“There’s no doubt that one learns through it all” : a qualitative exploration of the value surgery trainees assign to master of medicine research

Thesis (MPhil)--Stellenbosch University, 2022.ENGLISH SUMMARY: Background: Since 2011 The Health Professionals Council of South Africa (HPCSA) has mandated the completion of a Master of Medicine (MMed) research project for specialist registration. This has introduced several challenges for the training environment and there is concern that institutions do not adequately prepare trainees for their role as scholars. MMed research has therefore received much critical resistance and stakeholders have questioned its value as part of the specialist training curriculum. To gain a deeper understanding of the affordances, enablers, and challenges of MMed research we were interested to hear how trainees construct the meaning of value in relation to their experiences. Aim: To explore the value surgery trainees assign to their MMed research experiences. Methods: This qualitative study adopted a social constructivist epistemological perspective. We purposively sampled 9 participants who had completed their research in a single surgical division at Stellenbosch University. Data were generated via semi-structured interviews with individual participants and analysed using reflexive thematic analysis. Results and discussion: We identified four key themes: 1) resentment, relief, realisation, and prerequisite; 2) the clinician versus clinician-scientist dichotomy; 3) research exposure and leadership, and 4) “there’s no doubt one learns through it all”. MMed research is a source of trainee stress but they can recognise in hindsight research has served an important role in professional development. Through experiential and social learning, trainees develop critical appraisal skills and an improved understanding of the research process and recognise the value of scholarly competencies for evidence-based medicine. Research supervision and leadership represent key enablers in this learning process. Conclusions: Our findings suggest that MMed research offers significant educational value to specialist trainees and therefore warrants continued inclusion in the curriculum. Research supervisors play an important role in managing the research process, initiating MMed candidates into the research community, and making explicit the hidden outcomes of postgraduate research. Therefore, amongst other recommendations for health professions education, we especially recommend that future research and faculty development initiatives should focus on the professional development of MMed research supervisors.AFRIKAANSE OPSOMMING: Agtergrond: Sedert 2011 het die Raad vir Gesondheidsberoepe van Suid-Afrika (RGBSA) die voltooiing van 'n Meester in Geneeskunde (MMed) navorsingsprojek vir spesialisregistrasie opdrag gegee. Dit het verskeie uitdagings vir die opleidingsomgewing meegebring en daar is kommer dat instellings nie voldoende voorbereid is vir hul rol as skoliere nie. MMed-navorsing het dus baie kritiese weerstand gekry en belanghebbendes het die waarde daarvan as deel van die spesialisopleidingskurrikulum bevraagteken. Om 'n dieper begrip te verkry van die voordeleinstaatstellers en uitdagings van MMed-navorsing, was ons geïnteresseerd om te hoor hoe leerlinge die betekenis van waarde in verhouding tot hul ervarings konstrueer te verken. Doel: Om die waarde wat chirurgie-leerlinge aan hul MMed-navorsingservarings toeken. Metodes: Hierdie kwalitatiewe studie het 'n sosiaal-konstruktivistiese epistemologiese perspektief aangeneem. Ons het doelbewus 9 deelnemers geneem wat hul navorsing in 'n enkele chirurgiese afdeling by die Universiteit Stellenbosch voltooi het. Data is gegenereer deur middel van semi-gestruktureerde onderhoude met individuele deelnemers en ontleed met behulp van refleksiewe tematiese analise. Bevindinge: Ons het vier sleuteltemas geïdentifiseer: 1) wrok, verligting, besef en voorvereiste; 2) die klinikus versus klinikus-wetenskaplike tweespalt; 3) navorsingsblootstelling en leierskap, en 4) "daar is geen twyfel dat 'n mens deur dit alles leer nie". MMed-navorsing is 'n bron van leerderstres, maar hulle kan agterna erken dat navorsing 'n belangrike rol gedien het, naamlik professionele ontwikkeling. Deur ervarings- en sosiale leer ontwikkel leerlinge kritiese beoordelingsvaardighede en 'n verbeterde begrip van die navorsingsproses en erken die waarde van vakkundige vaardighede vir bewysgebaseerde medisyne. Navorsingstoesig en leierskap verteenwoordig sleutelbemagtigers in hierdie leerproses. Gevolgtrekkings: Ons bevindinge dui daarop dat MMed-navorsing beduidende opvoedkundige waarde aan spesialisleerlinge bied en daarom voortgesette insluiting in die kurrikulum regverdig. Navorsingsleiers speel 'n belangrike rol in die bestuur van die navorsingsproses, die inisiëring van MMed-kandidate in die navorsingsgemeenskap, en om die verborge uitkomste van nagraadse navorsing uitdruklik te maak. In terme van gsondheidsberoepe opvoeding beveel ons dus onder andere aan dat toekomstige navorsings- en fakulteitsontwikkelingsinisiatiewe op die professionele ontwikkeling van MMed-navorsingsleiers moet fokus.Master

Writing centres as dialogic spaces : negotiating conflicting discourses around citation and plagiarism

