Postgraduate Diploma in Family Medicine

Purpose

The primary purpose of this Postgraduate Diploma is to enable working general practitioners to undertake advanced reflection and development by means of a systematic survey of current thinking, practice and research methods in Family Medicine.

The qualification is aligned to the national department of health's priorities of re-engineering of primary health care services. The qualification will address several of the Millennium development goals, with focus on HIV/AIDS/TB through the acute and chronic disease module.

Using the philosophies and principles of Family Medicine, the programme will enable doctors to comprehensively manage common obstetric, paediatric, medical, surgical and psychiatric conditions and emergencies that are present initially as undifferentiated problems.

The qualification will serve to consolidate and deepen a learner's understanding of theoretical concepts and mastery of essential generalist skills that were the foundations of undergraduate training.

This qualification will require high level of theoretical engagement and intellectual independence. By stimulating research reporting through critical reading, learners will be encouraged to develop research concepts and proceed to Masters level research qualification.

Furthermore, the qualification provides for recognition by the Health Professions Council of South Africa (HPCSA) for the purpose of accreditation required by the National Health Insurance.

Rationale

Family Medicine has only recently (2007) been recognised as a specialty in South Africa and the Family physician is generally regarded as the backbone of primary health care. It is well known that there are huge challenges in the development of primary health care in South Africa which has led the National Department of Health to focus on re-engineering of this facet of health care. The role of the Family Physician has never been so important in the process of re-aligning Family Medicine to focus on the primary health needs of the population.

About a decade ago, family medicine did not feature in the undergraduate medical curriculum and the emphasis was placed on vertical specialisation. Generalist training was acquired through experience with no formal Postgraduate training in the generalist domain.

This has led to a significant decline in the skills and knowledge amongst general practitioners with the current concepts and with the rapid advancement of knowledge through research and evidence based processes. Many current general practitioners have not had the opportunity to update their knowledge and keep abreast with medical advances or with the changes in the health priorities of the country. The increased availability of pharmaceuticals, the changing treatment protocols and the shift in focus to preventative care are current challenges that general practitioners are faced with.

This Postgraduate qualification will therefore serve to expand the knowledge and skills base of general practitioners through the exposure to evidence based and current concepts in Family Medicine, focusing on primary health care.

Younger learners on the other hand can benefit from the Postgraduate qualification by enhancing and consolidating knowledge and skills acquired in the undergraduate programme. The shift in focus to primary health care and general practice with continuous learning will motivate, encourage and provide confidence in young doctors to work in rural areas where the health needs of the country are needed most.

Completion of the diploma will provide general practitioners the opportunity to embark on further careers in Family Medicine through research at Masters and Doctoral level.

A further rationale for this qualification is the requirement by the National Department of Health for all general practitioners to undergo an accredited Postgraduate training programme in general practice in order to ensure the success of the proposed implementation of the National Health Insurance plan. The qualification will allow this objective to be achieved.

Recognition of Prior Learner (RPL)

The university's policy on RPL stipulates the following principles on which Prior Learning will be recognised

• Assessment must recognise learning from experience, and not simply experience.
• Assessment of learning must be based on evidence.
• The learning assessed must be related to the purpose for which the recognition is required.
• Learning must be assessed against the learning outcomes (and not primarily the content) of specific qualifications and/or modules.
• The learning must be assessed as sufficient and current.
• Quality assurance procedures must guarantee the integrity and credibility of the assessment.

Using these principles, candidates seeking to enter the Postgraduate qualification must demonstrate their Prior Leaning experience.

• In an interview with the qualification director/qualification team.
• By presenting a portfolio of their work experience.
• And/or writing a formal entrance test.

Entry Requirements

• Admission to this qualification is a Bachelor in Medicine (MBBS, MBChB/equivalent qualification).

This qualification consists of 4 compulsory modules at NQF Level 8, totalling 128 Credits

• Principles and tools of Family Medicine 32 Credits.
• Personal and Family Health, 32 Credits.
• Comprehensive Management of Infectious Diseases, 32 Credits.
• Acute and Chronic Diseases, 32 Credits.

