Health Professions Council Of South Africa Research Articles

Temporal Trends in the South African Diagnostic Radiology Workforce (2002-2019).

BackgroundTo facilitate imaging resource planning and address key health targets of the United Nations (UN) 2030 Sustainable Development Goals, accurate data are required on imaging personnel at the country level. Such data are currently limited.ObjectivesThis study aims to analyze trends in the number, geographical distribution, and demographics of South African (SA) diagnostic imaging personnel between 2002 and 2019.MethodA retrospective analysis of the Health Professions Council of South Africa (HPCSA) database of imaging personnel from 2002 to 2019 was done. The total number of personnel and personnel per million people were calculated for the country and for each professional group (radiologist, diagnostic radiographer, and sonographer) by calendar year, province, and demographic profile. Population data were provided by Statistics SA.ResultsThe total imaging personnel, number per million people, and national population increased by 283% (3,095 versus 8,753), 119% (68 versus 149/106), and 29% (45.45 versus 58.77/106), respectively.Diagnostic radiographers constituted more than 80% of the workforce throughout the review period, increasing by 185% (2,540 versus 7,242). Sonographers, the smallest cohort, recorded the highest (49 versus 503; 906%) and radiologists (506 versus 1,007; 99%) the lowest proportional growth.Although radiologists showed persistent male predominance, the male proportion decreased from 82% to 69%, while that of females increased from 18% to 31%. The average annual percentage increase in female radiologists (14%) was more than three times that of males (4%).Diagnostic radiographers showed female predominance, but the proportion decreased from 90% to 83%, while that of males increased from 10% to 17%. Sonographers showed overwhelming female predominance (94% versus 92%). The average annual percentage increase in male diagnostic radiographers (21%) was more than double that of females (9%).In 2002, 48% (n = 1,475) of imaging personnel identified as White, and 15% (n = 467) identified as Black African. By 2019, those identifying as White and Black African were 36% (n = 3,122) and 35% (n = 3,045), respectively.The Western Cape Province (WCP) maintained the highest overall number of imaging personnel per million people (165 versus 233/106) and Limpopo the lowest (12 versus 54/106). However, Limpopo recorded the highest proportional growth in imaging personnel/106 people (368%) and the WCP the lowest (41%). The differential between the best- and least-resourced provinces thus decreased from 14:1 in 2002 to 4:1 in 2019.ConclusionIn the review period, the SA imaging workforce has shown substantial expansion and transformation and has assumed a more equitable distribution.

Safe caesarean sections in South Africa: Is internship training sufficient?

Background. In Africa, the maternal mortality rate after caesarean section (CS) is 50 times higher than that in high-income countries. In South Africa (SA), women who undergo CS have a three times higher mortality rate than those who deliver vaginally. Anaesthetic complications and obstetric haemorrhage are major drivers of poor outcomes, and the case fatality rate for CS at district hospitals is particularly high. Objectives. To assess the adequacy of anaesthetic and obstetric internship training in preparing interns to perform CS independently and safely. Methods. This was an observational cross-sectional survey of all community service officers (CSOs) in KwaZulu-Natal (KZN), SA, in 2020. Data were collected via an electronic survey that comprised 68 questions in 4 domains, covering personal information, obstetric surgical training, obstetric anaesthetic training and support received as a CSO. Results. Surveys were sent to 228 CSOs in KZN, with 160 responses received (70% response rate). Respondents included participants from 8 medical schools and 33 internship facilities across the country. One in 8 interns (n=21/160) did not perform the required 10 CSs. Supervision in theatre was provided by an obstetric specialist for at least 1 CS in n=57/160 (35.62%; 95% confidence interval (CI) 28.54 - 43.39) participants, and n=45/160 (28.13%; 95% CI 21.66 - 35.64) interns never performed an emergency CS. Interns had limited opportunity to be the primary surgeon for complicated cases. Only 1/5 interns performed >5 obstetric general anaesthetics. Conclusions. This survey showed that there are deficiencies in the current CS-related training of interns in SA. A lack of exposure to adequate obstetric surgical training and obstetric general anaesthesia is likely to impact on the performance of CSOs and on the safety of the CS service provided at district hospitals. The content and quality of the CS-related intern training programme needs to be enhanced to improve the competence of CSOs. The Health Professions Council of South Africa (HPCSA)’s stipulations for internship training must be adhered to and should look to include simulation training, basic surgical skills courses and prioritisation of exposure to complicated surgical scenarios

Telehealth in South Africa: A guide for healthcare practitioners in primary care.

