Master of Philosophy in Endocrinology

Purpose

The purpose of this qualification builds cognitive, clinical and practical skills specific to the endocrine system (tissues and major endocrine glands, including the pituitary, pineal, thyroid, parathyroid, thymus, adrenals, pancreas, ovaries, and testes) to specialists in internal medicine (Internists).

Upon qualifying the learner will be able to

• Recognise and evaluate endocrine and metabolic diseases.
• Conduct a clinical history and perform a clinical examination of a patient with an endocrine or metabolic disorder.
• Manage endocrinological and metabolic emergencies.
• Understand the basic sciences and research techniques underpinning endocrinology and diabetes including literature searches, reviewing evidence, critical appraisal of scientific literature, use of databases, writing papers and articles and correct application of statistics.

Rationale

South Africa has a critical shortage of qualified Endocrinologists to address non-communicable diseases (NCD) such as diabetes, obesity, dyslipidaemia and other prevalent endocrine disorders including thyroid disease, endocrine hypertension, growth disorders, metabolic and other related disorders. The prevalence of obesity has doubled over the last 30 years due to the increasing population in South Africa furthermore; In NCDs have caused 29% of deaths in South Africa. Consistent with the vision of the National Department of Health, the Master of Philosophy in Endocrinology intends to develop scarce skills that will address the unique health care needs of the growing South African population.

Endocrinology is recognised and prescribed in terms of subsection (2) of section 35 of the Health Professions Act 56 of 1974, subject to regulation 4, as a Registrable Subspecialty of the Basic Speciality Paediatrics and Medicine with the designation Endocrinologist. The Master of Philosophy in Endocrinology addresses the need for capacity building and the development of scarce skills in the application of clinical Endocrinology as a subspecialty of Internal Medicine. This qualification intends to train registered specialists to become subspecialists (or "post- or super-specialists") in Endocrinology - one of a range of subspecialties officially recognised by the Health Professions Council of South Africa (HPCSA).

The qualification is proficiently developed by experts, within the framework of international comparability, occupational demands and requirements. It is also aligned with the national priorities in the Health Sector and complies with the criteria, norms and standards set by the HPCSA.

With regards to the stakeholder needs the qualification also meets national requirements since it is aligned with the Higher Education Qualifications Sub-Framework (HEQSF) which supports the goal of expanded access and responsiveness to address emerging skills and knowledge needs and in addition to provide for greater flexibility and options with respect to this professionally-oriented subspecialty qualification to meet the varying needs of the stakeholders and communities they serve. In addition, the Master of Philosophy Endocrinology allows a learner to obtain a nationally recognised qualification that permits access to horizontally and vertically articulated qualifications within the National Qualifications Sub-Framework, enhancing the status and employability of medical specialists committed to clinical endocrinology. The Health Professions Council of South Africa (HPCSA) as the professional body was consulted to determine whether this particular qualification meets the requirements for professional registration, membership or licensing. In addition, the Health Professions Act 56 of 1974 stipulates regulations relating to this subspeciality in medicine (published under government notice R590 in Government Gazette 22420 of 29 June 2001) sets the requirements for registration of the subspeciality by a medical specialist with the board and declared that they recognise this subspeciality qualification.

Recognition of Prior Learning (RPL)

RPL for access: In exceptional cases, based on merit, where applicants do not meet the minimum admission requirements a learner will be considered for access in compliance with the institutional RPL Policy. This includes approval of the faculty committee, on the recommendation of the academic Head of Department, with notification to the Executive Committee of Senate ECS. RPL is granted on the strength of a standard of proficiency that is sufficient for the purposes of postgraduate advanced study in the subspeciality. The rules and regulation of the HPCSA and the CMSA will be adhered to.

RPL for exemption: Based on the RPL Policy of the institution, learners may be granted exemption from required components of the qualification, fully or partially, on the basis of comparable training and clinical experience in the specific subspeciality, gained at another institution. The maximum admissible period of exemption is 12 months.

Entry Requirements

Admission requirements for the following qualification are as follows

• Learners must be registered for independent practice as a specialist Internal Medicine physician with the Health Professions Council of South Africa or equivalent for the country of origin.

Or

• Learners must be in possession of a Bachelor of Medicine, Bachelor of Surgery (MBChB) and FCP (SA) (College Fellowship).

Or

• MMed (Internal Medicine).

Or

• FC Internal Medicine (SA) (College Fellowship).

In addition to the above-mentioned entry requirements, the learner must also comply with the Health Professions Council of South Africa (HPCSA) requirements for registration of a subspeciality as follows:

• Submit a certificate to the board, issued by the relevant faculty of medicine or health sciences in South Africa, to certify that - they have obtained education and training in the relevant subspeciality of at least two years as the holder of a post of subspeciality trainee approved by the board under control of a unit in a teaching hospital which had been accredited by the board as a teaching unit in the said subspeciality.

Or

• Submit proof to the board that he or she, prior to commencing with education and training in the relevant subspeciality, complied with all the requirements for registration as a specialist in the basic or one of the basic specialities listed against the relevant subspeciality in regulation 4 of the Act and that he or she had been registered as a specialist in that speciality.

Or

• If learner has qualified after 1 January 2002, the learner must submit proof to the board that he or she passed an evaluation in the relevant subspeciality which had been approved by the board.

