Postgraduate Diploma in Family Medicine

The overall objective and purpose of the Postgraduate Diploma in Family Medicine are to strengthen primary health care in South Africa through building the capacity of primary health care doctors by strengthening their knowledge in Public Health Care (PHC). Working professionals will be able to undertake reflection and development of current thinking and practices in PHC.

The specific objectives that will enable the learner of the Postgraduate Diploma in Family Medicine to strengthen the PHC are:

• To build the capacity of primary care doctors to function in support of ward-based primary care teams and to improve the quality of PHC services.
• To build the capacity of primary care doctors to offer effective leadership and clinical governance to PHC facilities.
• To equip primary care doctors to contribute to strengthening district health services.

Rationale

South African plans to revitalise the Public Health Care, in the context of a move towards universal coverage through National Health Insurance (NHI) in the long term, include important roles for the doctor. Primary care doctors from both the public and private sectors are an essential contributor to achieving this goal.

Currently, primary care is mainly offered by nurses, with support from doctors. Since 2008, family physicians have never received training as expert generalists. However, there are a large number of doctors, general practitioners, already working in primary care who have not received any formal Postgraduate training. Thus, there is a need to strengthen and re-engineer primary Healthcare in South Africa, the need exists to up-skill and re-orientate the pool of existing primary healthcare doctors, while at the same time increase the numbers of newly trained family physicians.

The envisaged NHI will also require a mechanism to accredit primary healthcare doctors for inclusion and completing the Postgraduate Diploma qualification successfully could become a useful criterion. In the long term, South Africa will move towards a situation where all doctors in Public Health Care (PHC) who are fully trained family physicians.

The need for the Postgraduate Diploma level training, as opposed to the Master of Medicine in Family Medicine, is that it re-orientates existing primary care doctors for community-orientated primary care and up-skills them where necessary for essential services to the public. Nevertheless, the concept of a Postgraduate Diploma level training exists. The need is for these initiatives to be aligned with the re-engineering of PHC and development of NHI and to offer training at scale to meet the needs of PHC in the next 10-years.

There is a requirement to achieve this national consensus from this qualification is to strengthen PHC and NHI and has in principle been agreed upon by the Universities and the college (CFP of the CMSA). There is anticipation that when this qualification aligns with each other will impact on the quality of care for key clinical processes related to the quadruple burden of disease facing South Africa:

• HIV/AIDS and TB.
• Maternal and child health.
• Injuries and trauma.
• Non-communicable diseases (including mental health).

With the completion of this qualification, learners will be

• Competent clinicians.
• Capability builders.
• Critical thinkers.
• Community advocates.
• Change agents Collaborators.

Obtaining the qualification will enable the professional to register with the Health Professionals Council of South Africa.

Recognition of Prior Learning (RPL)

RPL for access will not be applied to this qualification as this qualification will require established clinical knowledge and competence obtained through a formal qualification such as the MBChB. However, there can be the transference of credits from, for example, an incomplete Master of Medicine in Family Medicine qualification according to institutional General and Faculty rules as well as RPL policy.

Entry Requirements

The minimum entry requirement for this qualification is a

• Bachelor of Medicine and Bachelor of Surgery, NQF Level 8.

And

• Be registered as a medical practitioner with the Health Professions Council of South Africa (Independent and Public Practice).

And

• Be based in a practice - either in an accredited general practice or working in a government Primary Health Care institute.

This qualification consists of the following compulsory modules at Level 8 totalling 120 Credits.

Compulsory Modules, 120 Credits

• Clinical Primary Care, 20 Credits.
• Consultation in Primary Care, 20 Credits.
• Community-orientated Primary Care, 20 Credits.
• Core Dimensions of Primary Care, 20 Credits.
• Learning in Primary Care Teams, 20 Credits.
• Clinical Governance in Primary Care, 20 Credits.

1. Practice competently across the whole quadruple burden of diseases and have the clinical and procedural skill to fulfil his/her role in primary care (Competent Clinician).
2. Engage confidently in learning conversations with other primary care providers, displaying the ability to mentor and culture inter-professional learning (Capability builder).
3. Apply and act autonomously in analysing and interpreting data or information and offer a level of critical thinking to the primary health care team (Critical thinker).
4. Exhibit a community-orientated mind-set, which supports the ward-based outreach teams, understand the community's health needs and social determinants of health in the community (Community advocate).
5. Conceptualise, interrogate and implement tasks to improve the quality of care and performance of the local health system (Change agent).
6. Demonstrate teamwork capabilities in solving problems across levels of care and within the community network of resources and organisations (Collaborator).

Associated Assessment Criteria for Exit Level Outcome 1

- Practice competently across the quadruple burden of disease facing South Africa

> HIV/AIDS and TB.

> Maternal and child health.

> Injuries and trauma.

> Non-communicable diseases (including mental health).

• Successfully apply the clinical and procedural skills as a primary care physician.
• Act as a role model for holistic patient-centred care with the accompanying communication and counselling skills.
• Offer care to the more complicated patients that primary care nurses refer to them.
• Support continuity of care, integration of care and a family-orientated approach.
• Offer or support appropriate health promotion and disease prevention activities in primary care.

Associated Assessment Criteria for Exit Level Outcome 2

• Engage in learning conversations with other primary care providers to mentor them and build their capability.
• Offer or support continuing professional development activities.
• Foster a culture of interprofessional learning in the work-place.
• As part of a culture of learning, they should attend to their learning and development.

Associated Assessment Criteria for Exit Level Outcome 3

• The primary care doctor is one of the most highly educated/trained members of the primary care team and as such should be able to offer a level of critical thinking to the team that also sees the bigger picture.
• Assist the team in analysing and interpreting data or evidence that has been collected from the community, facility or derived from research projects.
• Assist the team with rational planning and action.
• Apply IT and data management skills and be able to make use of basic statistics.

Associated Assessment Criteria for Exit Level Outcome 4

• Exhibit a community-orientated mind-set that supports the ward-based outreach teams understands the community's health needs and social determinants of health in the community and thinks about equity and the population at risk.
• Perform home visits in the community when necessary.

Associated Assessment Criteria for Exit Level Outcome 5

• Be a champion for improving quality of care and performance of the local health system in line with policy and guidelines.
• Be a role model for change - people need to see a change in action.
• Conduct a quality improvement cycle and partake in other clinical governance activities.
• Provide vision, leadership, innovation and critical thinking.
• Support some aspects of corporate governance as needed.
• Assist with clinically related administration e.g. occupational health issues, medical record-keeping, medico-legal forms as needed.

Associated Assessment Criteria for Exit Level Outcome 6

• Champion collaborative practice and teamwork.
• Use credibility and authority to assist the team in solving problems across levels of care (referrals up and down) or within the community network of resources and organisations.
• Assist in the development of a network of stakeholders and resources within the community.

Integrated Assessment

Institutional assessment policy will apply. Assessment will take the place of all modules and their embedded workplace-based learning. The qualification will employ formative and summative assessment.

Formative Assessment

• Learners must present practical assignments for assessment.
• At least one test/oral assessment.
• Portfolio, which includes case studies and logbook, for evaluation after the qualification.

Summative Assessment

Written and oral examination for all modules will take place during the College of Family Medicine exit-examinations after completion of all the modules.