MASTER of MEDICINE in Family Medicine MMed (FamMed)

Information Brochure for 2016

Division of Family Medicine Department of Public Health and Family Medicine

University of Cape Town

HEAD OF DIVISION A/Professor Derek Hellenberg

CONVENORS

Professor Derek Hellenberg (third and fourth years) Dr Beverley Schweitzer (first and second years) Dr Tasleem Ras (co-convenor first-fourth year)

The MMed (Family Medicine) is the degree required to gain specialist status in the discipline of Family Medicine. Registrars rotate through various disciplines in district level hospitals and community health centres over 4 years.

The UCT programme is associated with the Metro West Training Complex in the Western Cape.

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Contents WHO SHOULD DO THE COURSE? ................................................................................................. 2 ENTRY REQUIREMENTS for MMed (FamMed) ............................................................................... 2 TRAINING REQUIREMENTS ........................................................................................................... 2 FCFP Examination Structure ............................................................................................................ 2 APPLICATIONS ................................................................................................................................ 3 ROTATIONS ..................................................................................................................................... 4 LEAVE .............................................................................................................................................. 4 FORMAT of FORMAL LEARNING .................................................................................................... 5 CREDITS FOR MODULES ............................................................................................................... 5 COURSES ........................................................................................................................................ 5 GRADUATES OF FOREIGN UNIVERSITIES ................................................................................... 6 COURSE RULES ............................................................................................................................. 6 ASSESSMENT ................................................................................................................................. 6 TIME COMMITMENT........................................................................................................................ 7 ATTENDANCE ................................................................................................................................. 7 ASSIGNMENTS ................................................................................................................................ 7 APPLICATION FOR DEFERRED EXAMINATIONS ......................................................................... 7 GENERAL INFORMATION ............................................................................................................... 7

FEES ............................................................................................................................................ 7 FINANCIAL ASSISTANCE ............................................................................................................ 7 CAREER OPPORTUNITIES ......................................................................................................... 8 EXAMINATIONS ........................................................................................................................... 9 Rules for the Part 1 Exam of the MMed ......................................................................................... 9

COURSES for YEARS 1 and 2 ......................................................................................................... 9 1. PRINCIPLES OF FAMILY MEDICINE ....................................................................................... 9 2. CHILD AND FAMILY HEALTH ................................................................................................ 10 3. PREVENTION, HEALTH PROMOTION AND CHRONIC ILLNESS ......................................... 10 4. EVIDENCE BASED MEDICINE ............................................................................................... 11 5. ETHICS ................................................................................................................................... 12 6. CLINICAL MEDICINE A .......................................................................................................... 13 6. CLINICAL MEDICINE B .......................................................................................................... 13 7. RESEARCH METHODS .......................................................................................................... 13 8. COMMUNITY ORIENTED PRIMARY CARE ........................................................................... 13 COURSES for YEARS 3 and 4 1. ORGANIZATION AND MANAGEMENT ............................................................................... 14 2. ADULT EDUCATION ........................................................................................................... 14

DISSERTATION ............................................................................................................................. 14

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WHO SHOULD DO THE COURSE?

The course prepares doctors to practice as Specialist Family Physicians at a district level of care (primary and district hospital levels of care). Besides comprehensive clinical patient care, the programme includes aspects of management, teaching and research.

ENTRY REQUIREMENTS for MMed(FamMed)

Appointment as a registrar by the Metro District Health Service.

Registration with the Health Professions Council of SA as a medical practitioner and a letter of good standing from the HPCSA.

Computer literacy – basic knowledge of a word processing package and use of email and internet.

Proficiency in English at an academic level.

Clinical skills to the level equivalent to that of a doctor who has completed community service in South Africa – these may be assessed at the interview or at a practice visit, prior to acceptance into the course

Completion of internship and community service requirements.

TRAINING REQUIREMENTS

Registrars require the equivalent of a four year rotation. At least 3 of the years need to be in approved registrar training sites. Registrars are allowed a maximum of 4 years in a registrar post and a maximum of 6 years to complete their coursework and dissertation.

The award of the MMed (Family Medicine)

1. Coursework. Each end of course assessment needs to be passed.

2. Portfolio – Four annual portfolio assessments need to be passed with a minimum of

60%.

3. End of rotation assessments need to be passed. In addition, a satisfactory report by

the rotation supervisor is required.

3. Pass part 1 and part 2 exams. (The FCFP exam is used as the part 2 exam)

The part 1 exam is internal to UCT and is done at the end of year 2.

For exam details regarding the part 2 exam see:: http://www.collegemedsa.ac.za/view_exam.aspx?examid=102

4. Successful completion of Research

For the Fellow of the College of Family physicians requirements, look at the website of the College of Family Physicians

(http://www.collegemedsa.ac.za/view_exam.aspx?examid=102)

FCFP Examination Structure

1. FCFP(SA) Final Part A - can only be taken after 3 years of registrar training.

Commented [WU1]: Can this not indicated which academic

year the 2 exams occur?

