University of Stellenbosch

CONTENTS

* Introduction to the Faculty of Medicine, University of Stellenbosch
- Mission
- Degrees/Diplomas conferred 1959-1998
- Research relevant to the needs of the R.S.A.
- Outreach through the provision of services
- Student body
- Language medium
- Selection criteria for medical students

* Answers to Questions

* Addendum

Mission of the Faculty of Medicine of the University of Stellenbosch

MISSION
The Faculty of Medicine of the University of Stellenbosch chooses as its mission to promote the health of South Africa's population, while upholding the highest possible standards, by:
• training and educating its students, both graduate and postgraduate, in keeping with the University's teaching policy so as to develop into mature professionals, able to hold their own in any community now and in the future;·
• creating and disseminating new knowledge through basic, clinical and applied research;

• involving itself in primary, secondary and tertiary health care in such a way as optimally to perform its functions of training, service and research.

The Faculty anticipates, recognizes and responds to the needs, opportunities and expectations in these three broad areas through:
• effective and visionary leadership and management that provides for all stakeholders to share democratically in the processes of decision-making;
• creating and maintaining suitable structures for ensuring optimal interaction and participation of all levels of staff and students;
• well-informed management geared to ongoing proactive and strategic planning and action;
• actively gauging the needs of all stakeholders and reacting to their needs in responsible ways;
• creating and maintaining an environment that will help to retain and attract high quality staff of national and international repute;
• creating and maintaining strategically important areas of excellence in order both to make a relevant contribution locally and to continue enhancing its prestige internationally;
• encouraging and supporting its staff to actualize their full potential as teachers, researchers and practitioners;
• self-critical evaluation of its functioning in all areas;
• the effective and optimal utilization of all resources;
• flexible administration aimed at effective service to and support of the Faculty's various functions.

In its contacts or negotiations with all persons, groups, or organizations, the Faculty will at all times endeavour:
• to be accessible;
• to be willing te listen to and learn from the viewpoints of others;
• to ask in-depth questions;
• to supply answers and information sufficiently early;
• to respond effectively, fairly and creatively to genuine needs, opportunities and interests;
• to speak, to act, to initiate and to take the lead in the interests of the University, the Faculty, our profession, our students and our patients;
• to educate people to support and train individuals and groups or organizations to attain self-sufficiency in health care.

The Faculty believes that:
• in all matters the highest possible moral and ethical standards should be maintained;
• discrimination on the ground of sex, race, language, political conviction or religious creed is not acceptable;
• health is subject to physical, psychological and social factors and that living conditions conducive to health are important;
• access to appropriate health care is every citizen's right;
• a holistic approach to health care is the only acceptable one;
• the maintenance of the highest possible standards in regard to teaching/education, research and patient care is non-negotiable;
• in its unique task the components of teaching/education, research and patient care need to be evenly balanced;
• the academic complex must function and be managed as a unity, within which teaching/education, research and patient care are optimally integrated;
• people's individuality it must be respected at all times.

The Faculty of Medicine of the University of Stellenbosch is contributing significantly in the following ways:
• It caters for the academic needs of Afrikaans-speaking lecturers and students, while also accommodating the needs of speakers of other languages.
• It is a complete faculty with a range of eminent departments.
• It fulfils a leading role in medical research in the R.S.A.
• It meets specific needs of the inhabitants of its milieu and also of an extensive service area.
• It turns unique opportunities to good advantage, it provides education, and it carries out research under both first-world and third-world conditions.
• It actively works to preserve and extend Afrikaans medical terminology and phraseology.

RESEARCH RELEVANT TO THE NEEDS OF THE R.S.A.
Research is focussed on the building of capacity to perform research at the primary, secondary and sophisticated tertiary health care level. Also laboratory research concentrates on diseases having a national impact. Some examples of the broad spectrum of research projects are tuberculosis, malnutrition and vitamin deficiencies, sexually transmitted disease and AIDS, cancer, drug dependence, alcoholism, Alzheimer's disease, diabetes mellitus, heart diseases in Africa, infant and maternal mortality, smoking, asthma, miner's lung disease etc. Much effort goes into research on developing medicines from indigenous plants.