The use of telehealth is becoming a prevalent feature in clinical practice worldwide, partly because of advances in medical and telecommunications technology. The coronavirus disease 2019 (COVID-19) pandemic has been a key driver in justifying the accelerated use of telehealth, leading to healthcare practitioners (HCPs) utilising virtual consultations more avidly. Although challenges remain, recent data have shown that remote consultations are feasible, safe and effective in South Africa (SA) and that HCPs should become proficient in conducting telehealth, virtual or remote consultations. These guidelines are based on the revised Health Professions Council of South Africa (HPCSA) General Ethical Guidelines for Good Practice in Telehealth (Booklet 10) and guidelines on remote or video consultations from the University of Oxford, the Royal Australian College of General Practitioners and the Royal College of Psychiatrists. These guidelines aim to equip HCPs with the basic knowledge and skills pertaining to medicolegal, communication and practical aspects of telehealth and how to practise telehealth safely and effectively in primary care settings in SA during the COVID-19 pandemic and beyond.

Special-IST versus Special inter-IST

Dentists who wish to specialize in a specific discipline have to undergo and complete a rigorous, structured and extensive postgraduate academic and practical training programme, and pass all the requisite exams. Only then can they be registered with a regulating professional body and be recognized as such in that field. Thereafter their scope of practice becomes limited to that specialty alone. This differs from general dentists, who are not restricted in their scope of practice, but may have limitations to the extent of their capabilities. They may choose to upskill themselves through attendance at short courses, hands-on training workshops, informal study groups, dental company workshops or even YouTube videos. Unlike the trainee in a formal institution, this is unstructured and outcomes are unspecified, yet some of these practitioners then market themselves as specialists in these fields. While the Health Professions Council of South Africa (HPCSA) has set out a list of core ethical values and standards for good practice, there are no regulations enforcing the need for these practitioners to undergo and pass HPCSA recognized examinations to assess their capabilities, knowledge and skill in these modalities. This opens the profession up to risks of practitioners contravening a number of core values and standards expected of trusted professionals and can mislead and put the general public at risk. This paper aims to explore if regulation of this type of practice is required, who should be allowed to offer additional training to dentists, and who should be regulating the trainers.

Emergency care practitioners’ views on the use of ultrasound in pre-hospital acute care settings

Background: Ultrasound may assist in the detection of life-threatening conditions and evolving pathologies. South African emergency care practitioners (ECPs) working in pre-hospital contexts have historically not used ultrasound to diagnose and treat patients. However, recently published clinical practice guidelines from the Health Professions Council of South Africa (HPCSA) suggest that ultrasound be considered as an adjunct in the provision of pre-hospital emergency care. Our study investigated ECPs’ views and perceptions of introducing ultrasound to their scope of practice.

Estimating the emergency care workforce in South Africa

BackgroundEmergency care is viewed as a fundamental human right in South Africa’s constitution. In the public sector, all emergency medical services (EMS) come under the Directorate: Emergency Medical Services and Disaster Medicine at the National Department of Health (NDoH), which provides regulation, policy and oversight guidance to provincial structures.AimThe aim of the study is to understand the supply and status of human resources for EMS in South Africa.SettingThis research was undertaken for South Africa using the Health Professions Council of South Africa (HPCSA) database from 2002 to 2019.MethodsA retrospective record-based review of the HPCSA database was undertaken to estimate the current registered and future need for emergency care personnel forecasted up to 2030.ResultsThere are 76% Basic Ambulance Assistants registered with HPCSA. An additional 96 000 personnel will be required in 2030 to maintain the current ratio of 95.9 registered emergency care personnel per 100 000 population. The profile of an emergency care personnel employed in South Africa is likely to be a black male in the age group of 30–39-years, residing in one of the economically better-resourced provinces.ConclusionIt is time that the current educational framework is revised. Policy interventions must be undertaken to avoid future shortages of the trained emergency care personnel within South Africa.

