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Change the world


This artcle appeared in the M&G of 13 October 2017 written by Joan van Dyk.

The Eastern Cape and maybe North West could revolutionise how SA’s future doctors are trained

Nelson Mandela University (NMU) will open South Africa’s ninth medical school in 2020 when it is expected to accept its first class of 100 aspiring doctors.

Given the green light by Higher Education Minister Blade Nzimande last year, the Port Elizabeth university will expand its existing health science faculty to include an undergraduate medical degree, says NMU spokesperson Zandile Mbabela.

The school will eventually offer specialist training in fields such as radiography and emergency medical care, she says.

The faculty currently offers qualifications in psychology, nursing, social work, pharmacy and human movement sciences. By 2030, the university aims to train 200 new doctors each year, Mbabela explains.

Experts are optimistic that the project will help to address the Eastern Cape’s scarcity of doctors. Walter Sisulu University is the only school producing physicians in the province.

The new medical school could also help South Africa to begin reducing its shortage of doctors. The country has less than one medical professional for every 1 000 citizens, according to 2015 World Bank data.

North-West University has also applied to open a medical school at its Potchefstroom campus. The university should know whether the departments of health and higher education and training have approved its application by the end of the year, according to the university’s spokesperson Louis Jacobs.

Meanwhile, the University of the Free State is planning to partner with Sol Plaatje University and hospitals in Kimberley to increase its intake of medical students, says the president of the Public Health Association of South Africa, André Rose.

In Port Elizabeth, South Africa’s newest medical school is expected to pioneer novel ways of learning.

NMU’s medical students will receive “decentralised” training, dividing their time between working in primary healthcare clinics and lectures, many of which may be online.

South African medical students already spend time in health facilities as part of their studies but much of this happens in large academic hospitals. These facilities often specialise in complicated cases and don’t treat more common, everyday ailments, says Ian Couper, the director of Stellenbosch University’s Ukwanda Rural Clinical School.

“Patients who land up in big teaching hospitals have more complex health issues, not the ongoing problems like HIV, which [many people] have to deal with on a daily basis,” he says.

To better equip students for rural settings, Ukwanda already uses a form of decentralised training, sending students to rural hospitals for their final year.

Couper adds that, globally, many medical schools are moving towards online curriculums that can make decentralised and online training easier.

“Historically, medical schools were centred around big academic hospitals as a way of standardising practice but now we are far more connected.

“Medicine shouldn’t be taught in big classrooms. The best way to learn is in small groups that are practically focused,” he says.

And getting students out of the classroom and into clinics can be better for them and for communities.

Research conducted by Couper and others in 11 African countries, including South Africa, found that medical students improve the quality of care at health facilities, he says.

“We found the students increase the time and attention given to patients as well as the atmosphere of learning at the facility.”

The research, which has been repeated at sites in Stellenbosch, will be published in the Academic Medicine journal.

“Nelson Mandela University could become the shining light for the return of rural doctors in South Africa and the continent,” Rose says.

But if South African medical schools are looking for graduates to work where they are needed most, they are going to have to prioritise admissions for rural students, warns Couper.

Growing up in a rural area is the most important factor associated with doctors deciding to return to communities such as these to practice, a 2009 review by the Cochrane research network found.

Couper says: “There’s no absolute guarantee rural students will become rural doctors, but there is a likelihood.”

And students who are trained in a rural setting are also more likely to practise there, according to a 2007 article published in the South African Medical Journal.

But Couper cautions that universities such as the NMU will have to put resources into making new and rural decentralised models of learning work.

“The students will need connectivity, accommodation and a space to reflect on their studies with a supervisor,” he says.

And supervisors of primary health facilities will need training to accommodate the new students, former Ukwanda director Hoffie Conradie says.

Conradie is currently working with a Stellenbosch University project that facilitates training and support for health workers in rural hospitals. He says there are few supervisors in the Eastern Cape and ideally there should be one supervising doctor for every four students.

Student doctors are not allowed to prescribe medicines or take responsibility for patients, so without enough supervisors to help, Conradie says students miss out on important learning opportunities.

“Training hospitals need a head supervisor responsible for teaching student doctors. But other capable supervising doctors will be imperative to assist the head supervisor. That’s going to be the challenge.”

To close the gap in the future, the NMU’s new student doctors should be taught to facilitate teaching and learning from the start, he says.

At Ukwanda, the student doctors at district hospitals learn not only how to be a doctor, but also how to teach future physicians as part of their training.

Although they’re not able to teach others as students, they become equipped, while studying, to share their skills with others once they have qualified as doctors.

Conradie says supervising doctors should ideally be identified and appointed by both the NMU and the provincial department of health. “This will allow the supervisors to get ongoing support and medical education training from the university,” he says.

Both Couper and Conradie believe the NMU is equipped for this process but it will require careful planning. Couper says: “You can’t assume people will naturally slot into the role because they are health professionals. Training in the field is different from everyone just sitting in a lecture.

Each one teach one: Students examine x-rays at Cape Town’s Brooklyn Chest Hospital. In the future, medical training may move out of large academic hospitals and into facilities closer to communities. Photo: David Harrison

Contact information
Ms Zandile Mbabela
Media Manager
Tel: 0415042777