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2. FCFP(SA) Final Part B is the Research Component.. The FCFP(SA) is only awarded once both parts are fulfilled.

Before the Final part A exam can be taken, the following are required: Completion of three years fulltime in a numbered registrar post Obtained a current CPR, ACLS or ATLS certificate of competence. Portfolio - completed the CMSA approved portfolio successfully each year over the past three years.

APPLICATIONS

You will need to apply to the Provincial Government of the Western Cape Department of Health for a registrar position, AND to the University of Cape Town for the MMed Academic programme. Enquiries and requests for application forms for the registrar post, must be directed to:

The Deputy Director: HRM, 8 Riebeek Street, Norton Rose House, 2nd Floor, Cape Town, 8000. Tel: +27 21 483 4464; website: www.westerncape.gov.za/health

Applications must be submitted by 30th September and interviews will take place in October/November for the course starting the following year. Sometimes interviews also take place midyear so applications can be sent in at any time of the year.

Please supply the following with your application form:

A recently updated curriculum vita

Academic transcripts from your basic medical degree and any other university course that you have undertaken.

Certified copies of identity documents

Proof of permanent residence in SA

Names of contactable referees

Selection will require an interview and an academic reading exercise. One interview is done by a team consisting of representatives of the Metro District Health District and the Division of Family Medicine at UCT and the Dept of Family Medicine at University of Stellenbosch.

Application for the MMed (Family Medicine) degree at UCT should be done online: https://srvslspsw003.uct.ac.za/psp/onapplic/EMPLOYEE/HRMS/c/UCT_PUBLIC_MENU.UCT_SS_APPL.GBL?bCDC=y&FolderPath=PORTAL_ROOT_OBJECT.UCT_SS_APPL_GBL&IsFolder=false&IgnoreParamTempl=FolderPath%2cIsFolder

If you have any problems with the online application please contact

Ms Thobeka Mngaza. Postgraduate Office: Academic Administration, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory, 7925. Phone: +2721 4047768, Email mngaza@uct.ac.za

For further information Please contact:

Commented [WU2]: Where are these certificates obtained from?

They do it themselves via private trainers

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Ms Galiema Parker (admin assistant) at Galiema.parker@uct.ac.za. +2721 406 6510

Professor Derek Hellenberg at +2721 406 6510, email: Derek.Hellenberg@uct.ac.za

Dr Bev Schweitzer at +2721 406 6441, email: Beverley.Schweitzer@uct.ac.za

Dr Tasleem Ras at +27 21 650 5221, email: Tasleem.Ras@uct.ac.za

ROTATIONS

The 4-year rotation will include twelve months (divided into smaller blocks of time) at a community health centre/s, 6 month rotations in surgery, anaesthetics, obstetrics and gynaecology and internal medicine. Registrars will work for 3 months in each of paediatrics, psychiatry, emergency medicine. Registrars will work for 6 weeks in palliative medicine, which may include 2 weeks of oncology. If circumstances allow, registrars can apply to do a 6 week elective rotation. During your rotations you will have opportunities to attend specialist outpatient clinics such as ENT, Dermatology. ELECTIVE

Elective plans must be submitted in writing, six months before your planned elective. You should include a motivation for your selection. You will need the approval of Metro District Health Services (MDHS) for your elective and will need to continue to do approved overtime. If you fail an end of rotationassessment, you will need to use your time to do more work in the discipline that you failed. Clinical learning is divided into 10 domains:

1. Child health 2. Women’s health

3. Emergencies

4. Mental health

5. Surgery

6. Orthopaedics

7. ENT, Dermatology and Ophthalmology

8. Infectious diseases - HIV/AIDS, TB, STIs and malaria

9. Anaesthetics

10. General adult medicine

LEAVE

Registrars are required to organise annual and research leave 12 months in advance. You also need to inform the Division of Family Medicine and MDHS where you would like to do your overtime during your palliative medicine rotation and elective rotation. This is so that service delivery is disrupted as little as possible and that locums are not used

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unnecessarily. Your elective needs to be planned and submitted for approval a year ahead of time. You need to apply to the department concerned and to Dr Abdul Isaacs who is the complex co-ordinator for Metro West, and to the Division of Family Medicine Med, for approval. Your chance of being granted vacation leave, or research leave at the time of your choice, is decreased if youput in your application later than this. Registrars are required to take two weeks leave in each half of the year. If you obtain special permission to take leave for longer than 2 weeks at a time, you may be expected to make up calls for that time. Please note that Province requires you to take a period of two weeks of leave at least once a year. The other 10 days can be taken as shorter periods. Application for leave needs to submitted to the Head of Department where you will be placed at the time of the proposed leave. Please look at the coursework roster when planning leave to ensure that you will be available to do scheduled assessments. Coursework that is missed while you are away must be caught up.

