Magister Pharmaceuticae - MPharm / The World Health Organisation (WHO) has stated that “there is no health without a workforce” (Campbell et al., 2013). The health workforce is essential for every health care system. The availability, accessibility and quality of health care workers play an important role in improving and overcoming health system challenges, in particular the call to universal health coverage (UHC) as stipulated in sustainable development goal 3. It has been observed that there is limited collaboration between healthcare systems and academic institutions. According to an article by Frenk et al., 2010, this limited collaboration has resulted in a mismatch between health care graduates’ competencies (such as inter-professional collaboration) and the needs of the population that they serve. One of the problems of health education institutions is the emphasis on curriculum content and learning methods as opposed to social purpose and moral obligations. / 2021-08-30

Magister Chirurgiae Dentium (MChD) / Exodontia remains one of the most regularly done procedures in dentistry in South Africa (SA) and alveolar osteitis (AO) is considered one of the most common complications associated with exodontia. Despite the extensive research done on this clinical entity, the management of AO still remains controversial. Various management protocols have been suggested in the literature, varying from prophylactic to symptomatic management of AO (Blum,2002). However, none of these management protocols have to date shown any conclusive evidence on the effectiveness and benefit over another protocol. The author was of the opinion that general dental practitioners (GDPs) in South Africa generally use preventative and treatment protocols based on what they were taught at their alumni dental schools or use protocols modified from their own clinical experience in practice. The aim of this study was to assess which treatment protocols are routinely used by GDPs in South Africa for the management of AO and suggest a scientifically sound treatment protocol for AO. The study was done in the form of a questionnaire and the participants were randomly selected from the Health Professions Council's register. The results showed that most of the GDPs in South Africa continued to use the same treatment protocol as their alumni dental school. They were of the opinion that these protocols were still clinically the most effective. Despite the plethora of intra-alveolar medicaments available, Alvogyl®still remains the medicament of choice of GDPs. As there is no evidence in the scientific literature that suggests that one intra-alveolar medicament or antibiotic is more effective than the other, the author does not encourage the use of the medicaments or antibiotics in the treatment of AO. However, by following simple measures such as improving patients' oral hygiene and using a pre-operative 0.2% chlorhexidine mouth rinse, the incidence of AO can be reduced significantly.

While the body of evidence supporting the use of simulation-based learning in the education of health professionals is growing, howor why simulation-based learning works is not yet understood. There is a clear need for evidence, grounded in contemporary educational theory, to clarify the features of simulation instructional design that optimize learning outcomes and efficiency in health care professional students. Cognitive Load Theory (CLT) is a theoretical framework focused on a learner’s working memory capacity. One principle of CLT is example based learning. While this principle has been applied in both traditional classroom and laboratory settings, and has shown positive performance and learning outcomes, example based learning has not yet been applied to the simulation setting. This study had two main objectives: to explore if the example-based learning principle could successfully be applied to the simulation learning environment, and to establish response process validation evidence for a tool designed to measure types of cognitive load. Fifty-eight novice students from nursing, podiatric medicine, physician assistant, physical and occupational therapy programs participated in a blinded randomized control study. The dependent variable was the simulation brief. Participants were randomly assigned to either a traditional brief or a facilitated tutored problem brief. Performance outcomes were measured with verbal communications skill presented in the Introduction, Situation, Background, Assessment, Recommendation (I-SBAR) format. Response process evidence was collected from cognitive interviews of 11 students. Results indicate participation in a tutored problem brief led to statistically significant differences at t(52)=-3.259, p=.002 in verbal communication performance compared to students who participated in a traditional brief. Effect size for this comparison was d=(6.06-4.61)/1.63 = .89 (95% CI 0.32-1.44). Response process evidence demonstrated that additional factors unique to the simulationlearning environment should be accounted for when measuring cognitive load in simulation based learning (SBL). This study suggests that example based learning principles can be successfully applied to SBL and result in positive performance outcomes for health professions students. Additionally, measures of cognitive load do not appear to capture all contribution toload imposed by the simulation environment.

No description available.

