Master of Medicine in Cardiothoracic Surgery

Purpose

The purpose of the qualification is to prepare the learner for practice as a medical specialist. This qualification will allow the learner to apply for registration as a medical specialist, primarily with the Health Professions Council of South Africa (HPCSA), but also with the health regulatory agencies of other countries, who may place additional requirements on the learner. The target learners are medical practitioners with a basic medical qualification and at least three years of post-qualification experience. The learner will wish to complete this qualification to be registered as a specialist. This qualification will benefit the learner in that they will be eligible for registration and practice as a medical specialist.

The academic and professional pathway is via an undergraduate medical degree and registration as a medical practitioner with the HPCSA, followed by this master's-level qualification which qualifies the learner to register and practice as a specialist. After achievement, the learner will have the knowledge, skills, and experience necessary to practice as a specialist in the field of cardiothoracic surgery and will be responsible for exercising this knowledge and skill in the capacity of a medical specialist.

A qualified learner will be able to

• practise as a medical specialist in the field of cardiothoracic surgery,
• understand and conduct research in the biomedical field,
• embark on an academic career as a medical academic.

In addition, the following learner attributes will be integrated into the learning process: knowledge literacy, ability to solve complex problems in the medical domain, respect for ethics and professionalism in practice, management of information and knowledge production via research, professional communication in the context of medical practice and research, management of learning and accountability.

Rationale

The healthcare systems of all countries, including South Africa, require medical specialists in specific disciplines to apply a standard of care above that which the generalist practitioner can offer. Such specialists will provide patient care personally but are also responsible for raising the level of knowledge in their discipline amongst generalists, as well as being able to subspecialise further or to take responsibility for the teaching and training of undergraduate and postgraduate learners in the healthcare disciplines, and for the generation of knowledge via published experience and research. There is no similar qualification already registered on the SANQF.

The practice of a healthcare profession benefits society directly by promoting, maintaining and restoring health, and benefits the economy by contributing to the maintenance of a healthy workforce. The medical specialist has a critical role to play in the provision of healthcare. South Africa is under-supplied with medical specialists when compared with international norms. Medical specialisation may therefore be seen as a scarce skill and is remunerated as such in the public service. The qualification was developed in concert with all other South African universities offering specialist training, the HPCSA, the Colleges of Medicine of South Africa, the Medical Association of South Africa, the national and provincial departments of health, and with reference to international organisations responsible for the training of medical specialists in other countries.

The typical learner for the qualification is a medical practitioner with at least a bachelor's degree in medicine registered with the Health Professions Council, has at least three years of post-qualification experience, and wishes to train and practice as a medical specialist. Most qualifying learners will embark on specialist medical practice in the public or private sectors in South Africa, in the medical workforce of neighbouring and foreign countries, while some will enter academia as medical academics, undertake a full- or part-time research career, embark on medical administration in the public, private and corporate sectors or into the commercial sector, utilising their specialist medical knowledge in the context of the pharmaceutical industry or in areas of innovation in other industries, or join not-for-profit philanthropic organisations as providers of healthcare, advocates for healthcare or project managers.

The HPCSA, the professional body governing the health professions, cooperates with the relevant QC with respect to the qualification and quality assurance and conducts five-yearly on-site visits to evaluate the programme leading to qualification. Successful learners are immediately registrable with the HPCSA as medical specialists. They are, in principle, eligible for registration with the health regulatory bodies of other countries, though they may be subject to additional requirements.

The qualification is linked to a single profession: that of a medical specialist. The learning/work pathway is via an undergraduate medical degree followed by prescribed experience (in South Africa, internship and community service), which then articulate vertically with the Master of Medicine qualification. The successful learner is then eligible for admission to the specialist register of the HPCSA. In the South African public health sector, this permits the learner to progress from medical officer to specialist rank. Successful learners may also enter subspecialist training with subsequent admission to the subspecialist register of the HPCSA. This qualification, therefore, has important implications for career progression and mobility within the work environment.