STUDY LEAVE

Registrars may request study leave for working on their research for two weeks at a time, on two occasions during the 4 years. A motivation needs to be submitted 6-12 months in advance.

Registrars are required to do calls as usual when on research leave.

FORMAT of FORMAL LEARNING

First and second year registrars meet at the University on Wednesday afternoons for

seminars. There may be one or two workshops on weekends during the year. Third and Fourth year registrars will meet, or have time to work on research, on

Thursday afternoons. The Research Methods module runs over two, week-long blocks in second year.

CREDITS FOR MODULES

Registrars can apply for exemption of part or the whole of a clinical rotation if they have done that rotation under suitable supervision, prior to entering the registrar rotation. This refers to time spent as an MO or other more senior position. It does not include time spent as a COSMO or intern. Exemption needs to be approved by the HPCSA.

COURSES

The degree requires the completion of a dissertation together with coursework and clinical rotations during which the required skills are acquired. 2016 (first years)

Feb to May June to August September to November

Principles of Family Medicine

Community-oriented primary care

Chronic Diseases, Prevention and Promotion

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Clinical Medicine A 2017 (second years)

Feb to April May to June July to October

Research Methods, Child and Family Health

Evidence-based Medicine,

Ethics

Clinical Medicine B November: Part 1 exam for second years

GRADUATES OF FOREIGN UNIVERSITIES

It is a university rule that all graduates of foreign universities who have English as a second language must produce evidence of having passed an accredited test of English as a foreign language. The definition of a "non-English speaking country" is defined in the rulebook as is the list of tests acceptable. Information for prospective international students can be obtained from the International Academic Programmes Officehttp://www.iapo.uct.ac.za/

COURSE RULES

ASSESSMENT

See under modules for specific assessments. Where a module has more than one means of assessment, you need to attain at least 48% for each aspect of the module in order to pass. That is, if your total mark is a pass (50% or above) but you have attained less than 48% for any of the aspects of the assessment, you will not pass the module. Years 1 and 2

You will be assessed at the end of each module. You need to pass all the year 1 and 2 modules in order to pass the part 1 exam. EXCLUSIONS

Candidates who fail three courses or end of block assessments, or the same course or end of block assessment more than once, will not be allowed to continue with the programme. Unprofessional conduct may also result in exclusion. CURRICULUM REQUIREMENTS AND ORGANISATION

The research protocol needs to be submitted to the Human Research Ethics Committee by the end of the second year of registration. The very latest the research can be handed in is 2 years after completion of the registrar time (See MMed dissertation rules in the Faculty Handbook). Graduation and the award of Commented [WU3]: Is the information in the Faculty

Handbook?

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the degree can only occur once research has been successfully completed and any corrections requested by the external examiners have been made. The maximum time allowed in which to complete the coursework is six years and then, only with permission from the relevant Faculty structures. The Registrar contract is for a limited period of 4 years and cannot be extended. Award of the MMed(FamMed) degree requires successful completion of coursework, completed portfolio that records your clinical work over 4 years, successful completed dissertation, successful

completion of the part 1(internal) and part 2 (CMSA) exams. Information on FCFP

TIME COMMITMENT

It is estimated that preparation for the weekly contact sessions, self-study, research and assignments will require 6 to 10 hours per week. This is in addition to your time spent reading on your current clinical rotation.

ATTENDANCE

Registrars should inform Ms Galiema Parker (021 406 6510) Galiema.Parker@uct.ac.za if they are unable to attend the afternoon courseowrk sessions. Registrars will need to make arrangements to catch up the material missed.

ASSIGNMENTS

Assignments need to be uploaded to Vula by the specified date. Under exceptional circumstances a one week extension may be given. No further extension nor mark will be given beyond that date. Request for an extention must be made in advance ot the convenor of the particular course. If an assignment if not passed, the course convenor may allow a re-submission. The maximum mark for a resubmitted assignment is 50%.

APPLICATION FOR DEFERRED EXAMINATIONS

Applications for deferred examinations need to be submitted via the admin assistant (Galiema.Parker@uct.ac.za) Applications need to be handed in within one week of the missed exam. A doctor’s certificate is required if the deferment is required on the grounds of ill health.

GENERAL INFORMATION

FEES

See Fees Booklet (http://www.uct.ac.za/apply/fees/)

FINANCIAL ASSISTANCE

Contact Postgraduate Scholarships Office (http://www.uct.ac.za/apply/funding/postgraduate/applications/)

Commented [WU4]: Brief summary for portfolio guidelines to

be included?

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CAREER OPPORTUNITIES

The public sector and Universities all over South Africa offer family physician posts at specialist level for registered family physicians. Alternately the specialist family physician may work in the private sector.