Carbohydrate counting in type 1 diabetes mellitus: dietitians’ perceptions, training and barriers to use

Objectives A study was undertaken to determine the perceptions, training and barriers regarding the use of carbohydrate counting in the dietary management of type 1 diabetes mellitus (T1DM) among dietitians in KwaZulu-Natal (KZN). Design A cross-sectional, descriptive study was conducted. Setting Dietitians who were registered with the Health Professions Council of South Africa (HPCSA), and working in the province of KZN at the time of the study, were invited to participate. Methods Data were collected using a self-administered electronic questionnaire distributed through SurveyMonkey, an Internet-based survey programme. Results Dietitians agreed that carbohydrate counting was a useful dietary management approach for diabetes (p < 0.05) and that it was essential to manage T1DM (p < 0.05). However, they felt it was a difficult concept for patients with T1DM to understand (p = 0.001) and teaching it to patients was time consuming (p < 0.05). Although dietitians believed that there was a strong evidence base for teaching carbohydrate counting to patients with T1DM (p < 0.05), they indicated a need for further training or education in it (p < 0.05). Barriers to using carbohydrate counting included a lack of training, confidence and experience, financial resources, time, blood glucose records and poor patient motivation and patient illiteracy (p < 0.05). Conclusions Overall, dietitians who participated in the study had a positive perception towards the use of carbohydrate counting in the management of T1DM. However, further training needs to be addressed for carbohydrate counting to be used with confidence by dietitians in KZN to optimize their management of T1DM.

Doctor-perceived-barriers to telephone clinics at KwaZulu-Natal hospitals during the COVID-19 pandemic.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented international emergency, resulting in a need to adapt the existing healthcare systems, in order to enable ongoing patient care despite the current disruptions. Telemedicine may be a viable option to continue hospital workflow, however there are barriers to its implementation. We set out to establish what barriers might exist and to assess the viability of teleclinics within the province KwaZulu-Natal (KZN), as perceived by doctors.MethodsThis was a quantitative, observational, survey-based study targeted at medical doctors working in both the public as well as the private healthcare sector in University of KwaZulu-Natal (UKZN).ResultsOne hundred and forty-seven (147) responses were included. The majority (86%) of respondents felt that telemedicine could provide a useful means to continuing hospital workflow, however, only 47% believed that it was a viable option for their unit. The major barrier identified was a feeling that doctors would-be at-increased medico-legal risk. Only 38.4% of doctors were familiar with the Health Professions Council of South Africa (HPCSA) guidelines on telemedicine usage. Other major barriers included: doctors feeling uncomfortable with not seeing a patient in person or not being able to perform a thorough physical examination. Other reasons identified as potential barriers were doctors foreseeing difficulty in accessing patient medical records and the absence of available systems to order investigations without the patient being physically present.ConclusionTelemedicine is currently not widely utilised in KZN; although most doctors were of the opinion that it could be a useful tool in order to continue the workflow during the pandemic. The major barrier identified were issues surrounding medico-legal coverage.

The growth patterns of the medical technology profession in South Africa.

BackgroundConstant appraisal of healthcare workforce trends is vital; this measure determines the adequacy of the workforce in meeting its society’s healthcare demands. This includes determining the number of the incoming workforce (students, interns) and the active or practising workforce relevant registries.ObjectiveThis study aimed to examine patterns of workforce growth in the medical technology profession (students, interns and practitioners) from 2008 to 2018 in South Africa.MethodsStudent, intern and practitioner medical technology registries, from the 2012/2013, 2016/2017 and 2017/2018 Health Professions Council of South Africa (HPCSA) annual reports, were analysed. The number of National Health Laboratory Service and private laboratory posts were secured from the National Health Laboratory Service plan performance report. A comparison between the total number of South African medical technology (private and public) posts occupied versus the HPCSA practitioner 2016 register was completed, to determine the saturation status.ResultsAnnual student, intern, and practitioner registries indicated a mean growth of 6.8%, 28.9%, and 0.7% from 2008 to 2018. The transition of interns to practitioners is progressively dwindling (2015–2018). The practitioner register showed a 1.2% decline in registration from 2013 until 2018. In 2016, only 55.9% of the HPCSA registered medical technologists were employed (p < 0.001).ConclusionThere are more medical technologists than available public and private sector posts. The progressively growing student register compared to the dwindling practitioner register indicates attrition in the profession. An investigation identifying the reasons why graduates neglect to register as practising medical technologists should be undertaken.

