Bachelor of Clinical Medical Practice

Purpose

The purpose of this three year Bachelor degree is to train a competent, professional member of the health care team who will have with the necessary knowledge, skills and attitudes to function effectively as a clinical associate, who is able to assist, support and work alongside, and under the supervision of, a qualified medical practitioner, in consulting patients and doing clinical procedures, primarily in the district health system in South Africa.

This will improve communication with and education of patients and will enable medical practitioners to provide more comprehensive care and services to patients and communities. It will also relieve nursing staff of duties they are presently fulfilling as a result of the current doctor shortage. The curriculum for the clinical associate is designed to integrate knowledge of biomedical and clinical sciences and skills so as to manage common and important conditions seen in the district hospitals in South Africa and to perform relevant procedures. After successful completion, it will enable the graduate to register with the Health Professional Council of South Africa and practice as a clinical associate within the health service in South Africa.

Rationale

The focus should be on the following

• Range of typical learners.
• Providing added value to qualifying learners.
• Occupation, jobs or areas of activity in which qualifying learners will operate.
• Proof of demand for the qualification-Benefit to society and the economy.
• Evidence of planned combination of outcomes which have a defined purpose and will provide learners with applied competence and a basis for further learning).

The midlevel medical worker cadre is part of the Department of Health's Human Resource Plan. Presently there is a severe shortage of doctors in South Africa, especially in rural hospitals. Nurses try to supplement the doctors' work thus neglecting their own nursing duties and patients do not receive optimal care. Work overload compromises the quality of service. There is thus a gap for a midlevel medical worker (clinical associate) functioning under the supervision of and alongside a doctor to relieve the doctor of certain tasks and procedures in the context of district hospitals. Clinical associates will enable the health care team to deliver a better quality of care to patients.

The clinical associate will perform specific procedural, assessment and management functions in the district hospital.

This will create a new career opportunity within the health care team.

Midlevel medical workers trained in other countries already work in South Africa and are registered with the Health Professional Council of South Africa. Even in the absence of doctor shortages, many other countries, developed and developing, have seen the need for and usefulness of a cadre of worker who is sufficiently trained to provide important support for the doctor and perform particular tasks within the health care team. It is critical that appropriately trained and qualified midlevel medical workers are produced in South Africa, and it is believed that Wits is in a position to achieve this.

• English, Mathematics, Physical Science or Biology as above.
• An African Language.
• Knowledge of a local indigenous culture.

Access to the qualification

The following criteria are used to admit students to the undergraduate qualifications iIn the Faculty of Health Sciences and selection for The BCMP will use the same methods:

• Academic rating.
• Biographical questionnaire.
• Selection tests.
• Interviews-special cases (any degree if deemed necessary) and GEMP applicants.

Biographical questionnaire score

The biographical questionnaire score will be out of 20. For 2008 admissions, a combined (80:20) Composite Index will be considered. Where no BQ is available the application will be considered incomplete and not be assessed.

The same questionnaire to be completed by all applicants and marked according to the mark sheet, with sections specific to undergraduate and GEMP applicants.

Unsatisfactory referee reports to be referred to the Assistant Dean (Student Affairs) for assessment.

Interviews

Interviews will only be granted to special case applicants as deemed necessary by the Special Cases Committee and to twice the number of GEMP applicants in relation to the number of places available.

The interview is used to assess accurately the Biographical Questionnaire and the suitability of the applicant for a career in the health professions as per the guidelines for interviewers. Interview score for GEMP and Special Cases Committee applicants will be out of 10.

Admission requirements for eligibility

NOTE: The minimum admissions requirement is a matric exemption unless otherwise stated.

BCMP programme

Admission and selection in accordance with the admission criteria for the Faculty of Health Sciences as specified above, with the requirements:

• Mathematics; Pass HG or min 50% SG*.
• Physical Science or Biology; Pass HG or min 50% SG*.
• English; Pass HG*.
• These apply for admissions in 2008, i.e. before the National Senior Certificate replaces current Matric exemption.

Core

• NQF Level 5: 96 Credits.
• NQF Level 6:300 Credits.

Total: 396 Credits.

Elective

• NQF Level 6: 36 Credits.0; 36; 0; 0; 36.

