Celebrating the mepi success
2010 - 2016
the mepi principal investigators
foreword
professor Umesh Lalloo Lead, MEPI Grant Writing Team
mepi communicating pi dr sandy pillay
Co-PI professor Douglas Wassenaar
lead, mepi grant writing team professor Umesh Lalloo
Co-PI professor RAZIYA BOBAT
Co-PI Professor Philip LaRussa
(Columbia University)
Co-PI Professor jack Moodley
Co-PI Professor Scott M. Hammer, M.D.
(Columbia University)
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lmost six years ago, a small team, led by myself, from the Enhancing Care Initiative (ECI), was given a 6-week deadline to submit a competitive application for a multi-million dollar education grant to innovate and transform medical education. A multi-faceted and thoroughly thought out proposal was developed – each component carefully aligned with a transformative and forward-thinking agenda. The unique, albeit risky approach taken (given the brief to address medical education) was to develop a proposal that incorporated the disciplines of medicine, nursing and pharmacy based on an understanding that transformative education required a multi-disciplinary approach. A further innovation was to target a wide audience including the student, faculty and newly qualified graduate. Finally, the leadership model adopted was a co-principal investigator one, bringing together a range of skills, experience and backgrounds from HIV to paediatrics to maternal care to medical ethics. The result has been a stand-out application with 42 individual deliverables across multiple disciplines – a unique, innovative and highly successful grant exceeding expectations. There have been many successes of this NIH/PEPFAR-sponsored initiative, many of which will be highlighted within this commemorative publication.
Perhaps one of the most important achievements has been the success of the NIH’s bold approach of granting prime recipient status to African institutions which sub-contracted US institution partners. Not only has this given ownership to the African university with highly successful outcomes, it has also spawned the African PI Council, a spontaneous coming together of African PIs to form a powerful leadership structure of African health experts and academics on the African continent. The MEPI journey has been challenging but interesting, made light by a committed and hard-working team. It is hoped that the seeds sown especially in the PhD programme, HIVenriched nursing curriculum, innovations in the pharmacy curriculum, emergency medicine, maternal care, medical ethics initiatives, dual track qualification, graduate tracking and public health education will be sustained. As we close the chapter on this MEPI grant, I would like to take the opportunity to thank the funders for the trust and support and to all those who contributed towards the achievement of the MEPI goals - the PIs, participants, students, project managers and everyone who gave of their time, commitment and dedication to ensure the legacy of MEPI’s contribution sets the benchmark for the future generation of health students.
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Contents 1 family medicine / rural health Integrated PHC Rural Placement for
Final Year Medical Students..................................................... 4 Home Stays: A New Approach to Rural Placements......................................................................... 6 Transformation in Medical Education............................... 8 The Emergency Medicine Outreach Programme.......................................................................................... 10
Additional images:
shutterstock.com
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remeth......................................................................... 12 public health......................................... 14 nursing...................................................................... 16
pharmacy............................................................ 18 esmoe............................................................................... 20 rescap.......................................................................... 22 personal reflections................................................. 24
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monitoring and evaluating........................................................ 26
Succession planning is critical for sustaining and expanding the training of competent, researchminded health care workers.
graduate tracking................................................................ 28
research tracking................................................................ 30
clinical research.............................................................. 32
the mepi legacy................................ 34
What sets the MEPI initiative apart is the focus on ‘doing’ rather than ‘talking’. The data capturing, analysis and scientific writing workshops were all hands on and practical and I am a better supervisor for having been able to improve my own research skills.
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family medicine / rural health
telling the mepi story 5
Dr Mosa Moshabela Head: Department of Rural Health, UKZN Dr Bernhard Gaede Head: Department of Family Medicine, UKZN
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Integrated PHC Rural Placement for Final Year Medical Students
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n January 2015, the University of KwaZuluNatal launched the integrated primary health care rural placement for final year medical students (IPC3) at the Nelson R. Mandela School of Medicine. These students are now trained for six weeks within ten rural district hospitals across the KwaZulu-Natal.
Why the need?
With the current re-engineering of primary health care (PHC), the Department Of Health is decentralising health care towards PHC, and therefore medical institutions have to follow suit and decentralise training of medical education so that our graduates can adequately support the PHC-based health system. The main objective of student placement in the rural settings is to develop and reinforce the medical generalist skills of these ‘junior interns’, and to sensitize them to the importance of learning how to function in resource-limited district health system, and to cope with the realities of such PHC-based systems common to South Africa.
The Integrated Primary Health Care 3
The first group of final year students from Curriculum 2010 entered their sixth year in 2015, and groups of two to four final year medical students per site had the opportunity to work in rural district hospitals, closer to the many local and indigent communities in the KZN province. In the context of largely resource-constrained district hospitals where every member of the health care team
counts, and not just doctors, students become more visible than they often are in tertiary hospitals, and here like new little birds a moment of truth finally arrive where they finally learn to fly. Students are placed in the care of new and seasoned rural district hospitals doctors to experience first-hand the responsibility of care placed on the medical professional, and to assist them in overcoming the anxieties of practicing medicine with limited support and resources. Students become members of intimate medical and health care teams, realise first-hand the inter-dependence of health care team members on each other as they endeavour to make a difference for patients, and the difference made by managers of health care resources in creating access to care for patients.
Do Students Cope?
For many students on the programme, the biggest challenge they face relate to removal from their familiar environments, including their medical school. Prior to their placement, many experience major anxieties about issues like which hospitals they will be placed, location, accommodation, dietary needs etc. Academics involved in the programme work hard to allay their fears and address their concerns. It is not possible to satisfy all students who may have preferred hospitals they wish to go to, but we do allow them to choose a clinical partner, with whom they will work closely to reduce feelings of loneliness and isolation, and with whom they may be able to openly debrief about their disorienting experiences for peer support.
Meaning of a true doctor
Understanding of patient circumstances/ environment Individualisation of approaches to patient care
Balance of many attributes
Working as a team
significant transformations
Desire to practice as a rural doctor
Attitude towards patients and their conditions
“I’ve learnt that listening to patients is a healing remedy on its own.”
Responsibility
Confidence
Respect for patients and colleagues Clinical skills
"At the end of each rotation, students acknowledged the shortcomings of having held negative thoughts prior to entering into the rotation, and expressed the importance of having a positive mind-set from the beginning, and knowing from the outset that the rotation is designed to be a good learning experience given views of those who have completed it. Such positive ways of approaching the rotation are seen to enable students to adjust faster, cope better and learn more.”
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family medicine / rural health
telling the mepi story 7
Home-stays: A New Approach to Rural Placement
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number of additional projects are being linked to the rural block, including the possibility of placing students in community homes for the duration of the rural block. As a pilot project, the project is exploring the home-stays from 3 key perspectives: Whether the home-stays are suitable as accommodation for students during their rural block. Whether the home-stays contribute to community-embeddedness of the students. Whether the home-stays can contribute to the university’s engagement with communities.
The arrangements with host families were negotiated and a community liaison person identified at each of the participating sites. In April 2016 the first 8 volunteer students spent their rural block living in the homes of community members, and the initial placements went smoothly.
