Open Forum

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

Robert Mash, Hannes Steinberg, Mergan Naidoo

Received: 18 June 2021; Accepted: 06 July 2021; Published: 06 Sept. 2021

Copyright: © 2021. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: family physicians; health professions education; learning outcomes; education; curriculum; competency-based education.

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 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 sub-group, 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 re-aligned 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 activities and observable practice activities. The outcomes will be revised in 5 years’ time.

Acknowledgements

We acknowledge the other members of the national Education and Training Committee of the South African Academy of Family Physicians who were responsible for updating the learning outcomes: Prof Klaus von Pressentin, Dr Tasleem Ras (University of Cape Town); Dr Ts’epo Motsohi, Dr Zelra Malan (Stellenbosch University); Dr Elizabeth Reji, Prof Hanneke Brits (University of the Free State); Prof Olufemi Omole, Prof Richard Cooke, Ms Deirdre Pretorius (University of the Witwatersrand); Prof Indiran Govender, Dr Olga Maphasha (University of Pretoria); Prof Honey Mabuza, Dr Kefilwe Hlabyago, Dr Nnanile Nyalunga (Sefako Makgatho Health Sciences University); Prof Bernhard Gaede (University of KwaZulu-Natal); Dr Mohammad Shoyeb (University of Limpopo); Prof Parimalaranie Yogeswaran, Dr Busisiwe Cawe (Walter Sisulu University); Dr Emmanuel Ajudua, Dr Febi Ajudua (Nelson Mandela University); Dr Chantelle van der Bijl (Registrar representative).

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

R.M., H.S. and M.N., all helped to coordinate the process leading to the updated outcomes. The manuscript was drafted by R.M. and edited by H.S. and M.N. All approved the final version.

This article followed all ethical standards for research without direct contact with human or animal subjects.

This article received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data sharing is not applicable to this article as no new data were created or analysed in this study.

This is the official viewpoint of the South African Academy of Family Physicians.

References