Abstract
BackgroundMany European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.AimTo determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).SettingRural district hospitals in South Africa.MethodsNine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.ResultsSurveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.ConclusionThis study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.
Highlights
The rural district hospital ‘plays a pivotal role in supporting primary health care and ... provides level 1 services to inpatients and outpatients.’[1]
Several studies have demonstrated the breadth of procedural competencies required by family medicine doctors and medical officers working in district hospitals.[3,4,5,6]
All European-trained doctors (ETDs) who had been recruited through Africa Health Placements (AHP) and were working or had recently worked as medical officers and all hospital clinical managers were invited to participate in the survey
Summary
The rural district hospital ‘plays a pivotal role in supporting primary health care and ... provides level 1 (generalist) services to inpatients and outpatients.’[1]. Competency goes beyond technical skills and requires the use of knowledge, clinical reasoning, values, emotions and reflection.[2] Rural medicine demands a wide range of competencies because of the distinctive quadruple burden of disease in South Africa. This refers to high levels of HIV and TB, maternal and child mortality, injuries, and a rising burden of noncommunicable disease. Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work
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