Family Medicine became a speciality in South Africa in 2007. Postgraduate studies in Family Medicine changed from part-time MFamMed to a full-time MMed(Fam) degree with changes in curriculum and assessment criteria. The overall goal of this study was to evaluate the current assessment tool for extensive mini-dissertations in the postgraduate programme for Family Medicine, UFS and, if necessary to produce a valid and reliable assessment tool that is user-friendly. An Action Research approach was used in this study, using mixed methods. In the first phase, the current assessment tool was evaluated and the data analysed quantitatively. In phase two, the quantitative results of phase one was discussed during a focus group interview and data were analysed qualitatively. Phase three was the production of a new, improved assessment tool. The evaluation of the new assessment tool did not form part of this study. In phase one, 11 internal and four external assessors evaluated four extensive mini-dissertations with the current assessment tool. In phase two, the internal assessors took part in a focus group interview and evaluated the current tool for validity regarding regulations of the assessment bodies as well as reasons for the differences in marks allocated to specific assessment categories (reliability). The current assessment tool complied with all the regulations of the assessment bodies. In four out of the possible 12 assessment categories the median scores allocated to specific categories varied more than 15%. During the focus group interview, reasons for this were identified and the assessment tool was adapted accordingly. A lack of training and experience in the assessment of extensive mini-dissertations was also identified as a contributing factor. The existing assessment tool currently still in use is valid, but not reliable for all assessment categories. The new assessment tool addresses these areas and will be implemented after training of assessors in 2012.

The need to comply with the requirements of the SAQA Act necessitated a review of emergency care education and training in South Africa. The review and restructuring led to the creation of a formal two-year, 240-credit NQF level 5 Emergency Medical Care Technician (ECT) Qualification. The NDoH views the ECT programme as the âMid-Level Workerâ equivalent for the Emergency Care Profession. At the Higher Education level, the existing three-year National Diploma and one-year B Tech Programmes were collapsed to form a single four-year, 480-credit, NQF level 8 Professional Bachelor of Health Sciences Degree in Emergency Medical Care (B EMC). After the establishment of the two-year ECT and four-year B EMC programmes, the next challenge faced by the HPCSA, educators and educational providers within the emergency care field became that of facilitating articulation between the two qualifications. This study aimed to critically analyse and compare the two-year ECT qualification with the four-year professional B EMC degree in order to design a framework and bridging programme that may support and guide articulation between the two qualifications. An expository, retrospective analysis of existing documentation was followed by a focus group discussion with educators in the field in order to identify and explore potential obstacles and challenges with regard to articulation between the ECT and the B EMC qualifications. Finally, a detailed Delphi Questionnaire was sent to selected expert panel members. The study highlights a strong desire for articulation and academic progression within the emergency care profession. Similarities and substantial differences were identified in the scope, level and depth of knowledge of the ECT and B EMC qualifications. A framework was designed that includes a bridging programme to provide ECT graduates with the necessary knowledge, skills and insights required to enter directly into the third year of the Emergency Medical Care Degree.

