical students at the SoCM indicated six factors, namely underpreparedness, peer support, confidence, self-management, alienation and academic advice, that affected their transition from high school to university. After the social learning and integration factors had been identified by the medical students at the SoCM in the FoHS at the UFS, they were engaged further to suggest social learning and integration skills which could ease the social learning and integration factors that had been identified. The social learning and integration skills recommended by the medical students were subsequently presented to a panel of experts in a Delphi study. The experts in the fields of higher education and health sciences education were recruited in South Africa and xx abroad with the aim of achieving consensus on recommendations that could be used to formulate the contribution of the study, namely, the construction of a support framework for social learning and integration of first-year undergraduate medical students. In addition to achieving consensus on 12 of the recommendations suggested as useful skills for social learning and integration factors, the panel of experts also contributed comments that identified key role players who need to facilitate the recommendations, in an attempt to resolve the social learning and integration factors that had been identified. Four key roles were identified and denoted as levels of engagement, namely community: SoCM, individual, group setting and collaborative relationships. Complementary to the levels of engagement, the literature overview highlights support programmes, which were denoted as actions, namely preparation for health sciences workshop support, mentorship and student-led group support, which are likely resolve the identified social learning and integration factors. By combining the two theories on social learning (Bandura 1969:217) and social integration (Tinto 1975:107), greater depth of understanding was obtained on social learning and integration factors, skills and support programmes. As a contribution to new knowledge, this study constructed a support framework for social learning and integration of first-year undergraduate medical students. Implementing the support framework could facilitate successful transition of first-year undergraduate medical students from high school to university. ___________________________________________________________________Item 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.Item Open Access A framework for integrated emergency care education in South African undergraduate medical programmes(University of the Free State, 2021-02) Hagemeister, Dirk Thomas; Labuschagne, M. J.Competence to manage emergencies is expected from medical practitioners and should be acquired during undergraduate medical training. Since the causes of emergencies can originate from many different systems, both physiological and psychological, a variety of clinical specialities is involved in the teaching of the diagnosis and treatment of emergencies. Bringing various different people and approaches together in undergraduate medical education constitutes a challenge. The lack of an integrated approach to undergraduate medical education in emergency care was identified as a relevant gap worth investigating in this PhD project. This study was undertaken with the aim to provide a framework for the integration of undergraduate medical education in emergency care with the intention to contribute to the steady improvement of undergraduate medical education and, through this, ultimately, to better health outcomes. Specific objectives of the research included the identification of international and national trends in the field and of current education practices at the medical schools in South Africa, including outcomes, objectives, education strategies and ways of assessment. A constructivist approach was followed in the sense that the mostly qualitative insights from the different methods are regarded as contributions towards a larger overall framework, but without the epistemological claim to discover an ultimate truth behind the subjective facts. As methods, an extensive review of published literature on emergency care training and of the regulatory environment for undergraduate medical training provided an international background of recent developments and a local context for South Africa. Semistructured in-depth interviews were held with key people in the established undergraduate medical programmes in South Africa and this promoted a multi-facetted insight into current education practices in the country, into challenges and successes. A three-staged nominal group technique was applied as the second empirical method, to evaluate the current education practice in the undergraduate medical programme at the University of the Free State and to identify needs and make suggestions for improvements. This process collected prioritised statements on strengths and weaknesses from recent graduates and, informed by these contributions by members, prioritised suggestions by the members of the education team, which were then discussed with academic programme managers. Results of the methods are presented as five publishable manuscripts, with one manuscript each reporting the findings from a rapid review of the international and national regulatory environment, one on a scoping review of peer-reviewed publications on undergraduate medical education in emergency care over the last decade, one on in-depth interviews conducted at South African medical schools and the nominal group technique at the University of the Free State, with the fifth manuscript suggesting a framework for the training. Key