The South African Academy of Sciences (ASSAf) has a mandate to provide evidence-based scientific advice to policy makers. This report is the joint work of a ten-member study panel appointed by the Council of the South African Academy of Sciences (ASSAf).
Introduction
- Global context
- South African context
- Shortage of health professionals
- Collaboration between health and education sectors
- Recent developments
- Study information
- Problem statement
- Project brief
- Methodology
Currently, there is no unified framework for the joint development, innovation and sustainability of education and training of health professionals to support efforts to improve the health system. Identify and exploit synergies between the regulatory and statutory powers of the Department for Higher Education and Training (DHET), DoH and professional councils and committees specifically related to quality assurance, accreditation and compliance with the Higher Education Qualifications Framework (HEQF).
Conceptual Framework
- Introduction
- Conceptual framework
- Population health needs
- Health system services
- Health professional skills mix
- Iterative monitoring and evaluation
- Collaborative leadership, governance and partnerships
- Conclusion
This conceptual framework unequivocally confirms the interconnectedness of the health and higher education systems. In this chapter, we have briefly described the health system components, recurrent monitoring and evaluation, and leadership and management aspects of the framework.
Student Selection
- Introduction
- Theoretical constructs
- Concepts and definitions
- Equity
- Student selection
- Retention
- Success
- Key findings from the literature .1 Selection
- Retention and success
- Critique – adaptability and feasibility in the South African context; barriers and enablers
- Constraints on student selection
- Success rates
- Clinical success
- Reconceptualisation and implementation of HCE
- Quantity
- Quality
- Selection logistics
- Throughput
- Fitness for practice
- Recommendations
A South African study (Scott et al., 2007) of the 2 000 student cohort (all faculties) noted low (30%) graduation and retention rates and high attrition rates, particularly in the first year. Similarly, students selected from ethnically underserved areas tend to serve in those areas (Thomson et al., 2010).
Scaling up the Health Workforce
Introduction
Current South African situation
- Production of HCPs
- Maldistribution in relation to modes and geographical location of practice
- Attrition
- Alternative strategies employed to address HRH shortages in the public sector, other than increasing production
This time is usually used to access technology not available in the public sector. The rapid growth in the number of PAs (Fig. 4.6) shows the appeal of this program. There is a lack of data on the actual number of HCPs working in the public and private sectors.
The government has launched a number of strategies to address shortages, especially in the public sector.
Key findings from the global literature
- International experience with building institutional capacity and increasing production
- International experience with retention during studies and subsequent to qualification
- International experience with supplementation from abroad
Brazil has pursued a combination of all these options and has increased access to higher education to 30% of the population, with a third of students studying through the private sector (Redden, 2015). In high-income countries, the role of the private sector varies, with the United States having a long tradition of both private (for-profit and non-profit) and public academic institutions. In India, where 194 out of 356 medical schools are privately owned and where 72% of new admission slots created since 2000 have been in the private sector (Davey et al., 2014), serious concerns have been raised about staffing standards, availability of infrastructure, tuition fees and quality of students produced (Chen et al., 2012).
The better these are, the better the quality of the graduate, regardless of whether the institution is in the public or private sector.
Applicability and feasibility of various international scaling up approaches in South Africa
- Introduction
- Building institutional capacity
- Increasing productivity of existing institutions
- Increasing international scholarship programmes
- Improving retention
- Increased use of information technology
This should allay fears about the risk of discrepancies in the quality of private and public higher education. There are currently relatively few private higher education institutions involved in HCP training. A potential barrier to university production in the private sector is the suitability of the private practice clinical environment as a learning platform.
Most of the proposed international strategies can be implemented in the South African context.
Recommendations
- general recommendations
- Recommendations related to increased production
- Recommendations around retention in the profession and in the country
The challenge for every developing country is the accessibility, reliability and speed of the internet. However, the rapid increase in South Africa's internet user base from 2.4 million in 2000 to 12.3 million in 2012 has resulted in South Africa achieving the highest internet penetration in the sub-Saharan region. African and increases the feasibility of this approach.
Health Professionals’ Education for Practice in Rural and Underserved Areas
- Introduction
- How should universities respond?
- Student selection
- Rural clinical placements
- Community-based education
- Graduate tracking
- Recommendations
Faculties of health sciences must demonstrate the impact they are having on access to health care through the distribution outcomes of their graduates and how they are supporting PHC and health services in rural and underserved areas. The importance of training tailored to a country's needs was highlighted in the 2008 report of the Task Force on Enhancing Education and Training for Health Workers (WHO, 2008). Rural placement is mandatory, but the rest of the program does not have a specific rural focus.
