UNIVERSITY OF PRETORIA
FACULTY OF MEDICINE
MARCH 1999

QUESTION 1:
HOW MANY DOCTORS GRADUATED AT YOUR UNIVERSITY IN 1998? HOW MANY WERE AFRICAN, COLOURED, WHITE AND INDIAN?

ANSWER:
Total graduandi for 1998 were 118 Male and 98 Female = 216

African: 0
Coloured: 3
Indian: 6
White: 207

SEE TRANSPARANCY

UNIVERSITY OF PRETORIA
FACULTY OF MEDICINE
MBCHB GRADUANDI - 1998

Question 2:
provide a racial and gender breakdown of all medical students registered from 1st year to final year.

Total of 1st years registered for 1999: 184

A further 20 students will enroll in June 1999 from the BSC class.

See transparencies for breakdown of all other years.

PMG Note: Graphs (University of Pretoria female and male students enrolment by population group: MBCHB 1999) not included

Question 3:
provide a racial and gender breakdown of the attrition rate for 1st to final year medical students.

What were the main reasons for the attrition rates?

Reasons:
. First year students leaving for medical studies at other universities.
. Financial reasons.

IS THE ATTRITION RATE HIGHER OR LOWER?

Answer:
The attrition rate for total was lower in 1998 than in 1997.
From 4.80% down to 2.50%

IF LOWER, PROVIDE DETAILS OF WHAT YOU ARE DOING DIFFERENTLY.
Details:
. Tutor programmes as mentioned under question 4 have been implemented
. More support systems are available to students (see under question 4)

SEE TRANSPARANCIES FOR BREAKDOWN OF ATTRITION RATES

UNIVERSITY OF PRETORIA
FACULTY OF MEDICINE
ATTRITION RATES FOR FIRST YEAR MEDICAL STUDENTS 1997-1998

* Projected for 1999

QUESTION 4
IN THE LAST YEAR, HAVE NEW SUPPORT PROGRAMMES BEEN INTRODUCED, OR HAVE EXISTING SUPPORT PROGRAMMES BEEN ADAPTED? PROVIDE FULL DETAILS OF SUPPORT PROGRAMMES AND CHANGES.

SUPPORT PROGRAMMES IN THE FACULTY
The Faculty of Medicine has support programmes for its students undergoing training in the Faculty, and also runs bridging programmes for prospective students, particularly those from previously disadvantaged groups, outside the Faculty of Medicine. In addition the Faculty has teletuition programmes to schools in the vicinity by means of the University's interactive television programmes, to assist black school pupils with mathematics, biology and science subjects and thus improving their chances of admission to university. In January of each year, an information day for 1st year students and their parents is held by the University at which the Faculty of Medicine is also represented.

Support mechanisms for students
The Faculty of Medicine has a special Support Committee that meets every two months to ensure that the different support systems and programmes available in the faculty are operated effectively. These support systems fall into the categories of social, academic clinical, psychiatric and psychological and language support systems, as well as direct support via appointments that students can make with the Deputy Dean.

Social support systems
The Adcock-Ingram Mentor Programme was established in 1994.
The Deputy Dean is the supervisor of the programme and is assisted by a committee of two other members of the Faculty. Adcock-Ingram Pharmaceuticals sponsors the programme which has been specifically designed to help medical students entering the Faculty to adapt successfully to the demands of the academic, social and professional environment. A well-adjusted and happy student has a far better chance of academic success, so the programme is not just to give academic support but also to ensure that first-year medical students adjust socially and culturally to the Faculty.

Third-year medical students who volunteer to be mentors are interviewed and those who are selected are appointed for a one-year period. Each member has six to eight first-year medical students to care for, and a special effort is made to include representation of the different cultural groups in each mentor group to ensure cross-cultural understanding, respect for diversity and tolerance.

Mentors undergo a short training programme at the beginning of the year, concentrating on communication skills and enhancing their nurturing skills, as well as group dynamics. Their duties and tasks are explained to the mentors but they are also encouraged to take their own initiatives. Mentors have to report back about their group activities and the first-year students in their groups to the committee at a monthly meeting. In addition there are ad hoc and crisis channel facilities to the mentor supervisor.

