South African Medical Schools Research Articles

Understanding of 'generalist medical practice' in South African medical schools.

In South Africa, medical students are expected to have acquired a generalist competence in medical practice on completion of their training. However, what the students and their preceptors understand by 'generalist medical practice' has not been established in South African medical schools. This study aimed to explore what the students and their preceptors understood by 'generalist medical practice'. Four South African medical schools: Sefako Makgatho Health Sciences University, University of KwaZulu-Natal, Walter Sisulu University and the University of the Witwatersrand. The exploratory descriptive qualitative design was used. Sixteen focus group discussions (FGDs) and 27 one-on-one interviews were conducted among students and their preceptors, respectively. Participants were recruited through purposive sampling. The inductive and deductive data analysis methods were used. The MAXQDA 2020 (Analytics Pro) software was used to arrange data, yielding 2179 data segments. Ten themes were identified: (1) basic knowledge of medicine, (2) first point of contact with all patients regardless of their presenting problems, (3) broad field of common conditions prevalent in the community, (4) dealing with the undifferentiated patient without a diagnosis, (5) stabilising emergencies before referral, (6) continuity, (7) coordinated and (8) holistic patient care, necessitating nurturance of doctor-patient relationship, (9) health promotion and disease prevention, and (10) operating mainly in primary health care settings. The understanding of 'generalist medical practice' in accordance with internationally accepted principles augurs well in training undergraduate medical students on the subject. However, interdepartmental collaboration on the subject needs further exploration.Contribution: The study's findings can be used as a guide upon which the students' preceptors and their students can reflect during the training in generalist medical practice.

South Africa’s Psychiatric training capacity in 2008 and in 2018. Has training capacity improved?

Background: There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country.Aim: To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018.Setting: South African medical schools with departments of psychiatry.Methods: A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years.Results: Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only sub-speciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant.Conclusion: While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training.Contribution: This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning.

South Africa's Psychiatric training capacity in 2008 and in 2018. Has training capacity improved?

There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country. To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018. South African medical schools with departments of psychiatry. A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years. Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only sub-speciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant. While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training. This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning.

A content analysis of two african medical schools' antibiotic stewardship curricula.

Antibiotics are precious substances that have saved millions of lives since their discovery, resulting in significant advances in modern medicine. However, antibiotic resistance and a slowdown in the discovery of new antibiotics with novel mechanisms of action are affecting the sustainability of antibiotics. The objective of this study was to describe the content of South African and Nigerian medical students' curricula with respect to prudent antimicrobial prescribing. A content analysis framework was used to identify, describe, and count the keywords, key phrases, and sentences relevant to the teaching of prudent antimicrobial prescribing in the complete curricula content of two African countries' medical schools. The courses are taught in the Graduate Entry Medical Programme (GEMP) curriculum (years 3-6) of the South African medical school and years 4-6 of the Nigerian medical school. The frequency of keywords/key phrases relevant to prudent antibiotic prescribing such as antimicrobial stewardship, mechanisms of bacterial resistance, and principles of antibiotic therapy was determined. The two curricula reviewed were found to be different. While the South African medical school uses an integrated curriculum in the GEMP (a stream where candidates with undergraduate degrees are enrolled into the 3rd year of medical school and spend 4 years), the Nigerian medical school operates a traditional (discipline based) curriculum from MBBS 1-6. A greater number of keywords and key phrases were found in the South African curriculum compared to the Nigerian curriculum in relation to prudent antibiotic prescribing and antimicrobial stewardship. The key phrase "antimicrobial stewardship" or "antibiotic stewardship" was absent in the Nigerian curriculum but appeared four times in the South African curriculum. The findings of this curriculum review suggest a need for revision of the medical curricula of the two countries, to one that will better prepare learners for antimicrobial stewardship.

Neurophobia: A Side Effect of Neuroanatomy Education?

