Medical Educators' Perceptions of Research Culture in a Faculty of Health Sciences: A South African Study.

Phenomenon: In South Africa, as with many other developing countries, a call has been made for institutions of higher learning to participate in more research and set the pace for societal transformation. At the Faculty of Health Sciences (FoHS), University of the Free State (UFS), numerous strategic efforts are focused on supporting and stimulating research. An essential prerequisite for the success of these vital efforts is to be aware of the research culture within the academic faculties. A peculiarity of medical colleges in South Africa is that medical faculties are in partnership with the government through the academic training hospitals; hence, staff appointment occurs through a joint structure with both the provincial Department of Health and the National Health Laboratory Services. So far, no known study has investigated research culture in this context (joint staff appointment). Approach: This study included elements of case study evaluation and improvement-oriented evaluation. We distributed to 242 educators a structured questionnaire to obtain perceptions of aspects of research, research processes, and existing research culture in the FoHS, UFS. Suggestions on how to improve the research culture also were obtained. The structured questionnaire was self-administered, consisted of closed and open-ended questions grouped into five main sections, and was distributed electronically and manually (hard copy) to participants. Findings: One-hundred-eleven questionnaires were returned (46% response rate). Motivation to do research varied by school and included career advancement (77%, School of Allied Health Professions); change the situation (80%, Academic support); develop individual skillset (67%, School of Nursing) and improve patient care (62%, School of Medicine). Perceived factors affecting research culture included limited funding and allocated time for research, minimal leadership support for research, and absence of research-related support structures as well as minimal teamwork/collaboration. Frustration was the most reported (negative) emotion (25%). Participants suggested that encouraging teamwork among staff, reducing workload to allow time for research, establishing a mentorship program, providing training on deficient skills, and more support from leadership would improve research culture. Insights: This present study reveals some of the factors that impact negatively on research, research culture, and productivity in a medical college in a resource-limited setting. While the benefits of joint staff appointment cannot be overemphasized, our findings highlight that the complex interplay between employers/stakeholders result in poorly executed joint appointment scheme/models (i.e., competitive approach) and creates numerous challenges that negatively impact research productivity and research culture. Recommendations suggested herein can be implemented by the FoHS and other medical colleges in similar contexts to improve research productivity and foster an enabling research culture.

Contextualising the relevance of specialty-specific electives in dental education: Perspectives of dental and oral hygiene graduates.

INTRODUCTION: Electives have been shown to contribute to both the professional and personal development of students in specific areas of interest outside the standard curriculum. The School of Oral Health Sciences at the University of the Witwatersrand introduced electives as a pedagogy in the Bachelor of Dental Sciences (BDS) and Bachelor of Oral Health Sciences (BOHSc) curricula in 2010 and 2014, respectively. However, since its introduction, the relevance of these electives in the BDS and BOHSc curricula has not been investigated. METHODS: This research was designed as an evaluation study that used a questionnaire survey administered to 76 dental and oral hygiene graduates (BDS and BOHSc). RESULTS: Of the initial 76 questionnaires that were distributed, 55 (BDS = 38, BOHSc = 17) were returned, giving a response rate of 72.4%. Almost all the participants (92.7%) agreed that the electives enabled them to develop better interpersonal skills; 80.0% and 82.7% agreed that their clinical skills, and knowledge of key concepts in dental practice, respectively, had improved upon completion of the elective. In appraising the elective programme, 87.0% of the graduates agreed that the content and outcome of the elective programme should be reviewed and changed. CONCLUSION: Obtaining empirical data on the impact of electives on clinical knowledge, skill and behaviour of dental graduates will enhance the relevance of electives in dental education. Findings by this study reveal that the actual impact of the electives on dental graduates was desirable and corresponded with the intended impact. The problematic areas that were identified will inform future planning.

Omics-based molecular techniques in oral pathology centred cancer: prospect and challenges in Africa.