Total:36 Credits.

Total number of Credits: 432 Credits.

Exit-Level Outcomes

1. Perform a patient-centred consultation across all ages in a district hospital.
2. Apply clinical reasoning in the assessment and management of patients.
3. Perform investigative and therapeutic procedures appropriate for a district hospital.
4. Prescribe appropriate medication within scope of practice.
5. Provide emergency care.
6. Facilitate communication and provide basic counselling.
7. Function as an effective member of the health care team.
8. Produce and maintain clinical records.
9. Function as an ethical practitioner.
10. Demonstrate ongoing learning in clinical practice.
11. Integrate understanding of family, community and health system in practice.

Critical Cross-Field Outcomes

(a) "Identifying and solving problems in which responses display that responsible decisions using critical and creative thinking have been made".

Refer to the following Exit Level Outcomes: 1, 2, 3, 4, 5, 6, 7, 8, and 11.

(b) "Working with others as a member of a team, group, organisation, community".

Refer to the following Exit Level Outcomes:1, 2, 3, 4, 5, 6, 7, 9, and 11.

(c) "Organising and managing oneself and one's activities responsibly and effectively".

Refer to the following Exit Level Outcomes:1,3, 5, 6, 7, 8, 9, and 10.

(d) "Collecting, analysing, organising and critically evaluating information".

Refer to all Exit Level Outcomes.

(e) "Communicating effectively using visual, mathematical and/or language skills in the modes of oral and/or written persuasion".

Refer to the following Exit Level Outcomes: 1, 2, 3, 4, 5, 6, 7, 8, and 11.

(f) "Using science and technology effectively and critically, showing responsibility towards the environment and health of others".

Refer to the following Exit Level Outcomes:1, 2, 3, 4, 5, 8, and 11.

(g) "Demonstrating an understanding of the world as a set of related systems by recognising that problem-solving contexts do not exist in isolation".

Refer to the following Exit Level Outcomes:2, 4, 7, 8, 9, and 11.

(h) "Contributing to the full personal development of each learner and the social and economic development of society at large, by making it the underlying intention of any programme of learning to make an individual aware of the importance of:

> "Reflecting on and exploring a variety of strategies to learn more effectively".

Refer to the following Exit Level Outcomes: 1, 2, 3, 4, 5, 6, 7, 8, 10, and 11.

> "Participating as responsible citizens in the life of local, national and global communities;"-see ELO; note also that learners act in accordance with the code of conduct of the University and, where relevant, that of the professional discipline".

Refer to the following Exit Level Outcomes: 1, 4, 5, 6, 7, 8, and 11.

> "Being culturally and aesthetically sensitive across a range of social contexts".

Refer to the following Exit Level Outcomes: 1, 2, 3, 4, 5, 6, 7, and 11.

> "Exploring education and career opportunities".

Refer to the following Exit Level Outcomes: 10.

> "Developing entrepreneurial opportunities".

Refer to the following Exit Level Outcomes: 7. 8.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 1

• Patient's needs and problems are identified by effective listening.
• A relevant history is taken.
• An accurate and relevant physical examination is performed.
• Diagnostic tools are used effectively.
• Continuity of care is ensured by making arrangements for follow up and review.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 2

• High-risk situations and conditions in patients are timeously identified.
• Hypotheses are made from information obtained (differential diagnoses).
• Collaboration with the patient occurs in all aspects of the consultation.
• Assessment based on information (history, physical examination, investigation results) is made.
• Assessment is contextualised within the biopsychosocial model including preventive, promotive, curative and rehabilitative aspects.
• Management plan is based on the assessment and includes appropriate referrals e.g. rehabilitation.
• The assessment and management plan is presented to a supervising medical practitioner and is justified on the basis of information obtained.
• The assessment and management plan is reviewed on an ongoing basis, in consultation with a supervising medical practitioner, and adjusted accordingly.
• Special investigations are guided by information needed to confirm or reject a hypothesis.
• Assessment and management decisions take cost effectiveness into consideration.
• The results of relevant special investigations in common conditions are interpreted and the hypotheses are adjusted accordingly.
• Special investigations are guided by information needed to confirm or reject a hypothesis.
• The results of relevant special investigations in common conditions are interpreted.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 3