Analyses of the detailed evaluation reports indicate that the programme has been achieving its goals successfully: more than 90% of the students being mentored, respond annually that they are in favour of the programme.

As some of the black first-year students found the cultural differences intimidating, the `Izankanyezi group= was initiated in 1997. This group consists of third-year black students who `accompany= first-year black students to their respective mentor groups to address any uncertainties arising from cultural differences in the groups.

The Guardian System was also established in 1997: one mentor and his/her group of first-year students are placed in the care of a member of the academic staff. The staff members volunteer for his service and are expected to continue to be the group's guardian for the next 3-6 years.

1.1.2 Academic support systems include the Tutor System and the Extended Programme.

The Tutor System has a number of tutor posts in the Faculty of Medicine that are subsidised by the University of Pretoria. Senior and/or postgraduate students are appointed to offer academic support to first-year medical students, as well as students from the allied health professions (physiotherapists, nursing science etc.) who are taking preclinical subjects, i.e. physiology, anatomy, pharmacology, microbiology and pathology, for the first time. The individual departments are responsible for training the tutors.

The Extended Programme in the Science Faculty is headed by Prof Max Braun who collaborates closely with the Faculty to identify and select students with potential for the medical course, once these students have successfully completed a specially designed one-year academic support programme and have completed a programme equivalent to the first semester of the MBChB I course. Unsuccessful students can apply for training in medicine or any of the allied health professions after the end of their BSc I course, or even at a later stage.

Clinical support systems include the Community-based Education programmes that are part of the medical course as well as of the courses of all the allied health professions. This ensures that students are exposed to the conditions that the health care professions experience in rural areas. Lecturers accompany the students in these programmes, and local health workers and volunteers from the communities liaise closely to ensure fruitful participation in the programmes.

Since 1996 the Faculty has operated a fully equipped Skills Laboratory where students of all the health professions are trained in clinical communication and attitudinal skills. This was necessary to ensure that students from different cultural backgrounds become equally competent in clinical skills before coming into contact with patients, particularly as the new medical curriculum brings students into contact with patients much earlier than the old curriculum.

1.1.3 Psychiatric and psychological support systems

These support systems are in place in the Department of Psychiatry to assist students with stress-related problems. Referrals are made via the Deputy Dean, or alternatively students make an appointment to see the head of the Department of Psychiatry.

Appointment with the Deputy Dean: As the Deputy Dean is responsible for all matters concerning medical students, she may be seen regularly by special appointment. Students can also see her without an appointment every Friday after 14:00. The Deputy Dean maintains an open door policy and students who have problems are encouraged to visit her, and when necessary, further referrals are made to the finance department, the bursaries and loans divisions, department heads, etc.

1.1.4 Language support programmes
The Faculty has embarked on a programme to offer practical language courses to medical students so that they can acquire a working conversational knowledge of Afrikaans and/or Zulu. The students participate voluntarily and although they have to pay for the courses, the cost is reasonable and sponsorships are actively being sought. The Faculty intends to extend these programmes in future to include more languages and involve more students.

In 1997 about 10 students completed the Afrikaans programme.
In 1997 about 14 students completed the Zulu programme.

1.2 Bridging programmes outside the Faculty of Medicine
The selection panel consists of representatives of academic staff, community or alumni members and representatives from the relevant health profession. Students are also present. Special tests set by the University's guidance Division determine which students may have the potential to be selected for Category 17 which is part of the Affirmative Action programme in the Faculty of Medicine.

Applicants who show potential but lack the necessary academic background to be selected directly for the medical course, are specifically re-evaluated for selection for the second semester of the medical course, once they have passed a special one-year extended programme offered by the Faculty of Science and have also passed all the courses of the first semester of the MBChB I course (which are equal to the first semester courses for BSc I).
Special support programmes, for example, in chemistry, physics, maths, biology, language skills and added value skills, are presented to meet the needs of individual students.