BACKGROUND: The completion of the human genome project and the accomplished milestones in the human proteome project; as well as the progress made so far in computational bioinformatics and "big data" processing have contributed immensely to individualized/personalized medicine in the developed world. MAIN BODY: At the dawn of precision medicine, various omics-based therapies and bioengineering can now be applied accurately for the diagnosis, prognosis, treatment, and risk stratification of cancer in a manner that was hitherto not thought possible. The widespread introduction of genomics and other omics-based approaches into the postgraduate training curriculum of diverse medical and dental specialties, including pathology has improved the proficiency of practitioners in the use of novel molecular signatures in patient management. In addition, intricate details about disease disparity among different human populations are beginning to emerge. This would facilitate the use of tailor-made novel theranostic methods based on emerging molecular evidences. CONCLUSION: In this review, we examined the challenges and prospects of using currently available omics-based technologies vis-à-vis oral pathology as well as prompt cancer diagnosis and treatment in a resource limited setting.

CCR5 expression is elevated in cervical cancer cells and is up-regulated by seminal plasma.

The interplay between inflammation, cervical cancer and HIV acquisition in women is poorly understood. We have previously shown that seminal plasma (SP) can promote cervical tumour cell growth in vitro and in vivo via the activation of potent inflammatory pathways. In this study, we investigated whether SP could regulate expression of chemokine receptors with known roles in HIV infection, in the cervix and in cervical cancer. The expression of CD4 and CCR5 was investigated by RT-PCR analysis and immunohistochemistry. CD4 and CCR5 expression was elevated in cervical cancer tissue compared with normal cervix. Ex vivo studies conducted on cervical tissues and HeLa cells showed that SP significantly increases the expression of CD4 and CCR5 transcripts. Furthermore, it was found that SP also up-regulates CCR5 protein in HeLa cells. The regulation of CCR5 expression was investigated following treatment of HeLa cells with SP in the presence/absence of chemical inhibitors of intracellular signalling, EP2 and EP4 antagonists, prostaglandin (PG) E2 and a cyclooxygenase (COX)-1 doxycycline-inducible expression system. These experiments demonstrated that the regulation of CCR5 expression by SP occurs via the epidermal growth factor receptor (EGFR)-COX-1-PGE2 pathway. This study provides a link between activation of inflammatory pathways and regulation of HIV receptor expression in cervical cancer cells.

Forensic evidence preservation following an incident of rape: The role of the victim.

BACKGROUND:  Rape has a high prevalence in South Africa. The collection of credible and valid forensic evidence is a key legal factor that impacts case trial outcomes. Victim behaviour around the time of the rape can impact the collection and the integrity of forensic evidence, and can have a direct effect on case progression and conviction. Despite the importance of victim behaviour, few studies have been done on the role of victims in preserving forensic evidence. This article discusses how common personal hygiene practices undertaken by rape victims after being raped can impact the quality and validity of forensic evidence. This investigation was done with the aim of elucidating the role of victims in preserving forensic evidence post rape. METHODS:  This was a descriptive, retrospective clinical audit of all rape victims managed at Robert Mangaliso Sobukwe Hospital forensic unit in South Africa from 01 January 2020 to 31 March 2022. RESULTS:  A total of 192 rape cases over the study period were included in this review. The median age of rape victims was 20 years (minimum 2 years; maximum 76 years). The majority (n = 178; 92.7%) of the victims were female. About 44.8% (n = 86) of the victims reported that they had urinated post-rape and prior to forensic examination, 20.8% (n = 40) had changed their clothing, 8.3% (n = 16) had showered, 6.8% (n = 13) had bathed, 4.2% (n = 8) had douched, and only 1.0% (n = 2) had defecated. Only 44 (22.9%) of the victims reported to have ingested alcohol or spiked drinks before the rape. CONCLUSION:  These findings suggest that some rape victims engaged in personal hygiene practices that could militate against forensic evidence preservation. This finding, therefore, indicates the need for public awareness about ways to preserve evidence to the greatest extent possible after an incident of rape.Contribution: We provide simple guidelines for victims on the preservation of forensic evidence following rape and before detailed forensic medical examination and evidence collection.

Epidemiological pattern of rape cases managed at a regional hospital in South Africa.