OUTREACH TO ALL COMMUNITIES
In line with the Provincial Health Plan the Faculty participates in the controlled downscaling of expensive Academic Health Centres, thereby generating funds and extra manpower to strengthen health care delivery to outlying communities in the metropole and urban areas. Staff of our Faculty contribute significantly to organised outreach programmes in the context of direct service delivery and building of capacity in the periphery. Consequently under- and postgraduate students under the proper supervision of specialists are deployed to day hospitals, community health centres, small hospitals, as well as larger regional hospitals.

STUDENT BODY
The composition of the Faculty's student body does not yet reflect that of the population of its catchment areas. Those students who are not white, currently make up ±30% of first year students. Their numbers are rising progressively.
The Academic Development Programme of the US is designed to help selected, disadvantaged students with potential to overcome specific scholastic deficiencies. Amongst other mechanisms, special arrangements are in place to spread the subjects of the traditional first-year course in Medicine over two calendar years. Furthermore, mentor/tutor programmes are designed to function as "safety nets" for those students.

Activities of outreach to the disadvantaged will increasingly modify the student profile to resemble the demography of those that qualify. Thus the Faculty is striving to contribute towards the realization of the ideal, formulated by the national Committee of University Principals (CUP):
Para 7.2.1 of CUP's Strategy:
"In order to achieve equity, each institution of the CUP reflects in its composition of students the demography of the eligible pool of qualified applicants in the country/region".

In the interest of the University, community and the State the yardstick applied throughout is that a student, in order to justify selection, should have the proven academic and non-academic merit, or at least the potential, to study successfully.

LANGUAGE MEDIUM OF TUITION
The use of mainly Afrikaans as the medium of undergraduate instruction, does not imply either a disregard for the accessibility of courses to non-Afrikaans-speakers, or an unwillingness to accommodate the needs of non-Afrikaans-speakers. Special language courses are offered and tutorials, practicals and examinations in English are specially arranged for such students. Currently, the home language of at least 30% of our medical students is English. Depending on the needs of the students from year to year, both Afrikaans and English can equally be used in postgraduate education.

SELECTION CRITERIA FOR MEDICAL STUDENTS
1. MATRICULANTS:
This major group (± 120) is selected on the basis of:
1.1 Academic Merit, based on marks achieved at end of Std IX, accounts for 75% of selection mark.
1.2 Non-academic Merit, accounts for 25% of selection mark and evaluated on the basis of the following criteria:
Leadership 5
Community service 4
Cultural involvement 4
Communication and/or social skills 3
Linguistic proficiency (including a third
or any Black African language) 3
Degree of being disadvantaged 3
Parttime or after-hours work 3
All candidates are arranged in order of priority on the basis of the selection mark, irrespective of race, gender, creed or any other affiliation.

2. APPLICANTS AFTER SUCCESSFUL COMPLETION OF B.Sc I AND PROVEN ACADEMIC MERIT:
This group (± 20) normally represents candidates, unsuccessful in the selection for MBChB 1 during the previous year. If selected for the MBChB 1 course on the basis of merit, they get credit for relevant subjects successfully completed, but they have to spend one further year supplementing the subjects required to be promoted to MBChB II.
All candidates are arranged in order of priority on the basis of the selection mark, irrespective of race, gender, creed or any other affiliation.

3. APPLICANTS HOLDING A UNIVERSITY DEGREE:
This small group (±5-10) must have completed the degree within the minimum number of years at an average of ·60%. Candidates on the shortlist are interviewed by a panel of senior faculty members and selected on merit.
All candidates are arranged in order of priority on the basis of the selection mark, irrespective of race, gender, creed or any other affiliation.

4. APPLICANTS WITH POTENTIAL:
This group (±30-40) usually comes from disadvantaged communities and those with a proven deficient academic background. Candidates are placed in order of merit on academic and non-academic grounds and selected according to the number of vacancies available.
The selection panel also takes cognisance of the extent to which candidates have exploited those opportunities which do exist in their communities, as well as the degree of insight into the rigours and required discipline of the course and the occupation.