Neuroanatomy in the medical curriculum tends to be challenging for both lecturers and students. Students and lecturers perceive the relevance and importance of neuroanatomy differently. If not taught sufficiently, students develop a dislike or fear (termed neurophobia) for the subject. This fear prevents them from being receptive to the teaching and consequently applying the neuroanatomy knowledge in the clinical environment. Information on the approach and perception of undergraduate neuroanatomy lecturers in South Africa regarding neuroanatomy in the medical curriculum is scarce and inconclusive. A study was undertaken to explore the attitudes and perceptions of neuroanatomy lecturers towards the relevance of neuroanatomy, as well as the teaching techniques and approach thereof, in the medical curriculum. In order to determine whether the lecturers' teaching approach and attitudes could be a contributing factor to neurophobia. In a cross-sectional qualitative study, neuroanatomy lecturers from the nine South African medical schools were invited to complete an anonymous online questionnaire. Results were thematically analysed and grouped. Lecturing staff from seven of the medical schools participated in this study and included fourteen respondents. The respondents classified themselves mainly as either proficient (78.6%) or experts (15.8%) in their neuroanatomy teaching experience. All the respondents acknowledged that neuroanatomy is important in their students' medical training. A lecturer's perceptions and attitude towards the subject or content, greatly affect the facilitation approaches and techniques used. This might have far- reaching consequences for students as it might impact on their attitude towards the content.

Position paper on undergraduate Palliative Medicine education for doctors in South Africa.

BackgroundBasic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality.AimThis joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor.SettingPalliative Medicine programme leads and teachers from eight medical schools in South Africa.MethodsA survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers.ResultsResponses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the pre-clinical and clinical components of the curriculum.ConclusionThrough mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC).

Medical students’ perceptions of global health at the University of Cape Town, South Africa: The gap between interest and education

Background. Global health competencies are an increasingly important part of medical training; however, there is currently no integrated formal global health curriculum at South African (SA) medical schools, and perceptions of medical students towards global health have not been reported. Objectives. To describe SA medical students’: (i) perceptions of global health; (ii) access to global health education (GHE); (iii) awareness of global surgery as a global health priority; and (iv) perceived relevance of select medical specialties to global health. Methods. Medical students at the University of Cape Town (UCT), SA, were invited to complete a 35-item survey over 2 months in 2018. The survey was designed on REDCap (Research Electronic Data Capture) and distributed by email. All responses were anonymised and self-reported. Results. Of 1 640 medical students, 245 (18%) completed the survey. Only 66 (27%) reported GHE in medical school, whereas 213 (87%) reported a career interest in global health. Childhood in a rural setting was a positive predictor of a career interest in global health, while lack of medical resources and infrastructure in resource-limited communities was the most commonly cited barrier to a career in global health. Most students identified family medicine and infectious diseases as the two most important specialties in global health delivery. The majority of students had limited insight into global surgery, which ranked low as a past and future global health priority. Conclusion. UCT medical students are interested in global health careers, but lack formalised GHE or global surgery education during their medical studies to support and encourage integrating global health into their future careers.

An Experience on Facts about Teaching Forensic Medicine to Undergraduate Medical Students in South Africa

South Africa is struggling with an enormous amount of forensic pathology services because there is an extreme pressure on forensic pathologists to deal with the high number of medicolegal autopsies in the country. There are only five dozen forensic pathologists in South Africa who have to handle at least 80 000 autopsies per year. Medical officers, who have only received training as undergraduates in medical school, are expected to conduct these autopsies. Therefore, undergraduate teaching and training must be strong enough so that these young graduates can handle cases without any compromise in the quality of the outcome.This report is going to highlight the necessity of teaching forensic medicine at undergraduate level in South African medical schools. It will also discuss the shortcomings in medical school teaching programmes.