The Government Gazette, Gazette No 17721, Notice No 67, Regulation Gazette No. 5838 of 17 January 1997, in addition stipulates that: "In the case of the subspeciality endocrinology he or she shall, subsequent to having complied with all the requirements for registration in the speciality medicine or paediatrics, obtain two years' clinical experience in endocrinology as the incumbent of a clinical appointment acceptable to the council under the control of a unit in a teaching hospital recognised by the council as a training unit in endocrinology'.

This qualification comprises compulsory modules at NQF Level 9, totalling 300 Credits.

Compulsory modules at NQF Level 9 (practical work, skills and procedures)

• Module 1: Advanced Endocrinology I, 120 Credits.
• Module 2: Advanced Endocrinology II, 120 Credits.
• Mini-dissertation, 60 Credits.

1. Recognise and evaluate endocrine and metabolic diseases.
2. Conduct a clinical history and perform a clinical examination of a patient with an endocrine or metabolic disorder.
3. Manage endocrinological and metabolic emergencies.
4. Understand the basic sciences and research techniques underpinning endocrinology and diabetes including literature searches, reviewing evidence, critical appraisal of scientific literature, use of databases, writing papers and articles and correct application of statistics.

Associated Assessment Criteria for Exit Level Outcome 1

• A high level of theoretical knowledge in endocrine and metabolic diseases is demonstrated.
• The endocrine and metabolic diseases, crine and metabolic disorders based on theoretical knowledge of endocrine and metabolic diseases, including epidemiology, aetiology, pathogenesis, pathology, clinical features and management of these diseases are evaluated.

Associated Assessment Criteria for Exit Level Outcome 2

• Detailed physical assessment and analysis of patients is conducted.
• The laboratory data, interpretation of special physical features, interpretation of molecular and other diagnostic tests is demonstrated.
• Appropriate counselling for both individuals and families is performed.
• Certain procedures, extraction of relevant clinical information from a patient's medical record are performed.

Associated Assessment Criteria for Exit Level Outcome 3

• Endocrinological and metabolic emergencies are appropriately managed; modalities required interpreting metabolic changes, and changes that accompany the endocrine or metabolic disease as well as the progression of disease are correctly selected.
• Pharmacology and pharmacokinetics of drugs used in the endocrine and metabolic diseases and endocrine hormone replacement therapy are administered.

Associated Assessment Criteria for Exit Level Outcome 4

• The basic sciences and research techniques underpinning the practice of clinical endocrinology and diabetes is described.
• The literature to apply results from the relevant clinical sciences to the management of the endocrine patient is interpreted.
• Evidence is reviewed, the correct use of statistics is applied and the scientific literature is critically appraised to draw conclusions about endocrine physiology, pathology and clinical care.

Integrated Assessment

The qualification provides for both formative and summative assessments. The formative assessment focuses on the theoretical knowledge as well as the integration of knowledge and competencies during practical examination sessions that include clinical cases. For the purposes of this qualification's summative assessment, learners are subjected to the Colleges of Medicine of South Africa examination. Fellowship in the Sub-Specialty in Endocrinology and Metabolism of the College of Physicians of South Africa: Certificate Endocrinology and Metabolism (SA) Physicians. Apart from written and practical examinations, learners are required to engage in a research project and to submit a mini-dissertation.

The assessment approach of the qualification is based on the principles of integrated assessment since the assessment activities are focused on the different dimensions of the purpose of the qualification which is to reflect critically on theory and its application. Integrated assessment takes the form of an appropriate variety of assessments for example: written and oral examinations, problem-solving assignments, projects, presentations, case studies, portfolios, log books, clinical reports and assessment of clinical competence through simulated and clinical assessment in situ, Objective Structure Clinical Examinations (OSCE) and the successful completion of a mini-dissertation.

Assessment associated with the Endocrinology curriculum is undertaken within the context of the learner's everyday clinical practice. As such it is implemented within the reality of current workplace and workforce issues and the needs of health service provision. Where applied competence is required, theory and practice are integrated and aligned with the level descriptors of an NQF Exit Level 9 qualification. Each module consists of both theoretical (assignments, Objective Structure Clinical Examinations (OSCA) and tests)) and clinical assessments (case studies and demonstration of clinical procedures) which challenges learners to integrate the knowledge and skills acquired and to deal with complex issues both systematically and creatively. The research project challenges learners to design and critically appraise research, make sound judgements using data and information at their disposal and communicate their conclusions clearly to specialist and non-specialist audiences in the Endocrinology environment.

The Colleges of Medicine (CMSA) also requires a six-monthly assessment of competence by the Head of the Endocrinology and Metabolism Training Unit.

Assessment of a logbook will be kept by the learner to record the details of all patients seen, details of research undertaken and manuscripts accepted or submitted for publication in the field of endocrinology and metabolism. These logbooks are reviewed, monitored and assessed by the Head of Department. The exit examination under the auspices of the CMSA consists of a written paper and an objective test as stipulated above.

Three major elements are drawn together in the assessment of the experiential learning in the programme, i.e. preparation, collaboration and reflection. In addition, networking forms a part of learners' self-assessment through discussion with peers and experts in the field. Learners attend departmental seminars where issues of progression in their tasks and clinical practice are raised, assessed and corrective action, if needed, arranged. Learners' involvement in their research project and the logbook and/or portfolio also serves as assessment of the experiential learning since their progress and actions needed to close the gap between desired and actual levels of performance are reflected on and addressed.