Students have access to appropriate Academic Support Programmes, specifically aimed at addressing academic and other needs.

UNIVERSITY OF STELLENBOSCH
FACULTY OF MEDICINE

QUESTION 1:
The following number of doctors graduated at this university in 1998:
White: 129 (70M, 59F)
Coloured: 14 (10M, 4F)
African: 0
Asian: 0

These numbers have been maintained over the past 6 years.
There are several explanations for this phenomenon:
- It attests to the remarkable consistency of the "blind" selection process up to that stage, which had considered proven academic merit as the only criteria for selection, dictating even competition between candidates;
- It does not confirm any discriminating process other than academic considerations;
- It does not suggest any inferiority of one population group to another;
- It does, however, reflect the unfavourable conditions prevailing in certain secondary schools during the 80's
- It does place into perspective the accomplishments of the Faculty over the past decade through the modified selection process (Academic Merit 75%; Non-academic Merit 25%), different categories of selection, special out-reach campaigns and support systems, etc.

Due to the lag phase of the six year course, the systematic increase in the number of students of colour admitted over the past 5 years is not yet reflected in the number of graduates.

QUESTION 2:
A racial and gender breakdown of all medical students registered from the 1st year to the final year.
The tables illustrate:
* Genders are about equally represented;
* The total number of Whites are steadily declining, whereas those of the other population groups are increasing. In 1997, 1998 and 1999 the large fall-out of selected students of colour failing to attain minimum levels in matric, necessitated filling the vacancies with outstanding White candidates on the waiting list.
* About 30% of years I-III are students of colour if the numbers of students in the Academic Support Programmes are added.

QUESTION 3:
The racial and gender breakdown of the attrition rate for the student body:
* Only the attrition rate of the I-III year students is represented in the graph, since it drops to insignificant numbers amongst the more senior students.
* The attrition rate is relatively low and is improving steadily.
* The attrition rates of the different demographic groups are comparable.
* The reasons for the successes achieved are the responsible selection process, as well as the successful Academic Support Programmes for those with academic and cultural needs (see reply to question 4).

QUESTION 4:
New Support Programmes:
A series of new programmes have been launched by the Division for Academic Development and the Faculty and funded by external sources:

4.1 The Winter Programme is a part of a recruitment drive by a representative team of the University to draw the best learners from historically disadvantaged schools to register for study in Medicine, Engineering, Economics and Management and the general Sciences. Last year 128 schools were targeted and 51 top students (based on their Grade 11 results) were invited to the Winter Programme. The programme tested their abilities to flourish under university pressure and identified any special talents pertaining to the relevant fields of study. Twenty-one of these students were ranked among the best after a ten-day programme focusing on Science and Mathematics. These students were offered bursaries should they maintain their good performance at school and if they register at the University of Stellenbosch in 1999.

4.2 The success of this Winter Programme called for its extension to include a similar Autumn recruitment programme specifically for learners who intend to study in the medical field. Already 60 learners have been selected. The following invitation to attend the Autumn School was widely circulated in 1999:
"The Faculties of Medicine and Dentistry will be presenting a five-day Autumn School for promising scholars who have indicated an interest in a career in the medical sciences. These scholars will be selected from educationally disadvantaged backgrounds. This initiative will be replacing the annual Open Day event at the campus.

The Autumn School forms an integral part of the University's recruitment drive that aims to increase the access to and success in higher education of these students, supporting the approach suggested by the National Commission on Higher Education and subsequently by the Department of Education.

The specific aims of the Autumn School will be to give participating candidates some insight into the choice of careers that exists in the Health Sciences and the demands of the curricula and professions in these fields, over a period of five days. Concomitantly, the school will also aim to develop, apply and evaluate methods to determine which of these students have the potential to study successfully and complete their studies, given the necessary support."