findings from the regulatory review show that many international bodies explicitly include emergency competencies in their exit outcome objectives, and that the latest trend is towards expressing those objectives in entrustable professional activities. This trend was confirmed in the literature review, which also found that there is, internationally, a growing role being played by emergency medicine, that training is increasingly based on online resources and simulation, and that experiential training typically happens in emergency rooms. The routine standard use of ultrasound in emergency care and the broad integration of ultrasound teaching in undergraduate training was equally significant. The in-depth interviews provided information on an array of issues, with different medical schools sharing the challenges of integrating emergency skills training across modules, reviewing the outcome objectives for curricular renewal, and trying to map such objectives effectively. Increasing student load against a constrained staff basis, complicated further by joint appointment status, interprofessional teaching and the role of emergency medicine, were found to be relevant. From the nominal group technique conducted at the University of the Free State, the importance of short courses in skills training, the need for integrated and well managed coverage of emergency care, for more in-situ clinical experiential learning opportunities, and for appropriate staff development in the field of health professions education, was re-emphasised. The proposed framework illustrates the complex interaction between the key factors of high-quality clinical practice, best current educational practice, and the institutional culture, with each of the three factors dependent on additional factors. In conclusion, the researcher recommends further research to formulate a national set of entrustable professional activities and enabling competencies, and to achieve a comparative mapping of outcome objectives between different medical schools.Item Open Access Innate immune signalling induced by Crimean-Congo haemorrhagic fever virus proteins in vitro(University of the Free State, 2019-01) Viljoen, Natalie; Burt, Felicity Jane; Goedhals, DominiqueCrimean-Congo haemorrhagic fever orthonairovirus (CCHFV) is a tick-borne viral zoonosis associated with haemorrhagic fever in humans. The World Health Organisation identified CCHFV as a priority pathogen for research. The disease is widespread globally with regions of endemicity in Africa, Asia and eastern Europe; however, the emergence and re-emergence of disease in endemic and non-endemic regions is a cause for concern. Additionally, the lack of rapid point-of-care assays, a vaccine or therapeutic interventions approved for use in humans complicates the control and management of disease, which requires an improved understanding of the virus-host interactions. Viruses have co-evolved with their host/s. Dysregulation of the immune response is a common strategy utilised to evade immune detection and clearance. The innate immune response is a robust non-specific response to infection with the aim of limiting virus replication and spread while activating the adaptive immune response that mediates virus clearance and protection. In this study, innate immune modulation by selected non-structural CCHFV proteins, including the NSM protein and ovarian-tumour like (OTU) protease, and Hazara orthonairovirus (HAZV), a possible model for CCHFV, was investigated. The CCHFV NSM protein, encoded on the M-segment, was expressed in vitro to evaluate the ability of the protein to modulate innate immune signalling. In South Africa, isolates containing an M-segment that are genetically related to other South African isolates (non-reassortant) and isolates containing an M-segment that are genetically similar to Asian isolates (reassortant) have been identified. The CCHFV NSM proteins from both reassortant and non-reassortant CCHFV isolates were evaluated. Despite 92,88% amino acid sequence similarity between the reassortant and non-reassortant NSM protein, the non-reassortant NSM protein downregulated key innate immune markers, including DDX58 (RIG-1), IFNB1, IFNAR1 and STAT1, whereas the reassortant NSM protein upregulated DDX58 (RIG-I) and IFNB1 expression. The results indicate that the reassortant NSM protein induces innate immune signalling, whereas the non-reassortant NSM protein significantly downregulates innate immune signalling. The non-reassortant NSM protein may therefore potentially compromise virus recognition and the induction of an antiviral state. The CCHFV OTU protease, encoded on the L-segment, has deubiquitinating and deISGylating activity that interferes with the regulation of cellular processes, including innate immune signalling. Modulation of innate immune signalling at transcriptional level by the CCHFV OTU protease was determined by gene expression analysis. Expression of the CCHFV OTU protease resulted in downregulation of IFNB1, IFNAR1 and STAT1 expression. The results suggest that, in addition to interfering with innate immune signalling by deubiquitination and deISGylation, the CCHFV OTU protease also downregulates innate immune signalling at transcriptional level. The CCHFV OTU protease may therefore significantly compromise the host's innate immune response to infection and represents a potential target for the development of therapeutic interventions. HAZV, a closely related virus to CCHFV, has been proposed as a clinical surrogate for disease in type I IFN-receptor deficient mice. Innate immune signalling induced by HAZV and HAZV RNA was evaluated to determine whether HAZV modulates innate immune signalling. A