PRESCRIBED AND RECOMMENDED READING

Prescribed textbooks (as per the CMSA website): . FAMILY MEDICINE CORE TEXTBOOKS AND RESOURCES: 4.1.1 Handbook of Family Medicine (Latest Edition) Authors: Bob Mash and Julia Blitz (Eds) Publisher: Oxford University Press 4.1.2 South African Family Practice Manual (Latest Edition) Authors: Bob Mash and Julia Blitz (Eds) Publishers: van Shaik Publishers 4.1.3 General Practice (Latest edition ) Author: John Murtagh Publisher: Mc Graw-Hill Companies 4.1.4 Textbook of Family Medicine: (Latest edition) Editor: Robert E Rakel Publisher: Saunders Elsevier, Philadelphia 4.1.5 South African Family Practice Journal www.safpj.co.za 4.1.6 African Journal of Primary Health Care and Family Medicine www.phcfm.org 4.1.7 CME Journal www.cmej.org.za 4.2 OTHER RECOMMENDED TEXTBOOKS: 4.2.1 Handbook of Dermatology (Latest edition) Editors: Norma Saxe, Sue Jessop, Gail Todd Publisher: Oxford University Press 4.2.2 South African Medicines Formulary (Latest edition) Produced by: Department of Pharmacology, Medical School, University of Cape Town Publisher: Publications Department of the South African Medical Association 4.2.3 Concise Oxford Textbook of Medicine: (Latest edition) Editors: JGG Ledingham and DA Warrell Publisher: Oxford University Press 4.2.4 Clinical Examination (Latest edition): Authors: Nicolas Talley and Simon O’Connor Publisher: Blackwell Scientific Publication 4.2.5 Hutchinson’s Clinical Methods (Latest edition) Author: Michael Swash Publisher: Bailliere Tindall 4.2.6 MacLeods Clinical Examination (Latest Edition) Author: Munro Publisher:Harcourt Publishers Limited A number of national and local protocols will be available via a Resource list available on a Dropbox site.

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EXAMINATIONS

Examinations will be conducted at the end of year two (Part 1) and year 4 (Part 2 – FCFP exam of the CMSA). The Dissertation forms Part 3 of the MMed and part B of the FCFP.

Rules for the Part 1 Exam of the MMed

The exam consists of four components – Three written:

1. Multiple choice and EMIs 2. Modified essay questions exam. 3. Critical review of an article (under discussion)

Two practicals:

1. Clinical exam (To discuss having this during the year) 2. OSCE (Objective Structured Clinical Examination) - including both computer based

exams and procedural exams.

Each component of the exam must be passed with a minimum of 50% in order to pass. Subcomponents may compensate for each other. That is, your average mark for the combined clinical exam subcomponents should be 50% or more, the total for the OSCE should be 50% or more and similarly with the written components. If you fail one component, you will be required to re-do that component as well as any other component for which you obtained less than 70%. Registrars who fail the part 1 exam will be able to repeat the exam in October / November of the following year. No more than one repeat exam will be allowed. The final mark for the part 1 exam will be comprised as follows:

Course work: 40%

Exam: 40%

Portfolio: 20% (this excludes marks for assignments which are counted as coursework) (under discussion)

COURSES for YEARS 1 and 2

1. PRINCIPLES OF FAMILY MEDICINE

Convenors: Maryam Navsa and Graham Bresick Structure: Sessions will take place on Wednesday afternoons (14h00-17h30) Objectives: On successful completion of this module you should be able to:

Understand and apply the principles of family medicine Understand the dynamics of the primary care consultation Be able form and maintain a therapeutic doctor – patient relationship with a variety of patients Content: This module will include the philosophical basis of Family Medicine and the

principles on which it is based. The consultation and the doctor-patient relationship will be addressed. Role play and video review will be used to help integrate learning into practice

Commented [WU5]: Is this part of Part A or Part B which fits

where?

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Assessment: Patient study

2. CHILD AND FAMILY HEALTH

Convenors: Dr B Schweitzer Structure: This is online, but the group also meets for patient presentations with a resource

person. Discussion groups take place on internet.

Objectives: On completion of this module you should be able to:

Identify and manage common conditions in childhood and adolescence Institute key preventive and promotive activities in children and adolescents Describe key theories of human growth and development Demonstrate an understanding of the human life-cycle and how this can be applied

in practice Demonstrate a family-orientated approach to primary care Develop awareness of your own developmental issues and their impact on the

doctor-patient relationship Identify and manage emergencies in neonates and children

The study of human growth and development enables the learner to understand the person in the context of his or her own stage of human development in the life cycle. Focus is on the development of self-awareness for the doctor and the development of sensitivity to the various life stages. Content: This module aims to cover key topics in child health, clinical paediatrics, family-

orientated primary care, human growth and development. Topics include the therapeutic relationship, theories of development, developmental aspects of infancy, the toddler, the pre-school child, the primary school child, the adolescent, adulthood, ageing and death and dying