Background: South Africa has one of the highest incidences of rape globally. Understanding the epidemiological pattern of rape is needed to inform the design of effective intervention programmes for rape prevention and management of alleged rape cases. Aims: To investigate important epidemiological patterns associated with rape in Kimberly, Northern Cape Province, South Africa. Setting: The Robert Mangaliso Sobukwe Hospital (RMSH) forensic unit. Methods: A descriptive, retrospective cross-sectional clinical audit of rape cases. Results: The majority (93.3%) of the alleged rape victims were women, with a mean age (SD) of 21.6 years (11.3); the male population made up 6.7% of the cases, with a mean age (SD) of 10.5 years (6.9). The highest incidence of alleged rape in the male population was seen in the age group ≤ 16 years (81.8%) and for women 17-30 years (50.3%). Most of the incidents occurred at the perpetrators' homes (42.7%); on the days Fridays (14.6%), Saturdays (29.9%) and Sundays (23.2%); at night up to midnight 20:00-23:59 (32.9%) (p = 0.01) and involved threats of violence (55.5%). The majority (56.0%) of the perpetrators were known to the victims. Conclusion: Important information about the victims and circumstances in which rape occurs as reported herein can be used to inform the design of effective intervention programmes for sexual crime prevention and management in Kimberly, South Africa. Contribution: This study helped to advance knowledge and understanding of the epidemiological pattern associated with rape in Kimberley, Northern Cape Province of South Africa.

Human errors and factors that influence patient safety in the pre-hospital emergency care setting: Perspectives of South African emergency care practitioners.

Background: Delivering pre-hospital emergency care has the potential to be hazardous. Despite this, little is known about the factors that precipitate human errors and influence patient safety in the pre-hospital care setting, in contrast to in-hospital care. Similarly, limited report on patient safety and human error issues in the pre-hospital emergency care setting exist in South Africa. Aim: This study investigated the perspectives of emergency care personnel (ECP) in South Africa on the types of human errors and factors that precipitate human errors that influence patient safety in the pre-hospital emergency care setting in South Africa. Setting: This study was conducted in the pre-hospital emergency care environment in South Africa. Methods: This research was designed as an exploratory study that made use of a semi-structured questionnaire administered to 2,000 emergency care personnel. Results: A response rate of 76% was obtained. According to the participants, errors relating to poor judgement, poor skill or knowledge, fatigue, and communication, and individual error are common during pre-hospital care. Inadequate equipment, environmental factors, and personal safety concerns were reported as some of the factors that influence patient safety in the pre-hospital emergency care setting. Conclusion: Implementation of strategies that enhances education and training, clinical skill development, teamwork skills, fatigue management, and leadership skills can help prevent some of the errors identified in this study. Contribution: This study identifies the types of human errors, and factors that precipitate human errors that influence patient safety in the pre-hospital emergency care setting in South Africa.

An Evaluation of Pre-Hospital Emergency Care Personnel Knowledge About Crisis Resource Management and Perspectives of Educators About Inclusion of Crisis Resource Management in the Pre-Hospital Emergency Care Curriculum.

Purpose: To evaluate the knowledge of pre-hospital emergency care personnel (PECP) in South Africa on the principles, practice of crisis resource management (CRM), and obtain emergency medical care (EMC) educators' views on the teaching and learning of CRM skills in the pre-hospital EMC curriculum. Methods: This research was designed as an exploratory study that used a semi-structured questionnaire administered to 2000 PECP and focus group discussion (FGD) with 19 emergency care educators. Chi-squared test and Cramér's V were used to examine the existence and the strength of an association between cross-tabulated variables. Responses to open-ended questions, as well as the data generated by the FGD, were analysed qualitatively using iterative inductive coding to identify themes. Results: A response rate of 76% was obtained for the survey. Findings are that the majority (64.5%) of the PECP were not familiar with CRM, though familiarity varied significantly across cadres of PECP (p <0.001). EMC educators reported that the concept of CRM must be thoroughly researched and developed in the emergency medical service (EMS) context before it is included in the EMC curriculum. The educators reported that early introduction of CRM in the EMC curriculum will have a positive effect on students' professional development. Difficulties with assessment, knowing what to teach, and lack of universally accepted guidelines or teaching modalities are some of the challenges identified by EMC educators in relation to teaching CRM in the EMC curriculum. Conclusion: The findings of this study provide new insights into PECP's knowledge and EMC educators' views on the teaching and learning of CRM in the EMC curriculum. This study highlights that more research is needed to develop an EMS CRM curriculum. Investigation into the development of a teaching and learning framework for CRM in EMC education could be the focus of future studies.