1. Manage medical, paediatric and surgical emergencies within the South African context of limited resources and to use the knowledge of lifestyle illnesses (pathophysiology, presentation, complications and management) to practice holistic medicine from the biopsycho social frame work.
2. An understanding of practice management - within the South African context of limited resources, to have appropriate knowledge and skills to manage commonly occurring infectious diseases and to use the necessary knowledge, skills, values, attitudes and evidence based learning in the field to manage terminally ill patients in a culturally diverse South Africa.
3. Provide health promoting and preventative care to mothers and children as well curative care as well as acquire necessary knowledge, skills, values, attitudes and evidence based learning in the field of Human Sexuality to manage patients in a culturally diverse South Africa.
4. Knowledge of the principles and tools of Family Medicine to practice holistic medicine from the bio psycho social frame work, and a developmental framework as well as using a theoretical framework for evidence based practice and practicing medicine in an ethical and professional manner.

Associated Assessment Criteria for Exit Level Outcome 1

• Common emergencies are managed appropriately.
• A through clinical examination is performed.
• Clinical reasoning behind the use of special investigations is provided and the use of special investigations is justified.
• The management of patients is critiqued using standard treatment guidelines.
• Information on burden of disease/disease profile at a service site is gathered and analysed and a report is compiled.
• Communication is carried out in a clear and patient centered manner.
• An ethical dilemma in emergency care is analysed and the pros and cons of the different ways in which the dilemma could be resolved are discussed.

Associated Assessment Criteria for Exit Level Outcome 2

• A SWOT analysis of a practice or work area is carried out and the financial, human resource requirements and information management for running a practice/ work area are outlined.
• Drug interactions or a drug induced side effect and the management of common side effects are identified and discussed.
• The management of patients is critiqued using standard treatment guidelines.
• A plan for improving the quality of services provided in the practice or in the HIV clinic is developed and implemented.
• A comprehensive history (bio-psychosocial) using the tools of Family Medicine (ecomap and genogram) is taken and a 3 stage assessment and comprehensive management plan in managing patients presenting with infectious illnesses is developed.
• A thorough clinical examination is performed.
• The clinical reasoning behind the use of special investigations is explained and a justification for their use is provided.
• Analysis of an ethical dilemma is carried out, the ethical issues arising from the care of HIV infected patients are discussed and the pros and cons of the different ways in which the dilemma could be resolved are outlined.
• Communication is carried out in a clear and patient centered-manner.
• Bad news to a patient with a terminal condition is communicated in a sympathetic and patient centered-manner.
• The pain symptoms of a patient with a terminal condition are assessed and managed using the WHO pain ladder.
• Members of the health care team are included in the management plans that are developed for the management of a patient with a terminal condition.

Associated Assessment Criteria for Exit Level Outcome 3

• The procedure of admitting a patient under the Mental Health Act is carried out.
• Patients presenting with acute psychosis are diagnosed and managed appropriately.
• Mood, anxiety and psychotic disorders are diagnosed and managed appropriately.
• The management of patients against standard treatment guidelines is critiqued.
• Behaviour change models are described and applied appropriately in the clinical context e.g. smoking cessation.
• Antenatal care for both the low risk and high risk mother is appropriately provided in the clinical context.
• The quality of services provided is assessed using routine data and recommendations based on this data about service improvements are made.
• Obstetric emergencies are appropriately managed.
• Neonates needing resuscitation are appropriately managed.
• The quality of maternal health services provided at a District hospital using maternal and perinatal health measures is analysed and recommendations for improvement are made.
• Children are assessed and managed comprehensively using the IMCI guidelines.
• Patients are screened, counselled and managed appropriately for common sexual disorders.
• Patients presenting with sexual dysfunction are managed in a sensitive and understanding manner.
• Therapies available for the management of common sexual problems are discussed and applied appropriately.

Associated Assessment Criteria for Exit Level Outcome 4

• The principals of Family Medicine in are used in patient consultation.
• The three stage assessment and the Stott and Davis model is applied in clinical practice.
• A comprehensive history (bio-psychosocial) is taken, the tools of Family Medicine (ecomap and genogram) are used and a 3 stage assessment and comprehensive management plan in managing patients with differentiated and undifferentiated problems is developed.
• Communication is conducted clearly in a patient cantered manner.
• The application and integration of contextualised knowledge through self-directed study is applied to the practice of medicine.
• The research methodology is criticised, the results and the statistical methods are evaluated and conclusions presented are justified.
• An ethical dilemma in practice is analysed using the ethical pillars of medicine and pros and cons of the different ways in which the dilemma could be resolved are outlined.

Integrated Assessment

Each module will have a number of tasks and assignments which need to be completed. Fifty percent of the module mark will come from tasks assigned to the learners and the remaining fifty percent will come from the written and skills examination at the end of the module.

Formative and summative assessment

Feedback will be provided on all assignments submitted and on all presentations. Marking Guidelines will be provided for each written examination.