Abstract
Background: One of the reasons to develop training courses for medical mid-level workers in South Africa is a shortage of doctors. The introduction of this new profession has led to task sharing and redefining of professional boundaries. The primary aim of this study is to evaluate the introduction of new healthcare professionals in a rural hospital district.
 
 Methods: This multi-method qualitative research study used a semi-structured questionnaire to assess the effectiveness of Clinical Associates. A review of documents from 2012 to 2015 was done including a longitudinal study of the development of the Bachelor in Clinical Medical Practice (BCMP) programme at Shongwe hospital.
 
 Results: Three Clinical Associates in 2011 and six Clinical Associates in 2014 completed questionnaires. Student satisfaction increased as measured with the Med IQ tool. At the end of 2013 Shongwe Clinical Learning Centre (CLC) had improved from last position out of 17 CLCs in 2011 to position number eight in 2014. Casualty was run by Clinical Associates and during observations it became clear that Clinical Associates were able to take responsibility for outpatient departments (OPDs), the emergency unit and some wards with supervision by a doctor. 
 
 Conclusion: The introduction of the BCMP programme and the establishment of a Clinical Learning Centre in Shongwe hospital have led to improved patient care and a more conducive environment for teaching and learning. With the availability of more Clinical Associates vacant medical officer posts can be converted to employ Clinical Associates to serve patients without an increase in the cost of total human resources.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1248144
Highlights
South Africa is trying to deal with a huge shortage of doctors[1] as well as nurses and other health workers in the public sector.[2]In 2008 there were 250 000 healthcare professionals employed in the country, with a total population of 48.7 million
In 2014 it was reported that the appreciation for Clinical Associates and Bachelor in Clinical Medical Practice (BCMP) students had much improved and the number of students was increased to six final- year students
This case study of the introduction of the BCMP programme in Shongwe hospital illustrates the challenges when a new programme is started as well as the obstacles such as resistance by healthcare workers, overworked doctors, ignorance concerning the role of Clinical Associates and the lack of an approved scope of practice
Summary
South Africa is trying to deal with a huge shortage of doctors[1] as well as nurses and other health workers in the public sector.[2]In 2008 there were 250 000 healthcare professionals employed in the country, with a total population of 48.7 million. In the public sector the shortage of healthcare professionals was 80 000 and in some of the provinces the vacancy rates for doctors was 50%.3 This has been one of the reasons to develop training courses for medical mid-level workers in South Africa. Since the number steadily increased to 400 Clinical Associates in 2014.6 Clinical Associates are mid-level medical workers who are trained to assist doctors with routine tasks, with a focus on rural district hospitals.[7]. One of the reasons to develop training courses for medical mid-level workers in South Africa is a shortage of doctors. The introduction of this new profession has led to task sharing and redefining of professional boundaries. With the availability of more Clinical Associates vacant medical officer posts can be converted to employ Clinical Associates to serve patients without an increase in the cost of total human resources
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