Current norms and practices in using a seizure diary for managing epilepsy: A scoping review.

BACKGROUND: Epilepsy is a chronic and debilitating condition affecting people of all ages in many nations. Healthcare practitioners look for effective ways to track patients' seizures, and a seizure diary is one of the methods used. This scoping review sought to identify current norms and practices for using seizure diaries to manage epilepsy. METHOD: A scoping review was performed by screening relevant studies and identifying themes, categories and subcategories. RESULTS: A total of 1125 articles were identified from the database; 46 full-text articles were assessed for eligibility, of which 23 articles were selected. The majority (48%) of the studies were prospective studies. The majority (65%) of the articles were studies conducted in the United States. The themes identified were types of seizure diaries used in clinical practice, contents and structure of a standardised seizure diary, the use and efficacy of seizure diaries in medicine and challenges relating to using a seizure diary for patient management. CONCLUSION: The study revealed that a seizure diary remains a relevant tool in managing epilepsy. The two forms of diaries in use are electronic and paper-based diaries. The high cost of data and the expensive devices required to access electronic diaries make it unsuitable in a resource-limited setting. Despite its disadvantages, imperfections and inadequacies, the paper-based diary is still relevant for managing patients with epilepsy in resource-limited settings.Contribution: This study reviewed the literature to find the current norms and practices in using seizure diaries. The benefits of the different formats were emphasised.

Knowledge, attitudes and practices of men in a South African rural community in relation to exclusive breastfeeding.

BACKGROUND: Several lifelong maternal, child and societal health benefits have been associated with exclusive breastfeeding (EBF). However, despite all the potential advantages, EBF rates have been consistently low in developing countries, including South Africa. It has been suggested that the knowledge, attitudes and practices of male partners in relation to EBF are amongst the important factors that contribute to the success of EBF practices. Hence, the aim of this study was to determine the knowledge, attitudes and practices of men in Botshabelo, Free State province, South Africa, regarding EBF. METHODS: This study was designed as a cross-sectional analytical study that utilised a structured questionnaire administered to 200 adult men attending the outpatient department of a district hospital, in the Free State province, South Africa. RESULTS: The majority (n = 83; 41.5%) of participants had poor knowledge of EBF but reported positive attitudes (n = 153, 76.5%) and good practices (n = 151, 75.5%) towards EBF, respectively. Age, levels of education, employment status, marital status and whether the participant accompanied his partner to the antenatal clinic were associated with adequate knowledge, positive attitudes and good practices in relation to EBF (p  0.05). CONCLUSION: The study revealed a suboptimal level of knowledge on EBF in men in Botshabelo. Most men had positive attitudes and reported good practices in relation to EBF. Our findings highlight the need for targeted community-based intervention programmes directed to educating and promoting positive social and cultural change in relation to EBF amongst men in Botshabelo.

The Practicality of the Use of Liquid Biopsy in Early Diagnosis and Treatment Monitoring of Oral Cancer in Resource-Limited Settings.

An important driving force for precision and individualized medicine is the provision of tailor-made care for patients on an individual basis, in accordance with best evidence practice. Liquid biopsy(LB) has emerged as a critical tool for the early diagnosis of cancer and for treatment monitoring, but its clinical utility for oral squamous cell carcinoma (OSCC) requires more research and validation. Hence, in this review, we have discussed the current applications of LB and the practicality of its routine use in Africa; the potential advantages of LB over the conventional "gold-standard" of tissue biopsy; and finally, practical considerations were discussed in three parts: pre-analytic, analytic processing, and the statistical quality and postprocessing phases. Although it is imperative to establish clinically validated and standardized working guidelines for various aspects of LB sample collection, processing, and analysis for optimal and reliable use, manpower and technological infrastructures may also be an important factor to consider for the routine clinical application of LB for OSCC. LB is poised as a non-invasive precision tool for personalized oral cancer medicine, particularly for OSCC in Africa, when fully embraced. The promising application of different LB approaches using various downstream analyses such as released circulating tumor cells (CTCs), cell free DNA (cfDNA), microRNA (miRNA), messenger RNA (mRNA), and salivary exosomes were discussed. A better understanding of the diagnostic and therapeutic biomarkers of OSCC, using LB applications, would significantly reduce the cost, provide an opportunity for prompt detection and early treatment, and a method to adequately monitor the effectiveness of the therapy for OSCC, which typically presents with ominous prognosis.