This rural and urban district academic platform will consolidate and integrate PHC renewal and create space for further expansion of the teaching platform.
Inter-professional Education and Collaborative Practice
Introduction
- Aims
IPE is defined by the WHO as "the process by which a group of more than two professions, specifically students from health-related professions with different educational backgrounds, learn together during certain periods of their training with interaction as an important objective". The WHO (2010) emphasizes the following: “Governments around the world are looking for innovative, system-transforming solutions that will ensure the appropriate supply, mix and distribution of the health workforce.
Inculcating and assessing core competencies for ICP (See Chapter 7)
- Uni-professional competency frameworks
- IPE-specific competency frameworks
Describing and defining interprofessional competencies turned out to be a much more difficult task, because at the moment the field of interprofessional education and care is still not well understood.” In the Canadian framework (Fig. 6.1), interprofessional communication and patient/client/family/community-centred care are seen as 'supportive domains'. The IPEC's brief to its expert panel was to recommend a core set of competencies relevant across the professions for ICP as well as learning experiences and educational strategies for achieving the competencies.
Such an approach emphasizes "the essential behavioral combinations of knowledge, skills, attitudes, and values that constitute a 'collaborative practice-ready' graduate" (AACN et al., 2011).
Goal: Inter-professional Collaboration
A partnership between a team of healthcare providers and a client in a participatory, collaborative and. coordinated approach to shared decision-making around health and social issues. a Collaborative practices are crucial for the safety and quality of service users. This agrees well with Bainbridge et al. 2010) who explain that IPE competency statements “identify specific knowledge, skills, attitudes, values and judgments that are dynamic, developmental and evolutionary”. This implies that competencies are not static but must be adapted to changing population needs (Thistlethwaite et al., 2014).
Three skill levels are described, namely, 'novice' (a student at the end of the first year of an undergraduate degree); 'intermediate' level (a student at the end of the second or third year of an undergraduate degree) and 'entry into practice' (a student at the end of the final year of an undergraduate degree).
E TY &
CLIENT CENTRED
- Value of the international IPE competency frameworks
- Assessment of IPE competencies
- Summary
- Adopting an inter-professional approach to individualised healthcare
Students who do not see HCPs working together in practice are unlikely to believe that interprofessional practice collaboration is important. However, assessment of interprofessional competence should not only look at individuals, but also at the performance of the team as a whole (Thistlethwaite et al., 2014). An exception is the use in Canada of the behaviorally based Interprofessional Collaborator Assessment Rubric (ICAr) (Curran et al., 2011).
Inter-professional learning (IPL) is dynamic and IPE should follow a graded approach progressing from 'exposure' (or 'entry level') in the early years through 'immersion' (or 'intermediate level') and more at the end of "ownership". 'apprenticeship level' entry) before graduation.
Applications of ICF Framework
- The value of the ICF as conceptual framework to facilitate IPECP
- Empower role models through faculty development and capacity building
- Challenges to the introduction and delivery of an IPE curriculum
- The use of FD to address the challenges
- Early FD activities should be aimed at gaining an understanding of the education contexts of the other professions including opportunities for sharing
- and 3: Participants should agree on the IPE competency framework to be used and develop learning outcomes aligned with those competencies
- Barriers and enablers to IPECP and ways to address these challenges
- Stimulate discourse to research the impact of IPECP on HPE, patient outcomes and health systems
- Explore ways to ensure the sustainability of IPECP in South Africa .1 The current situation in South Africa
- Recommendations
Negativity also stems from staff not being involved in the planning of IPE initiatives (Lawlis et al., 2014). Healthcare workforce planning is an essential point of convergence for healthcare and education (Gilbert et al., 2010). In this context, Missen et al. 2012) believe that the inclusion of IPECP in the mission statements of health services is important.
Maintaining professional relationships with colleagues from other disciplines is essential to the success of IPE (Lawlis et al., 2014) and is a significant mediator of IPECP.
Core Competencies of South African Healthcare Professionals
Introduction
Key findings from the literature
- Competence and competency
- Competency-based education
- Perspectives of core and generic competencies
- Current competencies and standards in South Africa
Competency-based education dates back to the development of teacher education programs in the late 1960s in the United States. In theory, it originates from the behavioral goals movement, which has also been a major point of criticism against competency-based education. De-emphasizing time in a competency-based curriculum is a major point of discussion in the competency-based medical education (CBME) discourse.
Hybrid versions of competency-based education are proposed and currently being explored in CBME.