Competence committees are groups of educators that monitor the progress of medical trainees and decide when they should be promoted to the next stage of training. They represent an important part of modern-day competency-based medical education programs, yet relatively little is known about their implementation and decision-making practices. This thesis seeks to fill a critical gap in the literature by generating empirical evidence with respect to competence committee implementation and decision-making practices across multiple programs. The first data chapter uses a multi-method approach to examine competence committee implementation practices at a Canadian institution over a three-year period. The second and third chapters examine how individuals and groups make promotion decisions, respectively. These chapters also consider the role of non-traditional data sources, such as anecdotal evidence, in competence committees’ decision-making processes. The final data chapter considers the role of social influences and power and examines how factors such as members’ position on the committee, gender, and race/ethnicity influence their contributions to the committee. This thesis provides insight into some of the challenges that exist with respect to competence committee implementation and offers potential solutions based on best practices across multiple programs. It also highlights factors that can influence competence committee decision making and discusses ways that their decision-making processes can be optimized. Broader implications of this thesis, including the role of groups in solving complex problems and the importance of diversity (both in terms of demographics and functional specialization) in ensuring good decision-making outcomes, are also discussed. / Thesis / Doctor of Philosophy (PhD) / Competence committees are groups of experienced health professionals and educators whose job is to determine whether physician learners (i.e., residents) are ready to progress to the next stage of training and responsibility. These committees are relatively new, and as a result, we do not know very much about how they make decisions. Given the importance of competence committees in ensuring that physicians are able to provide high-quality and safe patient care, the purpose of this thesis was to examine competence committee implementation and decision-making practices at a Canadian academic centre. This took place in two parts. First, we studied competence committees over a three-year period using surveys, interviews, and observations. This helped us understand some of their benefits and challenges. Next, we conducted a series of experiments to understand how competence committee members make decisions both individually and as part of a group. These experiments also helped us understand how competence committees make sense of different types of data, such as prior knowledge about a resident or their assessors. Finally, we examined how various aspects of members’ social identities, such as their position on the committee, their gender, and their race/ethnicity, influence their contributions to the committee. Collectively, the findings of this thesis help to advance the scientific literature in the areas of medical education and group decision making. They can also be used to optimize competence committee operations, which can in turn positively impact patients, healthcare, and society.

This study evaluated three HCOP projects to determine, describe, and assess their overall effectiveness and identify successful strategies used by these projects to reach their specific objectives. Demographic and scholastic data were collected about 393 HCOP participants at the three HCOP projects in Kentucky, Tennessee, and Virginia during the years 1990-1999. Detailed information about the activities used to incorporate the HCOP legislative purposes into the programs was also collected. Sixty-seven percent of HCOP participants were Caucasian and 78% were female. Scholastic data was limited to data from the EKU and ETSU HCOP programs. The average high school GPA score for HCOP participants in this study was 3.34 on a 4.0 scale. The average ACT score was 20.6. When compared with institutional data, HCOP students had a higher GPA than the regular first-year college students at the specific institutions. The average ACT scores were similar for the HCOP and regular students taking into account the standard error of measurement. Ninety-three percent HCOP participants enrolled in college and 77% of them majored in a health profession programs. Fifty-eight percent of the HCOP participants graduated from a program of study and of those who graduated, 87% were from a health profession program. Eighty-seven percent of the HCOP participants were employed in a health profession. HCOP projects were required to conduct activities that addressed two or more legislative purposes. These legislative purposes were recruitment, preliminary education, facilitating entry, retention and dissemination of financial aid information. The activities of each project were summarized and the impact was discussed. Students who participated in HCOP programs were likely to enroll and graduate from a health related major and become employed in a health profession. The researcher recommended the need for (a) individualized retention strategies to prevent or minimize attrition rates among participants, (b) the development of a uniform participant profile that would allow for accurate comparisons across institutions, (c) HCOP grantees to be more supportive of evaluative studies and, (d) dissemination of research findings on HCOP programs and their impact.

