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General Surgery: Overview

Over the last 5 years the teaching of undergraduates has stabilised and the overall results remains constant. The number of students has increased during the clinical years and this has become a significant stress on the teaching platform. Although there are enough beds in the department the number of students has threatened the concept of small group teaching and the average size of groups have increased from the ideal number of 8 students per group to upwards of 16 students per group. The department has developed new strategies to cope with these numbers by dividing the groups and by focusing on clinical activities with a greater emphasis on in service training. We support the schools approach to addressing an expanded teaching platform as a matter of urgency. We reviewed our curriculum in 2014 and have updated the core competencies. Our assessment process has been enhanced by the development of an assessment group who are tasked with improving the MCQ question bank and establishing a better bank in Surgery.

Training Platforms and activities

The department operates fully functional undergraduate and postgraduate committees, which play a pivotal role in overseeing the training affairs of the department. Active participation from department members is essential, as these committees contribute significantly to staff development and form an integral part of succession planning.

Dr Murugan has led the undergraduate committee over the past years, overseeing its involvement in student examinations and related functions. Efforts have been made to enhance the examination process and introduce greater standardisation. Additionally, the committee keeps pace with the expanding training platform, which now includes undergraduate students at Edenvale, Thelle Mogoerane, and Klerksdorp hospitals. Currently, GEMP II, III, and IV students rotate through the department. The committee convenes regularly and provides feedback to the Head of Department.

The registrar numbers have continued to grow with the current group at 64 registrars. This group has transformed its self dramatically over the last 5 years with more than half the registrars being female and approximately an equal number being Black South Africans. The entry criteria have remained constant. All registrars are required to write the College of Surgeons exit exam which includes the intermediate exam and the final fellowship exam. Registrars are evaluated throughout their training and more formative examinations are being introduced.

The throughput at the intermediate level has been very good. The through put at the exit level has been mixed but we have graduated 58 Surgeons over the last 5 years. The college of Surgeons has required a research component since 2011 and as such the registrar MMed process has improved dramatically. The department has excellent support structures in the department to assist with research methodology training and has now introduced mandatory research supervision courses for the department. Registrars will also be required to attend a teaching course as a compulsory requirement. The MMed throughput over the last 5 years stands at 28 graduates.

We have established a post-graduate committee that meets monthly. This committee has a registrar support subcommittee. This comprises junior consultants who offer support for the registrars and report concerns to the post-graduate committee. The PG committee is reviewing the delivery of the teaching program to registrars. The attendance at the departmental teaching program has been poor. This was thoroughly investigated in 2014 and new measures have been put in place to ensure dedicated academic time for registrars to attend the program which runs over two years and covers all aspects of the college curriculum. This committee has also reviewed the in course registrar assessment process and we have modified the process which now requires an introductory process, a mid-block formal assessment and an end-block assessment. These are formative assessments but do contribute to decisions regarding progression.

There is a significant non-paid registrar component in the department. This ranges from between 8 – 12 registrars. The department is well prepared to incorporate these trainees who make a significant contribution to service delivery and allow the enhanced protected academic time. These registrars are predominantly from Africa.

We now have registrars rotating through the extended platform (Klersdorp Tshepong Complex, Edenvale, Leratng and Thelle Mogoerane Hospital). The stability of these platforms varies with available staff establishments.

We train in the Klerksdorp- Tsepong complex in North West Province and rotate registrars there routinely. We also teach in two District Hospitals and have registrars rotating to Edenvale Hospital and registrars who visit Jabulani Hospital a new district hospital recently opened in Soweto. The Head of Department meets each registrar at least once a year but attempts to meet the majority twice a year. Issues related to progress, research and other matters of common interest are discussed at these meetings.

Post graduate fellowship training is well established in the department. We have fellows in all the registered fellowships including Vascular Surgery, Trauma and GIT surgery. The throughput has been excellent especially in Trauma, vascular and GIT over the last few years. The teaching platforms include the Private sector with Milpark and Union Hospital active in Trauma training and the WDGMC providing an extensive platform for GIT training. The liver transplant Unit situated at the WDGMC also contributes to training.

The research output is increasing in the department. This is mainly based on the research requirement of the HPCSA and we have strengthened the research support in the department to enable this. Registrars have a dedicated research block in the senior rotation. We have also enhanced the research scientist group in the department. This is headed by Prof Deirdre Kruger. She is assisted by 3 full-time scientists (Prof Pascaline Fru, Dr Marietha Nel, and Dr Emmanuel Nweke). Prof Kruger also coordinates the Statistics Hub, a multi-centre international Global Surgery Initiative, that focuses on assisting Registrars and Staff members with Statistical and Data analysis. The department also has laboratories including 3 fully-fitted cell culture laboratories, a molecular biology laboratory, and a Flow Cytometry Unit. In addition, there are several PhD students and MSc students actively conducting research in the department.