Master of Philosophy in Infectious Diseases

Purpose

The Master of Philosophy in Infectious Diseases aims to educate and train medical specialists already in a clinical discipline such as internal medicine, paediatrics or pathology (microbiology/virology) to become infectious diseases sub-specialists with expertise in clinical infectious diseases, microbiology/virology and infection prevention and control (IPC). Qualifying learner will be experts in all aspects of diagnosis and management of organ, organ system and organism-specific infections. Qualifying learner will be able to, through research, contribute to the development of knowledge in Infectious Diseases.

The Master of Philosophy (MPhil) (Infectious Diseases) is designed to produce competent Infectious Diseases sub-specialists with expertise in clinical infectious diseases and microbiology/virology. Their training will combine clinical experience in infectious diseases medicine with laboratory training in microbiology and virology. The Infectious Diseases sub-specialist will have true expertise in all principles of communicable diseases including epidemiology, infection prevention and control and tropical health. The Infectious Diseases specialist will be a uniquely trained clinician fully capable to provide effective, ambulatory-based medicine and hospital-based clinical consultation and management. Finally, the Infectious Diseases specialist will also be able to perform invaluable roles in both the public and private sector in sectors such as hospital epidemiology and infection prevention and control, as well as rational utilisation of antimicrobial, anti-viral and anti-fungal medicine.

Rationale

Globally, infectious diseases constitute the single largest burden of illness afflicting mankind, especially in the poorer regions of the world. The impact and future of the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) and tuberculosis pandemics and of novel, emerging and re-emerging infectious diseases necessitates the training of infectious diseases (ID) experts for the continent. Infectious Diseases and in particular human immunodeficiency virus (HIV) and tuberculosis (TB) dominate the health landscape of South Africa (SA). South Africa faces about 5.5 million HIV-infected persons and with a TB incidence of about 1 000 per 100 000 it has one of the highest burdens of disease for these two infections in the world. Roughly 80% of newly diagnosed TB patients in SA are co-infected with HIV. Together HIV and TB constitute the largest burden of premature mortality in SA, accounting for 22%.

Other infections include community-acquired infections, imported infections as well as hospital-acquired infections. These pose an additional threat to the public health. South African hospitals, as in the rest of the world, have to deal with an alarming increase in Hospital-Acquired Infections (HAIs). These infections include multidrug-resistant organisms for which very limited or no treatment options remain. Hospital acquired infections increase morbidity, lengthen hospital stay (and costs), and impact negatively on in-hospital mortality. An outbreak like the influenza pandemic of 2009 is another reminder of the potential threat that infectious diseases can place on our health care system at any time. With this background South African universities need to produce competent infectious disease sub-specialists with expertise in clinical infectious diseases, microbiology, virology, parasitology, infectious diseases epidemiology, infection control practice, outbreak investigation and infectious disease research methodology.

This qualification will offer specialists in internal medicine, paediatrics and pathology (microbiology/Virology) the opportunity to extend their training to a sub-speciality where they will become competent in the diagnosis and management of infectious diseases. The qualification aligns with the national priorities in the Health Sector and complies with the criteria, norms and standards set by the Health Professions Council of South Africa (HPCSA). The establishment of this qualification is moreover supported by the Federation of Infectious Diseases Society of South Africa (FIDSSA).

The learner enrolling for this Master's Degree will be prepared for a career as an expert in the field of Clinical Infectious Diseases. This qualification will enable qualifying learner to register at the HPCSA as Infectious Diseases sub-specialists.

Recognition of Prior Learning (RPL)

A possible exemption, fully or partially, based on comparable training and experience gained at another institution could be granted by the institution. Recognition of Prior Learning (RPL) will give learners exemption from applicable components of the qualification. Implementation of the process will be in strict adherence to the relevant University RPL Policy. The faculty's RPL committee will assess the learner's portfolio thoroughly against the relevant learning outcomes.

In exceptional cases, based on merit, where learners do not meet the minimum admission requirements learners will be considered for access in compliance with the institution's RPL Policy. Granting of RPL is following the strength of a standard of proficiency that is sufficient for the purposes of the subspeciality. There will be adherence to the rules and regulation of the Health Professions Council of South Africa (HPCSA), and the Colleges of Medicine of South Africa (CMSA).

Entry Requirements

The minimum entry requirement for this qualification is

• Bachelor of Medicine, Bachelor of Surgery (MBChB) and FCP (SA) (College Fellowship);

And

• Registered for independent practice as a specialist Internal Medicine physician; or Paediatrician; or Pathologist (Clinical Microbiology/Virology) with the Health Professions Council of South Africa (HPCSA) or equivalent for the country of origin;

And

• Appointed in a full-time infectious diseases subspecialist training post at Universitas Academic Health Complex and the post must be registered as an allocated Infectious Diseases (Internal Medicine) training post with the HPCSA.