Introduction: Competency-based medical education (CBME) is a learner-centered outcomes-based approach. Competence by Design (CBD) is a hybrid time-based and outcomes-based CBME model that was adopted by all Royal College of Physicians and Surgeons of Canada-based residency training programs, with the primary objective of enhancing postgraduate medical education quality. However, preliminary findings suggest that residents experience higher levels of stress, anxiety, and exhaustion in CBD than with previous curricula. This thesis aims to identify and understand the emotional effects of CBME on residents, faculty, and administrative staff. Methods: This study used a qualitative approach, specifically hermeneutic phenomenology. Seven residents, six faculty members (several with education leadership roles), and one administrative staff member from a postgraduate Psychiatry program were recruited. Participants underwent semi-structured, one-on-one interviews where they were probed on their emotions with CBME. Interviews were transcribed and analyzed using a line-by-line approach that generated individual meaning units and, subsequently, themes. Results: Five themes were identified: 1) Education is an emotional experience; 2) The emotional toll of CBD; 3) CBD is a failed educational promise—Expectations vs. realities; 4) Structural and administrative burdens of CBD; and 5) Survival of educational demands—The quest for coping. Participants initially struggled to articulate their emotions, but expressed surprise at realizing they did have strong, often negative, emotions related to CBD. There was also a dissonance identified between the anticipated benefits and the execution of CBD. Furthermore, participants highlighted administrative and structural challenges of CBD, specifically regarding Entrustable Professional Activities, which were a burden and lacked much educational value. Participants discussed using various coping strategies to manage CBD’s demands. Conclusion: The findings of this work suggest that CBD has a negative emotional impact on residents and faculty, specifically due to tension between CBD’s theoretical benefits and its practical challenges, including increased emotional burden and structural challenges. / Thesis / Master of Science (MSc) / Competency-based medical education (CBME) is a learner-centered outcomes-based approach. Competence by Design (CBD) is a hybrid time-based and outcomes-based CBME model that was adopted by all Royal College of Physicians and Surgeons of Canada-based residency training programs, with the primary objective of enhancing the quality of postgraduate medical education. However, preliminary findings suggest that residents experience higher levels of stress, anxiety, and exhaustion in a CBD model than with previous curricula. This thesis aims to understand the emotional effects of CBME on residents, faculty, and administrative staff in a postgraduate Psychiatry program. In this qualitative study, participants underwent semi-structured, one-on-one interviews where they were probed on their emotions and experiences with CBME. The findings suggest that CBD has a negative emotional impact on residents and faculty, specifically due to tension between CBD’s theoretical benefits and its practical challenges, including increased emotional burden and structural challenges associated with the assessment methods.

ENGLISH ABSTRACT: The setting for this study was the University of the Western Cape, Faculty of Community and Health Sciences, first year undergraduate students. All students who participated in the compulsory interprofessional programme were from the following disciplines: Occupational Therapy; Physiotherapy; Psychology; Social Work; Natural Medicine; Dietetics; Human Ecology; Sports Sciences and Nursing. The objectives of this study were to measure the attitudes and perceptions of first year students who participated in an undergraduate interprofessional programme. The attitudes and perceptions were further measured in relation to the specific lecturers involved, the age of the students, their gender, race, background as well their specific discipline. This was primarily a quantitative study incorporating two qualitative questions in which 657 students were issued with a questionnaire designed to determine their attitudes and perceptions towards interprofessional education. A sample size of 264 students resulted in 95% confidence intervals with