Medical Expert
Conceptualising core competencies
Competencies in each of these themes and subthemes are supported and informed by particular principles, values and contexts for healthcare practice.
Pedagogical approaches for achieving competencies
- Transformative pedagogy
According to Horsfall et al. 2012) contemporary pedagogy emerged from critiques of assumptions about teaching, learning and people, and new forms of knowledge and knowing. The latter thus challenges how we optimize students' abilities and prior learning skills, not just their knowledge, in a CBE approach (Frenk et al., 2010). Chapter 8 mentions the development of faculty members as leaders who, according to Frenk et al.
At the level of teaching and learning, Horsfall et al. 2012) outline some of the contemporary pedagogies, including involving students as active participants (student-centered learning), promoting dialogue and focusing on the.
C LCC L
Competency assessment
In a systematic review of the literature between 1999 and 2008, Lurie et al. 2009) found no evidence that current measurement instruments can independently assess generic competencies (in the context of postgraduate medical education). According to the authors, what matters is that competencies should guide and coordinate assessment efforts (rather than developing instruments to measure individual competencies) and that assessment should be integrated with the curriculum from the outset (Lurie et al., 2009;. More recently, authors such as Van der Vleuten et al., 2012) and Franklin and Melville (2015) argue for assessments to be done over time in various situations, including clinical settings, and a programmatic assessment model that assesses for learning rather than assessment of learn to optimize.
Impact on learning, also known as consequential validity, is based on the notion that assessment drives learning (Van der Vleuten et al., 2012).
Recommendations
Faculty Development
- Introduction
- What is faculty development?
- Faculty development literature
- Core competencies for educators
- WHO recommendations
- Key concepts related to FD
- Relationship-centred teaching and learning
- Transformative learning
- Chapter summary and recommendations
Furthermore, citing Wilkerson and Doyle (2011), they also emphasize “the need for continuous quality improvement strategies that enable the individual teacher to tailor his/her faculty development through self-assessment, peer and student assessment, reflection, planning and mapping their learning process. learning path”. They continue: “It is particularly useful in healthcare professions learning, where courses involve hands-on experiences, often including unplanned, opportunistic learning” and state that “the IPE curriculum is influenced not only by the contributions and interplay of the three different components, but also due to the different professions working in IPE and the diversity of the IPL students”. According to Anderson et al. 2014) individuals in these roles are the 'IPE Champion', the 'IPE Professional Leads' and 'IPE Facilitators'.
The shift from workshop-based development to the development of communities of practice is now a key feature of international faculty development.
Internship and Community Service in South Africa
Implications for Undergraduate Education
- Introduction
- Methodology
- Key findings from the literature .1 Medical internship
- Pharmacy internship
- Clinical and counselling psychology internship
- Community service
- Experiences of CS
- Non-medical HCPs
- Policy initiatives
- HPE as a continuum into early professional life for the strengthening of the health system
- Recommendations .1 Related to universities
- Related to professional councils
- Related to the Department of Health
- Related to the Department of Higher Education and Training
About 90% felt that they had contributed to the health of the community and that they had made a difference. A rotation of at least two months in rural district hospitals should be a compulsory part of the undergraduate curriculum. Every new health worker should be involved in teaching other health workers or in a project that promotes the health of the community they serve.
Universities and their faculties of health sciences should take responsibility for education and professional development from admission to the end of the SHK year.
Financing Health Science Education in South Africa
- Introduction
- Funding of health sciences education in South Africa
- Public funding of higher education: the university funding framework
- Financing clinical teaching and training
- Provincial health sciences training expenditure
- Challenges and opportunities
- Inadequate funding of high education and health professional training
- Inadequate long-term demand and supply-side planning
- Foreign training vs. expansion of local medical training programmes
- Nursing education
- Potential partnerships in health sciences education
- The Joint Health Sciences Education Committee – a critical role player
- Conclusions
- Recommendations
- Improve governance of health sciences funding
- Improve human resources for health planning, resource allocation and budgeting
As shown in Figure 10.1, the university funding framework consists of three different sources of income: government subsidies, student fees and third-stream income. As shown in Table 10.3, the HPTDg has not kept pace with CPI inflation – growing at just 4.6% per year over the past three years. So we can conclude that there is a problem in the way the grant has been designed, and some have suggested that the grant should be given directly to higher education institutions, who would then 'buy' the relevant clinical platform from the provincial DoHs.
Part of this relates to the short-term focus on budgeting – the three-year MTEF is short compared to a decade or more needed for HRH planning, resource allocation and budgeting to meet the country's needs, such as increased enrollment and production of medical graduates .
