Health sciences literature from 1970 - 1977 which pertains to monitoring and maintaining competence of health professionals is abstracted and reported. Recognizing that competence is defined by the criteria and standards used to evaluate its presence, this thesis uses Donabedian's evaluation model to organize the bulk of the literature reviewed. While the model applies to competence of the health care system, this paper limits discussion to competence of health professionals. It considers literature concerned with definition, evaluation, and restoration/maintaince action related to knowledge and skills possessed by practioners (structure), clinical performance (process), and results of care (outcome). Additionally it provides information about the historical development of and current trends in credentialing mechanisms intended to certify competence, explores in some detail the issue of mandatory continuing education, and discusses contemporary social and political phenomena which influence and are influenced by competence monitoring activities. The concluding chapter offers observations on the current state-of-the art with respect to evaluating and maintaining competence and makes recommendations for further research, development and implementation of competence monitoring activities consistent with the North American social context. Finally, several implications for continuing educators' roles and responsibilities vis a vis monitoring and maintaining health professionals' competence are discussed. / Education, Faculty of / Educational Studies (EDST), Department of / Graduate

published_or_final_version / Business Administration / Master / Master of Business Administration

M.A. (Social Work) / Accountability and competence are two important attributes needed by medical social workers in the changing social, political, economic and organizational situation in South Africa, In order -to be accountable and competent, medical social workers must be in possession of scientific knowledge, skills and the correct attitude regarding assessment, intervention and evaluation. The change in emphasis from long-term to short-term hospitalization and the importance of primary health care, means that within the limitations of the present organization structure, assessment is often the most important and sometimes the only, aspect in the helping process. The knowledge and skills of the medical social workers need to be extended; this study therefore focuses on effective assessment that will equip the medical social worker to render an effective service through linking resources within the patient, hospital and within the community. The aim of this study is the development of a training programme for medical social workers to extend their knowledge and skills in assessment.

Dissertation submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2011. / South African Advanced Life Support (ALS) providers follow an autonomous practice model of care. This advanced role profile is characterized by clinical skill competence and autonomous decision making whilst demonstrating a high level of awareness of their own ethical attitudes, values and beliefs. It is through a professional commitment that ALS providers deliver an advanced evidence based practice that should be maintained constantly within a dynamic environment. Continuous Professional Development (CPD) is seen as an instrument for this. CPD should also serve as a means to acquire professional excellence and going beyond the boundaries of meeting the base level standard with the aim of providing the finest quality of care in the interest of patient safety. Purpose of the research The purpose of this research is to identify gaps in the professional development of out-of-hospital ALS providers trained in South Africa by assessing frequency of performance of ALS clinical skills, by determining perceived level of competence and predictors of confidence, and by sourcing information on attendance of CPD activities and training needs. vi Methodology This study used a quantitative non-experimental design. Data was attained from an e-mail based descriptive survey that was limited to a precise and concise questionnaire. The data from 140 (N) ALS providers was subjected to a descriptive statistical analysis using the PASW statistics version 18.0 to systematically show patterns and trends. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using Chi-square and Pearson correlation tests. Results Results indicated that ALS providers performed clinical skills infrequently. Of the total number of respondents 140 (N), the average ALS clinical skills performance was 6 (4.8%) daily. In the 2-6 times a week category 8 (6.4%) ALS clinical skills were performed. ALS clinical skills performance in the once a week category showed an average of 7 (5.6%) and the once a month category, an average of 17 (13.7%) ALS skills were performed. An average of 31 (25%) ALS skills were performed in the once in six months category whilst an average of 54 (43.5%) were performed in the greater than six months category. CPD activities that are appropriate to ensuring the maintenance of competence for these clinical skills were not adequately undertaken. Medical updates were mostly attended by ALS providers, 52 (42.9%) whilst CPD events that addressed clinical skills, was mostly limited vii to the ACLS course 42 (34.7%). The needs assessment for CPD showed that 56 (53%) of respondents expressed a need for paediatric and obstetric simulated skill sessions, whilst 43 (40.9%) requested clinical skills workshops and 39 (37.1%) expressed a need for clinical practice in theatre and coronary care units. Conclusions and recommendations This study shows that ALS clinical skill competence is maintained by frequent practice and appropriateness of CPD activities. The infrequent performance of ALS skills coupled with the lack of appropriate and diverse CPD activity attendance results in poor maintenance of competence. The loss of competence can be related to poor reported levels of confidence which consequently places patient safety at risk. To safeguard against medical error and ensure patient safety, it is strongly recommended that CPD audits be undertaken on all ALS providers for appropriate CPD compliance related to clinical skills performance. In addition to a clinical skills audit, it is recommended that a national clinical skills registry be established with the intention of facilitating clinical skill surveillance, to determine a notifiable, high risk skill set. To safeguard against knowledge and clinical skill attrition and loss of competence, the delivery of CPD activities should be assessed for effectiveness and appropriateness.