Similar procedures have been set in place for the courses in the associated disciplines of health workers, as indicated in the individual reports of each department or division.

1.3 Outreach programmes
In an endeavour to improve the qualifications of school pupils who may apply to do courses at tertiary education institutions, the University of Pretoria has for some years been operation a teletuition programme for secondary schools for black pupils in disadvantaged areas in the vicinity of Pretoria. By means of interactive television, where pupils can ask questions and have them answered during the sessions, pupils gain a better knowledge of subjects such as Biology, Mathematics and Science, for example, train teachers to teach pupils more effectively. A group of student volunteers also runs Saturday schools for secondary school pupils to help them obtain better examination results.

1.4 Outreach programmes for health care to other facilities and areas
At the request of the Gauteng Department of Health, the possibility was investigated of having outreach programmes to the following hospitals:

• Tembisa Hospital
• Mamelodi Hospital
• Pretoria West Hospital

The outreach programme also entails involving our students and lecturing staff of the Department of Family Medicine in providing health care to communities at the following clinics:
• Sedibeng Clinic in Atteridgeville - since 1990
• Daspoort Clinic in Pretoria West - a project completely organised and run by the Medical Student Committee under the auspices of the Department of Family Medicine.
• Stanza Bopape - this clinic is the brain child of a fourth-year medical student and will be commissioned in the near future.

The aims of these outreach programmes are as follows:
• To help with the building of capacity in the different hospitals so that the hospitals and clinics will be able to implement the National Health Plan
• To offer opportunities for training our students to cope with African conditions.

Various departments in the Faculty, for example the Departments of Radiology and Urology, also offers support with postgraduate training to colleagues at Medunsa.

The Department of Nursing Science in particular, and also the Department of Pharmacology, has given extensive support to the Lebone Nursing College in the design and setting up of new curricula for various courses. Other members in different faculties at the University of Pretoria have been and still are closely involved in special team-building sessions with all the academic staff members at Lebone College, leadership training sessions with the members of the Student Representative Council and various arrangements with the library of the Lebone College (including the transfer of various relevant books and scientific journals).

Faculty members have been involved in an outreach programme to Swaziland since 1993. Clinicians of various disciplines visit the Mbabane Government Hospital, the National Public Health Centre and three regional hospitals monthly or every two months to render medical services and give in-house training to local practitioners.

2. CONCEPT OF MULTI DISCIPLINARY HEALTH CARE
Students in all the departments of the Faculty of Medicine are taught to follow a team approach to health care at all levels. The problem-orientated approach to tuition ensures that each member of the team knows how the particular health professional should support and cooperate with the other health professionals involved in a particular problem or case. This approach ensures that due recognition is given to the professional care that the nurse, doctor, radiographer, nutritionist, social workers, etc. contribute to the well-being and total care of the patient.

3. MEDICAL ETHICS AND CODE OF CONDUCT
Great emphasis is placed on inculcating ethical values and establishing a professional code of conduct in all the students of the Faculty of Medicine. Special courses are held on these topics. A special workshop is arranged annually for the final-year students following the old curriculum.

The new medical curriculum presents formal courses in the first and second years of study: in the first semester of their first year, medical students attend an introductory course during the formal course in Philosophy. In the second semester of the block in their second year of study, students attend a more comprehensive course named: `Man and his social environment'.

Furthermore, ethical values and professional attitudes are emphasised throughout the old and the new curriculum. These values and code of conduct form part of the integrated curriculum in all the other blocks and are one of the `golden threads= of the new curriculum.

4. LANGUAGE POLICY AND RESPECT FOR DIVERSITY
In 1997 the Standing Committee of the Council of the University of Pretoria adopted an interim language policy which would be submitted for a decision by the Broad Transformation Forum. In terms of this interim policy, the University recognised all eleven official languages of South Africa and undertook to develop and use the languages of instruction, English and Afrikaans, as valuable instruments of science.