Outcomes of newborn hearing screening at an academic secondary level hospital in Johannesburg, South Africa.

BackgroundThe Health Professions Council of South Africa (HPCSA) issued early hearing detection and intervention guidelines, which has universal newborn hearing screening (UNHS) as one of the important goals. Despite established evidence of the importance of UNHS globally, there has been no mandated formalised and standardised implementation as yet in South Africa.ObjectivesThe aim of this study was to describe the outcomes of newborn hearing screening (NHS) in an academic secondary level hospital in Johannesburg, South Africa.MethodsThis was a prospective non-experimental feasibility study over a 3-month period, involving conducting hearing screening of 121 neonates. Audiologists conducted a risk factor assessment, otoscopic examinations and distortion product otoacoustic emissions (DPOAEs) screening on each neonate, with follow-up appointments for re-screening and diagnostic audiological assessments for all neonates with refer findings. Data were analysed using STATA intercooled version 11©, through both descriptive and inferential statistics (Fisher’s exact test), with significance established where p-values less than 0.05 were considered statistically significant.ResultsOf the 121 neonates screened, the majority (75%) were screened in the first 24 h of life. A high refer rate (47%) of the total sample was found on DPOAE screening. No maternal or neonatal risk factors were found to be significantly associated with refer findings.ConclusionFindings contribute towards the existing evidence base that raises implications for successful implementation of NHS programmes in public healthcare in South Africa. Screening protocols need to consider the timing of screening, the measures and procedures adopted in the screening protocols, as well as the follow-up strategies.

In Pursuit of Preventive Audiology in South Africa: Scoping the Context for Ototoxicity Assessment and Management.

ABSTRACTAim:The study explored the South African healthcare context for ototoxicity assessment and management from the audiologists’ perspectives.Materials and Methods:This was done through a survey research methodology that adopted a cross-sectional research design. South African audiologists were recruited from professional associations databases using specific inclusion criteria; and 31 audiologists from across the country participated. The study used an 18-item web-based survey guided by the Health Professions Council of South Africa (HPCSA) (2018) guidelines. Data were analyzed through both descriptive and inferential statistics.Results:Findings revealed serious contextual challenges influencing the implementation of assessment and management programs within the South African context. Over two-thirds of the participants engage with ototoxicity monitoring and management, but the practices adopted are not aligned to international standards nor the national HPCSA guidelines on assessment and management of patients on ototoxic medications. Findings speak to the frequency of practice; the referral pathways audiologists use; prevention and promotion methods used; availability of resources for the implementation of ototoxicity assessment and management; barriers to ototoxicity assessment and management; the influence of language and culture in ototoxicity assessment and management; as well as information management practices within this context. No relationship could be established between knowledge regarding ototoxicity, communication, caseload, and ototoxicity assessment and management on the chi-square.Conclusion:Implications for strategic planning, budget allocation, collaborative multidisciplinary within the same institution approaches; training; policy formulation; and translation of policies and guidelines into practice are raised by these findings.

Family medicine internship support during the COVID-19 pandemic in Cape Town, South Africa – A narrative report

The health-service redesign that came with the preparation for the surge of COVID-19 had a potential of disrupting the Family Medicine internship programme like it did to many other health and academic programmes. A team of Cape-Town based Community Health Centre (CHC) doctors mitigated this challenge by designing an innovative tool that facilitated ongoing supervision of the interns in order to achieve the outcomes of the Health Professions Council of South Africa (HPCSA).

Demographic transformation of the physiotherapy profession in South Africa: A retrospective analysis of HPCSA registrations from 1938 to 2018

