The workplace as a learning environment: Perceptions and experiences of undergraduate medical students at a contemporary medical training university in Uganda

Background. One of the most effective ways of translating medical theory into clinical practice is through workplace learning, because practice is learnt by practising. Undergraduate medical students at Makerere University College of Health Sciences, Kampala, Uganda, have workplace rotations at Mulago National Referral and Teaching Hospital (MNRTH), Kampala, for the purpose of learning clinical medicine. Objectives. To explore undergraduate medical students’ perceptions and experiences regarding the suitability of MNRTH as a learning environment to produce competent health professionals who are ready to meet the demands of contemporary medical practice, research and training. Methods. This was a cross-sectional study with a mixed-methods approach. Students’ perceptions and experiences were assessed using the Dundee Ready Educational Environment Measure (DREEM), as well as focus group discussions (FGDs). Data from DREEM were analysed as frequencies and means of scores of perceptions of the learning environment. FGD data were analysed using thematic analysis. Results. The majority of students perceived the learning environment as having more positives than negatives. Among the positive aspects were unrestricted access to large numbers of patients and a wide case mix. Negative aspects included overcrowding due to too many students, and inadequate workplace affordances. Conclusions. The large numbers of patients, unrestricted access to patients and the wide case mix created authentic learning opportunities for students – they were exposed to a range of conditions that they are likely to encounter often once they qualify. The areas of concern identified in the study need to be addressed to optimise learning at the workplace for undergraduate medical students

A modified delphi study to determine the contents of a seizure diary for patients living with epilepsy in South Africa

Background: Epilepsy is a debilitating chronic medical condition affecting many patients globally. A seizure diary is used in monitoring and managing patients with epilepsy. In South Africa, no standardized diary is currently being used. Objective: This study intended to develop a consensus among experts managing patients with epilepsy on the content of a seizure diary. Methods: The modified Delphi method consisted of three survey rounds spanning six months. Using a three-point Likert scale questionnaire, in round one, the panelists were required to choose an option (definitely required, optional, and not required) for 50 items and comment on the contents of the diary. In round two, three items were added based on comments from the panelists. In round three, panelists were allowed to deliberate further on unresolved items and change their responses in view of the group responses. The consensus was determined as a priori threshold of >70% on items definitely required, optional, or not required. Results: Eleven local and two international panelists were enrolled in this study. Twelve completed all three rounds. The consensus was achieved in 21 of 50 items in round 1, three of seven items in round 2, and one of two items in round 3, of which 18 were definitely required as contents of a seizure diary. Conclusions: Based on expert opinions, the modified Delphi study determined the essential contents of a seizure diary for use by patients with epilepsy in South Africa

Strategies to enhance the approach to prostate cancer screening of south African Black men in the Free State: a Delphi study

Background. The incidence and mortality rates of prostate cancer (PCa) are disproportionately on the increase among South African Black men. Recent studies show a greater net benefit of prostate-specific antigen (PSA) screening of Black men compared with the general population. There are, however, knowledge, attitude and practice (KAP) gaps among primary healthcare providers (HCPs) and users (Black men) on PCa screening. Likewise, there is scarcity of research on strategies to address these gaps. Objective. This study sought to determine complementing strategies to enhance the approach to PCa screening of African men in the Free State, South Africa, from the perspectives of primary HCPs and users. Methods. This study utilized a three-round modified Delphi survey to achieve its aim. Consensus was determined by an a priori threshold of ≥ 70% of agreement. Results. The survey involved a multidisciplinary panel of 19 experts. The consensus was reached on 34 items (strategies) to enhance the approach to PCa screening in the study setting. Community health education strategies were proffered, relating to relevant topics, methods and venue of delivery, and persons to deliver the education. Continuing education topics and methods of instruction were suggested for primary HCPs. Conclusion. In view of the existing KAP gaps in PCa screening among primary HCPs and users (Black men), an expert consensus was determined, on complementing strategies to enhance the approach to PCa screening of South African Black men in the study setting