Recognition of Prior Learning (RPL)

The institution has Approved Guidelines for the Recognition of Prior Learning (2024), which are applicable in respect of equivalent qualifications for admission into the qualification. RPL for access and exemption will not apply to this qualification, given its narrow focus. All learners must complete the prescribed modules, or comparable modules at another institution via credit accumulation and transfer.

Entry Requirements

• Bachelor of Medicine and Bachelor of Surgery, NQF level 8

Or

Recognised equivalent degree

And

have held such qualification for at least two years prior to registration, satisfy the requirements of the HPCSA to enter specialist training, are appointed to a specialist training "(registrar" post)" by the KwaZulu-Natal Provincial Department of Health or, in the case of foreign-qualified doctors who do not hold full South African registration, are given limited registration for training purposes by the HPCSA and may only be employed in unpaid specialist training posts designated as "supernumerary".

This qualification comprises of seven compulsory modules at National Qualifications Framework Level 9, totalling 360 Credits.

Compulsory Modules, NQF Level 9, 360 credits

• Research Methodology, 14 credits
• Research Project, 90 credits
• Cardiothoracic Surgery Clinical and Professional Practice 1, 52 credits
• Cardiothoracic Surgery Clinical and Professional Practice 2, 52 credits
• Cardiothoracic Surgery Clinical and Professional Practice 3, 52 credits
• Cardiothoracic Surgery Clinical and Professional Practice 4, 52 credits
• Cardiothoracic Surgery Clinical and Professional Practice 5, 48 credits

1. Posses the knowledge, skills and attitudes required for specialist practice in the discipline, recognise the limits of their expertise and seek assistance when required, utilise finite healthcare resources appropriately and understand practice in contexts other than the training institution (Professional competence).
2. Understand professional behaviour, ethical behaviour and medical ethics and practise med-icine professionally and ethically (Professionalism).
3. Establish effective and ethical therapeutic relationships with patients, families and commu-nities; communicate efficiently and appropriately with patients, families, communities, health professionals and external organisations and institutions; and keep adequate records (Com-munication).
4. Incorporate the knowledge, skills and perspectives of other health professionals into the management of patients to improve outcomes and demonstrate appropriate interpersonal skills and personal behaviour in their interactions with seniors, juniors, peers and colleagues from other disciplines and professions (Partnership).
5. Manage their work, career and practice effectively, manage a care team effectively, under-stand the strengths and weaknesses of the health care system and factor this into their prac-tice, and promote the success of health care and health education in the context in which they work (Management and leadership).
6. Respond to the needs of their patients and the communities they serve, and promote their interests (Advocacy).
7. Maintain and enhance professional competence through a commitment to lifelong learning, practice medicine in a spirit of enquiry, contribute to a general improvement in practice within a particular context, understand the research process, initiate and conduct a research project, and facilitate the learning of others (Scholarship).

Associated assessment criteria for Exit Level Outcome 1

• Practises to the standard appropriate to an entry-level specialist.
• Demonstrates the competencies required of an effective specialist in the South African context, and the specific competencies required of the discipline.
• Manages generic problems which are not specific to the discipline but are commonly en-countered, effectively.
• Assesses the patient accurately and comprehensively.

Associated assessment criteria for Exit Level Outcome 2

• Practises medicine with an understanding of professional behaviour, ethical behaviour and medical ethics.

Associated assessment criteria for Exit Level Outcome 3

• Establishes effective and ethical therapeutic relationships with patients and families and, where appropriate, communities.
• Accurately elicits and synthesises relevant information from patients, families and other health professionals.
• Communicates efficiently with patients, families and communities and with other health pro-fessionals in the course of clinical care.

Associated assessment criteria for Exit Level Outcome 4

• Readily incorporates the knowledge, skills and perspectives of colleagues and members of other health professions into the management of patients to improve outcomes.
• Works effectively with seniors, peers and juniors within the immediate working environment.
• Demonstrates appropriate interpersonal skills and personal behaviour in their interactions with colleagues.