The physiotherapy profession did not escape the effects of racially based segregatory practises. While numerous strategies and initiatives have been employed to redress the inequities of the past, the extent of demographic transformation within the physiotherapy profession in South Africa remains uncertain. Transformation is defined in this article as an intentional change aimed at addressing inequalities and the ultimate goal is for population group and gender profiles of higher education graduates to be representative of the national epidemiological profile. This paper describes the demographic patterns of Health Professions Council of South Africa (HPCSA) registered physiotherapists from 1938 to 2018. A retrospective record review of the HPCSA database from 1938 until 2018 was performed. De-identified data were extracted, coded and analyzed for descriptive purposes. Z-tests were used for analysis of proportion differences, along with P-values and 95% confidence intervals for interpretation. In 2018, 7663 physiotherapists (6350 women and 1313 men) were registered with the HPCSA. Most registered physiotherapists (55.6%) were classified as white, followed by black (17.3%), coloured (10.3%) and Indian (9.8%). A progressive increase was found in the number of new registrations over time (1949-2018) by black (0.00%-24.38% of total new registrations), coloured (0.00%-15.47%) and Indian individuals (0.00%-10.03%), with a statistically significant increase in newly registered black therapists in the decade prior to 2018 (P=.005). Gender transformation appears to be occurring at a slower pace as the profession remains female-dominated (82.9% of registered physiotherapists in 2018). There has been a steady transformation of the South African physiotherapy graduates composition regarding population categories and gender. However, it is clear that much more than selection criteria is needed to transform the profession in a way that is nationally representative, remain actively accountable for transformation and apt for local context.

COVID-19 in dentistry- Ethical considerations

The reach of Coronavirus Disease - 2019 (COVID-19) has even reached the ethical guidelines for good practice from the Health Professions Council of South Africa (HPCSA).The health care worker should carefully consider the guidance outlined in several of the booklets as patient treatment has multiple dimensions where COVID-19 had impacted on clinical practice. Due to the nature of dentistry and aerosol generation, special care must be taken when treating healthy patients and patients that are carriers but do not realise that they are COVID-19 positive.COVID-19 transmission and aerosol dissemination may expose the practice team to hazards of infection. The risk is elevated when implementing aerosol generating procedures without any protective equipment. The oral health care worker (OHCW) and staff thus require the appropriate personal protective equipment (PPE) as suggested by country-specific guidelines, for example, The South African Dental Association (SADA).To this extent, practicing dentistry in the 21st century is complex and amidst the current COVID-19 pandemic the OHCW is presented with more pitfalls. As the pandemic is showing no sign of abating in SA, this has presented the OHCW with a range of additional ethical considerations.These dilemmas may be resolved in a variety of ways following an understanding of the basic knowledge of core ethical values and standards for good practice outlined by the HPCSA guidelines.

Exploring national human resource profile and trends of Prosthetists/Orthotists in South Africa from 2002 to 2018

ABSTRACT Background The World Health Organization (WHO) in 2017 estimated that around 35–40 million people require prosthetic or orthotic services. The Framework and Strategy for Disability and Rehabilitation 2015–2030 for South Africa highlights a shortage of human resources for disability and rehabilitation services to manage the various risks and types of impairments faced by the population. Objective To describe the demographic trends of Prosthetists/Orthotists (P/O) registered with the Health Professions Council of South Africa (HPCSA) from 2002 to 2018. Methods The study was a retrospective record-based review of the Health Professions Council of South Africa (HPCSA) database from 2002 until 2018. The database of registered Prosthetists/Orthotists was obtained from the HPCSA. Results Data were analysed using the Statistical Package for the Social Sciences (SPSS version 22.0). In 2018, there were 544 P/Os registered with the HPCSA with a ratio of 0.09 P/Os per 10,000 population. There has been an average annual increase of 6% from 2002 to 2018. The majority (71.9%) of P/Os are located in the more densely populated and urbanized provinces, namely Gauteng, KwaZulu-Natal and Western Cape. The majority of registered P/Os identified as white (61%) followed by Black (22%), Indian (7%) and Coloured (2%). Most of registered P/Os are under the age of 40 years (54.2%) and males make up 73% of the registered P/Os. Conclusion This study highlights the unequal spatial distribution trends of P/Os which could be accounted for by South Africa’s apartheid history and the subsequent slow pace of transformation. Addressing the existing shortages is necessary to expand access to P/Os services and to ensure the motivation, planning and provision of adequate infrastructure to provide these services. The study presents a compelling case for the prioritization and strengthening of this workforce for the achievement of effective universal health coverage for persons with disabilities.