Sustainability and the way forward
The development of the rural block has been part of a larger process over the past 2 years at the University. Driven by both the imperative to increase the production of health care professionals as well as manage the re-orientation of the curriculum to reflect a stronger primary health care focus, the establishment of a decentralised training platform in the province has been initiated. With high level commitment from within the Department of Health as well as
the UKZN management, the planning process is moving ahead and increasingly district hospitals are providing suitable context for training health care professionals. The rural block has provided valuable experience regarding the engagement of the University with the rural district hospitals and provides a sound foundation for further development. It has also unlocked opportunities for the College of Health Science to explore novel approaches to both reorientation of the curriculum as well as address the imperative of increased student intake.
What the students had to say... So, having spent six weeks in a rural setting, did our medical students love the experience or vow never to return?
“Definitely worth the experience. I am an urban girl and thought I wouldn’t cope but I loved it and it made me realise that a patient must be treated holistically.”
“Wow! What an experience. I found it difficult at first as I had to walk to the hospital sometimes, as I could not always catch a taxi, but the community was warm and welcoming. I felt safe and my host-family really made me feel part of the family.”
“I think for the first couple of days, maybe even two weeks, we complained a lot. We were miserable and realised we were going to be here for a very long time. So it meant that we either try to make it work and improve our living situation or we just suffer. And we decided as a group - I was in a group of three other students that had never met before - to create a support structure from within, and the doctors were very helpful and supportive. They would transport us to collect and buy water. We had a good support structure from the hospital staff as well.” “You know, they have taught us that you learn medicine not from the textbook but the patient and I think that saying was real for me when I was there. You really learn a lot when you see a patient, from history-taking right up to diagnosis, management, and follow up; the whole process... and if you dedicate your time to each patient and you look at each step meticulously, go back and read, you never forget.”
“I felt I really developed as a person and as a future doctor. It made me realise that rural health is where I want to be; it’s where I can make a difference and reminded me why I wanted to become a doctor.”
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family medicine / rural health
telling the mepi story 9
Transformation in Medical Education A TiME STUDY CO-FUNDED BY MEPI & the national research foundation The main aim of the transformation in medical education (TiME) study is to investigate the constraints in the medical curriculum that limit training institutions from meeting the needs of the health care systems in South Africa. The official launch of the project took place in Durban 2014, which saw members from different Universities and organisations come together. In total, four Universities agreed to participate in the study; the University of KwaZulu-Natal (UKZN), the University of Witwatersrand (Wits), Walter Sisulu University (WSU) and Sefako Makgatho Health Sciences University (SMU). The objectives and aims of the study were presented and split into six specific research themes as follows: Attributes and competencies Theories of learning Balance between specialists and generalists Decentralised training platforms Mutual benefits The hidden curriculum
Each participating institution was allocated a theme and a leader. The following table shows the theme and link to the University:
attributes and competencies.............................. ukzn theories of learning............................................ ukzn specialists vs. generalists................................
smu
Decentralised Training Platforms............
wits
mutual benefits..............................................
wsu
hidden curriculum................................... ukzn Telling the Story
2014
saw the beginning of the project and besides from the Colloquium where the project was introduced, outputs were limited. They did include, however, an oral presentation entitled ‘Social accountability in the transformation of medical education to meet the needs of the health care systems and local communities in South Africa’ presented at the UKZN University Teaching and Learning Office (UTLO) conference. In addition, a poster presentation was made on a scoping review on medical education in Sub-Saharan Africa at the TUFH Educational Meeting in Brazil in November.
2015
Due to the unfortunate passing of one of the institution leaders, new members were needed for WSU which saw a delay in progress. New members from WSU were selected and members from each University met in Mthata in August. The purpose of the three-day meeting was to discuss scoping reviews, papers for publications, the possibility for students to work on the project and the future plans of the project, such as ethical submissions and the qualitative research phase. Each participant agreed to write a scoping review on their theme for both research and publication purposes. In October, team members met again in Johannesburg to discuss the qualitative phase and participate in qualitative research training. Members were taught the basics behind ethnography, photo voice and focus group discussions. Concept notes and data collection plans were finalised and participants were encouraged to finish scoping reviews that were not complete. Outputs for 2015 included an oral presentation at the UTLO conference in Durban entitled ‘Strategies adopted by learners in medical education to success in their learning spaces using a learner-centered approach’. A presentation on the results from the scoping review on decentralized training platforms carried out by Wits was
presented at the Network/SAHEE conference and a presentation on leveraging integrated community clerkship was made at the UNIEVEN-WSU International conference.
2016
After a slow start following previous challenges, 2016 has so far seen the start of the qualitative data collection phase. Ethical approval was obtained for the whole project at both WSU and WITS. An application has since been submitted to the Biomedical Research Ethical Committee (BREC) at the University of KwaZulu-Natal and is awaiting approval. A data collection workshop took place in Mtatha which was supported through the MEPI funding. Interviews with Head of Departments and students took place for each of the themes. Following this, another data collection week has been planned at WITS with additional members attending. A number of papers are ready for submission to a variety of journals on the background of each theme. Papers and abstracts for conferences will be written based on the case study notes from the two data collection workshops.
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family medicine
telling the mepi story 11
Dr Mergan Naidoo Lecturer/Head Clinical Unit: Family Medicine, UKZN
The Emergency Medicine Outreach Programme An Overview Since 2002, the Department of Family Medicine at UKZN has had a programme aimed at improving the skills of doctors and nurses providing primary emergency care in the province. From 2002 until 2011, the programme consisted of lectures followed by emergency skills training in the clinical skills laboratory. These were predominantly didactic PowerPoint presentations and the skills were static emergency skills such as basic and advanced life support. In 2011, clinicians from the disciplines of Family Medicine, Emergency Medicine, Nursing, Paediatrics and Trauma Surgery collaborated to put together a modular based programme using a combination of short PowerPoint presentations and simulation-based training. The programme was developed into a two-day Emergency Medicine Workshop (EMW). Common emergencies were identified and a module was developed around these emergencies. Dedicated individuals from the various disciplines were asked to develop the module content, fire-drills and skills. The plan was to provide decentralised training in various districts to small groups of key individuals to improve emergency skills. The main objective of the Emergency Medicine Outreach Programme tallied perfectly with the Medical Education Partnership Initiative (MEPI) objectives, which were to increase the quality and quantity of Health Care Worker (HCW) training and attract and retain HCWs in areas of need by creating a supportive
learning environment in rural facilities. The EMWs were planned and executed across the province of KZN at nine different sites which included all districts in KZN.
Achievements Through the MEPI Collaboration
Key successes included the training of over 400 HCWs across the province and the introduction of standardised patient assessment tools such as the South African Triage Scoring system. The use of local specialists in the training programme facilitated linkages between primary care or district hospital facilities and regional and tertiary facilities and improved the patient referral pathways. A key outcome of the course five years on, is the request from the Provincial Department of Health to use the EMW and adapt it for a primary health care nurse practitioner. This was successfully done and a new course is currently being rolled out for PHC nurses at over 200 clinics in the eThekwini district. This should improve the quality of primary emergency care and accredit facilities so that they comply with the “Ideal Clinic” concept. The MEPI provided ongoing support during this entire project – not only by providing the financial resources but also by assisting with the planning and logistics. MEPI staff enthusiastically embraced the aims of the programme and could always be relied on to “get it together”, even at very short notice. Personally, as the coordinator of the course, it allowed me
to understand the context at which emergency care is being rendered in public healthcare facilities in KZN. It also enabled me to network with a range of HCWs and develop a useful network of resources. In addition, it allowed me to truly develop and implement concepts such as inter-professional education in a service based setting. The course developed to a point where participants were taught how to use limited resources to deliver a high-quality service.