Training programmes are presented in either English or Afrikaans or in both these languages, provided that there is a demand for instruction in the language(s) concerned and that such programmes are academically and economically justifiable. The University will also promote the development of the other languages (official and nonofficial) by, for example, presenting language courses where there is a demand for such courses and programmes and provided that such courses and programmes are economially justifiable. A further tenet of the policy is that there shall be no discrimination against any staff member or student who has a command of only English or only Afrikaans or of only these two languages.

The students are encouraged to respect cultural diversity through the language courses presented (see paragraph 1.1.4) as well as through community-based education and contact with other cultures and ethnic groups, not only in their study programmes but also by contact with fellow students from other ethnic and cultural groups.

The current language policy is flexible, allowing lecturers to choose the language of instruction according to their own preferences and/or the dominant language preference of the class. Lecturers are requested to use the other language not spoken by the lecturer, for slides and overhead projections used in the lecture. Furthermore, all study guides, hand outs, test and examination papers are printed in both English and Afrikaans. Students may choose the language they prefer for doing oral examinations, conducting interviews and asking questions in class.

5. ELECTIVE PROGRAMME
Since 1990 students from abroad have been able to study for an elective period at our Faculty. Few students were involved initially, but since 1994 there has been a striking increase in the number of visits by students from various countries:
In 1993 there were fewer than 20 students (no statistical data kept then).
In 1994 there were 59 students from abroad in elective programmes.
In 1997 there were 118 students from abroad in elective programmes,
In 1998 there were 92 students from abroad who participated in elective programmes.

Agreements have also been reached with other medical schools to expand this programme.

QUESTION 5:
PROVIDE A RACIAL AND GENDER BREAKDOWN OF STUDENTS DOING POST GRADUATE STUDIES.

HAS THERE BEEN AN INCREASE OR DECREASE?

PROVIDE REASONS.

Answer:
At the moment it seems as if there has been a decrease in total postgraduate enrollments.
We suggest that the reason for the decrease could be the result of the moratoria on the filling of registrar posts at the Pretoria Academic Hospital.

2. Post graduate students are still enrolling and the number of post graduate students could possibly increase in the next month.

SEE TRANSPARANCIES WITH BREAKDOWN OF THE NUMBERS OF 1998 AND 1999 ENROLLMENT

PMG Note: Graph (Post-Graduate admission by population group 1998) not included.

PMG Note: Graph (Post-Graduate admission by population group 1999) not included.
T

QUESTION 6:
PROVIDE DETAILS OF THE CONTENT OF THE UNDERGRADUATE AND POST GRADUATE CURRICULUM.

DOES THE CURRICULUM ENSURE THAT STUDENTS ACQUIRE SKILLS FOR THE PUBLIC HEALTH SYSTEM?

SEE ATTACHED NOTES ON THE DETAILS.

Answer to skills question:
The university of Pretoria's Medical Faculty has a department of Community Based Education. Prof DR Prozesky is the head of this department. He runs an extensive community based programme which ensures that the students of all health courses are exposed to the need to master specific skills.
The university has a Valab (Skills Laboratory) where generetic skills are being taught to students and practised by the students of all health care courses throughout the year.

6. Content of undergraduate curriculum

* Characteristics
Problem-orientated
Integrated
Community based
Student centred
Emphasis not only on knowledge/facts, also skills and attitudes

* Organised/structured on basis of "International Classification of Diseases".

* Objective/aim
To provide a general practitioner who can work independently as a medical officer in a district hospital with confidence (attitude), with the necessary skills + the relevant information - he/she will also be able to learn lifelong, thus being able to specialise if he/she chooses.