significant downregulation in IFNB1 expression during infection was observed and a lack of upregulation of several key innate immune markers. The results suggest that HAZV has the ability to downregulate innate immune signalling without completely abolishing innate immune activation. Further investigation to determine the mechanism utilised by HAZV may provide insights into whether HAZV would be suitable as a surrogate for the screening of therapeutic interventions to overcome innate immune signalling modulation post-infection. HAZV provides a safer alternative to CCHFV since HAZV can be cultured and handled in a biosafety level (BSL)-2 facility. This study has identified targets for the development of therapeutic interventions and potential inclusion in vaccines. In vivo studies are required to determine the significance of the findings during infection.Item Open Access A framework for employability skills of consumer science graduates(University of the Free State, 2017-07) Du Preez, Minnet; Van der Merwe, L. J.; Swart, S. B.English: With the high graduate unemployment rate in South Africa, universities are realising the importance of delivering students with employability skills to attain employment and succeed in the work environment. A gap in the literature was identified, since no framework could be found that described the employability skills that consumer science employers require from employees. Hence, this study aims to construct a framework regarding the employability skills of consumer science graduates, including the teaching and learning strategies and assessment methods which can be used to ensure that graduates have mastered the needed skills. In order to reach the aim of this study, a mixed methods approach was followed. During the first phase of the study, questionnaire surveys were completed by consumer science employers, graduates, lecturers and students to determine which skills consumer science graduates need when entering the workplace. During this phase, 11 essential employability skills of consumer science graduates were identified and investigated. The second phase of the study comprised of focus group discussions with consumer science lecturers to determine the teaching and learning strategies that must be used to enhance the identified employability skills, as well as the assessment methods which must be used to ensure students have obtained the required skills. It was found that a variety of strategies can enhance the attainment of employability skills. The gap in literature was filled by constructing a framework of employability skills for consumer science graduates. This framework can be implemented by consumer science lecturers aiming to enhance the employability skills of consumer science graduates. This outcome can be beneficial for the university delivering more employable graduates as well as the industry who will receive more skilled employees.Item Open Access A framework for articulation between the emergency care technician certificate and the emergency medical care professional degree(University of the Free State, 2011-11) Vincent-Lambert, Craig; Bezuidenhout, J.; Jansen van Vuuren, M. V.English: The need to comply with the requirements of the SAQA Act necessitated a review of emergency care education and training in South Africa. The review and restructuring led to the creation of a formal two-year, 240-credit NQF level 5 Emergency Medical Care Technician (ECT) Qualification. The NDoH views the ECT programme as the "Mid-Level Worker" equivalent for the Emergency Care Profession. At the Higher Education level, the existing three-year National Diploma and one-year B Tech Programmes were collapsed to form a single four-year, 480-credit, NQF level 8 Professional Bachelor of Health Sciences Degree in Emergency Medical Care (B EMC). After the establishment of the two-year ECTand four-year B EMCprogrammes, the next challenge faced by the HPCSA,educators and educational providers within the emergency care field became that of facilitating articulation between the two qualifications. This study aimed to critically analyse and compare the two-year ECT qualification with the four-year professional B EMC degree in order to design a framework and bridging programme that may support and guide articulation between the two qualifications. An expository, retrospective analysis of existing documentation was followed by a focus group discussion with educators in the field in order to identify and explore potential obstacles and challenges with regard to articulation between the ECTand the B EMCqualifications. Finally, a detailed Delphi Questionnaire was sent to selected expert panel members. The study highlights a strong desire for articulation and academic progression within the emergency care profession. Similarities and substantial differences were identified in the scope, level and depth of knowledge of the ECT and B EMC qualifications. A framework was designed that includes a bridging programme to provide ECTgraduates with the necessary knowledge, skills and insights required to enter directly into the third year of the Emergency Medical Care Degree.Item Open Access Developing model for group work in phase I and II of the M.B.,Ch.B.-learning programme at the University of the Free State(University of the Free State, 2003-12) Raubenheimer, Daleen; Nel, M. M.; Petersen, S. A.English: Drastic changes in the guidelines for medical education have taken place over the past few years which have resulted in the adjustment of undergraduate medical learning programmes of medical schools. One of the prerequisites for being regarded as competent medical practitioners is the ability to function effectively in a health care team. This implies that group work needs to be incorporated as an instructional learning method in undergraduate medical education. The Faculty of Health Sciences, University of the Free State (UFS) implemented a transformed M.B.,Ch.B.