Submitted in fulfillment of the requirements for the Master of Health Sciences in Radiography, Durban University of Technology, Durban, South Africa, 2016. / Introduction: Continuing Professional Development (CPD) has been introduced as a means to ensure that professionals continuously update their knowledge and skills. In addition, CPD has become a mandatory requirement by the Health Professionals Council of South Africa (HPCSA). However despite CPD being mandatory, health professionals nationally and internationally alike have experienced numerous challenges obtaining the required CPD points/hours. Some of these challenges included lack of awareness of the CPD requirements, lack of available activities, lack of employer support, lack of funding and a lack of time to participate. No studies have been conducted amongst radiographers working in the province of KwaZulu-Natal (KZN), to determine if they are affected by similar challenges hence the need for this study. Purpose The purpose of this study was to identify the opinions, level of awareness, participation, and challenges related to CPD compliance by radiographers in KwaZulu-Natal, and to ascertain their suggestions for improvement to CPD practices in order to make recommendations to the HPCSA. Method A quantitative, descriptive research approach using a questionnaire with both open-ended and closed-ended questions was utilized. Radiographers from all four disciplines in Radiography, working in the province of KwaZulu-Natal were included in this study. A five point Likert scale was used for most of the closed questions. The open ended questions allowed respondents to express their opinions freely. The quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0. The inferential statistics included bivariate correlations and Chi-square testing. Open ended questions were analyzed by means of thematic analysis. Results Two hundred and ninety two questionnaires were administered and one hundred and forty six were returned which resulted in a 50% response rate. The mean age of respondents were 31.3 years. The majority of respondents were females (85.6%). Most of the respondents were diagnostic radiographers (80.8%) hence 59.6% were shift workers. Fifty percent of the respondents were employed in the public health sector. Respondent’s acknowledged the importance of CPD however majority indicated engagement due to the mandatory requirements by the council. The most common challenges identified were lack of funding and time. Suggestions for having formal polices in place and allocation for financial support were recommended. A number of respondents suggested having an online database for the systematic recording of CPD points in order to improve the audit process. In this study relationships between different variables were tested. It was noted that a progression in rank resulted in a greater level of agreement that CPD does improve professional competence. The infrequency of CPD engagement was directly affected by the difficulties associated with evidence and record keeping of CPD activities. The lack of funding was a greater challenge amongst the public health sector employees as opposed to the private sector. It was also noted that a lack of employer support affected how often respondents engaged in CPD activities hence support from employers was deemed crucial. Conclusion Radiographers working in KwaZulu - Natal were experiencing numerous CPD challenges. Suggestions were made to overcome these challenges as well as improving the auditing system by the HPCSA. / M

Indiana University-Purdue University Indianapolis (IUPUI) / While the majority of chronic pain patients report receiving inadequate care, there is evidence that female and Black patients receive less analgesic medications and treatment for their chronic pain compared to male and White patients, respectively. While treatment disparities have been evidenced in the literature, there is little understanding of provider-factors, such as their decision-making awareness and attitudes, which may contribute to the differences in treatment. This investigation employed quantitative and qualitative procedures to examine the relationship between patient demographics and chronic pain treatment variability, providers’ awareness of these non-medical influences on their decisions, and the extent to which providers’ gender and racial attitudes associate with their treatment decisions. Twenty healthcare trainees made pain treatment decisions (opioid, antidepressant, physical therapy, pain specialty referral) for 16 computer-simulated patients presenting with chronic low back pain; patient sex and race were manipulated across vignettes. Participants then selected among 9 factors, including patient demographics, to indicate which factors influenced their treatment decisions for the simulated patients and completed gender and racial attitude measures. After online study completion, follow-up semi-structured interviews were conducted to discuss the medical/non-medical factors that influence trainees’ clinical treatment decisions. Quantitative analysis indicated that 5%-25% of trainees were actually influenced (p<0.10) by patient sex and race in their treatments, and on the whole, trainees gave higher antidepressant ratings to White than Black patients (p<.05). Fifty-five percent demonstrated concordance, or awareness, between their actual and reported use of patient demographics. Follow-up McNemar’s test indicated trainees were generally aware of the influence of demographics on their decisions. Overall, gender and racial attitudes did not associate with trainees’ treatment decisions, except trainees’ complementary stereotypes about Black individuals were positively associated with their opioid decisions for White patients. During qualitative interviews, aware and unaware trainees discussed similar themes related to sex and racial/ethnic differences in pain presentation and tailoring treatments. We found that (1) a subset of trainees were influenced by patient sex and race when making chronic pain treatment decisions, (2) trainees were generally aware of the influence of patient demographics, and (3) trainees discussed differences in pain presentation based on patients’ sex and ethnic origin. These findings suggest trainees’ are influenced by patient demographics and hold stereotypes about patient populations, which may play a role in their decision-making.