* a) Practicals
• skills are learned and practised on models (simulation) in SKILLS LAB.
• skills learned in SKILLS LAB are practised in community-based settings
• Jubilee district hospital
• Moretela health clinic
• Mamelodi
• Kalafong
• Mpumalanga (Witbank & Nelspruit)
• Pretoria Academic hospital

b) Content

I Year 1 Semester 1: Human Behavioural Science
Science & World Views
Medical Terminology
Chemistry for medicine
Physics for medicine
Molecular & Cell Biology

Year 1 Semester 2:
SA : Orientation (1 week)
SA2 : Computer orientation (1 week)
Block 1 : Molecule to Organism (9 weeks)
Molecule to cell
Cell to tissue
Tissue to organism

II Year 2 Semester 1:
Block 3: Homeostasis (7 weeks)
Intermediary Metabolism
Regulation and Control
Internal Milieu

Block 4: Pathological Conditions (11 weeks)
General Pathology and Immunology
Principles of Neoplasia
Principles of Infections
Infectious diseases
SA4: Anatomy Dissection (150 hours)

Year 2 Semester 2 :
Block 2 : Man and his environment (6 weeks)
Forensic Medicine
SA5: Introduction to Clinical Medicine (2 weeks)
Block 5 : Endocrine and Systemic conditions (3 weeks)
Block 6A: Blood (2 weeks)

III Year 3 Semester 1:
Block 6B: Heart & Blood vessels (6 weeks)
Block 7: Lungs & chest (4 weeks)
Block 8 : Abdomen and Mamma (11 weeks)
Abdomen and stomach problems
Mamma

Year 3 Semester 2 :
Block 9 : Pregnancy and Neonatology (10 weeks)
SA6 : Preceptorship (2 weeks)

IV Year 4 Semester 1 :
Block 10: Deceases of Childhood (6 weeks)
Block 11: Genital and Urinal diseases (12 weeks)
Block 12: Head and Neck (4 weeks)
SA7 : Endocrine (1 week)

Year 4 Semester 2 :
Block 13: Nerves Tissue 6 weeks)
Block 14: Moving apparatus (6 weeks)
SA8 : Geriatrics (2 weeks)

Year 5 Semester 1 :
Block 15: Psychiatry and social dysfunction (7 weeks)
Block 16: Health & Health Care (6 weeks)
Block 17: Thaumatology (5 weeks)
Block 18: Pharmacotherapy & Anaesthesia (5 weeks)

Plus elective period - Year 4 Semester 2 (4 weeks)

QUESTION 7:
HAS YOUR FACULTY DONE AN ASSESSMENT OF THE QUALITY OF MEDICAL EDUCATION WHICH IS BEING PROVIDED? WHAT MECHANISMS ARE IN PLACE TO MAKE SUCH ASSESSMENTS? WHERE APPLICABLE PROVIDE REASONS FOR NOT CARRYING OUT MEDICAL ASSESSMENTS OF THE QUALITY OF MEDICAL EDUCATION.

ANSWER:

Assessment
• External International Examiner
• External National Examiner
• Medical Council accreditation
• Students feedback (after every block)
• Progress Test:

- 2 x per year
-1 test which covers the whole curriculum
- every student from every year writes the same test at the same time
- a) the progress of every student and every class is assessed
- b) the system is assessed - do our teaching + the outcomes correlate?
- test = TRUE or FALSE or DO NOT KNOW
- every question is a real life/patient problem.

• Normal evaluation: every block has during the block, evaluation sessions and at the end of every block an evaluation on the whole block.

QUESTION 8:
PROVIDE DETAILS OF YOUR UNIVERSITIES ACTIVITIES AND ATTEMPTS TO ATTRACT STUDENTS TO STUDY MEDICINE

FACULTY OF MEDICINE, UP PROSPECTIVE STUDENTS

Specific projects to attract prospective students, especially from the disadvantaged communities

1. Seminar for Guidance Teachers
The faculty of Medicine's Public Relations Division, in 1996 started to stage this event on a yearly basis. From 1996 the number of teachers who attended this information day has increased dramatically. In 1997 the seminar attracted about 70 guidance teachers while 115 teachers attended the event in 1998. In 1999 (9 March) 176 teachers confirmed that they would attend this day of which 139 eventually turned up. Of the total number of teachers, 82% were black and 17,98% white. On average, this figure also applies to the previous year. The teachers were mainly from Mpumalanga, Northern Province, Gauteng and North West.

