Abstract
BackgroundSpecialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa. The strong emphasis on workplace-based learning for speciality training makes it vital to gain in-depth insights into registrar supervision. Previous studies have explored aspects of supervision at decentralised sites in high-income countries, however, little is known about the benefits and constraints of decentralised postgraduate supervision in low- to middle-income countries, especially in Africa.AimThis study aimed to explore family physicians’ and registrars’ perceptions of the strengths and challenges of clinical and educational supervision across decentralised training sites.SettingThe study was conducted across two provinces at five decentralised training sites affiliated with the University of the Witwatersrand, Johannesburg.MethodsThis qualitative study involved semi-structured interviews with a purposive sample of 11 FPs and 11 registrars. The data were thematically analysed.ResultsTwo of the four themes identified, ‘supervision is context-specific and supervisor-dependent’, and ‘the nature of engagement matters’, involved strengths and challenges. The other two, ‘supervision is not ideal’ and ‘the training environment is challenging’, focussed on challenges.ConclusionSupervisors and registrars described the postgraduate FM supervision as context-specific and supervisor-dependent. Supervisors displayed good clinical-teacher characteristics and supervisory relationships. However, several challenges, including registrars’ workload, resource shortages and a lack of standardisation across training sites, need to be addressed. Regular faculty development is essential for supervisors to be aware of relevant aspects of, and current trends in, postgraduate training.
Highlights
Specialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa
While Decentralised clinical training (DCT) is well established in high-income countries (HIC), such as Australia, the United Kingdom and Canada,[4] it is a relatively new concept in low- and middle-income countries (LMIC), such as South Africa (SA) and other sub-Saharan nations.[3,4,5,6]
DCT is affected by factors more likely to prevail in LMIC, including a lack of resources and comprehensive support
Summary
Specialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa. Previous studies have explored aspects of supervision at decentralised sites in high-income countries, little is known about the benefits and constraints of decentralised postgraduate supervision in low- to middle-income countries, especially in Africa. While DCT is well established in high-income countries (HIC), such as Australia, the United Kingdom and Canada,[4] it is a relatively new concept in low- and middle-income countries (LMIC), such as South Africa (SA) and other sub-Saharan nations.[3,4,5,6]. Decentralised clinical training offers trainees more handson experience of clinical and procedural skills during longer longitudinal rotations. It provides flexible curricula typical of postgraduate medical training.[3,7]. Training at DCT sites has been shown to improve healthcare provision across communities; DCT needs to be optimised in order to ensure that the priority health concerns of LMIC are met.[3,4,8,9]
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