Sustainable workforce: South African Audiologists and Speech Therapists

BackgroundAudiologists and Speech Therapists play a vital role in addressing sustainable development goals by supporting people who are marginalised due to communication challenges. The global burden of disease and poor social living conditions impact negatively on the development of healthy communication, therefore requiring the services of Audiologist and Speech therapists. Against this background, we examined the demographic profile and the supply, need and shortfall of Audiologists and Speech Therapists in South Africa.MethodsThe data set was drawn from the Health Professions Council of South Africa (HPCSA) registers (for 2002–2017) for the speech, language and hearing professions. This demographic profile of the professions was created based on the category of health personnel; category of practice, geographical location, population group (race) and sex. The annual supply was estimated from the HPCSA database while the service–target approach was used to estimate need. Additional need based on National Health Insurance Bill was also included. Supply–need gaps were forecast according to three scenarios, which varied according to the future intensity of policy intervention to increase occupancy of training places: ‘best guess’ (no intervention), ‘optimistic’ (feasible intervention), and ‘aspirational’ (significant intervention) scenarios up to 2030.ResultsMost (i.e. 1548, 47.4%) of the professionals are registered as Audiologists and Speech Therapists, followed by 33.5% registered as Speech Therapists and 19.1% registered as Audiologists. Around 88.5% professionals registered as Audiologists and Speech Therapists are practising independently, and 42.6% are practising in the Gauteng province. The profession is comprised majorly of women (94.6%), and in terms of the population groups (race), they are mainly classified as white (59.7%). In 2017, in best guess scenario, there is a supply–need gap of around 2800 professionals. In the absence of any intervention to increase supply capacity, this shortfall will remain same by the year 2030. By contrast, in aspirational scenario, i.e. supply is increased by 300%, the forecasted shortfall for 2030 reduces to 2300 from 2800 professionals.ConclusionsIt is clear that without significant interventions, South Africa is likely to have a critical shortfall of Audiologists and Speech Therapists in 2030. Policy-makers will have to carefully examine issues surrounding the current framework regulating training of these and associated professionals, in order to respond adequately to future requirements.

Strategic and focused solutions to challenges faced by medical postgraduate students, in performing research at a South African University

Background and objectives : Poor research output is a major issue at some South African Universities especially among medical postgraduate students. A number of students struggle to complete the research component, which is a requirement for registration with the Health Professions Council of South Africa (HPCSA). Aim: To evaluate and uncover factors hindering research performance at a South African university, with a plan to implementing strategic and focused remedial action. Methods: Post-graduate students in the School of Medicine were enrolled in a cross-sectional descriptive study. Using self-administered questionnaires, students were requested to provide information on barriers hindering research performance. Raw data from questionnaires was captured and analysed using STATA software. Results: A total 125 questionnaires were returned however some participants did not answer all the questions. The major reasons for non-performance were cited as; lack of prior research experience with only 14 per cent having had prior research exposure. Regarding association of research methodology (REME) course attendance with students starting research activities, 90 per cent of those that had attended the REME course, had started research activities at the time of this study. Research supervision was cited as inadequate by 48 per cent of respondents, while 61 per cent cited excessive workload as factor another factor hampering research course attendance and research participation. Most students indicated the need to have research taught and incorporated in the Masters curriculum, with time ring-fenced for research activities. Conclusion: Prior research exposure and attendance of a research course were important factors influencing students’ participation in research and should be encouraged. The institution should strive to improve supervisory and mentoring support as well as provide bio-statistics support. There is a need to ring-fence time specifically for research activities in order to counter the workload issue as a deterrent to research activities.

What Are the Current Audiological Practices for Ototoxicity Assessment and Management in the South African Healthcare Context?

