Mediclinic supports public sector doctor training

Posted on 21 May 2018

The number of doctors graduating within South Africa has become a cause for concern over recent years. With the volume of graduates increasing only incrementally from those being produced in the 1970s and the population doubling in this time frame, it is essential that all role players investigate new and sustainable options for training doctors in South Africa.

Since 2014, Mediclinic Durbanville has played host to a team of medical students doing their internal medicine rotation alongside Dr Rust Theron, a Physician based at the hospital. In the interceding years, this rotation has extended to Mediclinic Cape Gate, Mediclinic Panorama and, until very recently, Mediclinic Louis Leipoldt.

Stellenbosch University medical students in their 4th or 5th year doing their mid-clinical rotation in internal medicine, complete this over 4 weeks within the Mediclinic hospitals. A total of 17 students are accommodated each cycle, resulting in 119 students rotating through the private platform each year.

A number of specialists within the four hospitals contribute to the training received during the rotations. At Mediclinic Durbanville, Dr Rust Theron, Dr Pierre Tredoux, Dr Jacques v Deventer, Dr De Vries Basson and Dr Mariëtte Buchner accommodate students daily. In addition, other doctors provide tutorials once a week, these include Dr Erne Richter, Dr Elizabeth Wasserman, Dr Marli Conradie, Dr Corne Kruger and Dr Annari van Rensburg. Doctors at Mediclinic Cape Gate include Dr Lior Sarelli, Dr Roger de Andrade, Dr Kobie Grobler and Dr Phillip Botha. Dr Rudi Renison presents one tutorial per rotation. Within Mediclinic Panorama, Dr Marius Wasserfall, Dr Carine Wasserfall and Dr Roy Spammer manage the students and then arrange for doctors to present practical lectures during the 4-week period. These willing doctors include Dr Clive Corbett, Dr Ignatius Botha, Dr Morne Vorster, Dr Tinus Brink, Dr Izak Burger, Dr Francois de Goede, Dr Theo Hattingh, Dr Ingrid Louw, Dr Anne Halland and Dr Claudia Schubert. Dr Kevin Gartrell from Mediclinic Louis Leipoldt was involved since the inception of the project, but unfortunately had to withdraw as from April 2018.

It is clear from the scale of participation of doctors across these hospitals that the skills and expertise currently housed within the private sector are willingly being shared across the spectrum. The following specialties are covered during the students’ rotation: General Internal Medicine, Cardiology, Nephrology, Neurology, Rheumatology, Endocrine, Gastro-enterology, Radiology, Microbiology, Chemical Pathology and Clinical Haematology. Where possible Mediclinic Durbanville students are also able to observe a Da Vinci robotic procedure during their rotation as was recently done during the CSI procedures at this hospital.

According to Dr Rust Theron, “The benefits are extensive – both for students and specialists. The students see a whole different spectrum of diseases in the private sector. They also get to work one on one with a specialist every day whereas at Tygerberg hospital, they can easily be up to 30 students during a ward round – from 3rd year students up to 6th year students and interns.” This large number of students makes it very difficult for them to ask any questions or to maintain sustained contact with a specialist.

“In the public sector, students may often see a patient that has been in hospital for a long time and the student may leave the rotation before the patient is better or discharged,” he explains, “In private hospitals they often get to see a patient admitted at the start of the illness and will witness the discharge when the patient has recovered or even cured.”  Students may also accompany the specialist when talking to the patient’s family when a patient has passed away. “Overall, a much closer relationship is possible with a patient in the private sector. The downside is that the students do not get as much practical time as they would in the public sector. Students will not have the opportunity to draw bloods or perform any procedures – as these are performed by the sisters or the specialists themselves.”

Dr Theron also believes that there are benefits for the specialists supporting these rotations. Specialists have to keep up to date with all the latest information and innovations regarding treatment of different diseases, they treat a patient with much more ‘awareness’ as students are observing them during consultations and questioning every step of the treatment.” In addition, the patient gets a more thorough workup as the students will spend a longer time with each of them than a specialist is able to, taking the time to explain in further detail to a patient why certain things are tested or done.

The public sector benefits from the knowledge the students gain during rotation in private sector – learning how to approach a diagnosis, the different treatments and the overall improvement of their self-confidence. Students will examine and present a patient to the specialist quite a few times during their rotation – discussing how and why they came to a certain diagnosis with the specialist and why they would suggest a certain treatment. Dr Theron explains, “During these discussions, the doctor is able to assist them in developing their thinking pattern in considering all the clinical signs, together with the patient’s history, and coming to a final diagnosis. Students remaining in the public sector also benefit as there are fewer students at the bedside, which in turn improves their teaching.”

Prof Wim de Villiers, Vice-chancellor of Stellenbosch University, feels that in order for the University to stay a key player on the world platform of tertiary education, it is important to strengthen the collaboration between the private and the public sector. “Our vision is that if this project can be expanded, the Mediclinic facilities in the Northern suburbs of Cape Town can become true centres of excellence, not only in service provision, but also in research and the training of healthcare professionals,” says Dr Theron. The John Hopkins Hospital in Baltimore and the Mount Sinai Hospital in Manhattan are examples of private institutions that have become international leaders in medical education.

Rust feels that having a passion for teaching is essential if the best value is going to be transferred to the student. “I build a rapport with each of my students and nothing gives me greater satisfaction than to see them graduating and the excitement for the new road ahead. I invite each group to a dinner at my house during the last week of their rotation, so that I get to mingle with them in a social setting outside of work as well.  To see how confident they became in the four weeks of the rotation, is something money can never buy.”


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