Programme Initiatives

Team's Overall Performance in Teaching

The first cohort of students under the WITS-NMFC Project numbered 149 and commenced their training in late July 2018. With the existing Wits training platform congested, faculty development and change management were key to support trainers at peripheral training sites, with the objective of delivering competent and safe doctors prepared for Day 1 internship.

121 students successfully completed the integration programme in the minimum period of 18 months(a pass rate of 81,2%). Wits was one of only two universities nationally to achieve a pass rate higher than 80%. The Wits students were then eligible to sit for the Cuban National Exam on the 20th December 2018, of whom 100% passed. 

Of the approximately 500 students who started their internship in January 2020, Wits contributed nearly a quarter of this cohort. 

It is a testament to the committed effort as a collective that all these students are now busy with their internship in service to the patients and communities of South Africa.

Student Support, Success and Development

Specific initiatives related to the success of the NMFC students include: 

• The inclusion of a Clinical Psychologist in the team places the well-being of the student at the heart of its goals and activities. The role includes promotion of wellness and prevention of mental ill-health, rather than only "downstream" therapeutic interventions. 

• The inclusion of an Academic Support Officer provides the students with access to expertise in helping with their academic literacy. 

• Student leaders and mentors are appointed at each of the Academic Health Complexes. 

• The Student Academic Review Committee assists with the review of the academic programme in preparation for the arrival of the next cohort of students from Cuba.

• Close cooperation with the NMFC Student Representative Council provides for a channel by which to listen and respond to student concerns. 

• Site Administrators who are located on each site to oversee the day-to-day administration and logistics.

Broader Impact of the Programme: A Community of Learning

The three phases of the NMFC integration programme are split between the Faculty (Phase 1), central hospitals (Phase 2)  and the peripheral Academic Health Complexes (Phase 3). While a Faculty project within the School of Clinical Medicine, the programme is hosted by the Department of Family Medicine and Primary Care. The NMFC programme has by far the largest student representation on the peripheral training platform for the Faculty.

• Vertical synergy and integration: The programme is a catalyst to strengthen the links between the central and peripheral academic platforms as a single entity for each discipline. 

• Horizontal synergy and integration: The strengthening of the peripheral platform (particularly in local governance provided by the Academic Governance Committees is critical to the Wits FHS vision of an increased emphasis on primary health care in curricula.

• The programme has allowed the Department of Family Medicine and Primary Care to strengthen and integrate its training platform within the district health services. 

• Clinical educators are now resource persons for faculty-wide teaching and learning as well as assessments in undergraduate teaching.

• The Interprofessional Logistics and Operations Team (comprising of representatives of the NMFC programme, the Integrated Primary Care programme (Graduate Entry Medical Programme) and the Bachelor of Clinical Medical Practice (Clinical Associates programme) provides increased efficiency and effectiveness, including in opportunities for Interprofessional learning (IPL). Site Administrators have also become liaison officers on these peripheral sites for undergraduate student activities. Accommodation facilities on some of the peripheral sites have become a logistical resource for other divisions in the department.

Innovative Teaching, Learning and Assessment Strategies

A dedicated task team was appointed by the School of Clinical Medicine (SOCM) and they put together"Simple rules" which informed the development and growth of the programme:

Workplace-based assessments (WBAs) are the foundation on which the training and assessment rest. The WITS-NMFC medical training program includes regular assessments, both formative and summative, structured in line with the human resources available. Multiple low-stakes summative assessments during the teaching encounters, coupled with real-time feedback are the heart of the teaching and learning strategy in the programme. 

The Teaching and Learning strategies adapted and established to date include:

• A focus on developing local academic governance, working in partnership with the central faculty team, with the development of Academic Governance Committees, one for each of the peripheral Academic Health Complexes (AHCs).

• Workplace-based learning and assessment (WBA) rubrics, with the patient at the centre of learning, such as the Mini-CExs; SNAPPS; DOPS, and Interprofessional assessment rubrics. In excess of 2500 data points are captured, then uploaded online each rotation. Both the limitations and the successes have helped inform the development and roll-out of the WBA-enabling online application, DotDr in the Faculty. Participation in workshops on digital assessments in the clinical workspace at Ottawa 2020 and AMEE conferences this year (changed to online) is a testament to the innovation and relevance of this WBA model.

• Dot-Dr App is currently under development to mirror and replace eventually the paper-based WBA assessments.

• 'Question-mark on Demand' for online remote assessments.

• Online Anatomy &Physiology course for supporting the basic science foundation of the students. 

In keeping with the importance of feedback, formative ("mock") OSCEs are held regularly. 