Bibliometrics to assess the productivity and impact of medical research

Background: Bibliometrics is the use of statistical and mathematical analysis to assess research production and quality. These metrics provide important insights into the quality and impact of research by applying standardised metrics. However, there are inherent limitations in their application. Objective: We aimed to review existing bibliometric indices and assess their comparative utility in the assessment of medical researchers. We specifically aimed to evaluate the utility of the h-index in identifying young or developing medical researchers with future research potential. Method: We conducted a focussed literature review on commonly used bibliometrics. To explore the utility of these metrics we then used them to evaluate a sample of researchers from a South African medical school faculty. Researchers were ranked with the following metrics: number of publications; h-index; citations per paper; citations per paper per year; and m-index. The h-index, citations and publication counts were drawn from ResearchGate and, if not available, from Google Scholar. The top 20 researchers, based on publication count, were then analysed further. Results: We identified 145 researchers for analysis of which 37 were excluded due to an inability to obtain additional information. Higher time-dependent metrics (publication count, citation count, h-index) were directly proportional to years since first publication. Indices that corrected for time, such as the m-index, provided more insight and better discrimination in identifying younger researchers with greater research potential. Conclusion: Bibliometrics have utility as part of the assessment of academic output but may be subject to time-dependent bias. Research quality is best measured using the h-index, g-index and m-index. The h-index is limited by being time dependent and field specific and overlooks highly cited papers. Bibliometrics that account for time, such as the m-index, should be considered in the early identification of young researchers, ideally accompanied by critical peer review.

Monica Lewin: surgeon to victims of political violence in Jamaica

At the height of the political unrest that rocked Jamaica's capital, Kingston, during the 1960s and 1970s, many of the injured brought to Kingston Public Hospital found themselves cared for by the expert hands of surgeon Monica Lewin. Her career illustrates the combination of high parental expectations, sympathetic mentorship, and personal determination that often underlies extraordinary achievement by people from under-represented groups. For most of Lewin's life, there were few female consultant surgeons, and she was one of the first in her country. Women making medical history: introducing A Woman's PlaceIn December, 2017, The Lancet issued a call for papers for its special theme issue on women in science, medicine, and global health .1 The Comment outlined the gender inequalities in medicine that still persist, long after many overt barriers to women's participation have fallen. While that theme issue will be forward-looking, I believe we can also gain insights from looking to the past for examples of women who have made their mark against the odds, and by asking what it was about their particular circumstances that enabled them to do so. Full-Text PDF Mary Susan Malahlela: practising medicine under apartheidUntil well into the 20th century, the only way Black South Africans could train as doctors was to travel abroad. This was an expensive option and there were few scholarships, so the numbers remained small. Not until 1941 did South African medical schools agree to admit a small minority of students of Indian or African ancestry. One of the first through the doors at the University of Witwatersrand (Wits) in Johannesburg was Mary Susan Malahlela. In 1947, she became the first Black woman to qualify in South Africa. Full-Text PDF

Academic Guidance for Undergraduate Students in a South African Medical School: Can we guide them all?

Higher education institutions, including medical schools, still grapple with the challenge of poor academic performance of students. Some studies report the positive results of providing academic guidance for common challenges such as poor and/or ineffective time management, study methods,test- and exam-taking techniques and management, and the high academic workload of undergraduate medical students. However, limited detailed insights and understanding of medical students who experience more complex challenges are available. This study was conducted at a medical school in South Africa to determine undergraduate medical students’ perceptions of factors affecting their academic performance. A total of 89 semi-structured interviews were held with undergraduate medical students who were identified as having academic problems between 2012 and 2015. According to the results, more blacks, males and first- and secondyear students experienced poor academic performance. Prominent findings included the harsh realities and implications of lack of accommodation for black students; how poor academic performance can lead to an array of other social and psychological problems, such as withdrawal of bursaries and negative achievement emotions that some students experience. Compared to the usual objective measures of individual ability, the rich qualitative data of cases presented in this study reveal critical, real insights and understanding of students’ challenges from their own perspective.