The epidemiological profile of meningitis among adults in a South African district hospital.

Introduction: understanding the epidemiological profile of a disease in a particular region allows for proper planning of public health resources for prevention, early diagnosis and treatment. In this present study, we describe the epidemiological profile of viral, fungal, tuberculous and bacterial meningitis among adults at National District Hospital (NDH), Free State province, over three years period (January 2017 to December 2019). Methods: a retrospective, observational study of all adult meningitis cases, managed at the National District Hospital (NDH) Bloemfontein, Free State Province, South Africa between January 2017 and December 2019. Results: of the 236 case files reviewed, majority (93.2%; n=220) of the patients managed for meningitis were black, as well as males (55.5%; n = 131). Higher incidence was found between the ages 20 to 49 (81.7%). Of those who died, the majority (n = 14; 63.6%) were males, in the age group 40-49 (n = 7; 31.8%), had TB meningitis (n = 12; 54.5%), were HIV positive (n = 20; 90.9%), and had cell count <100 cells/mm3 (n = 10; 45.5%). Conclusion: our study suggests that combining information on patient demography, co-morbidities, clinical presentation, and examination findings can substantially contribute to raising clinical suspicion, leading to swift identification, diagnosis, and treatment of patients.

The COVID-19 pandemic: the benefits and challenges it presents for medical education in Africa.

The coronavirus disease (COVID-19) has impacted many facets of everyday daily life, resulting in far-reaching consequences on social interaction, regional and global economies, and healthcare delivery systems. Numerous reports have commented on the impact of the COVID-19 pandemic on medical education in various world regions. However, we know little about the influence of the pandemic on medical education in Africa. Here, we discuss the potential impact of COVID-19 on teaching and learning in undergraduate medical education in sub-Saharan Africa, illustrating some of the unexpected benefits and challenges the pandemic presents for medical education in sub-Saharan Africa.

More than myalgia: An unusual presentation of exertional rhabdomyolysis.

Exertional or exercise-induced rhabdomyolysis (ER) is a condition in which excessive and unaccustomed physical activity results in skeletal muscle damage. The ER is a relatively uncommon condition but can have very serious consequences such as acute renal failure, severe electrolyte abnormalities, acid base disturbances and death if not recognised and managed appropriately. The risk factors for rhabdomyolysis exist in our local setting, hence, it is paramount that healthcare practitioners (GPs) in our settings be made aware of ER, its prevention and symptoms. Cases of ER are often reported in sports men or women. Here, we report a case of a 33-year-old healthy female, with clinical and serological presentation, which is typical of ER following the commencement of a regimen of exercise to lose weight.

A classic case suggestive of an unruptured ectopic pregnancy with unexpected finding of a unilateral dermoid cyst intraoperatively: A case report.

Acute lower abdominal pain or pelvic pain is a common presenting complaint in women of reproductive age, which can be accounted for by numerous aetiologies. The presentation of lower abdominal pain with associated findings of an adnexal mass on transvaginal ultrasonography and positive beta-human chorionic gonadotropin (ß-hCG) (serum and urine) in a sexually active woman of reproductive age is an ectopic pregnancy until proven otherwise. Here, we present a classic case suggestive of an unruptured ectopic pregnancy, with an unexpected finding of a unilateral dermoid cyst intraoperatively in a 33-year-old woman. Findings presented herein suggest that practitioners in our local setting should evaluate patients carefully, and consider neoplasms as a possible source of ß-hCG production in sexually active women of reproductive age who present with subacute lower abdominal pain, identified adnexal mass on ultrasonography and positive serum or urine ß-hCG readings.

Profile of geriatric presentations at the emergency department of a rural district hospital in South Africa.