Associated assessment criteria for Exit Level Outcome 5

• Promote the success of health care and health education in the context in which they work.
• Explains the strengths and weaknesses of the healthcare system.
• Manage career and practice effectively.

Associated assessment criteria for Exit Level Outcome 6

• Identify the health needs of the community they serve.
• Acknowledges the contribution of institutional partners in the health of our communities, and exploits these to improve both individual patient care as well as to promote health more generally.
• Recognise vulnerable or marginalised populations, adapts clinical management to their needs, and works to improve their condition.
• Speak knowledgeably in support of efforts to promote health in whichever context the oppor-tunity arises.
• Apply the ethical and professional principles inherent in health advocacy, including altruism, social justice, autonomy, integrity and idealism.

Associated assessment criteria for Exit Level Outcome 7

• Maintains and enhances professional competence through a commitment to lifelong learing.
• Practices medicine in a spirit of enquiry.
• Contributes to a general improvement in practice within a particular context.

The assessment strategy is comprehensive and integrated. Knowledge and its application are assessed via formal written examination and oral examination. Practical skills and procedures are assessed via live clinical examination, portfolios, logbooks and formal sign-off of entrustable professional activities (EPAs). Logbook must include 75 Cardiac cases and 80 major thoracic cases as primary surgeon. Behavioural and attitudinal aspects are assessed along with general competence in clinical supervisor reports, semesterised comprehensive evaluations and portfolios, and written and oral assessments at the end of each semester.

Knowledge of research methodology is assessed by the evaluation of a research protocol developed by the learner. Research competence is assessed by submission of a Master's-level dissertation formally examined by external or internal and external examiners.

Unless otherwise indicated, all assessments are integrated and do not focus exclusively on a single learning outcome.

Formative Assessments

Semesterised comprehensive evaluation

These competencies are assessed on a 6-monthly basis by a discipline-based assessment panel, which consists of the academic head of discipline and other staff members in the discipline. The learner is assessed in terms of all the exit-level outcomes, including their academic, professional and research progress. Although this assessment is essentially formative, the rules for the programme allow the School Examinations Board to place learners with a poor record on probation, impose probationary conditions and recommend subsequent academic exclusion where these conditions are not met or performance remains unsatisfactory.

Logbooks, clinical supervisor reports and portfolios

Logbook entries assess how much exposure learners have to different modalities and procedures as they progress through specialist training. Cases are marked as observed, supervised and unsupervised. The logbook is also used to assess the learner's competency levels throughout the training program, as they are expected to report cases and perform procedures unsupervised at the end of the training program. Logbooks monitor learner progress through the program, allowing for additional exposure where there is unsatisfactory performance. Progress in the research project is assessed at four quarterly research meetings.

Oral and clinical assessments

These are used to assess holistic competence, including knowledge, practical skills, behaviours and contextualisation of health in the local community. The following are assessed the end of each semester; written assessment, oral assessment, case presentation, clinical assessment, imaging assessment (chest radiology, CT scans), echocardiogram, angiogram.

Summative Assessment

Knowledge, understanding and clinical skills are assessed through the national summative Fellowship of the College of Cardiothoracic Surgeons of South Africa examinations, administered by the Colleges of Medicine of South Africa on behalf of the University and prescribed by the Health Professions Council of South Africa. These examinations are:

Part 1(a) of the Fellowship Examinations

Scope of assessment: Anatomy, physiology, pathology

Format of assessment: 2 MCQ papers

Part 1(b) [Intermediate] Fellowship Examination

Scope of assessment: ICU and critical care, surgical elective and emergency management, organ system failure and management, TPN, trauma

Format of assessment: 2 MCQ papers, oral examination

Part 2 of the Fellowship Examinations

Scope of assessment: Congenital and acquired heart surgery, thoracic surgery

Format of assessment: Written 2 3hour papers, Oral examination, case studies, clinical management, investigation, and management (including surgery), radiology (Chest radiographs, CT scan, MRI), echocardiography, angiogram.