CITATION: Moxley, K. & Archer, A. 2019. Writing centres as dialogic spaces : negotiating conflicting discourses around citation and plagiarism. Stellenbosch Papers in Linguistics Plus, 57:25-37, doi:10.5842/57-0-808.The original publication is available at http://spilplus.journals.ac.za/Citation is fundamental in successfully constructing academic discourse. There has been much discussion concerning the considerable difficulties tertiary students experience when writing using sources, especially for those who speak English as an Additional Language. This paper interrogates the predominantly negative discourses that surround plagiarism, involving notions of honesty, integrity, punishment, trust, and deceit. These negative discourses tend to perpetuate hierarchical and impenetrable spaces in higher education. Drawing on our experiences in South African writing centres, and using key concepts from academic literacies, this paper explores ways of addressing plagiarism that can serve to empower students, including developing academic voice through citation, acknowledging “mimicry” as part of writing development, and developing critical thinking.https://spilplus.journals.ac.za/pub/article/view/808Publisher's versio

Profiles of traditional healers and their healing practices in the Eastern Cape province of South Africa

Background: Despite the widespread use of traditional healers in the management of mental health problems among South Africans, there is a knowledge gap in their practices that needs to be narrowed in order to develop a more collaborative and integrated mental health system. There is a need to better understand traditional practices from the perspective of the healers themselves and how these align with Western approaches. Aim: We specifically explored the journey towards becoming a traditional healer, the types of interventions and key practices in the management of mental disorders, and the extent to which traditional healers collaborate with conventional medical practitioners. Methods: This mixed-methods study involved 77 traditional healers who practice in the Eastern Cape province of South Africa. We administered semi-structured interviews to gather data on healer training, experiences and practices. The Patient Health Questionnaire (PHQ-9) was used to screen for depression. All interviews were conducted in isiXhosa at participants’ homes. Results: Most of the healers were female (80.5%) and only half (49%) had a traditional healing certificate. Healer training typically consisted of six key steps and was mostly facilitated by a non-family member or trainer, as directed by the ancestors. Most healers treated physical illnesses (86%) and called on their ancestors to assist with diagnoses (90%). Only 40% of healers treated mental illnesses. While some healers revealed tensions in working with Western practitioners, the majority were open to collaboration (71%). Conclusion: Traditional healers may have an important role to play in the development of culturally-relevant mental health care in South Africa. This study contributes to a greater understanding of what it means to be a traditional healer, and the types of treatment provided. The findings emphasise that conventional mental health practitioners need to make equal effort to collaborate, especially if we are to provide culturally-relevant mental health care in traditional South African settings

Factors affecting specialist psychiatry training in South Africa: Bullying during specialist psychiatric training?

CITATION: Beath, N. et al. 2021. Factors affecting specialist psychiatry training in South Africa : bullying during specialist psychiatric training? South African Medical Journal, 111(4):280, doi:10.7196/SAMJ.2021.v111i4.15518.The original publication is available at http://www.samj.org.zaAs many of us served as members of the Council of Psychiatrists, Colleges of Medicine of South Africa, for the triennium 2017 - 2020, we were keen to understand how workplace experiences and supervision could affect training and examination outcomes in South African (SA) centres. We conducted a cross-sectional, descriptive study of registrar trainees in psychiatry at the University of the Witwatersrand, the University of Cape Town, the University of KwaZulu-Natal, the University of Pretoria, the University of the Free State, Stellenbosch University, the University of Limpopo, and Walter Sisulu University between 1 June and 30 November 2019. We made use of an online survey that included questions on bullying/discrimination. All questions were closed-ended.Publisher's versio

Body dysmorphic disorder : a diagnostic challenge in adolescence

CITATION: Thungana, Y., Moxley, K. & Lachman, A. 2018. Body dysmorphic disorder : a diagnostic challenge in adolescence. South African Journal of Psychiatry, 24:a1114, doi:10.4102/sajpsychiatry.v24i0.1114.The original publication is available at http://www.sajp.org.zaBody dysmorphic disorder (BDD) is a chronic and disabling condition that is characterised by distressing preoccupations with perceived defects in one’s own appearance, which might be slight or not observable to others. It is considered to be an obsessive–compulsive spectrum disorder and is associated with depression, feelings of shame and poor quality of life. It is primarily a disorder of childhood or adolescent onset, and sub-clinical BDD symptoms begin, on average, several years before an individual’s symptoms meet full criteria for the disorder. Here we report the case of an adolescent admitted to an inpatient psychiatric unit for treatment of psychotic symptoms that were poorly responsive to standard treatments. This challenging case of BDD in an adolescent highlights the various comorbidities of the disorder, as well as the difficulties associated with BDD diagnosis.https://sajp.org.za/index.php/sajp/article/view/1114Publisher's versio

Iron deficiency in South African children and adolescents with attention deficit hyperactivity disorder

