Prof Bob Mash Primafamed Network Stellenbosch University Family doctors who do we mean Family physicians specialists in family medicine Medical officers working in public sector General practitioners working in private sector ID: 1047648
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1. State of the training of family doctors in Africa and lessons to be learntProf Bob MashPrimafamed NetworkStellenbosch University
2. Family doctors – who do we mean?Family physicians – specialists in family medicineMedical officers – working in public sectorGeneral practitioners – working in private sectorWorking in primary care, primary/district hospitals and higher levels of care
3. What training do these family doctors have?Family doctorsTraining levelFamily physicians4-years of postgraduate trainingMedical officers/general practitionersOnly undergraduateMost have no postgraduate trainingDiploma in Family Medicine (very few)
4. The state of PG family medicine trainingMash R, de Villiers M, Moodley K, Nachega J. Guiding the Development of Family Medicine Training in Africa through Collaboration in the Medical Education Partnership Initiative. Academic Medicine 2014; 89(8 Suppl):S73-7. doi: 10.1097/ACM.0000000000000328.
5. High level support linked to stages of changeStage of changeType of support neededPre-contemplationShare evidence with ministry of health, council and higher education bodiesContemplationMeet with ministry of health, council and higher education bodies – discuss pros and cons, advocacyPreparationCurriculum design and accreditationTraining site selection and preparationFaculty developmentActionImplementation of training programmeSupport for teaching, training and assessmentMaintenancePrepare health system for first graduatesOngoing faculty development and development of training sites
6. Lessons learnt in implementing family medicine trainingProgrammatic learning outcomesRoles and responsibilities in the health system
7. Define the contribution of family medicine in the region in broad termsRegional statement of consensus in 2010Wonca Africa Conference4-day participatory processSupported by prior research studies – Delphi.Mash B, Reid S. Statement of consensus on Family Medicine in Africa. Afr J Prm Health Care Fam Med. 2010;2(1), Art. #151, 4 pages. DOI: 10.4102/ phcfm.v2i1.151Mash R, Downing R, Moosa S, de Maeseneer J. Exploring the key principles of Family Medicine in sub-Saharan Africa: international Delphi consensus process. SA Fam Pract 2008;50(3):60-65
8. Define the roles and responsibilities at a national level in the health systemNational coordinating body to support dialogue and collaboration (FaMEC in South Africa and later SAAFPs)6 roles of the family physicianEmbed and align with HRH policyMash R, Ogunbanjo G, Naidoo SS, Hellenberg D. The contribution of family physicians to district health services: a national position paper for South Africa. South African Family Practice. 2015 May 1;57(3):54-61.
9. Define national programmatic learning outcomesFive unit standards:Leadership and governanceClinician and consultantCommunity-orientated careClinical trainer and capacity builderEthics and professionalismNational Delphi process with final consensus by national professional bodyAligned with all nine training programmesRevise periodicallyCouper I, Mash B, Smith S, Schweitzer B, Outcomes for family medicine postgraduate training in South Africa. South African Family Practice Journal 2012; 54(6): 501-506. Akoojee Y, Mash R. Reaching national consensus on the core clinical skill outcomes for family medicine postgraduate training programmes in South Africa. African Journal of Primary Health Care and Family Medicine 2017; 9(1):1-8.
10. YearModule 1Module 2Module 3Exam February 1st May 9th August 15th November 11th and 12th 1ConsultationEthicsEvidence-based MedicineClinical Family Medicine I 2Applied ResearchPrinciples of family medicineCommunity-oriented primary careClinical Family Medicine II 3Family-oriented primary careTeaching and LearningLeadership and Clinical GovernanceClinical Family Medicine III 4RehabilitationGeriatricsForensics ororFinal clinical exam Cancer carePalliative CareResearch assignment E-learningNOT silosCFM domains withPortfolio every yearClass mark 50%Final examResearchCurriculum design at level of programme
11. Curriculum design at level of programmeSurgeryMentalHealthNT, Eyes, SkinHIV/AIDSTBSTIEmergencies Ortho-PaedicsWomen’sHealthChildHealth General AdultMedicineAnesthetics10 clinical domains
12. Educational approach: Adult learningMash B, Edwards J. Creating a learning environment in your practice or facility. S Afr Fam Pract. 2020;62(1), a5166. https://doi.org/ 10.4102/safp.v62i1.5166
13. Educational approach: Hybrid
14. Educational approach: Workplace basedMash B, Edwards J. Creating a learning environment in your practice or facility. S Afr Fam Pract. 2020;62(1), a5166. https://doi.org/ 10.4102/safp.v62i1.5166
15. Training of clinical trainersEstablishing and maintaining a learning environment Curriculum design and alignmentWorking with adult learners (including reflective practice)Assessment methodsGiving feedbackTeaching consultation skillsSmall group teaching Learning in the clinical setting Leadership and strategic capacityMash R, Blitz J, Edwards J, Mowle S. Training of workplace-based clinical trainers in family medicine, South Africa : Before-and-after evaluation. African Journal of Primary Health Care and Family Medicine 2018; 10(1):1-6.
16. Formative assessment visitsFive key areas:Ensuring safe and effective patient care through trainingEstablishing and maintaining an environment for learningTeaching and facilitating learningEnhancing learning through assessmentSupporting and monitoring educational progressMash R, Malan Z, Blitz J, Edwards J. Improving the quality of clinical training in the workplace: implementing formative assessment visits. South African Family Practice. 2019 Nov 18;61(6):264-72.
17. Workplace based assessmentAssesses activities at the top of Miller’s pyramidMultiple (direct) observationsSample widely across curriculumMany sources (methods/observers)Over time and different settingsFocus on effective verbal and narrative feedback more than scoresHarness power of reflection-on-actionAssessment is activity and context boundSharpen the assessor not the instrumentSeparate formative from summative judgementsSwanwick, T and Chana,N 2005 Workplace assessment for licensing in general practiceBritish Journal of General PracticeBurch VC. The Changing Landscape of Workplace-Based Assessment. Journal Appl Testing Technology, Vol 20(S2), 37-59, 2019
18. Workplace based assessment
19. Portfolio – assessment for learningIntroductionAlignment with learning outcomesAllocationsLearning plans, reflections, periodic assessmentsEducational meetingsObservations and feedbackMultisource feedbackAssignmentsLogbook of clinical skillsOther learningPortfolio assessment tool
20. E-portfolio of learning
21. Other types of programmatic assessmentAnnual clinical family medicine assessment (MCQ exam and Portfolio)Module mark – assignments, quizzes, participationResearch assignment
22. National licensing examinationConstructive alignment - blueprintingValidity – removal of invalid forms of assessmentReliability – increase in sampling of curriculumWriting groups – improve quality of questionsTraining of examiners – improve quality of assessmentStandard setting – set an appropriate thresholdWorkplace based assessment – the future
23. Issues for the futureAdvocacy for appropriate HRH policyDevelopment of workplace based assessment and one national e-portfolioAccreditation of clinical trainersImproving throughput and pass rate in national examTripling the output of family physicians by 2025Developing career pathway