Abstract
BackgroundThe training of family physicians is a relatively new phenomenon in the district health services of South Africa. There are concerns about the quality of clinical training and the low pass rate in the national examination.AimTo assess the effect of a five-day course to train clinical trainers in family medicine on the participants’ subsequent capability in the workplace.SettingFamily physician clinical trainers from training programmes mainly in South Africa, but also from Ghana, Uganda, Kenya, Malawi and Botswana.MethodsA before-and-after study using self-reported change at 6 weeks (N = 18) and a 360-degree evaluation of clinical trainers by trainees after 3 months (N = 33). Quantitative data were analysed using the Statistical Package for Social Sciences, and qualitative data were analysed thematically.ResultsSignificant change (p < 0.05) was found at 6 weeks in terms of ensuring safe and effective patient care through training, establishing and maintaining an environment for learning, teaching and facilitating learning, enhancing learning through assessment, and supporting and monitoring educational progress. Family physicians reported that they were better at giving feedback, more aware of different learning styles, more facilitative and less authoritarian in their educational approach, more reflective and critical of their educational capabilities and more aware of principles in assessment. Despite this, the trainees did not report any noticeable change in the trainers’ capability after 3 months.ConclusionThe results support a short-term improvement in the capability of clinical trainers following the course. This change needs to be supported by ongoing formative assessment and supportive visits, which are reported on elsewhere.
Highlights
South Africa is on a journey towards improving universal health coverage through national health insurance, which requires the revitalisation of primary health care (PHC) in the country.[1]
Six roles for the family physician (FP) have been identified:[2] a competent clinician who can offer patient-centred holistic care in PHC and the district hospital, a consultant to the health care team who sees more complicated or difficult patients, a capacity builder who improves the competence of the health care team, a clinical trainer for students in formal education, a leader of clinical governance who improves the quality of services and a champion of community-orientated primary care who supports the development of communitybased services
The majority of participants were FPs from South African training programmes where registrars were working within training complexes that consisted of communitybased services, primary care facilities, district hospitals as well as regional or tertiary hospitals
Summary
South Africa is on a journey towards improving universal health coverage through national health insurance, which requires the revitalisation of primary health care (PHC) in the country.[1] A number of initiatives have been implemented to try and improve the quality of PHC. One of these is strengthening PHC through the introduction of family physicians.[2] Currently, there is no requirement for doctors working in PHC to have additional postgraduate training to equip them for work in this setting. There are concerns about the quality of clinical training and the low pass rate in the national examination
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