-Iearning programme in 2000, consisting of a hybrid curriculum with lectures, group work and directed self-study as the main components of instruction. However, group work was implemented without guidelines and it currently appears not to be reaching the objectives it was intended to. This study was conducted in an attempt to provide guidelines for the implementation and practice of group work through an appropriate model. An opinion survey was conducted amongst the students and staff involved in Phases I and II of the M.B.,Ch.B.- learning programme at the UFS, so as to determine the importance of various indicators for a group-work model, using the literature as a basis for the compiling of suitable questionnaires. The opinions of national and international experts in group work and medical education were also obtained through a Delphi study in an attempt to reach consensus amongst the experts on the importance of the indicators for the group-work model. The model was eventually designed by considering the literature and the results from these two investigations in order to determine its structure. The group, consisting of students, forms the centre of the model, whereas the roleplayers (i.e., students, lecturers and facilitators) are united through group-work sessions. The important input factors which could influence the effectiveness of group work include training, support and resources for group work. All aspects of group work need to be evaluated for various reasons: Not only should the group process and -task be evaluated and assessed, for students to receive marks and thus progress in their studies, but all the elements of group work should be reviewed as part of assuring the quality of group work. However, quality assurance also entails reflecting and reacting on the evaluations in order to ensure that the outcome of group work (i.e., learning in terms of knowledge, skills and attitudes) is reached. The organisation (in this instance, the Faculty of Health Sciences, UFS) needs to provide a suitable environment and academic climate for group work to take place in. This study may therefore contribute to the quality of the undergraduate medical education at the UFS, assisting students to develop the skills necessary to function as competent health care professionals.Item Open Access Antibiotic resistance in anaerobic bacteria(University of the Free State, 2000) Theron, Maria Magdelena; Chalkley, Lynda; Van Rensburg, NolanEnglish: 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.Item Open Access Development of guidelines for team-based learning in an undergraduate pharmacy curriculum: a case study(University of the Free State, 2017-01) Eksteen, M. J.; Swart, S. B.; Reitsma, G. M.English: An in-depth study was done with a view to develop guidelines for the implementation of team-based learning (TBL) in an undergraduate pharmacy curriculum. The research was initiated in response to the identification of a gap in the knowledge regarding the usage of TBL in a management module within a BPharm curriculum in South Africa. TBL is an active, small group-based teaching strategy where students are actively engaged with one another and the module content to solve real-life problems they might encounter in future. This structured, student-centred strategy allows minimal time for traditional lecture methods. Instead, students are required to acquire knowledge independently prior to class. This opens up time during class for students to work together in teams on an issue, similar to what will be expected of pharmacists as part of the health professions team. The aim of this study was to develop guidelines on how to effectively implement TBL in pharmacy education to enhance student learning. It was attained by means of the following six objectives: to conceptualise and contextualise TBL as a teaching strategy in higher education; to determine the experiences of the pharmacy students regarding team work in the pharmacy profession before they were exposed to TBL; to determine pharmacy students’ learning experience of TBL in the management module of the BPharm curriculum after they were exposed to TBL; to identify whether TBL as a teaching strategy increase pharmacy students’ understanding of the theoretical work (curriculum) presented in the module; to determine whether TBL allows students to develop generic skills such as time management, team work, communication, change, innovation, problem solving and precision, as required for pharmacists on a NQF level 8; and to develop guidelines on how to effectively implement TBL in pharmacy education to enhance student learning. A case-study research design was followed because a single phenomenon of interest in one fourth-year pharmacy group was investigated. A mixed-method research approach was followed including both qualitative and quantitative methods. During the first phase of the study in the beginning of the semester, data were collected via written narratives as part of the exploratory design of mixed method research. This was followed by focus group interviews to further explore the themes identified and to establish the initial experiences of pharmacy students regarding team work in the pharmacy profession before exposure to TBL. At the end of the semester, after student exposure to TBL, a questionnaire was used to collect both quantitative and qualitative data on students’ learning experiences with TBL in comparison with traditional