Lessons Learnt
One of the key lessons for the future would be to measure the impact of this intervention on patient outcomes and currently plans are afoot for saturation training in one district for one acute emergency module – namely sepsis. The training is going to be linked with a research component and the team are hoping that the evidence generated from this project will be used to define a new way of providing emergency care outreach in KZN. For such programmes to be successful, ongoing resources are needed. Within the current financial climate, different options are being employed to maintain the long-term sustainability of such a programme. This is needed in the public health environment due to the rapid attrition rates of staff. Internal partners within UKZN as well as external partners have shown an interest in developing and maintaining the programme, so for now, the programme is set to continue.
Feedback from one of the district clinical nurse specialists who was a participant in the first course:
“Dear Doctor Naidoo and the Team, We would like to express our sincere gratitude to Dr Naidoo and the team of doctors that were facilitating the Emergency Workshop for PHC nurses, which was well structured and very informative. Participants were very impressed and saw the workshop as the beginning of a new life in their daily practice. Some even expressed their heartfelt feelings when recalling cases inadequately managed due to lack of knowledge and skills. Thus we thank you very much for such a comprehensive workshop.”
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remeth
telling the mepi story 13
Dr sandy pillay MEPI Communicating PI
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Research Methodology PhD Support Programme (REMETH) An Overview UKZN enrolled approximately 274 students into its undergraduate medicine programme, 174 students into the Bachelor of Nursing programme and 111 into the Bachelor of Pharmacy programme in 2015. There is, therefore, limited capacity for training healthcare professionals that are essential for the optimum functioning of the health system. The MEPI programme, ENTRéE (ENhancing Training and REsearch capacity Expertise) sought to address this challenge by increasing research capacity as one of the major goals. This assumption is based on the premise that healthcare professionals who are well trained and experienced in medical research are more likely to follow an academic research career, and will be retained within local academic institutions. This provides mentorship and supervision to the undergraduates and results in the output of competent health care professionals equipped with the necessary skills to address the challenges facing the South African health care system. One of the MEPI components, the Research Methodology (REMETH) PhD support programme, designed by the Principal Investigators, Professor Umesh Lalloo, Professor Raziya Bobat and Dr Sandy Pillay, aimed to promote retention of academic and research staff by providing a research career pathway and research support. The programme was designed to align both with the university’s vision of achieving academic excellence and producing innovative research, as well as the Department of Health’s (DOH) goal to produce competent researchers and academics.
Being experienced academics, the PIs wanted to create an enabling environment for research and academic enrichment with optimal mentorship, that will enhance the possibility of medical faculty and trainees remaining in academia.
The REMETH Difference
Many institutions (including UKZN) have made it imperative for academics to have a PhD to qualify for promotion, but often without adequate support for the doctoral studies. The REMETH Programme has responded to this challenge by providing substantive support for budding academics to obtain PhD qualifications. Senior and junior academics tend to become frustrated unless such support is provided. Thus, succession planning is critical for sustaining and expanding the training of competent, researchminded healthcare workers. If we fail to do this, academic and service standards will suffer, and the vicious spiral of a declining workforce with deteriorating academic standards will be perpetuated. The REMETH PhD support programme aims to improve retention of academics, produce faculty members of high quality and calibre, provide academic opportunity for future role models and produce locally relevant, good quality research that will strengthen public health systems. This programme was structured with the understanding that these academics are often responsible for teaching, as well as clinical duties and require special support and encouragement to complete a PhD.
REMETH PhD Students “The PhD has been one of the most challenging things I have ever done. It has opened up areas of myself that I did not know were there.”
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Year on year enrolment trends by gender Plus 4-year totals
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men women men & women
“Research opens up your mind and encourages you to think in a different way.”
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19
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2 2011
2012
2013
2014
4-year total
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public health
telling the mepi story 15
Dr Saloshni Naidoo Head of Discipline: Public Health, UKZN
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The MEPI success hiv & me programme Through MEPI funding, ‘HIV and Me’ Workshops were conducted for facilitators in order to prepare for the students’ workshops. A pre-and post-workshop MCQ was administered to the students as a Quiz on Moodle, a platform used extensively in both the Becoming a Professional module and the Selectives’ Programme. The HIV and Me workshops were evaluated by students and facilitators, who gave positive feedback. We have linked with the co-ordinator Mrs N. Magantolo for the Student HIV and AIDS Clinic based at medical school who has reported a brisk response from students who have come for HIV testing. A structured process led by Sandra Glajchen enabled students to feel heard, respected and discover their creativity. Building a link and thread throughout all these activities helped to familiarise students with these concepts and opened their thinking to new ideas.
Making a Difference Group community service activity
Student learning is strengthened via the design and implementation of structured reflective practice in the ‘Making a Difference’ group community activity, where students engage with community-based organisations. Students explore both personal awareness and public health issues and the application of these in becoming a professional. Learning goals include the process of community entry, self-
presentation and communication skills to build good relationships with the organisation and the participants it serves. Students develop a poster presentation where they present their evidence and learnings.
Selectives’ Programme
Using the Community-Oriented Primary Care approach and a social accountability framework, the Selectives’ Programme aims to develop medical students who are responsive to the needs of local communities and who will become socially accountable agents of change in the ailing South African healthcare system. Three Selectives’ modules are now undertaken in the second, third, and fourth academic years. Dr Stephen Knight is leading Selectives 01 in 2nd year, Dr Saajida Mahomed (a REMETH candidate) and Dr Ozayr Mahomed (a REMETH graduate) leading Selectives 02 in 3rd year and Dr Andrew Ross (Family Medicine) is leading Selectives 03 in 4th year. Clear learning outcomes are prescribed for these modules (unlike with an elective), where the student decides how to spend their time. Academics from family medicine, public health medicine and rural health are collectively responsible for the design, coordination, delivery and assessment of students on the programme. Students choose their own Selectives’ Site (usually near their hometown), and are encouraged to work in groups of two to four. During each four-week block, the selfselected groups identify a local primary care
Compassion in Action!!!
practitioner as a facilitator with whom to liaise for placement. Students identify a patient with a chronic condition (or a newborn baby) and conduct home visits over the three years, describing the individual, family and environmental situation in which the patient lives to gain a greater understanding longitudinally of the psycho-social factors that have an impact on the patients’ well-being. As a group, they formulate a community diagnosis based on disease patterns they have identified. Each student then conducts a brief referenced literature review on an identified community health problem, emphasising a psychosocial perspective of the problem. The group returns to the same community in their third year, having prepared a protocol for a community-based research survey (following instruction in research methods and after obtaining ethical approval from the Institutional Ethics Review Board). The research findings and community diagnosis are then used to develop a community-based health promotion activity plan in their fourth year. Students have to evaluate the intervention and present their findings to peers and assessors from a population perspective, detailing the health promotion activity and its evaluation, reflections of the longitudinal patient followup and an evaluation of the prescription and primary healthcare facility usage.
PhD Cohort Programme Led by current Biomedical Research Ethics Committee (BREC) chair, Professor Joyce Tsoka-Gwegweni and Professor Myra Taylor.