In this research project, an in-depth study was done by the researcher with a view to formulating an educational approach for the distinct generation profile of undergraduate students in the Faculty of Health Sciences (FoHS), University of the Free State (UFS). This research was initiated in response to the identification of a gap in the knowledge regarding the so-called Generation Y (born 1981-2000), forming the current cohort of undergraduate students at the UFS. According to both scholarly and popular literature, Generation Y possesses unique characteristics that impact on the teaching and learning environment. Their distinctive values and behaviours, communication styles, skills and needs, learning styles and needs, as well as the prevailing environment and the shaping events of their position in history influence their attitudes and actions as students. In addition, the perceived differences between these students and the academic staff lecturing them, who generally belong to older generational cohorts, may lead to conflict and misunderstanding that impairs the successful attainment of outcomes in Health Sciences Education. Both education and health care face tremendous challenges in the 21st century. For example, the current Information-Communication Technology revolution has exerted compelling effects on social interaction as well as the current teaching and learning and health care environments. However, the demands on education and health care stretch further than just emerging technologies and their aftermath. Issues such as globalisation, socio-political and economic instability, inadequate and unequal access, as well as sustainability should also be addressed. The aim of this study was to formulate an educational approach for the generation profile of undergraduate students at the FoHS, UFS. This was attained by means of the following objectives, namely, obtaining data as to whether the characteristics of Generation Y as described in the literature are applicable and relevant to undergraduate students in the FoHS, UFS; identifying discrepancies in awareness and understanding of perceptions regarding the characteristics of Generation Y between undergraduate students and academic staff lecturing them; and finally, formulating an educational approach (including recommendations) for the generation profile of undergraduate students in the FoHS, UFS, incorporating the characteristics of undergraduate students as well as discrepancies in perceptions between undergraduate students and academic staff lecturing these students that could affect the teaching and learning environment. This study made use of a mixed-methods research design in two phases. In the first phase, concurrent triangulation, quantitative and qualitative data were gathered simultaneously by means of closed and open questions in a questionnaire survey for undergraduate students and academic staff members respectively. In the second phase, sequential explanatory design, the results from the first phase were used to inform the formulation of an agenda for a focus group interview held with academic staff members, yielding qualitative data. Quantitative data were analysed statistically, while thematic analysis of qualitative data were done. The final steps in the second phase included making use of the literature survey as well as the results of the questionnaire survey and focus group interview respectively to inform the formulation of the educational approach as indicated in the aim of the study. From the results of the questionnaire survey it emerged that although many of the characteristics typically ascribed to Generation Y in the literature are similar to those perceived by both undergraduate students and academic staff members regarding the cohort of undergraduate students in the FoHS, UFS, there were distinct differences between these perceptions and those described in the literature, indicating that Generation Y students in the FoHS possess a unique generational profile. In addition, academic staff members indicated significant differences in their perceptions from those of undergraduate students, with subsequent implications for the teaching and learning environment. Major themes identified from the focus group interview indicated that three important aspects were vital in the development of an educational approach, namely the nature of the teaching and learning environment, the personal qualities and attributes of the lecturer and the characteristics and role of the student.These findings were incorporated in the formulation of guidelines and recommendations for the educational approach proposed by the researcher. The conceptual framework guiding this approach alluded to the realisation that in order to stay relevant, educational approaches need to move away from traditional and somewhat archaic teacher-centred to innovative student-centred approaches intent on actively engaging students in transformative knowledge construction, as well as providing for mentoring by motivational role-models. Furthermore, emerging technology must be incorporated in a rational and balanced way without losing vital human interaction to ensure that an optimal teaching and learning environment is created. The training of skilled health professionals who are equipped to deal with the challenges of the future should ultimately lie at the heart of the educational approach in Health Sciences Education. This research project generated comprehensive knowledge of the profile of the so-called Generation Y undergraduate students in the Faculty of Health Sciences, University of the Free State, which informed the formulation of an educational approach that is both thoroughly grounded in theory as well as applicable in practice. This research study offers a novel contribution to the field of Health Sciences Education by providing evidence-based data incorporated into an educational approach that takes into consideration key elements for successful pedagogy in Health Sciences Education. These include the a) teaching and learning environment, b) approaches to teaching and learning as well as the role-players in this context, namely the c) participants (students) and d) practitioners (academic staff). The approach is built on the four key elements, and forms an integrated background to a central nexus alluding to concepts including structure and support, a student-centred viewpoint, technology, relationships, student characteristics, mentoring, engagement and supervision. Both the survey instrument developed for the purpose of data collection in this study, as well as the educational approach that was formulated, may be used to facilitate the creation of optimal teaching and learning environments in Health Sciences Education, both locally and further afield.

The current global emphasis on appropriate standards for medical education and greater civic engagement by higher educational institutions, and the value of electrocardiography as diagnostic aid stimulated the researcher to perform this study. Globally electrocardiography is an essential exit-level core competency of undergraduate medical programmes. Although an outcome-based curriculum was introduced by the UFS School of Medicine in 2000, certain aspects of competencybased education (such as the registration and interpretation of an electrocardiogram) can be adapted and included in outcome-based curricula. Prior to the commencement of this study, a preliminary literature review revealed that little research had been performed with regard to the use of electrocardiography as a learning task in community settings in the preclinical phase of medical curricula. The overall goal of the study was to facilitate the transition between electrocardiography teaching and learning in the preclinical and clinical phases of the UFS medical curriculum. The problem that initiated the research was that more information was required regarding the practicability of implementing electrocardiography teaching and learning in community settings during semesters four and five of the UFS undergraduate M.B.,Ch.B. curriculum. To address the problem, two research questions were formulated concerning the generic, context-specific and task-specific issues that inform decisions regarding community-based electrocardiography learning during semesters four and/or five of the UFS undergraduate medical curriculum and the attitudes and opinions of a purposive sample of Faculty members regarding community-based electrocardiography learning in semesters four and/or five. To answer the research questions, two research objectives were pursued regarding the identification of the principal issues and challenges that inform decisions regarding the feasibility of introducing community-based tasks in the preclinical phase of a South African undergraduate M.B.,Ch.B. curriculum and the collection of quantitative and qualitative information from a purposive sample of personnel employed at the UFS Faculty of Health Sciences. The first part of the study consisted of a comprehensive literature review, which assisted the researcher to identify applicable key aspects for inclusion in the interview schedule used for the empirical study. The survey was performed with a view to later formulating an effective strategy to facilitate the transition between the electrocardiography learning provided in the preclinical and clinical phases of the UFS M.B.,Ch.B. curriculum and possibly incorporate four additional hours of community-based learning in phase II of the curriculum. Ninety-two (92) per cent of the persons in the sample consented to participate in the study and a pilot study was conducted, to improve the reliability, validity and trustworthiness of the study. The data collected from the interviews was analysed and a description and discussion of the research findings were documented. Based on the literature review and the responses of the interviewees, several prominent conclusions were reached. Important faculty-related and communityrelated key issues and challenges were identified, and intervieweesâ favourable responses regarding CBL, task-based CBL and CB ECG learning in the UFS undergraduate medical curriculum indicated that further related research is justified. Intervieweesâ responses with regard to the practicability of implementing CB ECG learning in the preclinical phase were moderately favourable and useful recommendations were made. Of significance to the planning of future research studies was that twenty-six per cent more respondents supported the implementation of CB electrocardiography learning during the clinical phase of the curriculum than was the case for the preclinical phase. These research findings can assist with decisions as to whether future (more comprehensive and potentially more costly) research projects are justified. The appropriate implementation of electrocardiography, as community-based learning task during the preclinical and/or clinical phases, can contribute to a greater degree of community engagement and an improvement in the quality of electrocardiography learning in the UFS undergraduate curriculum. This should therefore benefit all the stakeholders involved.

