Postgraduate Diploma in Infectious Diseases

Purpose

The purpose of the Postgraduate Diploma in Infectious Diseases is to strengthen the learner's confidence and capability as a general practitioner and equip them with tools for lifelong learning and reflective practice to make a lasting contribution as a professional to the health of communities disproportionally affected by infectious diseases. Learners will be challenged with case studies and diagnostic conundrums to stimulate critical and creative thinking. An evidenced-based decision-making process will always be the focus of teaching, emphasising responsibility for keeping up to date with the latest research findings and guideline recommendations. Learners will be equipped with knowledge on how to access new knowledge on their own.

All the modules include transversal themes of the basic biology of organisms, infection prevention and control, reproductive health issues, radiology, antibiotic stewardship and drug access and emphasise the role of the doctor as a leader for change in practice and perceptions. To do this in a resource-limited environment needs creative thinking. Infectious diseases across the continent will be covered. Each country/region has its unique cultural norms and values, infectious disease challenges and resource limitations and learners will be made aware of this throughout the qualification.

The learner should be able to

• Clinically diagnose, manage and take professional and clinical steps to prevent infectious/tropical diseases in the context of African environments with limited resources.
• Apply and explain the disciplines of infection prevention and control; investigate and confirm an outbreak; support outbreak response; model antibiotic stewardship and take clinical leadership to achieve sustainable outcomes.
• Use the reflective practice to enable continuous development as a practitioner, and to be responsible and ethical in clinical governance aims to ensure that the learner demonstrates ethical and professional practice.
• Be able to select, apply and transfer appropriate standard procedures or techniques to the resource-limited setting, and solve complex problems to operate effectively in this context.

Rationale

South Africa and the African continent are disproportionally affected by a high burden of infectious diseases. Wars, poverty and humanitarian crises occur at a higher rate in Africa compared to any other continent on earth. The main health consequence of poverty and social collapse is an increase in infectious diseases and decreased resources to deal with them. Access to quality medical care is lacking in many areas, and prevention and control efforts remain largely insufficient. Doctors working in these environments require unique knowledge and skills to clinically diagnose and manage the range of patients they see and to provide services that are appropriate for the specific communities served and the available health care resources.

There is a significant number of young international and South African doctors who are interested in learning more about managing the burden of infectious diseases in poor communities and resource-constrained environments. Many of these doctors find the experience of working in different communities (often very rural) very challenging, as their previous training often does not prepare them for the specific challenges they face. These doctors (and the clinical managers of facilities) have reported a clinical skills gap (particularly amongst young doctors and international doctors) when practising independently in areas such as obstetrics, paediatrics, HIV/TB, infection control, antibiotic stewardship and emergency medicine. Young practitioners also have more responsibility for contributing to service development and quality improvement at their facilities and supporting outreach into primary care and their local communities. In many locations, these doctors cannot benefit from direct support and advice from senior clinicians present near to them.

Providing specific training relevant to these clinical and health system domains will help clinics and hospitals to recruit and retain the health workforce they need. Young local and international doctors will be confident in applying for posts in resource-limited areas with a high incidence of infectious diseases and because they are better equipped with the appropriate skills, it will facilitate resilience and help to reduce burnout. Furthermore, this training will make doctors more effective in their roles in improving health outcomes in underserved communities. The qualification will also cover important new challenges in this field including antibiotic resistance and complex surgical infections and will provide academic-level training based in Africa that is tailor-made to equip the participants for the clinical challenges encountered in the field.

Recognition of Prior Learning (RPL)

Processes are in line with the institutions' Assessment and Recognition of Postgraduate Prior Learning Policy.

In terms of Access, applicants must be qualified medical doctors to be eligible to enter the qualification.

In terms of Advanced standing, recently completed short courses and/diplomas relevant to infectious diseases will be considered after evaluation of the curricula of these qualifications. Completion of the short course on 'Clinical management of HIV/TB related conditions' offered by the Division of Infectious Diseases from 2020 will be recognised as sufficient to be granted exemption from the HIV/TB module.

Entry Requirements

The minimum entry requirement for this qualification is

• Bachelor of Medicine and Surgery, NQF Level 8.

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

Compulsory Modules, Level 8, 120 Credits

• Adult Infectious Diseases, 30 Credits.
• Paediatric Infectious Diseases, 30 Credits.
• HIV and TB, 30 Credits.
• Infection and the Community, 15 Credits.
• Surgical/Trauma Infections, 15 Credits.

1. Clinically diagnose, manage and take professional and clinical steps to prevent infectious/tropical diseases in the context of African environments with limited resources.
2. Apply and explain the disciplines of infection prevention and control; investigate and confirm an outbreak; support outbreak response; model antibiotic stewardship and take clinical leadership to achieve sustainable outcomes.
3. Use the reflective practice to enable continuous development as a practitioner, and to be responsible and ethical in clinical governance aims to ensure that the learner demonstrates ethical and professional practice.
4. Select, apply and transfer appropriate standard procedures or techniques to the resource-limited setting, and solve complex problems to operate effectively in this context.