Mary Susan Malahlela: practising medicine under apartheid

Until well into the 20th century, the only way Black South Africans could train as doctors was to travel abroad. This was an expensive option and there were few scholarships, so the numbers remained small. Not until 1941 did South African medical schools agree to admit a small minority of students of Indian or African ancestry. One of the first through the doors at the University of Witwatersrand (Wits) in Johannesburg was Mary Susan Malahlela. In 1947, she became the first Black woman to qualify in South Africa. The next year the government introduced its racist policy of apartheid, and she pursued her entire medical career against a background of extreme racial segregation and inequality. After Malahlela's death, her daughter told a reporter that when Malahlela graduated, her class photograph—a Black woman amid a sea of white men—appeared in the local Afrikaans newspaper, captioned “The black danger”. Women making medical history: introducing A Woman's PlaceIn December, 2017, The Lancet issued a call for papers for its special theme issue on women in science, medicine, and global health .1 The Comment outlined the gender inequalities in medicine that still persist, long after many overt barriers to women's participation have fallen. While that theme issue will be forward-looking, I believe we can also gain insights from looking to the past for examples of women who have made their mark against the odds, and by asking what it was about their particular circumstances that enabled them to do so. Full-Text PDF Rebecca Lee Crumpler: first Black woman physician in the USAA passionate vocation to care for others and a desire to empower her patients drove Rebecca Lee Crumpler (1831–95) to overcome 19th-century prejudice against her gender and ethnicity and qualify as “doctress of medicine” (the term she used), the first African American woman to do so. Crumpler gained extensive experience treating destitute former enslaved people in the southern states after the end of the American Civil War, and published A Book of Medical Discourses: in Two Parts, a practical guide to the care of infants and women's health. Full-Text PDF

Burnout and associated factors in undergraduate medical students at a South African university

Background. Medical students are at risk of burnout owing to various challenges. Objectives. To investigate burnout and associated factors among undergraduate students at a South African medical school. Methods. In this cross-sectional study, findings of the Copenhagen Burnout Inventory (CBI), demographic data and information related to resilience were collected by means of an anonymous self-administered questionnaire. Associations between burnout subscales and various factors were determined. Results. Five-hundred students (preclinical, n =270; clinical, n =230) completed the questionnaire. CBI mean scores for preclinical and clinical students were 17.9 and 17.4 (personal), 22.3 and 21.9 (work related) and 24.8 (patient related; clinical students only), respectively. High scores on the subscale reflect low levels of burnout in related areas. Male students and students with high self-reported resilience and low stress had significantly lower burnout levels. White preclinical students had lower levels of personal and work-related burnout, and black clinical students had less patient-related burnout. Conclusions. High mean scores in all three burnout subscales indicated low burnout levels among students. Academic and personal stress, as well as perceived poor support from institutional structures, were associated with significantly higher personal and work-related burnout, but not patient-related burnout in clinical students.

Status of Curriculum Mapping of Undergraduate Medical Programmes in South Africa

Curriculum mapping in medical education allows for quick determination whether the curriculum meets the required standards and if its contents are aligned with the learning outcomes. This ensures the curriculum stays relevant, producing graduates capable of addressing the health needs of the institution’s host community. The status of curriculum mapping of the undergraduate medical programmes in South African medical schools was not documented in the literature at the time of this research. This study aimed to describe the current status of curriculum mapping of undergraduate medical programmes in South Africa. A qualitative study was conducted among the academic managers from all the eight medical schools in 2015. Semi-structured interviews were used to collect data from fourteen participants who were purposefully sampled, and data analysis was done by inductive thematic analysis after coding and verbatim transcriptions. None of the medical schools had a fully developed mapping platform, however they all possessed various guides and matrices that contained components of their curricula which were mainly used for accreditation purposes. In addition, they all had strategies in place for reviewing their curricula, although some of the institutions were at different stages of developing their own mapping platforms. The challenges described by the institutions as barriers to curriculum review appeared to be related to lack of a proper curriculum mapping process. In conclusion, curriculum mapping was in infancy stage at the time of this research in South Africa, the medical schools that were in the process or about to develop electronic mapping platforms had no uniform outcome framework. Future research on the features of the mapping platforms developed by all the institutions is highly recommended.

Cultural practices of the Zulu ethnic group on the body and their influence on body donation.