Objective: Iron deficiency may play a role in the pathophysiology of attention deficit hyperactivity disorder (ADHD) by causing dopamine dysfunction, but there is conflicting evidence in the literature regarding this relationship. This study investigates the possible correlation between iron deficiency and ADHD in children and adolescents attending a South African child and adolescent psychiatry outpatient service.Method: In this retrospective study, we gathered data from 245 outpatient children and adolescents who had their serum ferritin and/or iron levels tested between February 2011 and January 2016. Relevant statistical methods were used to test for correlations between ADHD and various demographic and clinical factors, including iron deficiency.Results: Out of 245 patients, 88 (35.9%) had iron deficiency, 156 (63.7%) had ADHD and 55 (22.4%) had both iron deficiency and ADHD. Variables found to be significantly correlated with ADHD included gender, age, and methylphenidate treatment, but there was no significant correlation between ADHD and iron deficiency.Conclusions: Our study emphasizes the great complexity involved in understanding ADHD. Comparisons between mentally-ill paediatric patients and matched healthy controls from the same communities are required to further explore the possible association between iron deficiency and ADHD

HPA-axis genes as potential risk variants for neurocognitive decline in trauma-exposed, HIV-positive females

CITATION: Jacobs, S., et al. 2018. HPA-axis genes as potential risk variants for neurocognitive decline in trauma-exposed, HI V-positive females. Neuropsychiatric Disease and Treatment, 14:2497-2504, doi:10.2147/NDT.S166992.The original publication is available at https://www.dovepress.comPurpose: Previous studies have independently provided evidence for the effects of HIV infection, hypothalamic–pituitary–adrenal (HPA) axis dysfunction and early life trauma on neurocognitive impairment (NCI). This study examined the interaction between single-nucleotide polymorphisms (SNPs) of two HPA axis genes, corticotrophin-releasing hormone receptor 1 (CRHR1; rs110402, rs242924, rs7209436, and rs4792888) and corticotrophin-releasing hormone-binding protein (CRHBP; rs32897, rs10062367, and rs1053989), childhood trauma, and HIV-associated NCI. Patients and methods: The sample comprised 128 HIV-positive Xhosa females of whom 88 (69%) had a history of childhood trauma. NCI was assessed using a battery of 17 measures sensitive to the effects of HIV, and the history of childhood trauma was assessed using the validated retrospective Childhood Trauma Questionnaire-Short Form. Generalized linear regression models were used to compare allelic distribution by trauma status and global NCI. The association between genotype, childhood trauma, and cognitive scores was also evaluated using generalized linear regression models, assuming additive models for the SNPs, and ANOVA. Results: Of the seven polymorphisms assessed, only the rs10062367 variant of CRHBP was significantly associated with global NCI (P=0.034), independent of childhood trauma. This polymorphism was not significantly associated with z-scores on any specific cognitive domain. The interaction of childhood trauma and variants of CRHR1 was associated with poorer learning (rs110402) and/or recall (rs110402 and rs4792888). Conclusion: These findings suggest that CRHBP rs10062367 A allele is a possible risk variant for NCI in HIV, independent of childhood trauma. Furthermore, results show that the interaction of childhood trauma with variants of CRHR1, rs110402 and rs4792888, confer added vulnerability to NCI in HIV-infected individuals in cognitive domains that are known to be impacted by HIV. While these findings need independent replication in larger samples, it adds CRHBP and CRHR1 to the list of known genes linked to HIV- and childhood trauma-associated neurocognitive phenotypes.https://www.dovepress.com/hpa-axis-genes-as-potential-risk-variants-for-neurocognitive-decline-i-peer-reviewed-article-NDTPublisher's versio

Factors affecting specialist psychiatry training in South Africa : are psychiatry residents satisfied with their training?

OBJECTIVE : The authors investigated South African psychiatry residents’ satisfaction with their training, physical, and mental health to inform the development of a strategy to improve the quality and experiences of training. METHOD : A cross-sectional online survey was undertaken to assess the factors affecting residents’ satisfaction with their current training program. The authors conducted a comparative analysis of residents across the training institutions in South Africa. RESULTS : Of 179 psychiatry residents in the country, 70 responses were received (39.1% response rate). Most were satisfied with the overall quality of their training, various aspects of training, and access to training resources. However, significant differences across universities were identified with regard to residents’ perception of the quality of their training, quality of their experiences, access to training resources, quality of supervision, and clinical workload. More than a quarter were dissatisfied with their mental and/or physical health. The top four factors contributing to stress were all training-related. CONCLUSION : While most residents were satisfied with their specialist training, institutional differences in access to training and training resources, quality of training, and availability of quality supervision were evident and need to be addressed to ensure equitable training. There is a need to actively address staff shortages not only for clinical cover during protected academic time but also to meet training needs. A centralized examination process should remain in place to ensure that there is a national standard. Workplace-based assessments could facilitate standardization across institutions, should these assessments be standardized and accompanied by rigorous training of supervisors.https://www.springer.com/journal/405962022-05-10hj2022Psychiatr