Surgical Education in South Africa

Abstract

Medical training has been well established in South Africa since the 1920s. This was initially undergraduate only, and specialist training required study overseas until the early 1960s. The first formal specialist training circuits were developed in conjunction with the formation of the Colleges of Medicine of South Africa (CMSA) in 1955, which was established largely as an examination body to oversee standards of training. Since then the member colleges of the CMSA regulate the standards of training and examinations of General Surgery, Orthopaedics, Urology, Cardiothoracic Surgery, Neurosurgery, Plastic and Reconstructive Surgery, Ear, Nose and Throat Surgery, Ophthalmology, and Obstetrics and Gynaecology, as well as the nonsurgical disciplines. A variety of bodies are responsible for the different stages of training. The universities train undergraduates and award the first degree (e.g., MB, BCh). This is followed by a two-year internship in all the major disciplines in a hospital accredited by the Health Professions Council of South Africa (HPCSA), and one year of community service (usually in relatively unsupervised rural hospitals), overseen by the state’s Department of Health. On completing these three years, the doctor is fully registered with the HPCSA as a medical practitioner. The Colleges are primarily a professional examining body and oversee subsequent postgraduate training which must be accredited by the HPCSA. Training in general surgery is delegated by the College to the academic surgical departments of the eight medical schools of South Africa [Witwatersrand, Cape Town, Stellenbosch, Nelson Mandela (Durban), Medunsa/Limpopo (Garankua), Walter Sisulu (Mthatha), Pretoria and Bloemfontein], where it occurs in the teaching hospitals of each university. There are differences in the training depending on the school, but each candidate must be a registrar (resident) for not less than four years (most require six years), must pass the College examinations [the Fellowship of the College of Surgeons of South Africa, or FCS(SA)], or, alternatively, an internal, university-specific MMed examination [similar to the FCS(SA)], and demonstrate (through a logbook and a report from their department head) sufficient practical experience to be registered as a specialist surgeon by the HPCSA. The examination for the Fellowship in General Surgery comprises three parts: Primary, Intermediate, and Final.