The study was an initial exploration of the current ototoxicity assessment and management practices by audiologists in South Africa. An exploratory survey research methodology through a cross-sectional research design was adopted where audiologists were recruited from professional associations’ databases in South Africa, using specific inclusion criteria. The study made use of an 18-item web-based survey guided by the Health Professions Council of South Africa (HPCSA) (2018) guidelines which were developed from reviewing international guidelines such as the American Speech-Language-Hearing Association (ASHA,1994) and the American Academy of Audiology (AAA, 2009). The study surveyed 31 audiologists from across the country. Data were analyzed through descriptive statistics. Findings implied significant gaps between knowledge and translation of this knowledge into practice. Over two thirds of the participants engage with ototoxicity monitoring and management, but the practices adopted by them do not align with international standards nor with the national HPCSA guidelines on assessment and management of patients on ototoxic medications. Most participants do not conduct baseline assessments, and the frequency of monitoring is irregular and reduced from the recommended; thus influencing ability for early detection and intervention of ototoxicity within this context. Non-standard assessment battery is used for assessment and monitoring, raising questions about the reliability and validity of the data used to make preventive treatment decisions. Lack of collaborative work between audiologists and the rest of the clinical team involved in the treatment of patients on ototoxic medications was found to be an important contributing factor to the less than optimal ototoxicity management practices. Of factors potentially influencing adherence to guidelines, the institution of employment, specifically employment in a tuberculosis hospital, seemed to have a positive influence, possibly due to the focused nature of the audiologists’ scope of practice there as well as availability of resources. The level of education appeared to have no influence. Current findings provide contextually relevant evidence on ototoxicity assessment and management within this context. They raise important implications for guidelines adherence and translating knowledge, policies and guidelines into practice, clinical assessment and management protocols followed, appropriate resource allocation per programme, as well as strategic planning for national ototoxicity assessment and management programmes in context. The findings also raise important implications for low- and middle-income countries, in terms of adopting international guidelines without considering context.

Publication rate of 309 MMed dissertations submitted between 1996 and 2017: Can registrars fulfil HPCSA Form 57 MED amendments?

The recent amendment to the Health Professions Council of South Africa (HPCSA) Form 57 MED allows specialist registration on publication of the compulsory MMed research assignment in an accredited journal. No data exist on the conversion rate of MMed dissertations to publication. To establish conversion rates of MMed dissertations to accredited publications. Associated variables arising from the publishing exercise were also investigated. A total of 309 MMed dissertations, submitted between 1996 and 2017, were downloaded from the public domain. Each dissertation was recorded as to format, submission year, awarding university and clinical discipline. Electronic searches determined publication outcomes. Journal title, accreditation status, year of publication, registrar position on author ranking and publication type were extracted for each output. Descriptive analysis was undertaken and, where appropriate, Fisher's exact test at p&gt;0.05 was used to establish statistical significance. A total of 116 dissertations were published at an overall conversion rate of 37.5%, culminating in 136 outputs. Publication-ready dissertations had a significantly higher conversion rate (60.3%) than monographs (30.5%) (p&gt;0.0001). All but 6 of the 80 publishing journals were accredited. SAMJ was the journal of choice for 13% of papers. The registrar was the first author in the majority of publications. In the case of monographs, 66% were published after dissertation submission compared with 50% of publication-ready formats. Conversion of the South African MMed dissertation into a journal-accredited scientific article was achieved in 60.3% of publication-ready-format submissions, suggesting that the HPCSA amendment facilitating specialist registration is attainable. Retrospective reviews of dissertations provide valuable insights to improve understanding of the contentious issue of the registrar research requirement that permits specialist registration.

Non-compliance with continuing professional development requirements: Perspectives of emergency medical care practitioners in a resource-poor setting

IntroductionIn 2002, the Health Professions Council of South Africa (HPCSA) made continuing professional development (CPD) a mandatory requirement for all registered healthcare practitioners. However, the latest (2017/2018) HPCSA report states that there is still a generally low level of compliance to CPD requirements by emergency medical care practitioners (EMCPs) nationwide.MethodsThis was a descriptive study that made use of a questionnaire survey administered to 261 EMCPs.ResultsOf the 261 questionnaires that were distributed, 247 were returned, giving a response rate of 94.6%. More than half (50.6%) of the EMCPs indicated that they lack knowledge on the HPCSA-recommended CPD requirements for EMCPs, and 54% stated that they do not have CPD portfolios. EMCPs listed the factors that hinder attendance of CPD activities: lack of information about the CPD activities (72.7%); cost of attending CPD events (70.6%); limited availability of CPD activities (70.6%); transportation problems (68.5%); timing of CPD activities (68.2%); difficulty in getting nominated to attend CPD activities (65.5%); and lack of personal funds (65.1%). Furthermore, EMCPs indicated that lack of internet access (45.5%) and poor knowledge of how to use the internet (15.2%) hinder them from accessing the internet for professional learning.ConclusionTo provide the best care to patients, healthcare professionals must commit to lifelong learning. Participating in CPD activities has been endorsed as a means for maintaining and updating professional competence. Identifying and alleviating barriers that limit engagement in CPD activities will ensure that EMCPs attain the required professional competence.