Family-oriented care facilitates an understanding of how families function and how illness impacts on the family and the family impacts on illness and the management of illness. You will gain skills to conduct family interviews. Topics will include family dynamics, genograms, understanding the effects of one’s own family on you as a doctor, stages of the family life cycle, and a family-oriented approach to specific problems. Role-plays will be used to practice skills. Child health and paediatrics is learned by means of self – assessments and patient presentation with input from a paediatrician. Assessment

Each aspect of the assessment must be passed in order to pass the module. This includes:

Individual contributions to group discussions

One written assignment

3. PREVENTION, HEALTH PROMOTION AND CHRONIC ILLNESS

Convenors: Dr B. Schweitzer and Dr M Navsa

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Structure: This is a 12-week web-based course. We will also have contact sessions on

clinical topics where you will be allocated to present patients.

Objectives This module includes key topics in chronic disorders, health promotion and

disease prevention.

At the end of this module you should be able to:

Describe current theories of disease prevention and health promotion

Implement a quality improvement cycle in your practice to improve the quality of care, promote health and prevent complications for a chronic condition

Diagnose and manage patients with common chronic medical conditions (cardiovascular, respiratory, rheumatological, neoplastic) according to the principles of family medicine

Describe the principles of palliative care and issues of death and dying

Manage common clinical problems in palliative care

Describe the principles of ageing and caring for the elderly

Manage common clinical problems in the elderly

Describe the principles of rehabilitation and perform a functional assessment of a patient

Manage patients with common disabilities and impairments

Describe the importance of the doctor-patient relationship in chronic care

Clinical and procedural skills related to the clinical topics will also be addressed during the contact sessions.

Content

Introduction to principles of chronic care, health promotion, disease prevention and the QI cycle

Chronic medical conditions: ischaemic heart disease, hypertension, diabetes, obesityasthma, COPD, smoking, occupational lung disease

Rheumatology, the Elderly, Cancer, Palliative Care, Rehab and the Doctor-patient relationship.

Requirements (as for degree) Assessment

Formative self-assessment will be by means of weekly MCQ questions. Summative Assessment

You will be required to pass (50% minimum) the end of module MCQ examination, as well as both assignments in order to pass the module as a whole. Audit project – 40% MCQ exam – 40% Rehabilitation assignment – 20%

4. EVIDENCE BASED MEDICINE

Practicing medicine means that one is constantly faced with decisions regarding diagnostic tests and treatment. This module helps one to ask clear questions and then identify and evaluate the evidence from the literature in order to come up with answers appropriate for one’s practice. It also teaches a critical approach to reading journal articles. Convenor: Mr James Irlam Objectives:

To understand what EBP is and why it is needed

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To gain skills in searching for the evidence online

To be able to apply the rules of evidence for appraising the validity and applicability of research into the effects of interventions.

To be able to apply the rules of evidence for appraising the validity and applicability of research papers that summarise other research.

To be able to apply the rules of evidence for appraising the performance of diagnostic and screening tests

To understand how to appraise the validity of prognostic information for use in counselling patients

To be able to assess the validity and applicability of guidelines for clinical practice Content

Definition of EBP

Need for EBP

Lessons from history

Principles of EBP

Cochrane Library

PubMed Clinical Queries

Search examples

Review design features of Randomised Controlled Trials (RCTs)

Review measures of outcome (RR, RRR, ARR, NNT)

Critically appraise the validity of an RCT and its applicability to a given clinical scenario

Review systematic reviews vs. traditional reviews

Review basic principles of meta-analysis

Critically appraise the validity of a systematic review and its applicability to a given clinical scenario

Review purpose of diagnostic and screening tests

Review measures of test performance (sensitivity, specificity, PPV, NPV, likelihood ratios, nomogram)

Critically appraise a cross-sectional validation study of a diagnostic test and its applicability to a given clinical scenario

Review understanding of prognosis and prognostic factors

Critically appraise a cohort study of prognosis and its applicability to a given clinical scenario

Critically appraise the validity and applicability of clinical guidelines

5. ETHICS

Convenor: Dr B Schweitzer, Tutored by Dr Maryam Navsa and Jess du Toit from the

Division of Ethics Structure: Weekly seminars Objectives

Learners will gain an understanding of the theoretical background to ethical analysis and develop the skills to identifying and solving ethical dilemmas in primary care. Assessment: Assignment

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6. CLINICAL MEDICINE A

Convenor: Dr Bev Schweitzer

Objectives: To help gain clinical competence primary care approaches to patients with

problems related to surgery and surgical specialities such as Orthopaedics, ENT, Eyes, Urology; acute medicine, rheumatology, emergency medicine, occupational Health. Structure: Learning is by discussion of patients seen during the course of one’s work, with

input from discipline specialists; self-study including the use of MCQs.