lecture methods, whether TBL fostered the development of a deeper approach to learning, and to investigate the possible development of generic skills essential to the health profession team. From the results of the first phase, it was clear that students had some exposure to being part of the health care team. The focus group interviews pointed out that pharmacy students could identify several contributions a pharmacist can make to the health profession team, which competencies they will need and how university training should prepare them to effectively contribute to the health professions team. The results of the questionnaire indicated that TBL provided students with an enjoyable learning experience and that they prefer TBL over traditional lecture methods. TBL also promoted deeper learning and understanding of course content and fostered the development of essential generic skills commonly referred to as graduate attributes or employability skills. The findings of the study were used to develop guidelines for health professions educators to implement TBL in undergraduate pharmacy education. These evidencebased conclusions can be used to optimise the teaching and learning of pharmacy students in South African higher education.Item Open Access Essential surgical skills in rural hospitals: a CPD programme(University of the Free State, 2016-12) Porter, D. C.; Bezuidenhout, J.; Du Toit, R. S.English: General practitioners have to deal with a variety of conditions, challenges and diseases. Currently there is little known about surgical practice and the surgical skills required to deal with it in rural South Africa. The aim of this study was to acquire an understanding of the current surgical practice of general practitioners in rural areas and identify the essential surgical skills needed for rural South Africa. The purpose of the study was to determine the contents of a Short Learning Programme in Essential Surgical Skills in Rural South Africa. The research consisted of a relevant literature search and document analysis to ascertain the current national and international scope of rural surgery, available programmes and the essential contents and outcomes thereof. Attention was also given to curriculum design, HPCSA guidelines for CPD points, learning tools and situations to acquire surgical skills and the development of short learning programmes. The current GP surgical practice for practitioners in rural areas was evaluated through the use of a Likert-type questionnaire, this was also employed to determine the essential content and outcomes for a short learning programme. The results of the research was applied to design a Short Learning Programme for Essential Surgical Skills in Rural South Africa. It is my recommendation that this programme is rolled out in the second part of 2017 at the University of the Free State. I trust it will contribute to surgical care not only in South Africa, but internationally as well.Item Open Access A model for the academic development and implementation of a postgraduate diploma in Transfusion Medicine in the Shool of Medicine at the University of the Free State(University of the Free State, 2010-11) Louw, Vernon Johan; Nel, M. M.; Hay, J. F.English: In this research, an in-depth study was done to construct a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine in the School of Medicine at the University of the Free State. Transfusion medicine as a discipline has experienced major advances over the past few decades with an emphasis on increased blood safety and the improvement of systems, technology and administrative processes. Unfortunately, attention has largely been focused on laboratory aspects and clinical transfusion medicine has lagged behind. This has resulted in the present situation where clinical transfusion medicine has become totally underrepresented in medical curricula, despite the fact that many doctors are involved in administering blood and blood products. This has led to a number of studies and publications on the increasing rate of preventable transfusionassociated deaths resulting from errors on the part of medical personnel. Many researchers have made the link between these errors and the inadequate education and training received by doctors in respect of transfusion medicine. This begs the question as to how this gap in the knowledge market can adequately be bridged and further what a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine should look like. Against this background, the problem that was addressed in this study was the absence of such a model. As far as the researcher could ascertain, no such model existed prior to his embarking upon this research. The goal of the research was thus to develop a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine – specific to the South African context – with a view to contributing to safer and more cost-effective transfusion practice by clinicians. A further aim of the study was to develop this model specifically in the School of Medicine at the University of the Free State. Both qualitative and semi-quantitative research methods were employed and used in a complementary fashion. The methods used included a study of the literature, semi-structured questionnaires and a Delphi survey. The literature review provided insights into the current status of education in transfusion medicine with special reference to the changing arena of transfusion practice. Also, a perspective was provided on some of the key issues that should be taken into account during the development and implementation of a model for a Postgraduate Diploma in Transfusion Medicine. Semi-structured interviews were conducted with experts in transfusion