CONTRACEPTIVE USE AND REASONS FOR TERMINATION OF PREGNANCY AMONG WOMEN ATTENDING A REPRODUCTIVE HEALTH CLINIC AT A DISTRICT HOSPITAL, FREE STATE, SOUTH AFRICA

Unplanned and unwanted pregnancies happen in all societies, regardless of medical, economic, educational or religious status. The reasons for seeking termination of pregnancy (TOP) vary with the majority of women seeking TOP for socio-economic reasons. This article seeks to identify the reasons for women seeking TOP and to establish their knowledge and use of contraceptives. It is a descriptive study conducted at a reproductive health clinic at a district hospital in Bloemfontein, Free State, South Africa. In total 534 patients attending the clinic between April to June 2007 participated. Data were collected through a questionnaire, which included demographics, age at first sexual encounter and first pregnancy, reasons for seeking TOP, and knowledge and use of contraceptives. The results are summarised by frequencies and percentages. Most participants (64.2%) were between 20 and 29 years, single (75.8%) and unemployed (44.4%). Participants had their first sexual encounter (82.4%) and first pregnancy (51.3%) at the age of 20 years. Three-quarters were aware of contraceptives; only 37.1% used contraceptives to prevent the current pregnancy. The most frequently mentioned reasons for the TOP were: ‘I am still at school’, ‘Partner not prepared for the parenthood’, and ‘Not supported by the family’. Although women knew about contraception, the use of contraceptives by participants of this study is low compared with the contraceptive prevalence rate in the country. Interruption of studies, problems in the relationship and nonacceptance of the pregnancy by the partner were the most frequent reasons for requesting TOP

KNOWLEDGE OF THE MANAGEMENT OF POSTPARTUM HAEMORRHAGE BY DOCTORS AND MIDWIVES WORKING IN FREE STATE DISTRICT HOSPITALS

Postpartum haemorrhage is a major cause of maternal mortality with an estimated annual occurrence of 13.8 million globally. In South Africa, postpartum haemorrhage accounted for above 73% of the 688 maternal deaths from obstetric haemorrhage during 2008–2010, with the majority occurring in district hospitals. This study seeks to determine the knowledge of doctors and midwives, working in maternity units of Free State district hospitals in postpartum haemorrhage management. In this cross-sectional study, self-administered questionnaires were completed by doctors and midwives working in the maternity units of 14 district hospitals in 2012/2013. In total, 132 participants were included in the analysis. The majority (64.1%) of the participants with known occupation (n=131) were midwives. The highest percentage (24.4%) of doctors were medical officers. Most (94.1%) participants had working experience of over one year to five years, and 44.2% had completed Essential Steps in the Management of Obstetric Emergencies (ESMOE). Only 40 participants (30.3%) obtained scores over 80%, the acceptable mark for core knowledge. Doctors performed significantly better than midwives (p=0.0002). ESMOE training resulted in significantly better performance (p=0.0045). Issues identified were inadequate overall theoretical knowledge and an inability to practically demonstrate acquired theoretical knowledge. The self-assessment of doctors on obstetrics-related surgical skills revealed insufficient practice. The overall theoretical knowledge of doctors and midwives working in the maternity units of Free State district hospitals is limited. The article recommends that the roll-out of the ESMOE training should include all midwives and doctors in maternity units at district hospitals. Adequate skills training and exposure to obstetric emergencies through rotation should also be encouraged for district hospital medical staff

Journal response types and times: the outcomes of manuscripts finalised for submission by the University of the Free State School of Medicine medical editor, South Africa