Ethelbert houses 65 children between 18 months - 18 years of age. These children come from traumatic/abusive backgrounds. In need of life skills, guidance and inspiration. The group met weekly to: Brainstorm. Plan activities. Set out Plan of Action. Guidance from facilitator aided in planning.
Regular calls were made to the social worker to arrange site visits. Tasks were delegated to each group member to arrange props and treats.
Basic hygiene and health education. HIV and adolescence talk. Life inspiration and motivation.
In 2013-2016 a PhD Cohort workshop was held for a week each quarter. Both local students and international students from other African countries, as well as UKZN staff attended. The training aimed to contribute to the three broad MEPI goals: 1 To increase the quality and quantity of trained HCWs 2 Improve regionally relevant, locally driven research in South Africa, and 3 Attract and retain HCWs in areas of need by creating a supportive learning environment for people working in rural facilities
The programme proved to be a good example of adult-learning in research methods and by the end of the four training workshops, the cohort had developed a warm camaraderie. It was also interesting to observe how the group assisted and critiqued one another. All the participating students enrolled for either a Masters or PhD degree had several opportunities to present their protocols as these were developed, and to receive constructive critical feedback.
Community provides stable environment important for child development. Involvement of host parents into program shows community participation. Leadership, interactive and planning skills were strengthened. Importance of group support, taking responsibility and initiative. Began to understand the importance of communication, patience and tolerance in all settings.
Need to be aware of the health requirements of the group in order to provide relevant information. Efficient delivery of content is important. Comfortable audience is more receptive . Participation is required. Abusive past influences reasoning and behavior. Interaction helped with thorough understanding of background and individual needs. More efficient use of time. Improve communication. Separate groups into age and gender for effective learning.
Our activities inspired the children to think differently about their current circumstances and future goals. Feedback in discussions showed their ability to apply the information given. Our open-minded approach allowed them to speak openly about very sensitive issues.
Dr Stephen Knight (facilitator). Lihle Biyase (Social Worker) Jocelynn Norman. Thapelo Dlamini. Nandipha Singano. Nandisa Ngubelanga.
The value of the programme lies in the local engagement of students with real situations in the community, which serves to improve their knowledge of health systems and clinical skills through experience with both rural and clinical environments.
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nursing
telling the mepi story 17
Dr Joanne R. Naidoo Lecturer, Discipline of Nursing, UKZN
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MEPI Success in Nursing
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gainst the backdrop of the introduction of antiretroviral therapy in all public healthcare facilities in 2004 and the role of nurses in the initiation and management of ART among people living with HIV, it became imperative that the Discipline of Nursing engaged in teaching and learning strategies to integrate HIV and AIDS education within the pre-service education and training of nurses in the undergraduate and post-basic nursing curriculum.
Strategies and Activities Through the MEPI grant, a series of activities and strategies were identified to be integrated within the BN programme. These included:
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HIV Case Studies
Case studies appropriate for the learning outcomes from first to fourth year were developed by a team of nursing experts in 2011 (in consultation with a clinical and academic mentor from Columbia University). All the academic staff who were involved in teaching and learning within the four-year programme implemented the HIV case studies as part of the curriculum for each level. HIV cases in General Nursing, Community Health Nursing, Midwifery and Mental Health Nursing were developed. In 2013, the case studies were reviewed and revised. Revisions aimed at updating information to make them more contextually relevant to the healthcare policies and HIV care plans.
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HIV/AIDS Counselling and Adherence Workshops
A five-day workshop was presented to second-year undergraduate students with the aim of developing skills in counselling and adherence regarding HIV care and treatment. Activities within the workshop included didactic lectures, role modelling, games and quizzes. Facilitators within the workshop included lecturers from within the Discipline of Nursing and experts from within the field of HIV and AIDS care and management.
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HIV/AIDS Clinical competencies
A total of 20 HIV and AIDS orientated clinical competencies have been developed, with the main objective being to equip nursing students with specialised skills needed in HIV and AIDS care. Skills such as HIV counselling and how to offer HIV results to the healthcare users (irrespective of their laboratory results) outcome were also included.
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HIV morning sessions
Clinical skills and related activities were structured through innovative continuous skills development on HIV and AIDS, directed at professional and academic development of undergraduate nursing students. These included lectures, group discussions, clinical skills demonstration, and the use of electronic and visual media.
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The HIV resource room
The HIV resource room was developed within the nursing clinical skills laboratory and contains relevant HIV and AIDS educational and training materials, both electronic, as well as hard copies and equipment. Material such as national and international guidelines related to prevention, assessment, diagnosis, treatment and care of HIV/AIDS were made available and updated regularly. Posters, testing and laboratory equipment/tools as well condoms, were among the resources available to students at all times.
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NIMART Training
Through the MEPI funding, expert facilitators conducted NIMART training over 5 days, and targeted both the 4th year undergraduate nursing students as well as registered nurses, who were already practising, but enrolled for post-basic programmes. The training focused on a number of topics related to the management of ART, and each topic was taught by an expert in the area of HIV and AIDS. Around 350 students were trained each year as a result of this initiative.
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Clinical Mentoring
A dedicated registered nurse (competent in HIV and AIDS nursing) was employed under MEPI to serve as a clinical mentor. The mentor ensured that integration of theory and practice took place in the training of nurses on MEPI developed HIV and AIDS activities in a clinical skills laboratory environment. The
clinical mentor remains an integral component of HIV/AIDS education in the undergraduate programme. While rotating within the respective clinical sites accredited for training, the mentor is also actively engaging students in the clinical skills laboratory through the development of competencies and exercises related to HIV/AIDS education and training.
Due to consistent support through MEPI, the integration of HIV and AIDS within the BN programme has been successfully integrated. The first cohort of BN graduates who experienced the HIV integrated curriculum completed in 2014 and feedback demonstrates they are successfully able to transfer the knowledge, attitudes and skills to meaningfully and effectively manage HIV-related nursing care.
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pharmacy
telling the mepi story 19
Professor Fatima Suleman Associate Professor, Discipline of Pharmaceutical Sciences, UKZN
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Pharmacy How it all began The Pharmaceutical Sciences Discipline was invited to participate in the submission to NIH for the MEPI grant as part of the Entrée submission. The initial focus was on integrating HIV/AIDS material throughout the curriculum, in a deliberate and cascading manner. The focus was also on the development of staff in terms of credentialing towards a PhD (as part of REMETH). The timing was thought to be opportune as there were mechanisms underway to revise the requirements of the Bachelor of Pharmacy programme by the South African Pharmacy Council (SAPC). Working with Nursing, Public Health and Medicine, objectives for each aspect of the grant and how it fitted into the overall grant outcomes were discussed at several meetings with the administrative staff, during the grant write up period.
Changes through MEPI
A major focus of the MEPI Pharmacy subcomponent of the ENTRÉE grant was the curriculum of the Bachelor of Pharmacy programme which was modularised and fragmented. New Exit level outcomes developed by the SAPC was the additional impetus to review the existing curriculum and get stakeholder input to make the curriculum applicable and relevant to local practice. In addition, there were a number of new staff that had joined the Discipline that had not been part of the curriculum development previously. It was, therefore, important for all staff to take ownership of the programme.
