The development of content and methods for the maintenance of competence of generalist medical practitioners who render district hospital services

De Villiers, Marietjie Rene (Stellenbosch : University of Stellenbosch, 2004-04)

Thesis (PhD)--University of Stellenbosch, 2004.

Thesis

ENGLISH ABSTRACT: District hospitals play a pivotal role in the district health system of the Western Cape and other provinces of South Africa. It is a dual role, supporting both primary health care services and serving as a gateway to higher levels of care. Most district hospitals are in rural areas, staffed by generalist medical practitioners who provide health services often supplied by specialists in urban areas. There is a paucity of research and published material on the scope of practice of district hospital practitioners in South Africa, as well as the factors influencing the performance of their duties. There were two main objectives for this study. Firstly, to identify the professional knowledge and skills of medical practitioners delivering district hospital services in the Western Cape and to compare these with service platform needs. Secondly, to use the information gathered to make recommendations regarding human resource development and appropriate education and training and continuing professional development of these doctors. The study was conducted in three phases to ensure coherent evolution of investigation, co-ordination and response. Phase One was a comprehensive survey, utilising district hospital data, medical officer questionnaires and in-depth interviews to determine the professional knowledge and skills of medical practitioners working in district hospitals in the Western Cape. This information gathering endeavour resulted in a skills and knowledge compendium being formulated. It established that the spectrum of functions required of these doctors was extremely wide - ranging from the management of undifferentiated problems to performing complex surgical procedures, as well as providing a vital public health function. Two main factors influenced their performance, namely their working conditions and the education and training which they received.In common with rural practice in other countries, it was apparent that the working environment had a major impact on attitudes and functioning. These findings were developed into a conceptual framework depicting the negative influences that can build up and result in these doctors opting out of rural practice. In addition, other influences were established having a profound effect on doctors’ satisfaction, mainly in the realm of education and training. This gave rise to a second more comprehensive framework being evolved, encapsulating the positive and negative factors enhancing or retarding efficiency and satisfaction in the workplace. Phase Two of the study consisted of the validation of the findings of the basic research data. In keeping with the second aim of the study, the education and training perspectives of rural and district hospital practice were explored. The deficiencies exposed have implications for undergraduate and postgraduate education and training, as well as for continuing professional development programmes. Phase Three concentrated on the exploration of ways and means of defining and maintaining ongoing professional competence for district hospital practice. This was approached by using the data captured in Phase One and refined in Phase Two to pose a series of educational problems to a group of experts. Using the Delphi Technique, a series of electronic exchanges achieved consensus on a range of topics varying from educational content to learning modalities and modern adult teaching techniques applicable to district hospital practice. This research presents information defining the circumstances, experiences and needs of medical practitioners working in district hospitals in the Western Cape province of South Africa. It reveals clear challenges to the capacity, attitudes, costs, isolation, political will, monitoring and organisation which will be crucial in the development of future human resource strategies.It, furthermore, defines the educational objectives, content and methods required to establish and maintain the ongoing professional competence of medical practitioners delivering district hospital services in the Western Cape.

AFRIKAANSE OPSOMMING: Distrikshospitale speel ‘n sentrale rol in die distriksgesondheidstelsel van die Wes- Kaap en ander provinsies in Suid-Afrika. Dit is ‘n dubbele rol wat beide primêre gesondheidsorgdienste ondersteun en optree as ‘n deurgang vir verwysing na hoër vlakke van sorg. Die meeste distrikshospitale is te vinde in plattelandse gebiede. Dit is hier waar die algemene geneeskundige praktisyn dienste lewer wat gewoonlik deur spesialiste in stedelike gebiede verrig word. Daar is ‘n gebrek aan bestaande navorsing en publikasies oor die omvang van praktyk van geneeshere in distrikshospitale in Suid- Afrika, sowel as onvoldoende inligting in verband met faktore wat die funksionering van hierdie praktisyns beïnvloed. Hierdie studie het twee hoofdoelwitte vervat. Die eerste doelwit was die bepaling van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap, en die vergelyking daarvan met die behoetes van die diensplatform. Die tweede doelwit was om hierdie inligting te gebruik om aanbevelings te doen aangaande menslike hulpbronontwikkeling en toepaslike onderrig, opleiding en voortgesette professionele ontwikkeling vir hierdie geneeshere. Die studie is in drie fases uitgevoer om samehangende ontwikkeling van ondersoek, koördinasie en respons te verseker. Fase Een het bestaan uit ‘n omvattende opname van die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap deur die gebruik van distrikshospitaaldata, vraelyste vir geneeshere, en in-diepte onderhoude. Die resultate is gebruik om ‘n omvattende stel kennis en vaardigheidsareas te identifiseer. Fase Een het bewyse gelewer dat die rol en funksie van dokters in distrikshospitale uitsonderlik wyd is en wissel tussen die hantering van ongedifferensieërde probleme en die uitvoer van komplekse chirurgiese prosedures, sowel as ‘n belangrike rol in openbare gesondheid. Werksomstandighede en onderrigen opleiding is geïdentifiseer as die twee belangrikste invloede wat die uitvoer van hierdie praktisyns se pligte beïnvloed. Soortgelyk aan plattelandse praktyke in ander lande, het dit duidelik geword dat werksomstandighede ‘n groot invloed op houdings en funksionering het. Hierdie bevindings is saamgevoeg in ‘n konseptuele raamwerk om die negatiewe invloede toe te lig wat veroorsaak dat hierdie geneeshere die plattelandse diens verlaat. Ander faktore wat ‘n beduidende uitwerking op praktisyns se werksbevrediging gehad het, veral wat onderrig en opleiding betref, is saamgevat in ‘n tweede en omvattende raamwerk wat die positiewe en negatiewe invloede op effektiwiteit van dienslewering en werksverrigting uitspel. Fase Twee van die studie het bestaan uit die bevestiging van die bevindings van die basiese navorsingsinligting. Perspektiewe in die onderrig en opleiding vir plattelandse praktyk is ondersoek in oorleg met die tweede doelwit van die studie. Verskeie implikasies vir voorgraadse en nagraadse onderrig en opleiding en voortgesette professionele ontwikkelingsprogramme is uit ontblote tekortkomings geïdentifiseer. Die omskrywing en die behoud van professionele bevoegdheid is in Fase Drie ondersoek. Data verkry in Fase Een, en verfyn in Fase Twee, is gebruik in die ontwikkeling van ‘n reeks opvoedkundige vraagstukke. ‘n Groep deskundiges is daarna die taak gestel om konsensus te bereik oor ‘n spektrum van onderwerpe, insluitend toepaslike inhoud, metodes van leer en moderne volwasse onderrigtegnieke vir distrikshospitaal praktykvoering. Die Delphi tegniek met herhalende elektroniese rondtes is hiervoor gebruik. Hierdie navorsing lewer inligting wat die omstandighede, ondervindings en behoeftes van geneeshere werksaam in distrikshospitale in die Wes-Kaap provinsie van Suid- Afrika beskryf.Die navorsing onthul duidelike uitdagings vir die kapasiteit, houdings, koste, isolasie, politieke wilskrag, monitering en organisasie van strategieë vir die ontwikkeling van menslike hulpbronne. Dié navorsing definieër hierbenewens die opvoedkundige doelwitte, inhoude en metodes wat nodig is vir die vestiging en instandhouding van die professionele bevoegdheid van distrikshospitaalpraktisyns in die Wes-Kaap.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/16044
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