4.3 The Pilot Mentor Programme, launched on a small scale on the Main Campus in 1998, has proven its worth to the extent that a fully-fledged Mentor Programme for all faculties will be started early in 1999. At present the Division for Academic Development is in the process of identifying suitable Mentors and Mentees.

4.4 A full Mentor/Tutor Programme has been established for the Tygerberg Campus. Presently it embraces 37 student Mentor/Tutors supporting 115 mentees at no cost to the State or the University.

4.5 The official Academic Support Programme presently accommodates 26 students of colour, but the number is expected to rise to at least 50 before the end of the first semester, as failing students in the MBChB I course are caught up in the "safety net" represented by this programme.

QUESTION 5:
The racial and gender breakdown of students doing postgraduate studies:
* The number of Coloured, Asian and Black students are steadily increasing, whereas the percentage of Whites are declining concomitantly.
* The increasing number of students and lecturers of colour qualifying at our Faculty, as well as the appropriate support structures available, contribute to the phenomenon outlined above.
* Increased support from statutory bodies, such as the MRC, almost exclusively for these groups, enhances the shift.
* The gradual, relatively slow rise in the number of postgraduate candidates of colour is enhanced by the affirmative action drive in non-academic employment areas, as well as the opportunities for careers for graduated professionals of colour such as doctors, physiotherapists, etc.
* A significant number of postgraduate students of colour is registered at this Faculty and comprises about 20% of the student body at present.

QUESTION 6:
The details of the undergraduate curriculum:
Changes in international undergraduate training over the last decade as well as major reforms in health care policy in South Africa, necessitated a redefinition of the medical teaching platform and curriculum reform at the Faculty of Medicine of this University. Careful systematic planning over a period of 5 years resulted in the formulation and institution of a new curriculum.

The existing pre-clinical curriculum was adapted as follows:
• a significant reduction in the volume of the basic sciences (chemistry, physics, biostatistics, biology);
• the existing course in computer literacy was extended and adapted to be more medically relevant;
• increased emphasis is placed on the clinically relevant content of the abovementioned subjects;
• the physiology, anatomy and histology content was reduced with particular attention to reduced emphasis on memorisation of detail, stressing clinical relevance;
• the anatomical pathology, microbiology, virology, immunology and pharmacology content was approached similarly;
• a large proportion of the course content of all pre-clinical subjects, with the exception of the basic sciences, is integrated into the clinical components of the course.

The changes to the clinical components of the course are:
• a stronger emphasis on the maintenance of health and prevention of common diseases, medical ethics, alternative and complementary medicine and environmental influences' impact on health;
• less emphasis on uncommon diseases by all disciplines;
• stress on the application of a problem-solving approach;
• improvement of managerial and social skills necessary to function as an independent primary health care practitioner;
• a shift from a mainly lecture-based approach towards critical and questioning self-education;
• systems of assessment and technological resources were adjusted to be relevant and appropriate to the new curriculum.
It is believed that this new programme, which was implemented at the beginning of 1999 and represents a form of problem orientated learning, will produce doctors of a high and appropriate calibre, able to meet the clinical, social, economic and cultural needs of the community they serve, especially at a primary health care level, but also at a level where specialization at a later stage and research are within their grasp.

QUESTION 7:
Assessment of the quality of medical education:
• Teaching is based on attaining specified outcomes and objectives, handed out to students at the beginning of every module.
• Ongoing evaluation throughout the courses provides instant feedback to the lecturers and tutors involved.
• The results of the final examinations are compared with those attained at other medical faculties during external examination and also with the results achieved within the Faculty during previous years.
• The courses and examinations are routinely inspected by nominated representatives of the Professional Council.
• The performance of the Student Intern's, Interns and junior doctors doing community service is constantly being monitored in the clinical environment and timely feedback provided.
• Continuous Professional Development is encouraged, supported and nourished with own resources and courses available elsewhere.
• A one-day Faculty Teach-in is held annually and state-of-the-art lectures by national and international experts, as well as satellite-symposia, are part of the programme.