Listening to Student Feedback Curriculum review workshops were held from 2011 onwards using MEPI funding. Previous students requested that the material be more practical and application based, and that similar content taught across the years and across the four majors (pharmacology, pharmaceutics, pharmacy practice and pharmaceutical chemistry) be taught simultaneously, if possible. In order to benchmark the curriculum at UKZN, external facilitators from other Schools of Pharmacy in the country were invited to present on their curriculum and pedagogy used. In addition, Columbia University collaborators were invited to present on TeamBased Learning and on Case Study development. The UKZN Bachelor of Pharmacy programme was reviewed and areas of duplication and non-essential matter analysed. The initial decision by the academic and support staff was to move towards Themebased curriculum using Team-Based Learning as a teaching method. However, thereafter, staff decided to have some modules merged and some staff teach in Team-Based Learning style. These changes have been approved and the new programme has been implemented. In order to address the students concerns on the relevance of parts of the curriculum as well as a lack of Pharmaceutical Industry experience, other activities were undertaken. Online Pharmaceutical Chemistry tutorials were piloted and implemented to demonstrate to the students how this content can be applied
This experience has taught me that curriculum review, when done properly with full staff involvement, requires patience and negotiation skills. Working as a researcher on this grant enabled me to work in an international grant environment with colleagues with different skills in multiple disciplines.
in practice and the necessity of having this knowledge as a pharmacist. Student feedback indicated that they appreciated these tutorials. Contact was made with a South African manufacturer of medicines and using MEPI funds, an academic staff member together with a staff member from the Audio Visual Centre at UKZN, visited the plant and undertook video
“A video game concept was developed by the Pharmacy Lead Researcher, and MEPI funding was used to collaborate with game specialists to develop a game on medicine research and development. Phase one of this game will be ready for testing on students later this year.” – Professor Fatima Suleman interviews of pharmacists in the different divisions within the manufacturing plant. Roles and responsibilities were outlined in the discussion, as well as the application of knowledge from the undergraduate programme. These were divided into sections and uploaded onto the UKZN site for access by students in the Biopharmaceutics and Advanced Drug Delivery modules.
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esmoe
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Dr Neil Moran Head of Clinical Department, Obstetrics and Gynaecology, KZN Department of Health Professor jack Moodley MEPI Co-PI
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Essential Steps in the Management of Obstetric Emergencies (ESMOE) Why The Need?
How ESMOE Works
In South Africa, a maternal death is by law, a notifiable event. Since 1998, detailed analysis of all notified maternal deaths has been carried out in the form of confidential enquiries. The South African National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) is responsible for the confidential enquiries and makes recommendations regarding how to reduce maternal deaths in the country. These recommendations are published every three years in a “Saving Mothers” report which is widely disseminated amongst health workers and health service managers in South Africa. A consistent finding in the Saving Mothers reports has been that sub-standard management by the health workers, during the emergency event leading to the death, occurred in a large proportion of cases. The sub-standard care included failure to follow standard protocols of management and sub-standard resuscitation. In response to this finding, the 2005-2007 report recommended that training in practical obstetrical and surgical skills should be provided for all health professionals working in maternity units. By the time the 2005-2007 report was released in 2009, a training programme had been developed in South Africa for improving skills in managing obstetric emergencies. This programme, called “Essential Steps in the Management of Obstetric Emergencies” or ESMOE, is based on similar programmes developed in the UK, but has been adapted to fit the needs of the South African setting.
The ESMOE programme consists of twelve modules conducted with a small group of participants. Due to the high rates of HIVrelated maternal deaths in South Africa, a module on HIV care in pregnancy is also included. In addition, there is an emergency obstetric simulation training (EOST) component for each module. The EOST component is also referred to as the obstetric “fire drills”. Taking this into account, the following target was set in the 2005-2007 Saving Mothers report with regard to skills training: “All hospitals must have implemented ESMOE fire-drills and skills training”.
MEPI strategy and activities
An opportunity for KZN Province to scaleup ESMOE training came in 2011 through a partnership between the provincial Department of Health and the University of KwaZulu-Natal (UKZN). The course was run using a trainthe-trainer format, with those completing the course then formally certified by the National ESMOE board as ESMOE master trainers. Experts, from both the KZN Department of Health and from UKZN, acted as the facilitators for the various modules. These experts included obstetricians, neonatologists, family physicians, anaesthetists, and emergency medicine practitioners (paramedics), many of whom were themselves ESMOE master trainers. A quality assurance observer from the national
ESMOE board attended the second of these KZN ESMOE master trainer courses in 2011 and advised on ways to improve the course. In particular, the organisers were advised to ensure that facilitators spent less time on going through the ESMOE lectures and more on training the participants in how to do skills demonstrations and run fire drills. This opportunity meant that the province no longer had to rely on national master trainer courses to increase its numbers of ESMOE trainers, and would make it possible to extend ESMOE training more rapidly to new sites in the province.
Key outcomes and successes of the 5 year MEPI-funded ESMOE activities KZN set a target that there should be ESMOE master trainers at every hospital in the province, at least one midwife and one doctor. This would mean that every hospital would be self-sufficient, in that regular ESMOE training could be conducted “inhouse” without the need for external trainers. This target was achieved by the end of 2013, by which time ten three-day KZN ESMOE master trainer workshops had been held, and over 250 master trainers trained. ESMOE master trainers had also been trained from several of the community health centres in the province. Since 2013 to April 2016, a further six KZN master trainer workshops have been held, increasing the number of master trainers trained to over 400. Thus the last few courses have predominantly aimed to fill the gaps where previously trained master trainers are no longer training.
Maternal deaths due to non-pregnancy related infections, obstetric haemorrhage and hypertension were the three biggest contributors to preventable maternal deaths, accounting for 65% of avoidable deaths. Saving Mother’s Report
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rescap
telling the mepi story 23
professor Douglas Wassenaar MEPI Co-PI Ms Nivedhna Singh RESCAP Project Manager
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MEPI success by numbers
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students attended advanced creditbearing Masters-level SARETI modules in research ethics.
Research Ethics & Capacity Building (RESCAP) Why RESCAP? RESCAP was designed to provide basic and intermediate training to improve local, provincial and national capacity in research ethics. Applicants had to submit motivated applications to attend RESCAP training in order to improve their research careers and professional development. Each of the five RESCAP components is described briefly below:
1
RESCAP sponsored the design and development of a substantive, peer-reviewed online research ethics module specific to South Africa, hosted on the Training and Resources in Research Ethics Evaluation (TRREE) website. The South African National TRREE Supplement was developed by RESCAP, based on South African law, ethics guidance and health regulations aimed at training individuals on the ethics guidance applicable to research in South Africa (so as to facilitate more ethical research proposals and ethical conduct of research). This module is available free online to all users. The four other components of RESCAP were specially designed to create opportunities through scholarships/fellowships to students, allowing them to be trained in conducting ethical research and reviewing research protocols.
2
The Biomedical Research Ethics Committee (BREC) fellowship allowed two PhD students to shadow the UKZN REC/IRB chair for 96 hours annually. The aim was to provide onsite applied REC/IRB training and allow the candidate to gain an understanding of the theoretical
and operational aspects of research ethics review, and the roles and responsibilities of health-related Research Ethics Committees. Students were also required to present literature-based opinions for BREC on topical questions.
3
In the SARETI modular training component of RESCAP, masters-level research ethics modules were offered to selected national and international fellows, enabling them to be trained in topics specifically related to research ethics, HIV/ AIDS prevention research, and ethics review systems. The aim was for established and post-graduate health researchers to gain advanced theoretical and practical knowledge in the ethical review of complex research protocols (such as those for HIV prevention trials), and in institutionalising effective research ethics review systems in their home institutions.
