Updated programmatic learning outcomes for the training of family physicians in South Africa

The training of medical specialists should constantly be re-aligned to the needs of the population and the health system. The national Education and Training Committee of the South African Academy of Family Physicians reached consensus on the updated programmatic learning outcomes for the training of specialist family physicians in South Africa. Learning outcomes were first developed to guide training programmes when the speciality was recognised in 2007. Fifteen years later, it was time to revisit and revise these learning outcomes. Learning outcomes define what family physicians are able to do at the end of 4 years of postgraduate training. This revision presents five unit standards and 83 programmatic exit-level learning outcomes.


Introduction
The training of medical specialists should constantly be re-aligned to the needs of the population and the health system. 1 In 2021, the discipline of Family Medicine in South Africa presents an updated set of programmatic learning outcomes for the training of specialist family physicians, which defined what family physicians should be able to do at the end of their 4 years of postgraduate training.
These new outcomes replace the previous ones that were published in 2012. 2 The original outcomes were developed simultaneously with the recognition of Family Medicine as a new specialty in South Africa in 2007. Over the last 10-years, the discipline has observed the actual competencies expected of family physicians as they engage with patients and the health system, mostly at a primary health care and district hospital level. 3 The health system has evolved through reengineering and strengthening of primary health care as well as through the piloting of national health insurance as a vehicle to enable universal health coverage. 4 The landscape of the burden of disease has also shifted with, for example, the human immunodeficiency virus (HIV) epidemic being more controlled through antiretroviral medication and non-communicable diseases, such as diabetes mellitus, becoming more prominent. 5 During the last 10-years, the university training programmes have coordinated their activities through the South African Academy of Family Physician's national Education and Training Committee (ETC). At the same time, the College of Family Physicians, within the Colleges of Medicine of South Africa, was mandated to run the national licensing examination. Over this period, a number of revisions were already approved, such as new outcomes for training in leadership and clinical governance, 6 as well as a new list of clinical skills. 7 The national outcomes should be aligned with the curriculum content, educational approach and forms of assessments within each training programme. These new outcomes will, therefore, have implications for each university. Workplace-based training and assessment is an essential component of all programmes; and a standardised national portfolio of learning has been introduced across all programmes. 8 This in turn is one of the entry requirements for the licensing examination.

Process of revision
The previous unit standards and outcomes were included in an electronic questionnaire that went to all training programmes in the country. Each training programme discussed the outcomes The training of medical specialists should constantly be re-aligned to the needs of the population and the health system. The national Education and Training Committee of the South African Academy of Family Physicians reached consensus on the updated programmatic learning outcomes for the training of specialist family physicians in South Africa. Learning outcomes were first developed to guide training programmes when the speciality was recognised in 2007. Fifteen years later, it was time to revisit and revise these learning outcomes.
Learning outcomes define what family physicians are able to do at the end of 4 years of postgraduate training. This revision presents five unit standards and 83 programmatic exitlevel learning outcomes.
Keywords: family physicians; health professions education; learning outcomes; education; curriculum; competency-based education.

Updated programmatic learning outcomes for the training of family physicians in South Africa
Read online: internally and gave feedback in the questionnaire on the structure of the unit standards and whether to keep, discard or re-phrase each outcome. In addition, every training programme had the opportunity to suggest new learning outcomes. The collated results were presented to the ETC, and all changes and comments were discussed. From the results of the survey, it was recognised that unit standard three, on community-orientated primary care, 9 needed more extensive revision and careful thought. A sub-group was tasked with re-writing these outcomes completely and presenting the results to the ETC. At the same time, a subgroup, assessing the curriculum content for unit standard four, also made recommendations on revising the learning outcomes. The final set of outcomes were discussed again by the ETC, and a consensus was reached across all training programmes.

Unit standards and learning outcomes
The five unit standards were retained, but the definitions were revised as shown in Table 1. The learning outcomes for each unit standard are presented in Table 2.

Conclusion
This open forum article, presents the updated programmatic learning outcomes for training family physicians in South Africa as agreed by the discipline in 2021. Departments of Family Medicine at all universities that train family physicians will need to ensure that their programmes are realigned with these new outcomes. The College of Family Physicians will also need to ensure that in future the blueprinting of their national licencing examination is aligned with the new outcomes. Plans are underway to align the learning outcomes with a set of entrustable professional

Unit Standard Description
Unit standard 1 Effectively manage themselves, their team and their practice, in any sector, with visionary leadership and self-awareness in order to ensure the provision of high-quality, evidence-based care.

Unit standard definitions Unit standard capabilities
Unit standard 1: Effectively manage themselves, their team and their practice, in any sector, with visionary leadership and self-awareness in order to ensure the provision of high-quality, evidence-based care.
A person who has achieved this standard is capable of effectively managing themselves, their team and their practice, regardless of the sector, shows self-awareness in their personal and professional approach and provides high-quality care based on current evidence Unit standard 2: Evaluate and manage patients with both undifferentiated and more specific problems in a holistic, cost-effective manner.
A person who has achieved this standard is capable of evaluating and managing patients, with both undifferentiated and more specific problems, holistically and cost-effectively.
Unit standard 3: Improve the health and quality of life of the community.
A person who has achieved this standard is capable of leading and implementing integrated and comprehensive communityorientated primary care.
Unit standard 4: Facilitate the learning of others regarding the discipline of family medicine, primary healthcare, and other health-related matters.
A person who has achieved this standard is capable of educating, teaching, mentoring or supervising others regarding the discipline of family medicine, primary healthcare, and other health-related matters. For example, this may involve the supervision of clinical associates, interns or registrars, teaching of medical students or mentoring of clinical nurse practitioners and junior medical officers. The capability also extends to interaction with community groups and patients.
Unit standard 5: Conduct all aspects of healthcare in an ethical, legal and professional manner.
A person who has achieved this standard is capable of conducting all aspects of healthcare in an ethical, legal and professional manner.
https://www.safpj.co.za Open Access activities and observable practice activities. The outcomes will be revised in 5 years' time.