INTRODUCTION: the geriatric population is increasing in South Africa and globally. According to Statistics South Africa (STATSSA), people aged 60 years or older constitute approximately 8.4%-9.3% of the population in the Free State province, South Africa, the majority of which are rural dwellers. Elderly patients constitute a high percentage of patients presenting at the emergency department (ED) and it has been suggested that understanding the pattern of geriatric morbidities presenting at the ED can help prepare the healthcare workers and the healthcare system to confront the challenges of delivering acute geriatric care. In this present study, we compiled the profile of geriatric patients that presented at the ED of Botshabelo district hospital (BDH), Free State province, South Africa, with the aim of formulating evidence-based strategies to improving quality of service and patient outcome. METHODS: this was a descriptive, retrospective cross-sectional clinical audit of all geriatric cases (≥ 65 years), that presented at the ED of BDH from January 1st 2017, to March 31st 2017. RESULTS: geriatric cases accounted for 25% of the total adult ED presentation at BDH. The majority (66.6%, n=197) of the patients were female and the mean age at presentation was 75 years. The majority (63.5%) of cases were self-referred and trauma (fracture) was the most frequently diagnosed morbidity. More than half (53.7%) of the cases were classified as priority 2 (P2) and the average waiting time was 86 ± 93 minutes. Less than half of the patients (48.3%; n=143) were admitted for further management, while 36.1% (n=107) of them were discharged from the ED. The remaining 46 cases (15.5%) were referred to a tertiary hospital for further management. CONCLUSION: it is crucial that healthcare facilities in South Africa recognise the special needs of elderly patients due to the growing aging population. Compiling the profile of geriatric cases presenting at ED can help identify crucial area of need and help prepare the healthcare workers and the healthcare system to confront challenges of delivering acute geriatric care. Findings presented herein will assist in formulating evidence-based strategies to improve geriatric patient outcome at the ED in BDH.

The economic burden of deliberate self-poisoning: insight from a tertiary hospital in the Free State Province, South Africa.

Suicide rate in South Africa is contentiously rated among the top ten highest in the world. Deliberate self-poisoning (DSP) remains one of the common methods for suicide. The management of DSP often impose a significant economic burden on health services with a growing loss of resources. However, studies on the financial implications associated with the management of DSP cases in South Africa are scarce and no known study has investigated the financial implication of managing DSP in a resource strained health system as obtained in the Free State Department of Health (FSDoH). This present study investigated the financial implication of managing DSP in a state regional hospital in the Free State province and proffer efficient ways of utilizing limited available resources in DSP management. This was a descriptive, retrospective cross-sectional study in which clinical records of 212 DSP cases which presented during an 18-month period at the emergency department of a state regional hospital were reviewed. The incidence of DSP was higher among individuals who are females (66% females vs 34% males), unemployed (65.6%) in the age group 20-29 years (44.8%). DSP management cost an average of R50, 000 per month. Wasteful expenditures such as blanket requests for laboratory investigation accounted for 19% of the cost. These findings agree with prior studies that have reported that managing DSP could pose a huge direct financial burden on hospital expenditure and health service delivery. If future cost containment and quality of care are to be achieved in the Free State province, efforts must be made by healthcare personnel to combat wasteful and unnecessary expenditure during patient management. We hope that recommendations proffered by this current study will alleviate the financial burden of DSP management in the province.

The need for nationally accepted guidelines for undergraduate nuclear medicine teaching in MBChB programmes in South Africa.

According to the South African Health Professions Act No. 56 of 1974, specific skills outcomes of MBChB programmes are that a medical graduate must be able to utilise diagnostic aids, interpret findings and make diagnoses. Imaging techniques are an integral part of the numerous diagnostic and therapeutic aids used in contemporary medical practice; however, in South Africa, no formal directives exist to guide programme directors or nuclear medicine departments regarding an appropriate undergraduate nuclear medicine educational module. As of 2013, six South African schools of medicine are involved in undergraduate nuclear medicine teaching, in which it forms part of clinical modules taught at varying stages in the academic curriculum. Against this backdrop is the inequitable distribution of nuclear medicine resources, training facilities and staffing in the local state health sector. Inadequate undergraduate teaching and provincial differences in nuclear medicine service provision suggest that many clinicians and graduating medical students are unaware of how radionuclide techniques can facilitate patient management. This high level of imaging illiteracy has been associated with lack of patient referral, poor quality and inadequate referral, poor knowledge of radiation doses and poor awareness of radiation risks. Here we highlight the challenges of undergraduate nuclear medicine teaching in South Africa, emphasising the need for the implementation of guidelines for undergraduate nuclear medicine education. Employing nationally accepted guidelines for undergraduate nuclear medicine teaching in South African MBChB programmes will contribute to the effective utilisation of nuclear medicine and molecular imaging as a diagnostic and therapeutic modality by newly qualified medical practitioners.

