Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa

BACKGROUND: In 2021, South Africa introduced a 6-month internship rotation in family medicine, in the second year of a 2-year internship programme for newly qualified doctors. This was a major change from the previous 3-months training in family medicine, and expanded the training platform to smalle...

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Autores principales: Hutton, Lauren, Jenkins, Louis Stander, Mash, Robert, von Pressentin, Klaus, Reid, Steve, Morgan, Jennie, Kapp, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478251/
https://www.ncbi.nlm.nih.gov/pubmed/37667252
http://dx.doi.org/10.1186/s12909-023-04605-6
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author Hutton, Lauren
Jenkins, Louis Stander
Mash, Robert
von Pressentin, Klaus
Reid, Steve
Morgan, Jennie
Kapp, Paul
author_facet Hutton, Lauren
Jenkins, Louis Stander
Mash, Robert
von Pressentin, Klaus
Reid, Steve
Morgan, Jennie
Kapp, Paul
author_sort Hutton, Lauren
collection PubMed
description BACKGROUND: In 2021, South Africa introduced a 6-month internship rotation in family medicine, in the second year of a 2-year internship programme for newly qualified doctors. This was a major change from the previous 3-months training in family medicine, and expanded the training platform to smaller district hospitals and primary health care (PHC) facilities, many of which had never had interns. The medical disciplines in South Africa needed to know if this change in the internship programme was worthwhile and successful. The aim of this study was to assess the new family medicine rotation for medical interns at district health facilities in the Western Cape Province. METHODS: Descriptive exploratory qualitative research included six intern programmes across the province. Purposeful sampling identified a heterogeneous group with maximum variation in experience. Overall, eight interns, four managers, four supervisors and four intern curators were included. Individual semi-structured interviews were audio-recorded and the transcripts were thematically analysed using the framework method and Atlas-ti software. RESULTS: Four major themes emerged around the varied structure and organisational characteristics of the rotations, the orientation and arrival of interns, their learning during the rotation, and impact on health services. A programme theory was developed that defined the key inputs (i.e. infrastructure, communication, orientation, preparation, prior learning and guidelines), processes (i.e. model of the rotation, clinical training and supervision, clinical teaching), outputs (i.e. more independent decision making, approach to undifferentiated problems, approach to chronic care and continuity, development of procedural skills, approach to sequential coordination of care and referrals, working in a multidisciplinary team and inter-professional learning, integration of multiple competencies, as well as becoming more person and community orientated). CONCLUSIONS: The new rotation in family medicine was positively experienced by most interns, supervisors and managers. It should lead to improved quality of care, better preparation for obligatory community service, and an increased likelihood of considering a career in district level health services. This study will form part of an exploratory sequential mixed methods study that incorporates the key issues into a questionnaire for a descriptive survey of all interns in a subsequent study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-023-04605-6.
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spelling pubmed-104782512023-09-06 Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa Hutton, Lauren Jenkins, Louis Stander Mash, Robert von Pressentin, Klaus Reid, Steve Morgan, Jennie Kapp, Paul BMC Med Educ Research BACKGROUND: In 2021, South Africa introduced a 6-month internship rotation in family medicine, in the second year of a 2-year internship programme for newly qualified doctors. This was a major change from the previous 3-months training in family medicine, and expanded the training platform to smaller district hospitals and primary health care (PHC) facilities, many of which had never had interns. The medical disciplines in South Africa needed to know if this change in the internship programme was worthwhile and successful. The aim of this study was to assess the new family medicine rotation for medical interns at district health facilities in the Western Cape Province. METHODS: Descriptive exploratory qualitative research included six intern programmes across the province. Purposeful sampling identified a heterogeneous group with maximum variation in experience. Overall, eight interns, four managers, four supervisors and four intern curators were included. Individual semi-structured interviews were audio-recorded and the transcripts were thematically analysed using the framework method and Atlas-ti software. RESULTS: Four major themes emerged around the varied structure and organisational characteristics of the rotations, the orientation and arrival of interns, their learning during the rotation, and impact on health services. A programme theory was developed that defined the key inputs (i.e. infrastructure, communication, orientation, preparation, prior learning and guidelines), processes (i.e. model of the rotation, clinical training and supervision, clinical teaching), outputs (i.e. more independent decision making, approach to undifferentiated problems, approach to chronic care and continuity, development of procedural skills, approach to sequential coordination of care and referrals, working in a multidisciplinary team and inter-professional learning, integration of multiple competencies, as well as becoming more person and community orientated). CONCLUSIONS: The new rotation in family medicine was positively experienced by most interns, supervisors and managers. It should lead to improved quality of care, better preparation for obligatory community service, and an increased likelihood of considering a career in district level health services. This study will form part of an exploratory sequential mixed methods study that incorporates the key issues into a questionnaire for a descriptive survey of all interns in a subsequent study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-023-04605-6. BioMed Central 2023-09-04 /pmc/articles/PMC10478251/ /pubmed/37667252 http://dx.doi.org/10.1186/s12909-023-04605-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Hutton, Lauren
Jenkins, Louis Stander
Mash, Robert
von Pressentin, Klaus
Reid, Steve
Morgan, Jennie
Kapp, Paul
Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa
title Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa
title_full Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa
title_fullStr Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa
title_full_unstemmed Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa
title_short Medical interns in district health services: an evaluation of the new family medicine rotation in the Western Cape of South Africa
title_sort medical interns in district health services: an evaluation of the new family medicine rotation in the western cape of south africa
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478251/
https://www.ncbi.nlm.nih.gov/pubmed/37667252
http://dx.doi.org/10.1186/s12909-023-04605-6
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