6. CLINICAL MEDICINE B

Convenor: Dr Bev Schweitzer

Objectives: To help gain clinical competence in the primary care approach to patients with

issues related to Women’s Health, Mental Health, HIV, TB, STIs, Pharmacology, Radiology, Medical specialities e.g. Geriatrics, Neurology, Dermatology. Structure: Learning is by discussion of patients seen during the course of one’s work, with

input from discipline specialists; self-study including the use of MCQs.

7. RESEARCH METHODS

CONVENOR: Dr Liz Gwyther The aim of this module is to equip family medicine and palliative care professionals with the knowledge and understanding of research methods and to develop the skills to conduct independent research. It covers the topics of research methods, biostatistics and epidemiology, qualitative methodology, research ethics, scientific writing skills. These topics are explored through interactive workshops, focused readings, and practical examples with web-based support of learning. UCT FHS Human Research Ethics Committee SOP on Ethical and Regulatory Requirements for Human Research includes the statement that “Researchers who perform human research must be suitably qualified by experience and/or training to safeguard participants’ rights in their research, and all others involved in a study share this responsibility in varying degrees.” Competence to conduct ethical research is assessed through the Research Ethics assignment to be completed following the research methods workshop. Alternatively, a current Good Clinical Practice (GCP) certificate is recognised (RPL) as competence in research ethics.

8. COMMUNITY ORIENTED PRIMARY CARE

CONVENOR: Prof Steve Reid

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OBJECTIVES: This module aims to cover the principles and some of the practice of

community-oriented primary care in your community. At the end of this module you should be able to:

Describe the concept and steps of community-oriented primary care

Define and characterize a community within which your practice is situated

Prioritize the major health issues of that community

Design an intervention that would address one of the high priority health issues Structure: There will be seminars and field work which includes a home visit and

discussion with members of the community. Assessment: The report backs from home and community visits will be assessed. The final assessment will include a presentation of the community assessment and prioritisation of the needs.

YEAR 3 MODULES

1. ORGANIZATION AND MANAGEMENT

Convenor: Professor Derek Hellenberg

2. ADULT EDUCATION

Run by the Education Development Unit.

DISSERTATION

You may apply for funding (to a maximum of R500) for your research via Carmen de Koker at Carmen.deKoker@uct.ac.za. More information is available on the MMed Vula site under <Research> Registrars can apply to the MDHS for study leave to work on the dissertation for two periods of two week each over the four years. You should apply for study leave which is given on a 50:50 basis with vacation leave i.e. you can take two weeks’ vacation leave and receive two weeks to give a total of a month for study. You need the approval of your supervisor as well as the head of the department in which you are working. Leave will only be granted if service provisions can be met and applications need to be at least 6 months in advance. You are still expected to fulfil your overtime requirements while on study leave.

MMed Part III (minor dissertation) Guidelines for candidates, supervisors and examiners

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The MMed minor dissertation is one of three examination components of the MMed degree. This minor dissertation carries one third of the weight of a full master’s dissertation in terms of its credit weighting, i.e. 60 credits which approximate 600 hours of work. In order to register as a specialist (or sub-specialist) in South Africa, the Health Professions Council of South Africa (HPCSA) and the Colleges of Medicine of South Africa (CMSA) now require all specialist trainees who register for training after 1 January 2011 to have completed a relevant research study.

The dissertation must be the result of independent work of the candidate conducted under the guidance and direction of a supervisor(s) and should demonstrate evidence of an ability to undertake research, to interpret results adequately and to review the relevant literature comprehensively and critically. Although the research need not necessarily be original, the findings must be seen to advance scientific understanding. A case report is not acceptable for the dissertation, as it cannot meet these requirements. The topic, study design and scope of research will depend on the particular disciplines and must be agreed on in consultation with the supervisor(s).

The dissertation may be presented in publication-ready format;

Research protocol

Candidates intending to register for the MMed Part III are required to submit a full research protocol for approval to their respective Departmental Research Committee (DRC). The candidate must then obtain UCT Research Ethics Committee (REC) approval prior to

conducting their research; studies that involve the audit of clinical records or services also require formal REC approval. Any primary research taking place in a provincial or local authority health facility, such as public sector hospitals or clinics, must also be submitted to the provincial government for approval, after the UCT Research Ethics Committee approval has been obtained. Approval to access public sector facilities for research is needed for all provincial and local authority facilities. There are five points where approval for

research can be applied for - the three teaching hospitals, the local authorities and "all other province". Teaching hospitals and the local authorities approve research projects in-house. "All other province" approvals are done via the Directorate: Health Impact Assessment (Sub-directorate: Research) at provincial head office. If research crosses these boundaries, up to five approvals may be needed. Further details can be found at http://www.capegateway.gov.za/other/2011/3/phrc_approval_guidelines_november_2010.pdf. The Provincial Health Research Committee does not approve research proposals itself, but oversees this approval process by reviewing difficult applications on referral (Chair: Prof Rodney Ehrlich).