Cultural practices in the African continent have been thought to impact negatively on body donation. Thus, most African countries continue to rely on unclaimed bodies for dissection programs, or bequests from the white population. The latter situation is dominant in South African medical schools. Since South Africa is multi-cultural with nine main ethnic groups of the Black African population, it is important to seek the reasons behind lack of participation in body donation. This report represents a move in this direction with its qualitative study of the cultural practices of the Zulu ethnic group in the province of KwaZulu-Natal from the perspective of a variety of participants, with emphasis on their treatment of the human body after death. Four themes emerged from interviews: (1) Death is not the end; (2) Effect of belief in ancestors; (3) Significance of rituals and customs carried out on human tissue; and (4) Burial as the only method of body disposal. Each of these themes is discussed in relation to the likelihood of body donation being seen by Zulus as an acceptable practice. It is concluded that this is unlikely, on account of the need to preserve the linkage between the physical human body and the spirit of the deceased person, and the perceived ongoing relationship between the spirit of the dead and the living. In view of these conclusions, a number of options are canvassed about the manner in which anatomists in KwaZulu-Natal might obtain bodies for dissection. These possibilities have implications for anatomists working in comparable cultural contexts.

Doctor retention and distribution in post-apartheid South Africa: tracking medical graduates (2007\u20132011) from one university

BackgroundDoctor emigration from low- and middle-income countries represents a financial loss and threatens the equitable delivery of healthcare. In response to government imperatives to produce more health professionals to meet the country’s needs, South African medical schools increased their student intake and changed their selection criteria, but little is known about the impact of these changes. This paper reports on the retention and distribution of doctors who graduated from the University of the Witwatersrand, South Africa (SA), between 2007 and 2011.MethodsData on 988 graduates were accessed from university databases. A cross-sectional descriptive email survey was used to gather information about graduates’ demographics, work histories, and current work settings. Frequency and proportion counts and multiple logistic regressions of predictors of working in a rural area were conducted. Open-ended data were analysed using content analysis.ResultsThe survey response rate was 51.8%. Foreign nationals were excluded from the analysis because of restrictions on them working in SA. Of 497 South African respondents, 60% had completed their vocational training in underserved areas. At the time of the study, 89% (444) worked as doctors in SA, 6.8% (34) practised medicine outside the country, and 3.8% (19) no longer practised medicine. Eighty percent of the 444 doctors still in SA worked in the public sector. Only 33 respondents (6.6%) worked in rural areas, of which 20 (60.6%) were Black. Almost half (47.7%) of the 497 doctors still in SA were in specialist training appointments.ConclusionsMost of the graduates were still in the country, with an overwhelmingly urban and public sector bias to their distribution. Most doctors in the public sector were still in specialist training at the time of the study and may move to the private sector or leave the country. Black graduates, who were preferentially selected in this graduate cohort, constituted the majority of the doctors practising in rural areas. The study confirms the importance of selecting students with rural backgrounds to provide doctors for underserved areas. The study provides a baseline for future tracking studies to inform the training of doctors for underserved areas.

“I am still here!” Undergraduate medical students’ perceptions of resilience

This study explored students’ perceptions as resilient learners. Participants were 500 South African medical school students (59.0% female; pre-clinical group median age 20 years; clinical group median age 22.6 years). The students completed an open-ended questionnaire on factors impacting their resilient learning. Thematic analysis of the data indicated that students reported factors such as intrinsic motivation and family support to contribute to higher levels of resilience. Those self-reporting with less resilience were of the view that their pre-existing mental health challenges impeded resilient learning. Student support services should factor in personal and social assets and liabilities on students in supporting their resilient learning

Second and third year medical students' self-reported alcohol and substance use, smoking habits and academic performance at a South African medical school.