4
RESCAP also invited all UKZN staff and post-graduate students to be trained in grant writing and grant management with the aim of providing training and to allow local and international researchers and research administrators to gain an in-depth understanding of grant writing, funding opportunities, application process, budgeting, management of awards, and reporting.
5
The final component of RESCAP allowed for one post-graduate student to be trained in research ethics and project management, with the aim of allowing the student to specialise in research ethics and project management. This intern managed the RESCAP MEPI portfolio,
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PhD students completed the RESCAP BREC fellowships
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UKZN health researchers, research managers and administrators, local, national and international students enrolled for and completed the RESCAP grant writing and management workshop.
lectured undergraduate psychology students in research ethics, presented RESCAP data at local and international conferences, and co-authored papers on RESCAP process and outcome data.
Lessons learned Feedback from trainees regarding the workshops and fellowships was overwhelmingly positive. The use of innovative presentations at workshops, discussions and ‘learning by doing’ in the fellowship programme was seen as a benefit to the training sessions. Capacity building interventions are good value for money. Our approach allowed for large numbers of students to be trained through the various faceto-face activities, as well as the online TRREE platform. It proved to be cost-effective. All of these activities have successfully developed capacity at the local, national and
international levels. We found that our activities acted as a platform for further training and enabled students to network with each other. Capacity building involves targeting the right people. Training initiatives were made available to all employees and senior postgraduates at UKZN. Training was also made available to employees at other MEPI sites around Africa. There is a need for a high level of support and engagement from relevant stakeholders. At all times RESCAP received high levels of support from the MEPI steering committee and MEPI management. There was clear understanding and synergy between RESCAP and MEPI management, which contributed to the success of this component of MEPI. RESCAP has collaborated with other programmes during the past five years: – The South African Research Ethics Training Initiative (SARETI) through training MEPIsponsored students in the SARETI programme – Training and Resources in Research Ethics Evaluation (TRREE) through the national supplement, the South African module. – The UKZN BREC provided a venue for onsite training for the BREC fellows throughout their practical placement. This has enabled RESCAP to save time, money and resources whilst driving the agenda of the component, (which was to build capacity in research ethics).
Integration of existing structures and programmes saves time and resources.
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reflections
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telling the mepi story 25
Personal reflections on the MEPI collaboration The ENTRéE (ENhancing Training and REsearch) project of the MEPI programme for UKZN was born out of my collaboration with the US National Institutes of Health ACTG project. It represented a unique opportunity to enhance our research and academic capacity to increase our health professional training capacity qualitatively and quantitatively. ENTRéE was designed to address the health care priorities in KZN and to increase the expertise and training capacity in this respect. I was able to assemble a group of academics to set up 4 programs, one of which was the flagship, REMETH programme. I can confidently state that we have left a legacy from which medical professionals will derive benefit for several decades. This will strengthen the cycle of medical academic professional development. It’s been a pleasure to be the PI of this magnificent project and I must pay tribute to all who participated, in particular, my co-PIs Professor Jack Moodley, Professor Raziya Bobat, Professor Doug Wasserman and Dr Sandy Pillay.
Professor Umesh Lalloo lead, MEPI Grant Writing Team
Professor Fatima Suleman MEPI Co-PI The process of the curriculum review has enhanced my skills in developing learning outcomes and assessment strategies for the course I teach. The focus is always to make content relevant and practical, such that students can see the application in practice. I believe the experience has also allowed new, and young academic staff to understand the process of reviewing a curriculum, but more importantly, how each module with its learning objectives and assessments, and explicit (but also underlying values), shape the ultimate graduate of the Bachelor of Pharmacy programme. Exposure to different teaching practices and pedagogies has allowed staff to experiment with their own teaching practices and develop their own teaching style. These have proven to be useful in the development of their teaching portfolios, as well for promotion and performance management purposes.
With efficient use of MEPI grant dollars and the leveraging of other resources, Drs. Lalloo and Pillay and their team have catalyzed improvements in the curricula of the respective schools, organized didactic and interactive educational initiatives involving local, regional and U.S. educators and have nurtured academic futures for many individuals. The progress made in biomedical education under the MEPI programme has been outstanding, but as with any programme, sustainability and excellence are qualities that require ongoing oversight and commitment. Sincerely, Scott M. Hammer, M.D.
Harold C. Neu Professor of Medicine Professor of Epidemiology Chief, Division of Infectious Diseases
The MEPI graduate tracking project was a first for the College, hence my keen interest in pursuing the clearly defined survey goals. With a committed team at hand, their combined expertise served to make this rather protracted journey an interesting one. Having not anticipated some of the logistical challenges, the resultant delays created much concern. The team adapted smoothly to the changing scenarios, drawing on their research skill to ensure that the survey continued and data was collected, albeit limited in number. The poor uptake was a disappointment but the team persisted in securing respondents. A perusal of the qualitative feedback was very encouraging and will certainly guide the College on its future approach to graduate tracking.
Dr Saloschini Pillay Student Support Services Manager, UKZN
We have, and will continue to send our medical students, and pediatric trainees from Columbia University to Durban to develop and collaborate on Pediatric HIV-related projects. In addition, with the help of MEPI support, we have been able to mentor and advise UZKN pediatric trainees on their PhD projects. In summary, the MEPI initiative has afforded our institutions the opportunity to develop productive collaborative relationships, which will continue into the future. We look forward to continuing and expanding our collaborative efforts. Please feel free to contact me if you have questions or issues that I have not addressed. With warm regards,
Philip LaRussa, M.D.
Professor of Pediatrics, Columbia University Medical Center, Black Building 4-442, 650 West 168th St, New York, NY 10032 Tel: 212-305-0898; E-mail: plarussa@columbia.edu
Professor Douglas Wassenaar MEPI Co-PI “It has been exciting and rewarding to be associated with this Fogarty International Center/ NIH project at UKZN. Research ethics capacity and systems are essential components of an evidencebased healthcare system, and my small component of MEPI, RESCAP, aimed at building such capacity in the several ways that are detailed in the RESCAP section of this brochure. It was also stimulating to work closely with the UKZN MEPI PI team, all of whom are national and international leaders in their respective fields. The outstanding administrative support team must take much of the credit for driving the MEPI deliverables, in particular Dr Nisha Nadesan-Reddy, Prem Ramnarain, Aruna Sevakram and Jill George. The actual management of the MEPI RESCAP portfolio was conceptualised as a capacity-development opportunity for a young researcher/ academic and I was privileged to work with Nivedhna Singh who occupied this role meticulously through the lifespan of MEPI and kept RESCAP deliverables on track for the duration of the grant period, in addition to considerably developing her capacity to work in the international research and grants environment in future”
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m&E
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Moise Muzigaba M&E Specialist, MEPI UKZN
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review of mepi project Description/Performance Narratives
Monitoring and Evaluation
A
lthough not yet a widely recognised practice in many tertiary institutions, the Monitoring and Evaluation (M&E) of health professions education has been in existence for many years. The value of M&E is much greater than the provision of simple audit information to determine programme performance. It is a methodological tool that can be applied to any programme for planning, adaptation and scale up. The M&E unit was established within MEPI at the UKZN to serve several functions at different levels of the MEPI programme implementation cycle.
indicators, indicator definitions, how each indicator will be measured, the frequency of measurement, disaggregation of the indicator, person/unit responsible for measurement, as well as specific targets and standards. The process monitoring matrix connects various evaluative themes related to the programme service utilisation and organisation’s plans to specific process indicators and standards that are used to monitor and evaluate the extent to which the programme has been implemented as planned. This served the function of putting programme outcomes and impact into context.