medicine from all over the world. Open-ended questions were asked, which allowed for an interactive discussion between the researcher and the interviewees. Prior to the interviews, a letter of request and explanation was provided to the participants and formal, informed consent obtained. The purpose was to collect information on a number of issues related to clinical transfusion medicine practice. As well as wanting to determine the nature of the challenges with which clinicians are faced, the researcher set out to delineate their scope of practice. Questions dealt with the roles, tasks, functions, skills, deficiencies, areas of clinical knowledge and competences practised by doctors involved in transfusion medicine. An attempt was furthermore made to determine not only the relevant outcomes of a Postgraduate Diploma in Transfusion Medicine but also the relevant academic, educational and sustainability factors. The results of the semi-structured interviews were analysed and collated in tables. These, combined with the findings from the literature review, formed the basis of the statements used in compiling the Delphi survey. The Delphi survey was used to test the criteria derived from both the literature review and the semi-structured interviews qualitatively and semiquantitatively. The Delphi questionnaire was provided to South African doctors with appropriate experience in transfusion medicine and medical education subsequent to their receiving an information letter and giving informed consent. The Delphi questionnaire was divided into sections corresponding to the main themes in the semi-structured interviews. After analysis by the researcher, the findings of the Delphi survey were presented in the form of a description of the findings, a discussion and recommendations. Aspects discussed in the model comprised the premises for the development of the model, the points of departure, the key internal and external role players who could potentially influence the model and the different elements that should be included and/or addressed in the model. Perspectives were provided on the model and its implementation, including some thoughts on procedural, policy and management issues. The researcher proposed that, before anything else, a situational analysis had to be done to identify the needs, deficiencies and challenges related to transfusion medicine practice and education. This needed to be done in consultation with all the relevant role players. Subsequently, the educational, academic and sustainability factors relevant to the programme had to be identified. Careful planning was required within the context of a qualified and motivated team. Once the structure, programme content, timeframe, target audience and funding streams had been identified, and the appropriate approvals for the programme obtained, the programme would have to be marketed. Cooperation and networking with all role players through continuous dialogue would allow for the linkage of resources and lay the foundation for long-term collaborative relationships. Finally, continuous feedback from role players, including students would be required to determine whether goals had been achieved and if not, to use this as the basis for continuous improvement. In that the stated problem was addressed and the goal and objectives of the research were met, this study makes a unique contribution to transfusionmedicine education by providing a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine. Final conclusions were drawn and the limitations and recommendations of the study were highlighted. It is hoped that this study will make a contribution to the better education of clinicians in the clinical aspects of transfusion medicine and that this will, in turn, translate into patients’ receiving better and safer transfusions.Item 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.Item 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. ___________________________________________________________________Item Open Access A stratified competency based learning programme for practitioners of medical aesthetics in South Africa(University of the Free State, 2016) Khumalo, Ntombi Valencia; Bezuidenhout, J.; Vincent-Lambert, C.; Sinclair, W.𝑬𝒏𝒈𝒍𝒊𝒔𝒉 In this study, a comprehensive study was carried out by the researcher with the intention of developing a stratified, competency-based learning programme for practitioners of medical aesthetics (MA) in South Africa (SA). MA in the current South African context is characterised by a shortage of literature and a lack of evidence-based guidelines for the knowledge, skills and competencies required by the persons practicing MA in SA. This is in contrast to countries such as Brazil and the United States of America, where MA is far more advanced and where guidelines for the regulation of the MA industry are in place. To the contrary, in SA there is a lack of practice guidelines and regulations applicable to the wide variety of professions involved in the practice of MA. Furthermore, there is an absence of a stratified, competency learning programme for the various professions involved in the practice of MA in SA. Therefore, this research study was carried out in order to develop a stratified, competency-based learning programme for practitioners of MA in SA. In addressing the above challenges, the central research question was: What would a stratified, competency-based learning programme consist of in order to provide learners with the required knowledge, skills and competencies to function as professional medical aestheticians in the South African healthcare environment? For this study, an exploratory mixed-method design that was sequential in