a maximum precision of 5%. The questionnaire was adapted, with permission, from Cameron; Rennie; DiProspero; Langlois & Wagner (2009). MS Excel was used to capture the data and STATISTICA version 9 (StatSoft Inc. (2009) STATISTICA (data analysis software system), www.statsoft.com.) was used to analyze the data from the questionnaires. Descriptive statistics was used to describe the main features of the sample of this study and summary statistics was further used to summarize the findings of this study in order to communicate the bulk of the information as simple as possible. Two open-ended questions were included at the end of the questionnaire and this was used to triangulate the data. The Kruskal-Wallace test was used to measure the results, whereby a p-value of <0.05 indicated statistical significance. Of all the factors used to measure the attitudes and perceptions of students, the following three were significant: Gender; Race and Discipline. No other factors impact on the attitudes and perceptions of students towards interprofessional education. Student attitudes and perceptions towards interprofessional education were found to be very positive. The findings revealed that the most significant factor in the study was the lack of understanding of various disciplines participating in the programme and their understanding of the relevance of the teaching approach (interprofessional) as well as their specific role in the health care team. This clearly illustrated the need to recommend to the co-ordinating unit of the programme that this be defined more clearly for the students and specifically the Sports Sciences students. / AFRIKAANSE OPSOMMING: Die studie het plaasgevind by die Universiteit van die Wes-Kaap, in die Fakulteit van Gemeenskap en Gesondheidswetenskappe, met eerste jaar voorgraadse studente wat die verpligte interprofessionele program doen. Studente sluit in die volgende dissiplines: Arbeidsterapie; Fisioterapie, Sielkunde, Maatskaplike Werk, Natuurlike Medisyne, Dieetkunde, Menslike Ekologie, Sport en Verpleegkunde. Die doelwitte van hierdie studie was om die houdings en persepsies van die eerste jaar studente wat deelgeneem het in 'n voorgraadse interprofessionele program te meet. Houdings en persepsies was gemeet met betrekking tot die ouderdom geslag, ras,agtergrond sowel dissipline van spesifieke studente. Daar was ook gekyk of die betrokke dosente ń invloed het op studente se houdings en persepsies teenoor die program. Die studie was hoofsaaklik kwantitatiewe met n kwalitatiewe komponent. Vraelyse was uitgereik aan 657 studente om hul houdings en persepsies teenoor interprofessionele onderwys te bepaal. 'n Steekproefgrootte van 264 studente het in 95% vertrouensintervalle met 'n maksimum akkuraatheid van 5%. Die vraelys is aangepas, met toestemming, van Cameron, Rennie; DiProspero Langlois & Wagner (2009). MS Excel was gebruik om die data op te vang en Statistica weergawe 9 [StatSoft Inc (2009) STATISTICA (data-analise sagteware stelsel), www.statsoft.com] is gebruik om die data van die vraelyste te analiseer. Beskrywende statistiek is gebruik om te beskryf die belangrikste kenmerke van die steekproef van hierdie studie. Opsommingstatistiek is verder gebruik om op te som die bevindinge van hierdie studie met die doel om die grootste deel van die inligting so eenvoudig as moontlik te kommunikeer. Twee oop vrae is ingesluit aan die einde van die vraelys en dit is gebruik om die data te trianguleer. Die Kruskal-Wallace-toets is gebruik om die resultate, waar 'n p-waarde van <0,05 aangedui word statistiese betekenisvolheid te meet. Van al die faktore wat gebruik was om die houdings en persepsies van studente te meet, was die volgende drie beduidende: geslag, ras en dissipline. Geen ander faktore impakteer op die houdings en persepsies van studente in interprofessionele onderwys. Studente se houdings en persepsies teenoor interprofessionele onderwys was beduidend positief. Die studie het bevind dat daar ń algemene gebrek aan begrip is vir die relevansie van die program. Dit sluit in hoekom die verskillende dissiplines aan die program deelneem as ook wat hulle spesifieke rolle in die gesondheidsorg span is. Die aanbeveling is dus dat die koördinerings eenheid van die program die kursus meer duidelik sal moet definieer om so doende die studente se kennis in terme van relevansie van die interprofessionele program uit te brei met spesifiek verwysing na die Sport studente.

