Master of Philosophy in Geriatric Medicine

Purpose

The purpose of this qualification builds cognitive, clinical and practical skills specific to clinical training to specialists in Geriatricians.

Upon qualifying the learner will be able to

• Conduct a comprehensive review of leading and current research in the subspecialty to produce significant insight.
• Engage with critique current practices in Geriatric Medicine.

Rationale

All medical practitioners are finding that an increasing proportion of their patients are older and look to Geriatricians for expert advice and opinion. The roles currently filled by Geriatricians are varied as their training and expertise make the Geriatrician's services extremely valuable across the broad spectrum of health care. The specific role undertaken by Geriatricians is of utmost importance since the proportion of older people in the general population is increasing worldwide, including South Africa, where more than 5% of the general population is currently 65 years and older. The main drivers for the aging population are socio-economic development, lower infant and childhood mortality rates, and improved health care and survival of middle-aged and older people. This resulted in a greater proportion and in the number of elderly patients. Due to specific physiologic changes that accompany aging together with increased life expectancy of those suffering from chronic diseases and disability, the health care needs of older persons are unique. A need has developed for a cadre of suitably qualified clinicians to take care of the specific and unique health care needs of a growing elderly population.

Geriatric Medicine 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 subspeciality of the Basic Speciality in Medicine with the designation Geriatrician.

Although medical practitioners and specialists in South Africa assume responsibility for the diverse healthcare needs of the elderly, the country has a critical shortage of qualified Geriatricians and only a few medical schools are available to provide subspecialty training. Furthermore, the elderly population of South Africa will increase significantly over the next two decades. Consistent with the vision of the National Department of Health, the Master of Philosophy in Geriatric Medicine intends to develop scarce skills that will address the unique health care needs of the expanding elderly population of South Africa which is to address acute geriatric internal medicine and rehabilitation care of older people in the hospital setting, hospital consultation/liaison services, outpatient clinics and domiciliary care.

The Master of Philosophy in Geriatric Medicine 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 the comprehensive care of the elderly. This qualification intends to train registered specialists to become subspecialists (or "post- or super-specialists") in Geriatric Medicine, one of a range of sub disciplines officially recognised by the Health Professions Council of South Africa. This recognition underscores the investment in and necessity for scarce skills development, the building of specialised capacity and advanced competency in the field of Medicine, in particular Geriatric Medicine, within the context of advanced learning and in depth research.

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. 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 thus adhering to the criteria that professional bodies have a role, derived from legislation or undertaken in terms of international professional conventions or agreements, to set requirements for professional registration, membership or licensing and to regulate professional conduct in the field of the subspecialty. 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.

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. 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 Health Professions Council of South Africa (HPCSA) and the Colleges of Medicine of South Africa (CMSA) will be adhered to.

Entry Requirements

Admission requirements for the following qualification are as follows

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

Or

• Learners must be in a possession of a Bachelor of Medicine and Bachelor of Surgery (MBChB) and MMeD (Internal Medicine).

Or

• Relevant Fellowship of the College of Physicians: CP (CMSA).

Or

• Equivalent qualification.

In addition to the above-mentioned entry requirements, the learner must also comply with the 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.

Or

• Registration as a specialist in the basic or one of the basic specialities listed.

Or

• 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.

Government Gazettes 17721 Notice No 67 of 1997 stipulates that: "In the case of the subspeciality geriatric medicine he or she shall, subsequent to having complied with all the requirements for registration in the speciality medicine, obtain two years' clinical experience in geriatric medicine 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 geriatric medicine."

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

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

• Module 1, Advanced Geriatric Medicine I (Theory and Clinical Practice) 120 Credits.
• Module 2, Advanced Geriatric Medicine II (Theory and Clinical Practice) 120 Credits.
• Mini-dissertation 40 Credits.

N/A

Associated Assessment Criteria for Exit Level Outcome 1

• Current processes of knowledge production are correctly evaluated and an appropriate process of enquiry for the area of Geriatric Medicine practice is chosen.
• Current practices in Geriatric Medicine are appropriately engaged with and critiqued.
• Autonomous ethical decisions are suitably made and effectual contributions to the development of ethical standards in a Geriatric Medicine context are made.
• A range of advanced and specialised skills and discourses appropriate to the practice Geriatric Medicine are used to contribute to academic teaching and to the advancement of new knowledge in the subspecialty.
• Autonomous ethical decisions are suitably made and effectual contributions to the development of ethical standards in a Geriatric Medicine context are made.

Associated Assessment Criteria for Exit Level Outcome 2

• Methods, techniques, processes and technologies are appropriately and creatively selected and applied to complex clinical and theoretical problems in Geriatric Medicine.
• A wide range of specialised skills in identifying, conceptualising, designing and implementing methods of enquiry to address complex and challenging problems within the Geriatric Medicine practice are correctly and satisfactorily used.
• Interventions at an appropriate level are clinically correctly made and the intended and unintended consequences of such interventions are appropriately addressed.

Integrated Assessment

The qualification provides for both a formative and summative assessment. The formative assessment focuses not only on theoretical knowledge, but also on 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, i.e. the Fellowship in the Sub-Specialty in Geriatric Medicine of the College of Physicians of South Africa: Certificate Geriatric Medicine (SA). Apart from written and practical examinations, candidates 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 methods for example; written and oral examinations, problem-solving assignments, projects, presentations, case studies, portfolios, log books, clinical reports, 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 Geriatric Medicine curriculum is undertaken within the context of the student'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, OSCAs 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 Geriatric Medicine environment. Submission of the completed prescribed portfolio for Cert Geriatric(Sa) Training, which has been certified by the head(s) of the department(s)/division(s)/unit(s) in which the candidate trained is also required.

Formal evaluation/examination is an examination under the auspices of the Colleges of Medicine of South Africa (CMSA), which will be held twice a year and which may be taken after a minimum training period of 18 months. There are at least four examiners, of which at least two will be Registered Geriatricians and the others General Internal Medicine Specialists or subspecialists with an interest in Geriatric Medicine. At least two of the examiners will be from centres other than that of the candidate.

The logbook will have to be submitted to the Colleges of Medicine of South Africa (CMSA) before the formative assessment at the time of the examination. This is evidence of:

1. All new patients and follow - up patients managed.
2. Practical procedures performed.
3. Academic activities involved, i.e. clinical and scientific meetings, courses and involvement in research projects.

These logbooks are reviewed, monitored and assessed by the Head of Department.

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.