This qualification consists of the following compulsory modules at National Qualifications Framework Level 9 totalling 300 Credits.

Compulsory Modules,300 Credits

• Advanced Infectious Diseases 1, 120 Credits.
• Advanced Infectious Diseases 2, 120 Credits.
• Dissertation, 60 Credits.

1. Demonstrate expertise and critical knowledge in the sub-specialty of infectious diseases.
2. Use a wide range of specialised skills and competency in identifying, conceptualising, critiquing and implementing methods of inquiry and diagnoses to address medical challenges that demand high levels of expertise in the sub-specialty.
3. Apply specialist knowledge and theory in reflective, original, creative ways to solve complex practical and theoretical problems related to infectious diseases.
4. Create new knowledge and research initiatives in the study of infectious diseases.
5. Create new clinical applications and practice in infectious diseases, based upon independent scholarship.
6. Independently reflect scholarly on theories of knowledge and processes of knowledge production in the field of infectious diseases.
7. Implement improved competences in the administration and management of the sub-specialty.
8. Proficiently assess, plan and implement surgery systems that are acceptable and affordable.
9. Clinical knowledge and competence on gastrointestinal infections.
10. Clinical knowledge and competence on antimicrobial therapy, antiviral therapy and antifungal therapy.
11. Clinical knowledge and competence on para-infectious diseases, infection in ICU and oncology service.
12. Clinical knowledge and competence on sexually transmitted infections.
13. Clinical knowledge and competence on travel related infections and outbreaks.
14. Clinical knowledge and competence on basic microbiology and virology laboratory practices.

Associated Assessment Criteria for Exit Level Outcome 1

• Analyse, reflect, describe, understand and apply knowledge in the treatment of the following regarding immunology in relation to the development of the immune system from fetus to adulthood, innate and acquired immunity, primary and secondary immune deficiencies and show competency in investigating the adult or child with recurrent infection by identifying immune responses in specific infections: Human Immunodeficiency Virus (HIV), tuberculosis (TB), viral infections.

Associated Assessment Criteria for Exit Level Outcome 2

• Recommend treatment and plans for managing congenital infections and understand implementation of preventive measures related to classic TORCHS infections, uncommon: TB, Varicella-zoster, and neonatal infections (for Paediatric ID specialist).

Associated Assessment Criteria for Exit Level Outcome 3

• Access literature, clinical and laboratory data to describe, diagnose and manage HIV/AIDS related medical problems related to the virus, pathogenesis, diagnosis and interpretation of laboratory assays, disease spectrum, TB/HIV co-infection, management/treatment issues, opportunistic infections, prevention, including vaccination and Prevention of mother-to-child transmission (PMTCT) interventions.

Associated Assessment Criteria for Exit Level Outcome 4

• Engage in independent research in to describing, diagnosing and manage the comprehensive spectrum of tuberculosis for pathogenesis, disease spectrum, epidemiology and molecular epidemiology, diagnosis (specimens, microscopy, culture, PCR, immune, other management issues, including INH mono-resistant, MDR-, pre-XDR- and XDR-TB) and in prevention, including vaccine strategies.

Associated Assessment Criteria for Exit Level Outcome 5

• Present the written work through critical analyses end to a degree of intellectual independence by describing and give comprehensive advice on EPI/disease eradication and elimination, EPI and non-EPI vaccines, vaccine adverse events, vaccine development: vaccine types, immunological responses, phase I to IV trials and immunisation for immunocompromised individuals, immunisation of travellers and immunisation for adults.

Associated Assessment Criteria for Exit Level Outcome 6

• Apply research strategies in appropriated methodology in delivering theories, articles, textbooks and guidelines regarding nosocomial infection: definitions, surveillance, hospital infection control policy and practice, antibiotic policy and practice and antibiotic stewardship, sterilisation and disinfection, waste disposal, prevention of transmission of communicable disease in hospital (e.g. TB, meningococcus, varicella, measles etc.) through acceptable scientific formats.

Associated Assessment Criteria for Exit Level Outcome 7

• Show and demonstrate a clear and comprehensive advice on (policy, legislation and global issues) in the management of periodic syndromes, diseases that may mimic infections: malignancy, toxins, auto-immune etc., exanthems of childhood and adults including an approach to infections presenting with skin rash and fever, fever of unknown origin (clinical approach).