Associated Assessment Criteria for Exit Level Outcome 1

• Classify human pathogens and explain the pathology caused by them including the immune response against pathological microorganisms.
• Explain the cost-effective use of the laboratory and point-of-care tests in the diagnosis and management of adult and childhood infections in resource-limited settings.
• Systematically evaluate an adult and a child patient with a potential infection.
• Diagnose and manage common community-acquired infections in adults, neonates, babies and children.
• Diagnose and manage common tropical infections and infestations especially malaria in adults, babies and children.
• Recognise and systematically evaluate an adult patient with a fever of unknown origin.
• Recognise, diagnose and manage sepsis and septic shock in an adult patient.
• Perform essential diagnostic and therapeutic procedures required for the diagnosis and management of infections in adults.
• Identify the specific radiological appearances of infectious conditions prevalent in adults in Africa and explain the indications and limitations of different radiological procedures.

Associated Assessment Criteria for Exit Level Outcome 2

• Explain the biology of HIV and Mycobacterium tuberculosis including the immune response against HIV and TB.
• Explain the cost-effective use of the laboratory and point-of-care tests in the diagnosis and management of HIV and TB in resource-limited settings.
• Describe the pathophysiology of HIV and TB and their involvement in the different organ systems in the body.
• Prevent, diagnose and manage the full range of common conditions related to HIV and TB.
• Explain how to reduce the risk of HIV transmission in different scenarios.
• Explain how to reduce the risk of TB transmission in healthcare facilities, households and communities.
• Identify the specific radiological appearances of tuberculosis and HIV related conditions prevalent in adults in Africa and explain the indications and limitations of different radiological procedures.
• Classify common human pathogens occurring in surgical and trauma-related infections.
• Identify and investigate healthcare-associated outbreaks.
• Describe core epidemiological concepts, definitions and health determinants.
• Identify, confirm and investigate an outbreak of common infectious diseases in African communities.
• Classify vaccines and explain the recommendations of their use in different situations
• Explain the fundamental mistakes in anti-vaccine campaigns.
• Identify populations vulnerable to infections and explain the challenges in the prevention and management of infections in vulnerable populations.
• Interpret the global emergence of antimicrobial resistance and explain the essential components of antimicrobial stewardship and the role of vaccination in antimicrobial stewardship qualifications.

Associated Assessment Criteria for Exit Level Outcome 3

• Demonstrate development as a life-long learner in applying reflective and social learning practices and accessing additional learning resources.
• Interpret the global emergence of antimicrobial resistance and explain the essential components of antimicrobial stewardship and the role of vaccination in antimicrobial stewardship qualifications.

Associated Assessment Criteria for Exit Level Outcome 4

• Identify the specific radiological appearances of infectious conditions prevalent in adults in Africa and explain the indications and limitations of the different radiological procedure.
• Discuss the microorganisms of relevance to infection prevention and control in facilities and the community and the application of standard and transmission-based precautions.
• Explain environmental cleaning, waste management and decontamination of medical devices.
• Perform essential diagnostic and therapeutic procedures required for the diagnosis and management of HIV and TB.
• Diagnose, prevent and manage post-operative wound infections, catheter-related hospital-acquired infections, central line-associated bloodstream infections and hospital-acquired and ventilator-associated pneumonia.
• Diagnose and manage trauma-related acute and chronic osteomyelitis, primary and post-traumatic necrotizing fasciitis and pyomyositis.
• Diagnose and manage intra-abdominal infections.

Integrated Assessment

The set outcomes about knowledge, skills and values will be assessed both formatively and summatively.

Multiple methods of assessment will be used, with more than one assessment being required per module. Each module will have assessment formats that are appropriate to the nature of the module. Formative feedback is given throughout all modules.

Assessment formats include the following

Infectious Diseases in adults: Case-based portfolio assessment (summative), Mini-Clinical Examinations (formative), Multiple Choice Question and Short Answer Question papers (summative).

Infectious Diseases in children: Case-based portfolio assessment (summative), Mini-Clinical Examinations (formative), Multiple Choice Question and Short Answer Question papers (summative).

Surgical/Trauma-related infections: Case-based portfolio assessment (summative), Mini-Clinical Examinations (formative), Multiple Choice Question and Short Answer Question papers (summative).

Infection and the Community: Case-based portfolio assessment (summative), Multiple Choice Question and Short Answer Question papers (summative) and Clinical outbreak scenario reports (long essay - summative).

The case-based portfolio is an ideal assessment tool to test clinical reasoning in the workplace as well as facilitating reflective learning. Ethical practice can also be assessed via this method.

Multiple choice and short answer questions, if constructed according to the institution's standards and recommendations can assess knowledge at a basic level but also higher-level understanding and application including clinical reasoning. Long essay assessments are valuable in assessing a logical and structured approach to a specific problem including the use of evidence-based arguments originally and creatively.

HIV and TB: Case-based portfolio assessment (summative), Mini-Clinical Examinations (formative), Multiple Choice Question and Short Answer Question papers (summative).