The research protocol should outline the scope and content of the dissertation and must include the title of the proposed dissertation, name of the supervisor(s) and their brief curriculum vitae(s). This full research protocol together with a copy of the REC approval letter and completed Form D1 must be submitted to the postgraduate administration office, for approval by the Professional Masters Committee Chair and the Board of the Faculty of Health Sciences, prior to commencement of the research.

Timelines

Submission of the research protocol for approval should generally be made within the first 18 months of the registrar programme. Heads of Departments or Divisions should meet with their registrars at least annually to review progress towards their research project. Unless

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otherwise stipulated by your Division / Department or constituent College of the CMSA, the research project should generally be completed by the end of Year 2. For a number of constituent Colleges, the dissertation must be submitted 6-months before writing the Part II examination.

Supervisors

The importance of identifying a dissertation supervisor as early as possible cannot be overemphasized. The supervisor should be an individual who can relate to the candidate’s research project, be available for frequent and regular discussion and advice, and someone with whom the candidate can develop a good working relationship. Where specialised equipment and/or laboratory work is required for the study, the supervisor should assist in facilitating access to appropriate facilities.

The primary supervisor may be based outside the candidate’s home department, faculty or university. In such a case, an internal (co-)supervisor will also be required in addition to the primary supervisor, to serve as a guide and link to UCT faculty and discipline-specific procedures. Primary supervisors retain responsibilities to the candidate and the university until the dissertation process is complete. The supervisor and student must complete form D3, which describes the contractual agreement of supervision.

Please note: in order to assist a candidate with a master’s research topic the supervisor should hold a master’s degree or equivalent (such as a Fellowship of one of the constituent Colleges of the CMSA), and have relevant research experience. If the primary supervisor does not hold such a higher qualification, then a secondary supervisor who has a higher degree will need to be appointed in addition to the primary supervisor.

The dissertation

Submission of the dissertation should include the following:

The title page should contain the candidate’s name, dissertation title and the name of the

university. It must also state the degree, e.g. Master of Medicine (MMed) in Public Health Medicine, Occupational Medicine, Family Medicine, Surgery, etc. The title page should also include a statement to the effect that the research reported is based on independent work performed by the candidate and that neither the whole work nor any part of it has been, is being, or is to be submitted for another degree to any other university. It must also state that this work has not been reported or published prior to registration for the abovementioned degree.

The abstract should summarise the study rationale, methods, results, discussion and

conclusion in fewer than 500 words.

Publication-ready Format:

The body of the dissertation, which must be structured to include the following:

Part A: The protocol as approved by the Departmental Research Committee and UCT

Faculty Research Ethics Committee (REC). The protocol should not exceed 4000 words. Should the protocol approved by the REC exceed 4000 words, the candidate should provide a shortened version of this protocol in not more than 4000 words.

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Part B: A structured literature review appropriate to the subject matter and methods of the

dissertation. The literature review must, amongst other things, show that the student is sufficiently acquainted with, and is able to conduct a critical appraisal of the relevant literature. If appropriate for the topic, candidates should demonstrate a good understanding of evidence-based medicine.

The structured literature review should be between 3 000 and 4 000 words.

A suggested structure for the literature review is as follows:

a. Objectives of literature review; b. Literature search strategy, including inclusion and exclusion criteria; c. Quality criteria. These will vary with the nature of the dissertation; d. Summary and interpretation of literature, and its implications for the research; e. Identification of gaps or needs for further research; f. References (which will overlap with but will not be the same lists as in the

journal article and protocol).

Part C: Publication-ready Manuscript:

The results of the study must be presented in the form of a manuscript of an article for a named peer reviewed journal, meeting all the requirements set out in the “Instructions for Authors” of that journal, including the word count and referencing style. Unless specially motivated, the journal chosen will need to allow for at least 3000 words excluding abstract, tables, figures and references. The “Instructions to Authors” of the journal must be appended. The co-authors should be listed in the appropriate order, and each of their contributions to the manuscript stated. The journal chosen for publication must be appropriate to the subject matter of the dissertation and listed in the citation index of the Institute for Scientific Information (ISI) or accredited by the Department of Education:

Important note: The candidate need not have submitted the article for publication, nor is

the acceptance of the article for publication a requirement for passing the degree. However, the norm is to publish the study with the supervisor(s) as co-author(s), and candidates are strongly encouraged to submit their manuscript for publication either before or shortly after examination of the minor dissertation. Submitting the manuscript for publication before submitting the minor dissertation has the advantage that addressing the peer reviewers’ comments improves the standard of the manuscript included in the dissertation. A candidate who fails to submit a manuscript for publication within one year of examination of the minor dissertation must accept that their supervisor(s) may publish their data with him/her as co-author.

For a systematic review, Parts B and C are combined in the publication-ready

manuscript.