An overview
Lessons learned
Through stakeholder engagements, 11 componentspecific M&E plans were mapped out. The first was the MEPI theories of change. These were developed to depict hypothetical pathways showing how MEPI is designed to work. The theories of change were component-specific and each consisted of the impact theory, the service utilisation plan and the organisational plan. The second component was the monitoring plan for the MEPI programme. This was developed as a matrix of several monitoring elements and consists of two components: a) the outcome monitoring matrix and; b) the process monitoring matrix. The purpose of the outcome monitoring matrix is to map the links between various outcome variables articulated in the programme impact theory and specific indicators and/or proxy-
A number of observations have emerged over the past 5 years. It should be noted that M&E plans put in place for individual MEPI components were, in our view, robust and comprehensive. With the help of the project manager, the M&E unit gained support across the leadership of various MEPI components. Stakeholder engagement throughout the project cycle was central to ensure success. However, adaptation of M&E plans to the context of the MEPI programme proved a challenge over time. The initial plans had to be reviewed several times as a result of concomitant changes in programme designs. This sometimes limited the use of old monitoring data during scheduled evaluations. Also, determining the impact of the MEPI programme as a whole was not practical. Some of the MEPI components desired impacts will only be realised many years after MEPI has been concluded.
Promoting and ensuring use of M&E results for planning
Articulation/review of project-level theories of change
Data analyses, visualisations and strategic information packaging
stakeholder participation Data management, capturing, quality assurance and storage
Development of M&E budget plans and timelines
Collection of primary and secondary data and data quality
Ongoing project monitoring and scheduled ad‑hoc evaluations to determine performance
Development/review of a project-level monitoring plans (matrices)
Develop evaluation questions, methods, tools and plans
Mapping of possible risks and moderating factors
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graduate tracking
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Dr Saloschini Pillay College of Health Sciences: Student Support Services Manager, UKZN
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Graduate tracking Why Graduate Tracking? The MEPI (in collaboration with Student Support Services from the College of Health Sciences) developed a tracking platform for UKZN Medical School graduates. The objective was to assist the medical school to keep in touch with their graduates, capture and learn from their field work experiences, as well as track the first job destination of graduates. An expected outcome of the tracking platform was to help medical schools to better understand the impact of medical policies on the retention and placement of medical graduates in and outside the country. In addition, it was aimed at facilitating a better understanding of the preparedness of graduates in core medical competencies; the quality and relevance of UKZN medical school curricula, educational programmes and facilities; and experiences of medical graduates in their areas of practice.
Achieving The Objectives The tracking process was achieved through the following: Strategies and Activities The MEPI team conducted a survey aimed at capturing the graduate’s perspectives on the curricula, work readiness and challenges faced in the workplace. This study, in the form of a survey, was administered face–to-face, telephonically and online. The various options of administering the
tool was made known to the respondents to allow them to select the most appropriate method that suited their busy schedule. A database that allowed for the viewing and analysing of the graduates’ demographic and professional information was designed. Graduates’ responses were recorded on a password-protected central database which can only be accessed by those who are directly involved in the project. Data sources were: UKZN Alumni database through e-mail communication; Social media sites such as Facebook and Linked-in; Though an online Google Forms survey; Through telephonic communication; Face to Face interviews; and Through medical managers at the hospitals.
Lessons learnt The success of such a programme is dependent on a clear vision and a dedicated team working collaboratively to achieve the aims of graduate tracking. Resources (both material and human) must be made available timeously to facilitate the efficiency of implementing such a programme. In future, it would be helpful if the graduates are aware that the university would require them to participate in such a study after they have graduated (with the purpose of same being
outlined prior to graduation). This would make it easier for them to participate. Key individuals (such as medical and clinical managers) could have a positive role to play in such studies as they may have better knowledge of how many of their staff are UKZN graduates. If MEPI had an established working relationship with these managers, the reception of researchers at hospital sites would be a much more pleasant experience, as we have had experience with administrative staff acting as gatekeepers and restricting access to participants from researchers. PICTURE Valeriya Anufriyeva/shutterstock.com
“Being part of this study has been both challenging and interesting. It’s been a learning experience throughout because we had to adapt our methods many times during the study. This required us to think on our feet and to find new and more effective ways of doing things within a short space of time. This also taught me the importance of teamwork. Everything that I had learned about conducting research came into play in this study. As challenging as this was, I thoroughly enjoyed myself. Going out into the field made me realise how important it was to be adaptive and be able to deal with new and unexpected situations effectively. This has been quite an experience and the lessons I have learned at MEPI have definitely honed my research skills.” – Mandy Lombo
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RESEARCH TRACKING
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Dr Irene Mackraj Academic Leader: School of Laboratory Medicine and Medical Science, UKZN
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Research tracking Background The University of KwaZulu-Natal (in partnership with UCT and MEPI) embarked on a programme to introduce a dual track for a research trajectory for Clinician scientists in 2015. Senate approved the track and the model is one of an integrated approach, with research competencies interspersed throughout the curriculum. It is targeted primarily toward the training of bench-work scientists, but has flexibility to accommodate other research paths such as that in Public Health. This programme is in keeping with both national and international initiatives, where scholars may opt to take a year out to do an Intercalated MBChB/BMedSc (Honours) and then an Integrated MBChB/PhD. Our proposal is summarised below, where the student decides to take a course within the MBChB programme and completes an MBCHB/MSc at the end of 7 years.
Summary outline of research track As the MBChB graduate is not skilled sufficiently in laboratory skills to embark on a laboratorybased PhD, this programme will enable the student to acquire competencies in research skills. The student may then (at the end of his MBChB) complete a Masters Dissertation and ideally embark on a PhD.
In order to do the above, we planned that from year 2 the student will register for research methods modules (covering ethics and statistics). Thereafter, they will embark on a Molecular Medicine module in year 3. After rotations in year 4, they will choose a Supervisor and Masters topic. The expectation is that these students will be skilled with an in-depth knowledge of the underpinnings of pathological processes (from a Molecular perspective). An insight into Molecular Medicine will empower the student, both as Medical Doctors and as future researchers. Students accepted to this programme will be awarded a Scholarship to cover the tuition fee of a Molecular Medicine course and their tuition fees for other modules. The Integrated MBChB/MSc Track will lead ideally to a PhD (i.e. once they complete MBChB & Masters they will then embark on their PhD). Students accepted to this programme will be awarded Fellowships to cover tuition and living expenses during their PhD studies.
Advantages of the research track Skilling clinicians with biological sciences training and laboratory experience, which will enable and fast track their career paths into clinician scientists. There is sufficient evidence that these individuals become leaders in clinical research.