The first two years of higher education is critical in creating a foundation for future academic success as this is the time with the highest gain in knowledge, namely the development of critical thinking and cognitive development (Reason, Terenzini & Domingo 2006:150). Experiences during this stage will influence future academic performance. In South Africa, as many as 33% of enrolled students do not proceed beyond the first year of study (CHE 2013:44). Factors that influence academic performance of first-year students include individual, organisational, environmental and academic programme factors. These factors are often interconnected (James 2007:2; Krumrei-Mancuso, Newton, Kim & Wilcocs 2013:248-253; Reason et al. 2006:149,167; Yates 2012:46-49). The extent to which a specific factor will influence an individual student is affected by the individualâs perspective and experience of such a factor. The strengths and weaknesses of a curriculum - as perceived by students - will affect academic performance, among other factors (Henzi, Davis, Jasinevicius & Hendricson 2007:642-645). Against this background, the problem that was addressed was the poor academic performance of students in module MEF153 (Structure and development of the body) in the first year of the Programme for Professional Medicine (MBChB), in the School of Medicine, Faculty of Health Sciences, University of the Free State. The question that had arisen was: âWhich factors, within the curriculum of the first-year undergraduate medical programme module MEF153, influence the academic performance of students in this module?â An investigation was done by the researcher to identify factors contributing to the poor academic performance of students in the module MEF153. Therefore the aim of the study that was pursued was to investigate studentsâ perspectives regarding the importance of the various factors affecting their academic performance in their first year of study in the module MEF153. Research was conducted with the goal of making recommendations for changes to the curriculum of module MEF153. This was deemed necessary to improve the academic performance of first-year medical students in the module, without the lowering of academic standards. To answer the research question and in order to achieve the aim, the objectives pursued included conceptualising and contextualizing factors affecting studentsâ academic performance through conducting a literature survey. The presence and relevance of these factors within module MEF153 were determined through the analysis of module MEF153. Emphasis was placed on the curriculum, module structure and layout, educational strategies and methods, study content, assessment methods and finally, the time available for this module. A questionnaire was composed from these factors. The studentsâ perception of the importance of factors affecting academic performance in module MEF153 was then evaluated by means of the questionnaire and statistical analysis of data. The research approach used was a descriptive survey with quantitative and qualitative methodologies. All students registered for the module MEF153, and present on the day of data collection were included. The prevalence and perceived importance of factors affecting academic performance was determined by means of voluntary participation in an anonymous and confidential self-administered questionnaire completed by numerous research participants. The questionnaire contained questions with reference to demographic- and personal information, curriculum and programme characteristics and educational information such as teaching and learning methods used in this module. Quantitative data on the perceived importance and effect of factors on academic performance were recorded with the aid of questions and a Likert scale. Qualitative data were gathered through open-ended questions in the questionnaire. The results of the quantitative data were reported as frequencies and percentages or medians for each factor evaluated and discussed. The major findings from this study were that all factors, except âpersonal interracial relationsâ, investigated for their possible effect on academic performance, are perceived to have an effect of median = 5 or more on academic performance on a scale from 0 to 10 where 10 = most important. Except for nine factors, the majority of participants reported a positive effect on academic performance for factors investigated. The factors that reported a majority negative effect on academic performance included financial cost of studies; workload of the undergraduate medical programme; workload of module MEF153; load of independent study in module MEF153; difficulty of content in module MEF153; difficulty of language in resources used in module MEF153; number of assessment opportunities in module MEF153; volume of content assessed per assessment opportunity; and stress associated with assessment in module MEF153. The qualitative data presented and discussed here were classified in themes and categories for each question. It provided further insight and understanding of the quantitative results. These results show that the undergraduate medical programme and module MEF153 manage most factors in such a way that it contributes positively to academic performance for the majority of participants in this study. It also identifies areas that negatively influence the academic performance of the majority of participants. Furthermore, it emphasises the diverse effect of each factor on academic performance among participants. This knowledge can be used to address problematic areas of the curriculum to improve academic performance. It can also be used to improve academic development and support activities to address shortcoming in skills among students.