Associated Assessment Criteria for Exit Level Outcome 8

• Make the required decisions and show effective application of systems in addressing malaria and selective parasitic infections regarding pathogenesis of malaria, spectrum of disease of malaria, malaria diagnosis (microscopy, antigen tests etc.), malaria management including newer therapeutic options, malaria control and prevention, including prophylaxis regimens, HIV/Malaria co-infection, malaria in pregnancy and neonatal period, selective parasitic infections, schistosomiasis, cystercercosis, toxoplasmosis, helminthic infections and hydatid disease.

Associated Assessment Criteria for Exit Level Outcome 9

• Justify and describe and give comprehensive advice on gastrointestinal infections related to infective diarrhea, cholera, giardiasis, amebiasis, viral hepatitis and clostridium difficile.

Associated Assessment Criteria for Exit Level Outcome 10

• Justify and describe and give comprehensive advice on and treatment plans for antimicrobial therapy, mechanisms of action of antibiotics, mechanisms of resistance, pharmacokinetics characteristics of antibiotics, interpretation of MIC results, managing antibiotic resistant infections, antibiotics for immunocompromised children. Anti-TB drugs, Antivirals including anti-retroviral and antifungals.

Associated Assessment Criteria for Exit Level Outcome 11

• Evaluate and critically analyse outcomes on the comprehensive care for necrotising enterocolitis, Reye syndrome, Kawasaki syndrome, Guillain-Barre syndrome, Chronic fatigue syndrome/Myalgic encephalopathy, Infections in ICU and oncology service, and infection in immunocompromised adults or children and propose treatment plans.

Associated Assessment Criteria for Exit Level Outcome 12

• Purposefully plan, recommend and provide treatment plans for and give comprehensive advice on sexually transmitted diseases.

Associated Assessment Criteria for Exit Level Outcome 13

• Show evidence and demonstrate interventions, application of skills, strategies and give comprehensive advice on travel related infections and current emerging infectious diseases and outbreak response related to infections in travellers, including preventative measures in current issues/emerging infectious diseases, e.g. Influenza immunisation, SARS/Swine influenza, Avian Influenza, Poliomyelitis eradication, potential bioterror agents, public health principles applicable to infectious diseases, Include detailed discussion on outbreak investigation notifiable diseases, Tropical public health, environmental control issues, including surveillance.

Associated Assessment Criteria for Exit Level Outcome 14

• Demonstrate the required skills in routine laboratory investigations: principles of specimens processing and applications in order to effectively understand antimicrobial resistance testing: methodologies and results interpretation, methodologies for detecting infectious agents including direct detection and identification methods, cultures, molecular diagnostics, serology, viral isolation, automated identification.

Integrated Assessment

Formative Assessment

Maintenance of the portfolio for the experiential learning and will provide immediate feedback to the learner. The portfolio documents the following: details of cases managed; case presentations, laboratory experience and Elective experience e.g. Immunology Continuing in-course evaluation and feedback, (i.e. mentorship) is mandatory. In addition, networking forms a part of learners' self-assessment through discussion with peers and experts in the field.

Learners' involvement in their research project and the 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.

Summative Assessment

An exit examination consists of a written paper. Successful completion of this paper leads to an invitation for the 3-hour Objective Structured Clinical Examination (OSCE). The review of the case portfolio will also form part of the evaluation and assessment of ability to perform research or at least to scrutinise and appropriately evaluate research data and scientific articles.

The 60-Credit research project will culminate in the acceptance of a Mini-dissertation 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 Infectious Diseases environment. The mini-dissertation has to be assessed by two examiners, of which at least one has to be an external examiner. Examiners are appointed by the Faculty Executive Management and the Faculty Board.

Assessment of the Master of Philosophy (MPhil) Infectious Diseases is done by the College of Physicians of South Africa; Sub-specialty Certificate in Infectious Diseases: Cert ID(SA) Phys. The regulations are subjected to change and learners must ensure that they familiarise themselves with the latest regulations.

Exit examination

Prior to an exit evaluation of professional competence, each learner's portfolio needs approval by the Head of the Infectious Diseases Unit. A letter of approval should be submitted to the Colleges of Medicine of South Africa (CMSA).

Final evaluation of professional competence includes

A 3-hour written examination comprises a short answer essay paper (6 x 30-minute question) Learners who successfully pass the written examination will be invited to attend the next stage of the examination, which includes the OSCE and Clinical examination. A 3-hour OSCE includes case histories, clinical and radiological scenarios, laboratory specimens Clinical examination - consisting of 4 paper-based short cases.

Assessment of ability to perform research or at least to scrutinise and appropriately evaluate research data and scientific articles will form part of the evaluation. This examination will be held under the auspices of CMSA twice a year.

Mini-dissertation

A mini dissertation has to be completed by the learner. The mini-dissertation has to be assessed by two examiners, of which at least one has to be an external examiner.