Perceptions of postgraduate family medicine supervision at decentralised training sites, South Africa

Abstract

BackgroundIn 2013, the World Health Organization advocated expanding health professionals' training from academic centres to decentralised training platforms in order to address communities, and nations' priority health concerns. 1,2 Decentralised clinical training (DCT) refers to training at sites away from tertiary centres for six months or more in the context of primary healthcare (PHC) clinics, community, district or regional hospitals, or general practice settings. 3 While DCT is well established in high-income countries (HIC), such as Australia, the United Kingdom and Canada, 4 it is a relatively new concept in low-and middle-income countries (LMIC), such as South Africa (SA) and other sub-Saharan nations. 3,4,5,6 Decentralised clinical training offers trainees more handson experience of clinical and procedural skills during longer longitudinal rotations. It also provides flexible curricula typical of postgraduate medical training. 3,7 Despite these affordances, DCT is affected by factors more likely to prevail in LMIC, including a lack of resources and comprehensive support. Training at DCT sites has been shown to improve healthcare provision across communities; however, DCT needs to be optimised in order to ensure that the priority health concerns of LMIC are met. 3,4,8,9 Background: Specialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa. The strong emphasis on workplace-based learning for speciality training makes it vital to gain in-depth insights into registrar supervision. Previous studies have explored aspects of supervision at decentralised sites in high-income countries, however, little is known about the benefits and constraints of decentralised postgraduate supervision in low-to middle-income countries, especially in Africa.Aim: This study aimed to explore family physicians' and registrars' perceptions of the strengths and challenges of clinical and educational supervision across decentralised training sites. Setting:The study was conducted across two provinces at five decentralised training sites affiliated with the University of the Witwatersrand, Johannesburg.Methods: This qualitative study involved semi-structured interviews with a purposive sample of 11 FPs and 11 registrars. The data were thematically analysed.Results: Two of the four themes identified, 'supervision is context-specific and supervisordependent', and 'the nature of engagement matters', involved strengths and challenges. The other two, 'supervision is not ideal' and 'the training environment is challenging', focussed on challenges. Conclusion:Supervisors and registrars described the postgraduate FM supervision as contextspecific and supervisor-dependent. Supervisors displayed good clinical-teacher characteristics and supervisory relationships. However, several challenges, including registrars' workload, resource shortages and a lack of standardisation across training sites, need to be addressed. Regular faculty development is essential for supervisors to be aware of relevant aspects of, and curren...

Evaluating postgraduate family medicine supervisor feedback in registrars’ learning portfolios

“…Mini-CEX forms have descriptors that guide structured feedback on observed performance, 8 but these were not used effectively. Possible reasons for supervisors not providing effective feedback could be their multiple roles and responsibilities 33 and the lack of protected time for educational activities, 40 especially for direct observations or their lack of skills or training. 5 , 17 , 39 The supervisors in this study often appeared reluctant to provide honest and negative feedback and grade trainee performance when it is poor, as has been seen in previous studies.…”

“… 1 , 5 Other possible reasons for the poor supervisory feedback reported in this study could be deficiencies in trainers’ knowledge and clinical competence, facilitation or interpersonal skills, and awareness of trainee’s learning needs – all factors that have been described in other studies. 2 , 33 Organisational factors such as work demands, poor recognition for teaching activities and a lack of a conducive environment could also negatively affect feedback provision. 1 Some FP supervisors participated in training courses conducted by the academy or the university but ongoing training opportunities could capacitate them better than once off attending training.…”

“… 32 A previous publication from the broader study reported evaluating postgraduate supervision as a process in the logic model. 33 This article reports evaluating supervisors’ feedback as a proxy measure for effective supervision as an output in the logic model. In the setting for this study, registrar training is primarily based in primary or community healthcare clinics or a district hospital.…”

Perceptions of resources available for postgraduate family medicine training at a South African university

“…The issue of FPs’ lack of availability and accessibility was regarded as an example of ineffective supervisory behaviour, 46 which could be attributed to their multiple roles and responsibilities, as seen in other studies. 37 , 47 …”

“…Academic supervision involves the supervision of assignments, research and various presentations. 37 The educational supervisory role includes mentoring the registrar, performing various summative and formative assessments and participating in the district training programme, as evidenced in the registrar’s learning portfolio. 37 …”