2. Expo or Information Day
Every year the Faculty organises an expo or information day, mainly for Grade 10 - Grade 12 pupils. The event was first organised in 1997. In 1998, 1 400 pupils attended the Expo over a period of three days. Disadvantaged pupils including Black, Coloured and Indian pupils represented 79% of the total number of pupils present at the Expo. The pupils represented the Northern Province, Mpumalanga, Gauteng and the North West Province. this year's expo will be taking place from 19-22 April.

3. National Advertising
An advertisment, containing information about the Faculty's courses and compulsory subjects for every degree, is published annually in the Mathematics study guide that is distributed by Proverto Publishers free of charge to every school in the country.

QUESTION 9:

WHAT MECHANISMS ARE IN PLACE TO EVALUATE THE EFFICACY OF COMMUNITY SERVICE?
HAVE ATTEMPTS BEEN MADE TO MEASURE IMPROVEMENTS IN THE PERFORMANCE OF STUDENTS DOING COMMUNITY SERVICE?
IF NOT, STATE WHY. IF YES, WHAT CONCLUSIONS CAN BE DRAWN?

ANSWER:
The mechanisms fall under the academic heads and they take responsibility to audit and monitor the doctors doing their community service at the various hospitals to which our academic departments have an outreach programme.

The hospitals where community service is renderred:

PRETORIA ACADEMIC HOSPITAL
KALAFONG ACADEMIC HOSPITAL
PRETORIA WEST HOSPITAL
MAMELODI HOSPITAL
TEMBISA HOSPITAL
JUBILEE HOSPITAL
WITBANK HOSPITAL
MORITELE DISTRICT CLINICS

QUESTION 10:
WHAT AMOUNT WAS ALLOCATED TO YOUR FACULTY FOR 1999/2000?

ANSWER:
The total budget for the Pretoria Academic Complex is as follows:

Pretoria Academic Hospital 1998 R386 226 000

Kalafong Academic Hospital 1998 R215 124 000

University of Pretoria 1998 R 82 802 000

TOTAL R684 152 000

WHAT AMOUNT IN DONOR FUNDING DID YOU RECEIVE?

ANSWER:
R1 827 919.00 FOR THE YEAR 1998/1999

QUESTION 11:
WHAT ARE YOUR FACULTIES PRIORITY PROGRAMMES FOR 1999/2000?

PROJECTS
• MPUMALANGA/WITBANK PROJECTS.
• JUBILEE HOSPITAL/HAMMANSKRAAL PROJECT.
• PUBLIC PRIVATE PARTNERSHIP eg.
- Clinical Epidemiology Chair
- Senior lecturership in Community based education
- Senior lectureship in Primary Health Care
- HASS Project

• QUALITY ASSURANCE OF ACADEMIC TRAINING
• INTERNATIONALIZATION PROJECT
• EMPLOYMENT EQUITY PROJECT
• RESTRUCTURING OF FACULTY OF MEDICINE
• TELEMEDICINE PROJECT
• HUMAN DEVELOPMENT PROJECT
• IMPLEMENTATION OF NEW CURRICULUM PROJECT
• TELEMATIC TEACHING PROJECT
• COMPUTER TEACHING PROGRAMME
• INTER-UNIVERSITY LECTURESHIP PROGRAMME
• RESEARCH DEVELOPMENT PROGRAMME
(UNIVERSITIES AND TECHNICONS)
• NEW ACADEMIC HOSPITAL PROJECT
• SPORT MEDICINE PROJECT

QUESTION 12:
PROVIDE ANY ADDITIONAL INFORMATION WHICH MAY BE OF INTEREST TO THE COMMITTEE.

1. SEE TRANSPARANCY ABOUT LANGUAGE OF PREFERENCE BY POPULATION GROUP

2. SEE TRANSPARANCY ABOUT CANCELLATION OF STUDIES BY POPULATION GROUP
PMG NOTE: Graphs (University of Pretoria: MBCHB- 1999 and Language of preference by population group) not included.