There is growing interest in the use of simulation for surgical skills training and evaluation. The purpose of this study was to assess whether training to proficiency with the FLS laparoscopic simulator would result in improved performance in the operating room (OR). GOALS, a validated tool, was used to measure clinical operating room performance. Nineteen junior residents underwent baseline FLS-testing and GOALS evaluation during elective laparoscopic cholecystectomy. Those with GOALS scores≤15 were randomly assigned to training (n=9) or control (n=8) groups. An FLS proficiency-based curriculum was used in the training group. Scoring on FLS and in the OR was repeated at the end of the study period. Evaluators were blinded to randomization status. Sixteen residents completed the study. There were no differences in baseline simulator or OR scores. After training, simulator scores were higher in the training compared to control group. At the final assessment, the training group improved their OR performance significantly more than the control. The observed improvement was from novice to intermediate level of residency. These results show the transferability of basic laparoscopic skills gained on a physical simulator to the OR and emphasize the value of lapa roscopic simulators for training purposes. / Il y a un intérêt grandissant pour l'utilisation de la simulation à des fins de formation et d'évaluation des compétences de chirurgie. Le but de cette étude consistait à déterminer si une formation menant jusqu'à la compétence, effectuée sur le simulateur FLS, produirait un meilleur rendement en salle d'opération. Le rendement clinique a été mesuré à l'aide de GOALS, un outil validé. Initialement, dix-neuf résidents juniors ont subi un test FLS ainsi qu'une évaluation GOALS effectuée en salle d'opération pendant l'exécution d'une cholécystectomie par laparoscopie non urgente. Les résidents ayant un score GOALS ≤ 15 ont été répartis au hasard entre le groupe de formation (n=9) et le groupe témoin (n=8). Le groupe de formation a suivi un programme centré sur la compétence en matière de FLS. Les scores FLS et les scores en salle d'opération on été évalués de nouveau à la fin de la période d'étude. Les évaluations ont été effectuées en aveugle. Seize résidents ont terminé l'étude. Aux tests initiaux, aucune différence n'a été constatée entre les scores FLS et les scores en salle d'opération. Après la formation, les scores FLS étaient plus élevés chez le groupe de formation comparativement au groupe témoin. À l'évaluation finale, le groupe de formation avait amélioré sa performance en salle d'opération de façon significative comparativement au groupe témoin. L'amélioration observée s'est traduite par un passage du niveau de résidence novice au niveau intermédiaire. Ces résultats démontrent que les compétences de base en laparoscopie acquises à l'aide d'un simulateur peuvent être transférées en salle d'opération. De plus, ils soulignent la valeur des simulateurs de laparoscopie en tant qu'outils de formation.

Thesis (Ph. D.)--University OF MICHIGAN.

Thesis (Ph. D.)--University OF MICHIGAN.

DISSERTATION (PH.D.)--THE UNIVERSITY OF MICHIGAN

The purpose of this study was to assess factors that are related to excellence among surgeons. The sample included 33 highly proficient surgeons involved in high- and low-mortality-risk surgery, seven of whom were known by reputation as "elite". A framework developed by researchers in athletics was used to examine how surgeons perform their best in challenging elective procedures. Individual in-depth interviews were carried out to determine their mental readiness before, during and after surgery. This provided a quantitative and qualitative analysis of mental readiness. These findings were compared with Orlick's "Theory of Human Excellence" which is based on results from world-class athletics and other high-performance domains. Common elements of success were found which included: commitment, belief, positive images, mental readiness, full focus, distraction control, and constructive evaluation. Major performance blocks were identified which interfered with optimal performance. Characteristics which distinguished certain groups of surgeons were identified. This investigation confirmed that there were many similarities in mental preparation procedures and perspectives engaged in by top surgeons and top athletes. Practical recommendations for mental training were provided relevant to excellence in the surgical arena.