Part D: Appendices All supporting documents including:

o Acknowledgements, including a description of the role played by each person who would be expected to be an author on a published article arising from the dissertation. In a dissertation derived from work started by others, e.g. analysis of data collected for another project, the candidate’s contribution must have been made after his/her registration for the degree and therefore

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under supervision. In a manuscript from a multi-authored project suitable for submission towards a minor dissertation, the candidate would be expected to be first author;

o Questionnaire/data capture instrument(s) (if not appended to protocol in Part A)

o Consent forms and any related participant information sheets (if not appended to protocol in Part A)

o Technical appendices, including, if considered necessary, any additional tables not included in the main manuscript for the examiner to have available. These should be accompanied by a brief narrative.

o Official Ethics approval letter from the Faculty Research Ethics Committee and any other approvals required (e.g. Provincial Government).

Language and writing

Candidates should refer to the document D4, Guidelines on the Layout and Style of the Dissertation or Thesis. Clear, grammatically correct English is essential. As long as the dissertation is readable and internally consistent, any of a number of styles is acceptable. Supervisors may assist candidates in developing scientific communication skills but they are not required to do detailed editing or correction of spelling, grammar, or style. They may refer candidates elsewhere for this, at the candidate’s own expense. Candidates who may have difficulties are encouraged to seek help from the writing support facilities on main campus (see: http://www.ched.uct.ac.za/adp/writing/).

The Harvard style for referencing is recommended. In this style, referencing is by first author in parentheses in the text and the bibliography is listed alphabetically (rather than using numerical superscripts in the text). NOTE: For Section C (Publication-ready manuscript) references should be formatted according to the instructions to authors for the journal selected, and candidates may prefer to use the same style throughout their dissertation. For reference management, Refworks can be downloaded from the ICTS or UCT library websites.

It is suggested that candidates look at previous examples of Master’s dissertations in the library for appealing layouts. Master’s dissertations are available in the Health Sciences Library. A search will need to be done to obtain a list of titles and authors. This search can be done using search words (e.g. dissertation, health, health sciences, etc.). The librarian should be asked for assistance. Some of these dissertations are available online at http://srvrhldig001.uct.ac.za/R/R3CAKV8FM3PHV23A363D7J4F947AN4AXGRBTHIPM2L62RSUXDM-02943?func=collections&collection_id=1526 but this site does not yet differentiate MMed, MPhil and MSc dissertations within the faculty of Health Sciences, so candidates will have to open each dissertation to identify whether it is relevant to their minor dissertation.

Submission of dissertations

On completion, the dissertation should be submitted to the Faculty Postgraduate Office. The candidate should inform the Faculty Officer one month in advance of the intention to submit, using Form D8 (Intention to submit). Supervisors will be requested by the Faculty

Postgraduate Officer to submit a letter supporting submission, and clearly specifying whether the dissertation will be submitted in a “Publication-ready” or “Monograph” format, so that the appropriate instructions are sent to the examiners. This letter should be supplied

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by the primary supervisor. If this supervisor is external, the internal supervisor must be kept informed at every stage of the process.

The candidate must submit 2 copies of the dissertation, in temporary binding (e.g. plastic ring) and an electronic copy in a universally readable format (e.g. pdf) on a compact disc. The candidate must clearly state which of the formats has been chosen (“Publication-

ready” or “Monograph”), so that the appropriate instructions are sent to the examiners. Specific submission requirements may be set by individual disciplines or constituent Colleges of the CMSA, and registrars are obliged to ensure that their research projects and dissertations meet these specific requirements.

UCT Dissertation Submission deadlines:

1. March 15th for June graduation 2. August 15th for December graduation

Note on fees: To avoid attracting fees, dissertations need to be submitted before the beginning of the first quarter (first day of academic year), and before the start of the second semester (mid July) to qualify for a 50% fee rebate.

Examiners

The full dissertation will be submitted for examination through the Postgraduate Office of our Faculty to two external examiners (nominated by the supervisors and HOD).

It is the supervisors’ responsibility to submit names of three potential examiners to the Faculty Officer when the candidate is ready to submit. Of the three examiners nominated, two are invited to examine, and one is held as an alternate. All examiners must be external to UCT, and appointment of examiners from outside South Africa is encouraged. These nominations need to be approved by the Deputy Dean: Postgraduate Affairs on behalf of the Faculty Board and submitted to the Faculty Board for ratification via a Dean’s Circular.

The examiners will be well briefed regarding the specific requirements and criteria for submission and examination of the minor dissertation. Such criteria will clearly explain the difference between the minor dissertation and a Master’s degree by dissertation alone, and between the monograph and the “publication-ready” format of dissertation.

Details required for each examiner are: academic qualifications, postal and/or physical address, telephone and fax numbers and e-mail address, and one paragraph description of their standing in the relevant field (drawn from their CV if need be.)

The candidate may not be informed of the identity of the examiners. After the outcome of the minor dissertation has been finalised, the examiners’ identities are made known if the examiners have indicated that they do not object to this.