• Explain the procedure in lay and medical terms.
• List indications and contraindications for a specific procedure.
• Demonstrate ability to prepare for a procedure, including patient preparation.
• Perform procedures competently (based on the list of required procedures).
• Explain possible complications for the procedure.
• Explain follow-up and safety-netting following the procedure.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 4

• Demonstrate knowledge in basic pharmacology.
• Demonstrate knowledge of standard treatment guidelines and the drugs in the EDL (National Essential Drug List) appropriate for district hospitals, including indications, contraindications, side effects and drug interactions-apply knowledge in common and important conditions.
• Prescriptions including dosage and frequency are written correctly to comply with legal requirements and scope of practice.
• The prescription is explained to a patient (drug literacy, adherence).
• A history of over the counter, traditional, complementary and alternative drug use is taken into consideration.
• Knowledge of non-pharmacological therapies is demonstrated.
• Knowledge and skills to administer and dispense medication is demonstrated.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 5

• Potentially life-threatening conditions in patients are timeously identified and evaluated.
• Emergency conditions are managed and referred appropriately.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 6

• Patient's needs and problems are identified by effective listening.
• Health information is shared in appropriate cultural and language terms.
• Amount and level of information given to a patient is appropriate.
• A suitable environment is fostered to communicate with the patient and/or family.
• Patient feedback and questions are facilitated.
• Confidentiality is ensured.
• Basic counselling skills are demonstrated addressing the patient's needs.
• Appropriate solutions are explored.
• Mutual decision-making is facilitated.
• Continual support and follow-up is provided.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 7

• Demonstrate understanding of the roles, functions and relationships of all the members of the district hospital team.
• Enhance team functioning through appropriate attitude and behaviour as a team member or substitute team leader.
• Clinical information from patients is clearly and concisely communicated to other team members, and to supervising medical practioners in particular.
• Patients are handed over to colleagues appropriately.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 8

• Patient records and medico-legal forms reflect all relevant information accurately and legibly.
• Patient referral letters are completed appropriately.
• Patient statistics are complete and accurate.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 9

• Explanation is given to the patient about the role and functions of a clinical associate.
• The basic ethical principles are applied.
• The Batho Pele principles are applied to the work situation.
• Recognise ethical problems and manage them appropriately, and refer when necessary.
• Statutory and professional obligations are complied with.
• Demonstrate appropriate and sensitive attitude to patient, family, communities and colleagues.
• Demonstrate reliability in work situations.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 10

• Professional strengths and weaknesses are identified by reflecting on clinical practice.
• Clinical practice is continually improved based on identified needs through appropriate self-directed learning.

Associated Assessment Criterion/Criteria for Exit Level Outcomes 11

• Each patient is assessed and managed within the context of his or her family and community/social/work environment.
• An ecomap and genogram for a family is done when appropriate.
• Knowledge of the local district health system informs practice in terms of referrals, follow-up and interaction with other team members and resource persons (e.g. pastor, traditional healer) and organisations (NGOs, hospice, crisis care).
• Awareness of and appropriate involvement in local community oriented primary care.
• Understand quality improvement cycle or process and participate in quality improvement activities.
• The principles and practice of comprehensive primary health care (e.g. water, sanitation, nutrition, housing, pollution, personal health care, health programmes etc) as it affects individuals, families and communities are understood and dealt with appropriately.

Integrated Assessment

The student will be taught to integrate medical and clinical sciences in the clinical situation. The student will be assessed continuously in his/her ability to integrate the necessary knowledge skills and attitudes when dealing with clinical problems.

Integrated assessment is achieved by a variety of strategies, most notably in the assessments during and at the end of the courses. Integrated Assessment techniques include written examinations, skills tests, group and individual projects and assignments, field trips and practical examinations on clinical problems. Some of the criteria may be assessed through observation of the students during their clinical assessments classes.

The assessment will thus integrate practical, theoretical and reflective competence. In addition there will be written (multiple choice and modified essay questions), objective structured clinical and practical examinations and oral examinations which will require integration of information from different areas of the curricular content.

Formative integrated assessment will take place during seminar presentations, discussions and tutorials during which students will be expected to participate in self-assessment, peer assessment and assessment by members of the academic staff.