Doctoral Degrees (Family Medicine and Primary Care)

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Browsing Doctoral Degrees (Family Medicine and Primary Care) by Author "De Villiers, Marietjie Rene"

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    The development of content and methods for the maintenance of competence of generalist medical practitioners who render district hospital services
    (Stellenbosch : University of Stellenbosch, 2004-04) De Villiers, Marietjie Rene; De Villiers, P. J. T.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Family Medicine and Primary Care
    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.