Master of Philosophy in Nephrology

Purpose

The purpose of the MPhil (Nephrology) is to train renal specialists to acquire advanced expertise in Renal Replacement Therapy (Chronic and Acute Haemodialysis, Chronic and Acute Peritoneal Dialysis, Continuous Renal Replacement Therapy, Plasma Exchange therapy and management of the end-stage renal disease patient) and/or in Acute Kidney Injury (AKI) prevention and management. The training of Nephrologists will also further enhance the clinical, educational and research programmes in the sub-specialty of Nephrology. The general objectives of the training in Nephrology would be to prepare the learner to practise renal medicine competently. Therefore, the learner will acquire a good working knowledge of the management of renal disease and related problems with a background of the relevant basic sciences. The learner should be able to serve as a Nephrology Consultant to general medicine and other medical sub-specialities, as well as the speciality services such as Intensive Care, Urology, Obstetrics and Surgery regarding kidney diseases and renal manifestation of systemic diseases. In addition, the learners will gain experience in both ambulatory and in-patients settings.

Rationale

The increasing emphasis on early detection of Chronic Kidney Disease (CKD) and the provision of non-dialysis care for some patients with advanced renal failure require a substantial increase in the number of Nephrologists. The Master of Philosophy in Nephrology [MPhil (Nephrology)] has met all the prerequisites of the Health Professions Council of South Africa (HPCSA) and is thus professionally recognised as a qualification in an independent sub-specialty.

The MPhil (Nephrology) will produce professionals that are able to deal with the special needs of patients wiith complicated kidney diseases. An increasing number of patients who are initiating Renal Replacement Therapy are elderly and suffer from substantial numbers of comorbid conditions. These in turn adversely affect the patient's health-related quality of life.

In the context of an expanding need for patients to be included in a dialysis programme, the training of Nephrologists will assist patients, families and the Nephrology team in making decisions about initiating, continuing and stopping dialysis. Nephrologist will help make the process timely and beneficial to the patient. Nephrologists and other members of the renal care team will benefit from this qualification as they will attain information that can inform their counselling of patients and families about the potential outcomes of patients with Acute Renal Failure.

The development of the qualification is also supported by the Southern African Renal Society. The qualification provides the foundation to develop a career path in the health care environment and to meet the need for the provision of efficient healthcare to the wider community by means of consolidating novel scientific research and professional medical practice in Nephrology.

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 subspecialty. 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.

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 subspecialty, gained at another institution. The maximum admissible period of exemption is 12 months. The said periods of training must have extending over a period of at least twelve months and for at least six months continuously in an accredited institution, division or department and have occurred within the last two years before registering for Postgraduate study in the subspecialty. This will be done in consultation with the particular Head of Department, the Head of the School of Medicine and appropriate structures within the Faculty of Health Sciences. The rules and regulation of the HPCSA and the CMSA will be adhered to.

Entry Requirements

Learners may register for the Degree Master of Philosophy in Nephrology if they

1. Are registered for independent practice as a specialist Paediatrician or Physician (Internal Medicine) with the Health Professions Council of South Africa.
2. Are in possession of an MBChB and an MMed (Paediatrics) or MMed (Internal Medicine) or the relevant Fellowship of The College of Paediatricians: (CPAED (CMSA)) or The College of Physicians: (CP(CMSA)) or an equivalent HPCSA accredited/approved qualification.

In addition to the abovementioned entry requirements the HPCSA requirements for registration of a subspeciality by a medical specialist are listed below, i.e. a medical specialist who wishes to register in a subspeciality with the board must:

• 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.
• After 1 January 2002, submit proof to the board that he or she passed an evaluation in the relevant subspeciality which had been approved by the board.
• Submit a certificate to the board, issued by the relevant faculty of medicine or health sciences in South Africa.
• To certify that the applicant obtained education and training in the relevant subspeciality of at least two years as the holder of a post of subspeciality student 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.

