Abstract
BackgroundCompetency-based education and the validity and reliability of workplace-based assessment of postgraduate trainees have received increasing attention worldwide. Family medicine was recognised as a speciality in South Africa six years ago and a satisfactory portfolio of learning is a prerequisite to sit the national exit exam. A massive scaling up of the number of family physicians is needed in order to meet the health needs of the country.AimThe aim of this study was to develop a reliable, robust and feasible portfolio assessment tool (PAT) for South Africa.MethodsSix raters each rated nine portfolios from the Stellenbosch University programme, using the PAT, to test for inter-rater reliability. This rating was repeated three months later to determine test–retest reliability. Following initial analysis and feedback the PAT was modified and the inter-rater reliability again assessed on nine new portfolios. An acceptable intra-class correlation was considered to be > 0.80.ResultsThe total score was found to be reliable, with a coefficient of 0.92. For test–retest reliability, the difference in mean total score was 1.7%, which was not statistically significant. Amongst the subsections, only assessment of the educational meetings and the logbook showed reliability coefficients > 0.80.ConclusionThis was the first attempt to develop a reliable, robust and feasible national portfolio assessment tool to assess postgraduate family medicine training in the South African context. The tool was reliable for the total score, but the low reliability of several sections in the PAT helped us to develop 12 recommendations regarding the use of the portfolio, the design of the PAT and the training of raters.
Highlights
IntroductionIn 2009 the World Health Assembly resolved that it is necessary to train and retain adequate numbers of health workers with an appropriate skill mix, including family physicians (FPs), in order to respond effectively to people’s health needs at the primary care level.[1]
In 2009 the World Health Assembly resolved that it is necessary to train and retain adequate numbers of health workers with an appropriate skill mix, including family physicians (FPs), in order to respond effectively to people’s health needs at the primary care level.[1]. This resolution was endorsed at the Primafamed conference in 2012 where family physicians and educators from 20 countries agreed that the family physician in Africa needs to be trained within an inter-professional primary healthcare (PHC) team and at the district hospital.[2]
There is a growing realisation that in order to make a difference FPs must be active in PHC teams and support the development of community-orientated primary care.[5]
Summary
In 2009 the World Health Assembly resolved that it is necessary to train and retain adequate numbers of health workers with an appropriate skill mix, including family physicians (FPs), in order to respond effectively to people’s health needs at the primary care level.[1]. In order to address the burden of disease in South Africa, a huge scaling up of family medicine training is being envisaged, which has relevance for appropriate postgraduate assessment.[6]. Medicine was recognised as a speciality in South Africa six years ago and a satisfactory portfolio of learning is a prerequisite to sit the national exit exam. A massive scaling up of the number of family physicians is needed in order to meet the health needs of the country
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