BackgroundHealth professional students frequently use alcohol and narcotics. The potential impact on academic performance and professional behaviour is concerning.AimThis study aimed to determine self-reported use of alcohol, illicit substances (e.g. cannabis, lysergic acid diethylamide [LSD], magic mushroom, cocaine, crack, ecstasy, methamphetamine and heroin), prescription medication and smoking habits, correlating academic performance.SettingFaculty of Health Sciences, University of the Free State.MethodsAn observational, descriptive, cross-sectional study design was used. Information was obtained using a self-administered questionnaire, capturing demographics, self-reported academic performance, drinking and smoking habits, and substance use. Coded responses were analysed using the Remark Office OMR 8 Software System. Descriptive statistics were calculated for categorical variables.ResultsCompleted questionnaires comprised 171 students. A total of 78.4% of second year and 82.8% of third year students reported using alcohol. Twenty-two per cent of second year and 24.1% of third year students reported cannabis use. In the second year group, three (2.7%) students reported using magic mushroom, two (1.8%) reported cocaine, two (1.8%) reported ecstasy and one (0.9%) reported using methamphetamine. Only third year students reported using LSD or ‘crack’. Cigarette smoking was common – 31.5% and 35.1% in both groups, respectively. Smokeless tobacco devices were used by 8.5% of second year and 7.1% of third year students. Almost 40% of both groups reported that they had smoked a water pipe. Academic performance achieved was mostly 60% – 69% (38.9%) among second year students and 70% – 79% (46.6%) among third year students.ConclusionSelf-reported use of alcohol and drugs and smoking among medical students is alarming. Additional student support, early identification and referral for management and/or rehabilitation should be a priority at tertiary institutions responsible for training future healthcare professionals.

\u2018The Good Doctor\u2019: the Making and Unmaking of the Physician Self in Contemporary South Africa

In this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa. The loss of health professionals from the South African public system is a key contributor to the present healthcare crisis. South African medical schools have revised curricula to engage trainee doctors with a broader set of social concerns, but the disjunctures between training, health systems failures, and a high disease burden call into question whether junior doctors are adequately prepared or whether conditions of care extend beyond medical training. A concern with 'resilience' suggests a correct ethical relation to a putative obligation to provide care in a struggling system. By examining the ways in which trainee doctors are expected to 'cope' with the demands of medical practice, to adopt the correct moral posture in relation to the urgency of care, and to enact a desirable ethical relation to the broader social and political context of medical practice, we examine the picture of humanist concern that animates the subjectivities and techniques of the self called for by this training, and advocate for endurance as an alternative framework for understanding the political and ethical relations between doctors, patients and health systems.

Measuring empathy in a group of South African undergraduate medical students using the student version of the Jefferson Scale of Empathy.

BackgroundPatient-centred care is a model of care that demands healthcare providers change their focus from the disease to the patient and his or her perceived physical and psycho-social needs. This model requires healthcare workers to listen actively and to have effective communication skills and well-developed levels of empathy.AimThe aim of this study was to determine the suitability of the Jefferson Scale for Empathy (JSE-S) as a valid test for empathy in third-year medical students at a South African university and also to determine the baseline level of empathy in this same group of students.SettingThe study took place at a medical school in the Western Cape, South Africa. This medical degree (MB ChB) is a 6-year programme. Students are first exposed to patients within their second year of training, but it is during their third-year that they start their clinical rotations. We wanted to test whether our empathy training would give students the necessary skills and enable them to establish good empathic communication habits in order to prevent a fall in empathy during this vulnerable period.MethodsThis article explores the suitability of the student version of the JSE-S as a valid test for empathy, within the South African medical school context. We briefly discuss the psychometrics and the scores against what is already known in countries like ours, specifically, developing nations where cultural and language differences exist in the student populations. Furthermore, we explore whether the JSE-S is a valid scale for pre- and post-intervention measurement of medical student empathy within our context and discuss the limitations of self-assessment. We also report on baseline levels of empathy in third-year medical students.ResultsTwo hundred and six third-year medical students (69% females) completed the JSE-S prior to the intervention. Females and students aged 25 years and older had significantly higher scores than males and those 22 years old or less. The mean JSE was 109.98 (SD = 12.54), which is lower than most internationally reported scores. The Cronbach’s alpha coefficient was 0.81, indicating scale reliability and consistency, but graded item response testing highlighted variance in three reverse-scored questions.ConclusionThe JSE-S is an appropriate and valid scale for measuring levels of empathy in undergraduate medical students in South Africa. However, language may need to be clarified in the negatively phrased items.