Assessing the knowledge of emergency medical care personnel in the Free State, South Africa, on aspects of paediatric pre-hospital emergency care.

INTRODUCTION: In South Africa in 2016, injuries accounted for 4 483 deaths of children aged 0-4 years. Prior studies have reported that, in some parts of the country, poor pre-hospital clinical care is a key contributor to the morbidity and mortality of critically ill and injured children. A key component of a coordinated emergency health care system are emergency medical care (EMC) personnel. Here, we assess the knowledge of EMC personnel employed by the Free State Department of Health on aspects of paediatric pre-hospital emergency care. METHODS: This descriptive study used a questionnaire survey to obtain data on the knowledge of Free State EMC personnel on aspects of paediatric pre-hospital emergency care. RESULTS: Only 197 of the initial 250 questionnaires distributed were returned, giving a response rate of 78.8%. More than half (51.2%) of the participants across the five districts had inadequate knowledge of paediatric pre-hospital emergency care. The majority of EMC personnel could not calculate the paediatric blood pressure for age and did not know the paediatric Glasgow Coma Scale (74.0% and 53.4% respectively; P < 0.0001 in both cases). Participants attributed inadequate knowledge to limited exposure to paediatrics cases, insufficient training, limited scope of practice, and lack of equipment. CONCLUSION: Enhancing the knowledge and skills of EMC personnel in paediatrics pre-hospital care through a short learning programme or continuous professional development programme, and providing adequate paediatric emergency equipment, will ensure that comprehensive pre-hospital emergency care is given to paediatric patients in the province.

Students' Perspectives of a Community-Based Medical Education Programme in a Rural District Hospital.

BACKGROUND: The adoption of community-based medical education (CoBME) into the undergraduate medical curriculum is in line with the SPICE model for medical curriculum proposed by Harden and colleagues. Students are the consumers of medical education and are, thus, the ideal evaluators of the efficacy of their own course and learning environment. To evaluate the quality of the CoBME programme in Botshabelo District Hospital (BDH), this study investigated student's perceptions of their experience during their CoBME training at BDH. In addition, suggestions on how to enrich students' experience during the CoBME posting were obtained from the participants. METHODS: This research was designed as a qualitative (ethnographic) study that used a structured questionnaire, to obtain written statements from 120 fourth-year undergraduate medical students describing their experience during their CoBME training at BDH. The structured questionnaire in the form of an evaluation form was self-administered, consisted of only open-ended questions grouped into 4 main sections and was distributed manually (hard copy) to the participants. RESULTS: Of the 120 questionnaires distributed, 84 were returned, giving a response rate of 70.0%. When asked to indicate what they liked or disliked about their CoBME training, 'Good educators/staff' and the 'Poor attitude of some doctors' were the themes that scored highly (25.1% and 19.4%) in the 'likes' and 'dislikes' category, respectively. Some of the major challenges faced during the CoBME training at BDH included: exposure to new learning environment (14.2%), clinical practice context (12.6%), and language barrier (7.2%). Participants stated that they gained knowledge of how to perform certain clinical procedures and acquired core clinical skills in the areas of formulating management and managing some medical emergencies during their training at BDH. Increasing the duration of training (25.6% coverage) was suggested as a major way to enrich students' experience during the training at BDH. CONCLUSION: Findings by this study reveal that CoBME is a valuable pedagogical tool to enhance learning in undergraduate medical education and that more work is required to improve the quality of CoBME training in BDH. We believe that the findings by this study will inform future planning of CoBME training programmes in BDH.