Summary of activities
2015
Meeting with UCT and submission of document to College Academic Affairs Board (CAAB) A proposal to CAAB was made in 2015, and approval was granted for the track was obtained A submission to MRC jointly with UCT was made to support student registration, and was successful
2016
Launching of MBChB Research Track Website design Preparation of material for Student support Template for Molecular Medicine Module final approval Admission requirements refined with UKZN legal Department Discussions on sustainability following cohort supervision
Molecular Medicine Course Curriculum Topics to be initially covered will be core concepts (which are covered partially in year 1) and then more advanced or applied topics on the molecular basis of disease. Core topics will include fundamental biochemistry of DNA, RNA and proteins and their roles in key cellular processes such as signalling, proliferation, apoptosis, development and differentiation.
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cappre
12 T
he Clinical and Professional Practice Research (CaPPRe) group was formed with support from MEPI to develop and enhance the scholarship of Clinical and Professional Practice Research, particularly in the School of Clinical Medicine at the University of KwaZulu Natal.
KEY OUTCOMES & SUCCESSES CaPPRe Graduates Two students graduated at the UKZN April graduation. Ms N Sahadew received her MMedSc and Dr S Hamid her PhD.
CaPPre Workshops CaPPre held research workshops to provide a space and to bring together researchers and postgraduate students. These spaces created opportunities for the CaPPre group to share, collaborate, think, learn, research and progress.
telling the mepi story 33
Clinical and Professional Practice Research Group Reflecting on the PhD A personal story by Dr S Saib, Clinical and Professional Practice Research Group, School of Clinical Medicine.
T
he PhD journey is a solo one and can be quite isolating as there is no “class” to attend and often there are no means of linking up with fellow students. This can make the process more difficult as peer support and mentorship is important (both as a means of support as well as re-energizing/stimulating the cognitive process). Thanks to the CaPPRe programme led by Dr Singaram, I was introduced to other students on the same journey as myself albeit in different stages. Our topics may have differed; however the challenges experienced were similar. This provided a context of ongoing support, morale boosting, critical reflections and stimulation of new ideas. The process was particularly critical in assisting with issues like funding, skills development and the development of critical thinking. I found presentations by other students and discussion of challenges they experienced and the manner in which they resolved said challenges (or other students’ inputs on these challenges) highly beneficial. Having undergone certain stages of the PhD process ahead of certain students also helped me support them through their journey. This normalized what I had experienced and increased my confidence in my ability to successfully navigate through the PhD. The support and encouragement I received from the group was overwhelming and played a critical role in my journey. The support received from Dr Singaram, both professionally and personally, was unparalleled. Having a supervisor as supportive and knowledgeable as her gave me a far greater advantage compared to some of my counterparts. When flying solo through this PhD journey, it is easy to get overwhelmed or delay it for some reason or the other. However, being part of the CaPPRe group, Dr Singaram ensured that we stayed on track, and were constantly stimulated and we left each session feeling highly motivated. The importance of this programme cannot be emphasized strongly enough.
From left to right
Ms Niki Sahadew, Dr Veena S Singaram and Dr S Hamid
S
chool of Clinical Medicine staff member, Ms Buhle Donda, impressed adjudicators at the annual College of Health Sciences Research Symposium where she was awarded R15 000 towards attending a national conference of her choice. Donda presented a case study exploring the correlation between study processes and academic performance in undergraduate medical students; particularly those funded by the South African government to be trained as medical doctors (partly in Cuba and returning to complete the joint Medical degree programme at UKZN). Donda explained that certain aspects of the Cuban model spoke to the South African aspirations of improving healthcare and prevention eradication of communicable disease as a developing country. As a developing country, Cuba had impressive health index statistics that compared well with those in developed countries. The study found that once enrolled in the MBChB programme, the single biggest predictor of success was the individual student’s motive for deep learning – learning with understanding. It was not enough to merely attempt learning the academic material off by heart in the hope that they would succeed.
‘Students with deep motivation performed better than the students with lower deep motive scores. Students with low deep motivation scores had psychosocial challenges that required them to consult the College Support Services. Challenges that affect student motivation are not always academic; they include even the private social aspects of the students life,’ said Donda. The students had to adjust to a new social setting, institution and being taught in English, after having learnt the medical curriculum in Spanish abroad. The Dean and Head of UKZN’s School of Clinical Medicine, Professor Richard Hift, who supervised Donda, said the Cuban-trained Medical students had been coming back to UKZN for many years but there was no research that went into how well they integrated in the MBChB programme. Hift said it was important to understand what determined success in transnational study. He said Donda was thoroughly motivated, committed to her work, related well with the students and had a strong background in education, which made the study a success and a valuable contribution to medical education at UKZN.
“Being taught in a programme that has a different role definition and professional culture from another is problematic. It is up to each individual student to negotiate meanings between the already acquired meaning, making mechanisms from Cuba work with the South African ones.” – ms buhle donda
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mepi legacy
13 What next now that MEPI draws to a close? How will the legacy of its success continue? We asked those involved and these are some of their responses‌
telling the mepi story 35
Taking the MEPI legacy forward
Remeth
esmoe
pharmacy
As South Africa moves towards a new model of health care, based on a preventative approach, we need to re-engineer our teachings in line with this paradigm shift. The MEPI REMETH programme aims to support this by empowering health professionals with skills to sharpen their knowledge and enhance their exposure to the health challenges within a South African context.
There will be an ongoing need for master trainer courses, although perhaps less frequent as time goes on, in order to maintain comprehensive coverage of all facilities with regard to on-site trainers. The format of the MEPIfunded courses has been successful and well-received and has established a model that can be maintained for future courses. The collaboration between the UKZN and the KZN Department of Health in running the MEPI courses has been productive and should be maintained with other sources of funding.
The curriculum review process has left a lasting legacy in the Discipline. More staff are aware of the processes involved and all feel ownership of the new curriculum. The first graduate of the new programme will be graduating in 2017. Having them review the changes will point to what was implemented successfully and what was not. The video game is also a legacy of the MEPI programme and will go a long way to exposing students from under-resourced areas to medicine research and development.
nursing In addition to training students, all undergraduate lecturers have been trained in NIMART and IMCI, and they are already integrating the training into courses and modules, thus making the initiative sustainable. All case studies have been developed and are continuously being reviewed for undergraduate HIV and AIDS teaching and learning, whilst all teaching sessions are video recorded and used on the e-learning platform for future use and to support learning by students from remote sites outside of Durban.
rescap
graduate tracking
By improving research ethics capacity, there should be an improvement in the way researchers conduct their research, ensuring that health research is conducted more ethically in the region. This has implications for the communities assisting UKZN research efforts, for society as well as the body of knowledge produced.
The MEPI graduate tracking programme has proved to be an invaluable exercise in gathering the perceptions, work experiences, the employment patterns, movement and placement of our graduates from internship through to their careers and highlights and gaps of the MBCHB curriculum. Such data will prove useful in any curriculum review process as well as the teaching and learning processes. The College of Health Sciences envisages continuing the tracking of medical graduates on an annual basis, as it also serves to highlight the trends and retention rates and the challenges around these. Lessons learnt from the initial study will help grow the strategy and will also help to lay the groundwork for future studies.
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MEPI Learning Centres within KZN district health facilities
“It always seems impossible until it is done” – Nelson Mandela
the UKZN Medical Education Partnership Initiative (MEPI) project – Enhancing Training, Research and Education (ENTREE) Programme
This publication was made possible by grant number: 5R24TW008863 from the President’s Emergency Plan for AIDS Relief (PEPFAR), and the National Institutes of Health, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the UKZN MEPI programme and do not necessarily represent the official views of the government.