nature was followed. This design consisted of a two-phased approach, whereby the qualitative phase (desktop study) was followed by a quantitative phase (questionnaire). A desktop study was first applied as a method for collecting qualitative data to highlight the knowledge, skills and competencies involved in the practice of MA in SA. This assisted in providing the relevant literature and components of programme for MA practitioners. The desktop study also assisted to place MA in context and understand its complexities in a South African context. The desktop study was then followed by the questionnaire (quantitative) which was used as another method of gathering data relating to the building of theory on stratified knowledge, skills and competencies of MA practitioners in SA. The questionnaires were distributed to stakeholders involved within the MA fraternity, in order to gain a clear view of the topic under study. The study resulted in a stratified, competency-based learning programme for medical aesthetics in South Africa. It became clear that to facilitate MA a short-learning programme would be suitable. The study meets the need for educational competence and regulation regarding the practice and implementation of MA in SA. The researcher believes the learning programme that was developed could serve as a source of inspiration to the education system as far as MA is concerned in the South African context; by doing so, the study may serve to provide encouragement for the regulation and professionalisation of MA in SA. This can be achieved through the expansion of education and training for MA, which has the potential to translate into an improvement of the quality of services rendered to patients. The results of this study indicate that there are very few mechanisms for regulating the practice of MA in SA, which cements the need for and importance of SA having both a stratified, competency-based learning programme for MA, and more robust regulatory mechanisms. Having completed the study, the researcher made a number of recommendations, the major one being that a pre-test/pilot of the proposed stratified competency-based learning programme be done, as it may identify issues related to the implementation process – this was not the main focus of this study. ___________________________________________________________________Item Open Access Pelvic floor rehabilitation in women undergoing pelvic floor reconstructive surgery(University of the Free State, 2016-07) Brandt, Corlia; Cronjé, H. S.; Janse van Vuuren, E. C.INTRODUCTION: Pelvic organ prolapse (POP) has a mean prevalence of 455 to 681 per 1000 women (aged 50 to 60 years). Approximately 11% may need surgery, of which 30% may need follow-up surgery. The effect that comprehensive muscle training can have on prevention and treatment of POP in conjunction with surgery, is still under-investigated and controversial. AIMS: To describe the symptoms, signs, quality of life (QOL) and muscle function in women scheduled for pelvic floor reconstructive surgery; and to determine/compare the outcomes of a pelvic floor muscle training (PFMT) programme, and a core training programme in this population. METHODOLOGY: Eighty one women scheduled for PF reconstructive surgery were randomly assigned to three groups in this randomised, controlled, double blind trial. Group 1 received a PFMT programme, group 2 a core stability programme, while group 3 was the control group. Participants received intervention for six months from pre- to post-operative. The P-QOL, SF-36, two-dimensional ultrasound, POP-Q staging, the PERFECT scale, EMG, Sahrmann scale and PBU was used to measure QOL, POP, PFM and abdominal muscle function respectively. Additional outcome measures included exercise compliance and the Visual Faces Scale for pain assessment. Descriptive statistics and 95% CI`s were used to determine statistical significance. Spearman, Pearson CC`s, and effect sizes were used to correlate muscle variables at baseline. RESULTS: Women (mean age 59 years) with predominantly stage III POP (n=100) showed affected prolapse impact (66.7%), social (median 33.3%), emotional (median 44.4%0) and severity measures (median 25%) according to the P-QOL at baseline. Women were physically inactive (80-85%) and showed a tendency towards hypertension (47%), depression (12%), and hypothyroidism (18%). Only 15% had previously been introduced to PFM exercises, and 7% to core training. All outcomes for the PFM and abdominal muscle function were not within normal reported ranges pre-operatively. Statistical significant correlations were found between different components of PFM function, and between PFM and abdominal muscle function (p<0.05) at baseline. PFMT yielded the most significant changes regarding PFM function during the first three months (endurance, thickness of perineal body, length of levator hiatus), while only group 2 showed significant changes in abdominal muscle function (Sahrmann and PBU levels, 95% CIs [1;3] and [1;9]) in addition to the latter up to six months. Both intervention groups had some statistically significant muscle changes when compared to the control group. Only group 2 yielded a statistical significant improvement in the total P-QOL score (95% CI [1.5;28.4]). DISCUSSION/CONCLUSION: It seems that both PFMT and core muscle training are important to address different, but specific biomechanics and muscle function for the prevention and treatment of POP. Co-morbidities, symptoms and signs, and the effect they may have on motor control and QOL, motivates for a comprehensive, lifestyle orientated, and biopsychosocial rehabilitation model for patients scheduled for pelvic floor reconstructive surgery.