Students willered as an allocated Nephrology (Internal Medicine) training post with the HPCSA. Also in the case of the subspeciality nephrology 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 nephrology 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 Nephrology".

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

Compulsory Modules

• Advanced Nephrology I, 120 Credits.
• Advanced Nephrology II, 120 Credits.
• Mini-dissertation, 60 Credits.

1. A comprehensive review of leading and current research in the subspecialty is conducted to produce significant insights.
2. Select and apply creative methods, techniques, processes and technologies to complex clinical and theoretical problems in Nephrology.
3. Make autonomous ethical decisions and contribute to the development of ethical standards in a Nephrology context.

The Associated Assessment Criteria are applied in an integrated way to the Exit Level Outcomes.

Associated Assessment Criteria

• Contemporary practices in the field of Nephrology are appropriately engaged with and critiqued.
• Current processes of knowledge production are correctly evaluated and an appropriate process of enquiry for an area of Nephrology practice is chosen.
• A way of doing or carrying out procedures in Nephrology interventions which include technologies and techniques are appropriately and creatively selected and applied to complex clinical and theoretical problems.
• A wide range of specialised skills in identifying, conceptualising, designing and implementing methods of enquiry to address complex and challenging problems within Nephrology practice are correctly and satisfactorily used.
• Independent ethical decisions are suitably made.
• Effective contributions to the development of ethical standards in a Nephrology context are made.
• A minor-dissertation is submitted using correct research principles and methods.
• A range of advanced and specialised skills and discourses appropriate to the practice of Nephrology to contribute to academic teaching and to the advancement of new knowledge in the subspecialty are properly and effectively used.
• Interventions at an appropriate level are clinically made and the intended and unintended consequences of such interventions are appropriately addressed.
• Full responsibility for own work is taken.

Integrated Assessment

Each of the concepts within the Master of Philosophy will be taught, learnt and assessed within the context of everyday clinical practice. These are therefore aligned with and fully integrated into, the learning outcomes within this curriculum. 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 (CMSA) examination, that is, The College of Paediatricians of South Africa for the Post-Specialisation Fellowship in the Sub-Specialty Nephrology - Certificate in Nephrology South Africa (SA). 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 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 Nephrology 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 Exit Level 9 qualification. Each module consists of both theoretical (assignments, OSCAs and tests) and a clinical assessment (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 Nephrology environment.

The compulsory portfolio is based on the "CRITICAL" Portfolio (Certified Record of In-service Training Including Continuous Assessment and Learning). It is a professional resource document structured in a flexible format which allows learners to plan and meet the outcomes of the specialty training programme through a documented process of work experience, learning and reflection. In addition a logbook is required by the CMSA (see below).

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.

Logbook and format and conduct of the examination

A logbook must be kept and in this a written record of training will be maintained by the learner in a form reflecting the required training to be countersigned by the Educational Supervisor and learner annually. It will remain the property of the learner and must be produced at the annual assessment. It will contain details of training requirements and competencies to be achieved within the context of the broad curriculum. This logbook must be submitted to the CMSA, at the time of applying for admission to the examination.

Evaluation of overall competence of the learner will be based on

• An appraisal by the Educational Supervisor.
• Submission of the Training Record (logbook).
• An examination under the auspices of the CMSA, which will be held twice a year.

The examination will be in written format and will consist of 2 written theory papers as well as a computer-generated objective test examination. The first paper will address the basic science aspects of Nephrology while the second paper will address clinical aspects of Nephrology. The objective test will cover both aspects in clinical case scenarios and data interpretation and will complete the evaluation of the candidate. There will be no clinical or oral examination.

The three examinations will be written on consecutive days.

A sub-minimum pass mark of 50% is expected for each of the two (written papers and the OSCE) components of the examination.

There will be at least 2 examiners for each component of the examinations both of whom are registered nephrologists and both components of the examinations will be moderated.