<p>There are great expectations that collaboration among professions and various sectors will further develop health care and thus lead to improved public health. In the World Health Organization’s declaration “Health 21” the designated goal for health professions in the member nations in Europe by the year 2010 is to have developed health promotional competence, including teamwork and cooperation based on mutual respect for the expertise of various professions. The challenges faced by the interprofessional teams are, however, multifaceted, and these challenges place demands upon society, which, in turn, determines the fundamental conditions for collaboration among the health professions within the health care organizations.</p><p>This licentiate dissertation contains discourse and content analyses of interprofessional teamwork in health care. The major objective of this dissertation is to study and describe how the team members construct and create the content and significance of teams and teamwork among health professions. One specific goal has been to study how the members of a multi-professional health care team refer to their team, especially the discursive patterns that emerge and the function that these patterns has (I). The second specific goal has been to identify and describe the difficulties that the health professionals have experienced within their interprofessional teamwork. One purpose has been to enable discussions of the implications for interprofessional learning (II).</p><p>Focused group interviews with team members (n=32) from six teams were studied using discursive social psychological research approach. The analysis concentrated on the use of the pronouns “I”, “we” and “them”. The results were then analyzed in relation to theories on discursive membership and discursive communities (I). Individual semi-structured interviews with team members (n=18) from four of the six teams were carried out using critical incident techniques. The interviews were analysed via latent qualitative content analysis and the results were interpreted in the light of theories on sociology of professions and learning at work (II).</p><p>The findings showed that two discursive patterns emerged in the team members’ constructions of “we the team”. These patterns were designated knowledge synergy and trustful support (I). The following three themes that touched upon the difficulties of interprofessional teamwork were identified in the personal interviews: (A) difficulties concerning the teams’ dynamics that arose when the team members acted as representatives for their respective professions; (B) difficulties when the various contributions of knowledge interacted in the team; and (C) difficulties that were related to the surrounding organisation’s influence on the team (II).</p><p>The conclusion was reached that the discursive pattern provided rhetorical resources for the team members, both in order to reaffirm membership in the team and to promote their views with other care providers, but also to deal with difficulties regarding, for example, lack of unity in outlook. The conclusion was also drawn that, in addition to the individual consequences, one outcome of the perceived difficulties was that they caused limitations of the use of collaborative resources to arrive at a holistic view of the patient’s problems. Thus the patients could not be met in the desired manner.</p><p>The practical implications of the research project concern the development of teams in which various forms of interprofessional learning can influence the continued development of the team and the management of health care in regard to the importance of implementation processes and organisational learning.</p> / <p>Stora förväntningar ställs på att samarbete mellan yrkesgrupper och mellan sektorer ska utveckla hälso- och sjukvården och leda till en förbättrad folkhälsa. I Världshälsoorganisationens policydokument “Health21” anges exempelvis målsättningen att hälsoprofessionerna i de europeiska medlemsländerna till år 2010 ska ha utvecklat en hälsofrämjande kompetens som bland annat innefattar teamarbete och samarbete på basis av ömsesidig respekt för de olika professionernas expertis. Det interprofessionella teamets utmaningar är dock mångfacetterade och kräver uppmärksamhet från det samhälle som skapar villkoren för hälsoprofessionernas samarbete inom hälso- och sjukvårdens organisationer.</p><p>Denna licentiatavhandling innehåller diskurs- och innehållsanalytiska studier om interprofessionellt teamarbete i vården. Avhandlingens övergripandet syfte var att undersöka och beskriva hur teammedlemmar konstruerar och skapar innebörder av team och teamarbete mellan flera hälsoprofessioner. Det ena specifika syftet var att undersöka hur medlemmar i multiprofessionella vårdteam talar om sitt team, särskilt avseende de diskursiva mönster som framträdde och vilken funktion dessa mönster hade (studie I). Det andra specifika syftet var att identifiera och beskriva svårigheter som hälsoprofessioner har uppfattat vid interprofessionellt teamarbete, där avsikten även var att möjliggöra en diskussion om implikationer för interprofessionellt lärande (studie II).</p><p>Fokusgruppintervjuer med teammedlemmar (n=32) från sex team analyserades utifrån en diskursiv socialpsykologisk forskningsansats och fokuserade på användningen av pronomina ”jag”, ”vi” och ”de”. Fynden relaterades sedan till teorier om diskursivt medlemskap och diskursiva samhällen (studie I). Individuella semistrukturerade intervjuer med teammedlemmar (n=18) från fyra av de sex teamen genomfördes med critical incident-teknik. Intervjuerna analyserades via latent kvalitativ innehållsanalys och fynden tolkades utifrån teorier om professionssociologi och lärande i arbetet (studie II).</p><p>Resultaten visade att två diskursiva mönster framträdde i teammedlemmarnas konstruktioner av ”vi-som-team”. Dessa mönster benämndes kunskapssynergi och tillitsfullt stöd (studie I). Vid individuella intervjuer med teammedlemmar identifierades följande tre teman som rörde svårigheter vid interprofessionellt teamarbete; (i) svårigheter som gällde den teamdynamik som uppstod när teammedlemmarna agerade som företrädare för sina professioner i relation till teamet, (ii) svårigheter när medlemmarnas olika kunskapsbidrag interagerade i teamet och (iii) svårigheter som rörde den omgivande organisationens påverkan på teamet (studie II).</p><p>Konklusionen gjordes att de diskursiva mönstren utgjorde retoriska resurser för teammedlemmarna, både för att bekräfta medlemskapet i teamet, för att hävda sina åsikter i kontakter med andra vårdgivare (”de andra”) och även för att hantera uppfattade svårigheter beträffande exempelvis bristande samsyn. Vidare drogs slutsatsen att en konsekvens av de uppfattade svårigheterna var, förutom individuella konsekvenser, begränsningar i användandet av de gemensamma resurserna för att nå en helhetssyn på patientens problem och att patienterna inte kunde bemötas på det sätt som önskades.</p><p>Forskningsprojektets praktiska implikationer rörde teamutveckling där olika former av interprofessionellt lärande påverkar teamets fortsatta utveckling, samt ledning av hälso- och sjukvården avseende betydelsen av imple-menteringsprocesser och organisatoriskt lärande.</p>

It is the aim with this paper, to research the shortcomings experienced in the appeal procedures as contained in the Engineering Profession Act ("EPA"), in order to determine whether the process should be revised or if only certain relevant sections of the EPA should be rewritten. Due to the administrative nature of certain duties of the Council as authorised by the EPA, it makes it inevitable that appeals will follow. It is therefore imperative that the procedures to appeal, must be both functional and effective. The relevant sections of the EPA as well as the appeal procedures of the Health Professions Act's will be researched, taking into account the stipulations of the Constitution and the Promotion of Administrative Justice Act ("PAJA"). Relevant legal administrative principles and doctrines, court judgments, as well as the views of authors are also taken into account. Two major areas of concern in certain sections of the EPA have been identified: • The fact that the whole council has to decide on appeals, and • the fact that such hearings have to take place within a very limited time frame. Relevant court findings have made it clear that decisions made by authorities, have to comply with the requirements set out in the Constitution in coherence with PAJA. In conclusion, based on the Constitutional and the legal administrative requirements, it is found to be necessary to rewrite the relevant sections of the EPA, as well as the rules of appeal, as these do not make the grade at present. / Thesis (LL.M. (Public Law))--North-West University, Potchefstroom Campus, 2009.