• A specially structured syllabus was employed. This focuses on common conditions per discipline, for which core competencies are graded on the knowledge of basic sciences, clinical presentation, investigations, and procedural skills. Students' learning is scaffolded around a portfolio of evidence that guides these preceptor-assessed activities.

• Clinical Educators appointed for training supervision, mentoring, and training assistance have become resourceful in other divisions and departments within the School of Clinical Medicine, in the Faculty of Health sciences. These Clinical Educators partner with the DoH-employed clinicians to complete the students' training in as optimal a manner as possible. The "ClinEds" have the agility and the oversight to respond to fluctuations in the capacity of the service platform to train students appropriately. These educators form the core of the Wits-NMFC team; they are linked to the AHC's over the 18 months and develop nurturing relationships with these students being able to red-flag vulnerable students for academic or psychosocial issues. 

• The Concept of active Remediation gives borderline but not weak students an opportunity to re-apply themselves around gaining theoretical and clinical competencies within a minimum time frame. Subject to completion of a specific "remediation logbook",  the student may complete a summative re-assessment. Continuity in educator-examiner involvement gauges improvement on and insight into identified learning challenges. There is a limit to the number and combination of competence domains (theory/clinical per discipline) that a student may remediate during the year. 

• A technology-enhanced learning strategy assists students to achieve knowledge and skills-based competencies efficiently and effectively. Students are expected to demonstrate initiative and intent to improve their knowledge and skills through these teaching methods. Wifi is installed at each of the accommodation and training sites, by which the students access the online resources and assessments, as well as uploading their WBAs.

• Assessments are broadly weighted into three types, reflecting the relative importance of the clinical and procedural competencies. Theory component- made up of a relatively low-stakes End of Rotation assessment (EoR)  prepared by the central WITS departments and analysed for reliability and validity. Clinical component- consisting of multiple low stakes WBA's as well as an EoR clinical viva that tests each student's clinical reasoning skills, data interpretation, approach to emergency management, and capacity to reflect insightfully.

• Critically, established clinical educators take responsibility for standards of quality and consistency per discipline across the five different AHCs, while local clinicians within the AHC also participate in exams. Sub-minimums for both the theory and clinical components are in place. The end -of year exams, for Integrated Primary Care, is also overseen by an external examiner.

• The NASS (NMFC Academic Student Success) Course recently conceptualized and undergoing development on Ulwazi as an 8-week parallel support site dedicated to supporting weak/borderline students.

Development of a Responsive and Appropriate Curriculum

A curriculum document recommended for the 18-month integration of the Nelson Mandela Fidel Castro Collaboration programme preparing them for South African qualifying examinations was jointly compiled by a National Curriculum Committee and approved by the SA Committee of Medical Deans. 

Wits provided key inputs to the development of the curriculum, following which the Academic Departments endorsed the curriculum. 

Wits has implemented this curriculum more successfully than most.

The curriculum reflects the competencies (breadth/depth of knowledge and skills) as a core set for students to attain, with reference to common clinical presentations

It focuses on students gaining clinical, procedural, and communication-related competencies. 

The curriculum guiding principles include:

• development of the students' ability to cope and flourish psychosocially and academically

• develop clinical skills in history taking, examination and management planning 

• display critical thinking and diagnostic reasoning

• demonstrate communication skills that are apt for interaction with patients and colleagues

• demonstrate value-add as health professionals to the South African health care domain

Promoting Student Engagement with Emphasis on Self-Directed Learning

The emphasis of their orientation during Phase 1 (1 month) does not only provide biomedical and clinical foundations. The themes of change management, peer support, academic literacy, leadership, and e-learning all include an emphasis on the benefits to be achieved from showing initiative, a willingness to learn from constructive feedback, and being self-motivated. Students are told that while faculty commitment is a given, whether the partnership succeeds is in their hands.

An example of how this is facilitated in practice is that students are required to submit a minimum number of WBAs in part-fulfillment of their SP. However, the "best" of these count towards their summative assessment, replacing the feelings of anxiety around these WBAs with a motivation to succeed.

For a full academic year, the students remain allocated to a single AHC (mirroring the districts in Gauteng and the North-West, as 3-4 facilities in the same geographical vicinity). The students are allocated to discipline-based rotations in subgroups of 5s or 6s. They are encouraged to embed within the peculiarities of their peripheral AHC's to which they are allocated. Students become familiar with their settings quickly. While the disciplines and competencies are ever-changing from one discipline to the next, the logistics, setting, and circumstances do not. in view of the resource-weaknesses in the peripheral sites as compared to the central teaching platform, self-directed learning, and insight into owning their learning have appeared increasingly from the first cohort. The second cohort has increasingly demonstrated zeal as a group, evidenced by their unanimous resolve to return to the learning platforms during level 5 of the COVID-19 lock-down.