Introduction: health professionals are involved in research as researchers themselves and as supervisors to undergraduate and postgraduate students. Authors may have unrealistic expectations regarding journal submission and review processes. The study aimed to describe journal response types and times for manuscripts finalised for submission by the University of the Free State School of Medicine medical editor. Methods: this descriptive cohort study with an analytical component included all manuscripts finalised for submission to accredited journals by the medical editor, 2014-2017. Excel spreadsheets capturing all stages of the manuscript process were used to confidentially note information regarding submission and subsequent journal responses. Results: ninety-five manuscripts were submitted to 72 peer-reviewed accredited journals. The total number of submissions was 163. Only 46 (48.4%) manuscripts were accepted by the first journals submitted to. Rejected submissions (n=82) had a median journal response time of 15.5 days (range 0-381 days), with a third being sent for review. Nine manuscripts were accepted with no revisions needed. Accepted submissions (n=72) had a median of one round of revision (range 0-4 rounds), and a median time of 119.5 days (range 0-674 days) from submission to final acceptance. Conclusion: within our setting, half of first submissions were unsuccessful, but rejection usually occurred rapidly. Acceptance for publication occurred at a median time of 4 months after one round of revision. If health professionals were made aware of expected outcomes and response times, it may prevent authors from falling victim to the publication practices of predatory journals

Accuracy of two-rescuer adult CPR performed by medical registrars at a South African university

Background: Cardiopulmonary resuscitation (CPR) is performed to manually keep brain function intact until the patient's spontaneous blood circulation and breathing are restored. In South Africa, registrars, who are qualified doctors training to specialise in a medical field, are usually the team leaders and oversee junior doctors and nurses during resuscitation. Objectives: This study aimed to determine the accuracy of the execution of two-rescuer adult CPR on a Resusci-Anne® manikin performed by registrars from the University of the Free State, South Africa. Methods: A cross-sectional study was conducted. From a target population of 142 registrars, 47 participated, of whom 44 were included in the analysis. During five cycles of CPR, compression quality was assessed. During a subsequent five cycles, airway management was assessed. Participants were evaluated executing CPR on the Resusci-Anne® manikin, with a recently Basic Life Support trained student researcher as second rescuer. A modified version of the American Heart Association's tick sheet for two-rescuer adult CPR was completed by two student researchers. Department, gender and the date of the most recent CPR training attended were recorded. Results: The median total percentage score was 82.2% (range 33.3% to 100.0%). Results showed that 88.6% of registrars consistently demonstrated correct hand placement, 25.0% correct compression rate, 93.2% correct compression depth, and 61.4% allowed complete chest recoil during compressions. Consistently correct E-C technique was found in 77.3%, and correct ventilation rate in 93.2%. Only 63.6% correctly managed an open airway, and 61.4% achieved visible chest rise. A consistently correct compression-to-ventilation ratio was performed by 59.1% of registrars. Conclusion: The study found that registrars were not consistently performing high-quality CPR on a Resusci-Anne® manikin and identified areas needing attention. The results of this study highlight the need for compulsory CPR training and regular fire drills for registrars

The influence of family physicians within the South African district health system : a cross-sectional study

PURPOSE : Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income countries, so this study aimed to evaluate the influence of family physicians on the South African district health system. METHODS : We conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary care facilities) with family physicians and the same numbers without family physicians. Facilities with and without family physicians were matched on factors such as province, setting, and size. RESULTS : Among district hospitals, those with family physicians generally scored better on indicators of health system performance and clinical processes, and they had significantly fewer modifiable factors associated with pediatric mortality (mean, 2.2 vs 4.7, P = .049). In contrast, among community health centers, those with family physicians generally scored more poorly on indicators of health system performance and clinical processes, with significantly poorer mean scores for continuity of care (2.79 vs 3.03; P = .03) and coordination of care (3.05 vs 3.51; P = .02). CONCLUSIONS : In this study, having family physicians on staff was associated with better indicators of performance and processes in district hospitals but not in community health centers. The latter was surprising and is inconsistent with the global literature, suggesting that further research is needed on the influence of family physicians at the primary care level.The European Union. Additional funding was received from the Discovery Foundation (South Africa) and the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.http://www.annfammed.orgam2018Family Medicin