QUESTION 8:
Student recruitment:
The National Government stated in its White Paper on Higher Education, that priority should be given to increase the growth in participation in tertiary education by historically disadvantaged communities and their education systems. The Faculty of Medicine supports such an approach and has established the following system:

• During the first semester of the academic year a representative recruitment team focuses on urban and rural previously disadvantaged communities by visiting schools, community centers, etc. in the Western Cape and in some other provinces. Pupils with potential from these communities, who obtained adequate marks in school/subjects dictated by the selection criteria, are offered bursaries and loans to further their studies at this Faculty. This offer is repeated at the end of their Matriculation Year provided that they still fulfilled the minimum selection criteria.

• For 1999, this special project was redefined by adding another method of evaluation and support - an Autumn School. Now promising pupils from educationally disadvantaged communities, who have indicated an interest in a career in the medical sciences, are invited to attend the Autumn School on the premises of the Faculty. One specific aim of this initiative is to give participating candidates some insight into the choice of careers that exists in the health sciences and the demands of the different curricula and the professions. Concomitantly, the school also aims to develop, apply and evaluate methods to determine which underprepared candidates have the potential to study successfully , given the necessary support. During the final phase of the recruitment drive interested candidates will undergo a series of psychometrical evaluations and if the results indicate strong potential and motivation to undergo tertiary education in the health sciences, these candidates will be invited to attend the Autumn School.

• Several Open Days, attended by Headmasters and Career Advisers from Secondary Schools, are conducted annually on the Main Campus and major centres elsewhere.

• The University recruitment team regularly participates in Parent Teacher Association meetings convened in specific schools.

• The Faculty participated in the Year of Science and Technology (YEAST), Exhibits held in Cape Town, Umtata, Durban and Kimberley, which were well attended by pupils from all sections of the community.

• Career Exhibits have been conducted in schools, the Good Hope Centre, the Show Grounds in Johannesburg and Pretoria, etc.

QUESTION 9:
The efficacy of community service by young doctors are being monitored by the supervisors in the academic complexes and at the Community Clinics and Day Hospitals. The system has only been in place for two months and cannot be judged at this stage. The Central Department of Health may be approached for further comments.

QUESTION 10:
Summary of the budget:
Salaries 1998 R29 457 115.00
Current Expenditure 1999 R2 437 960.00
Capital Expenditure 1999 R1 389 059.00

QUESTION 11:
Priority programmes for 1999/2000:
• The new Medical Curriculum is taking up most of the time of most of the staff in the Faculty, leaving little extra time for alternative activities.

• A Skills Laboratory and extension of the Multi Media Center are being executed at present.

• Safety measures against HIV and Hepatitis B infection and appropriate prophylactic treatment of needle stick injuries to students are presently being promoted amongst the student body.

• Strategies are being developed and tested to ensure the personal safety of students placed in community structures at primary health care level.

• The Mentor/Tutor programme on the Tygerberg Campus is maintained and monitored properly.

• Recruitment initiatives are being followed up.

• Outreach activities to the community locally and in remote areas are being actively pursued, as in the past.

PROF J DE V LOCHNER
DEAN
10/3/99

ADDENDUM
[Ed. note: the graphs for Questions 1 to 5 have not been included.]

UNIVERSITY OF STELLENBOSCH

FACULTY OF MEDICINE

UNDERGRADUATE-/POSTGRADUATE STUDENT PROFILE.

QUESTION 5:

QUESTION 2

UNIVERSITY OF STELLENBOSCH

FACULTY OF MEDICINE

DEMOGRAPHIC DETAIL OF STUDENTS REGISTERED FOR MBChB I – VI FOR 1998 AND 1999.

Question 1 University of Stellenbosch
Faculty of Medicine
demographic detail of doctors graduated in 1998.

Demographic detail of students registered for the academic development programmes for 1998 and 1999.

A racial and gender breakdown of the attrition rate for MBChB 1- vi in 1998.

A racial and gender breakdown of the attrition rate for MBChB students who follow the MBChB course via the academic development programme for 1998.