Factors Influencing the Development of Practical Skills of Interns Working in Regional Hospitals of the Western Cape Province of South Africa.

Abstract

Background: Clinical skills and the ability to perform procedures is a vital part of general medicine. Teaching these skills to aspiring doctors is a complex task. It starts with a good theoretical preparation and some practical experience at university. On graduating from university, each doctor is faced with the task of transforming theoretical knowledge into the practical, procedural skills of a competent professional. This study aims to assess the perceptions of intern doctors working in regional hospitals in the Western Cape of their skills training both at undergraduate level and during the intern year. Methods: Focus groups involving 25 interns with 11 months’ experience from five regional hospitals were used. Six themes were identified. These were undergraduate training, the student’s attitude, the intern’s approach to learning skills, opportunities for interns in regional hospitals, backup and support, and personal growth in procedural skills. Results: The majority of the participants found that their training at medical school prepared them adequately for the intern year. An obstacle to skills training at university was the structure of the teaching tertiary hospital, with its emphasis on rare diseases and lack of opportunities for hands-on experience. The amount of skills that were learned at university was related to the enthusiasm of the student. Once the student had qualified and was employed in a regional hospital, opportunities to learn skills were available in excess. The benefit of doing an internship in a regional hospital was described as a fine balance between opportunities, responsibilities and backup. In all the focus groups, the interns remarked on the high level of responsibilities that they had to bear, but this spurred them on in the learning of skills. The relationship between intern and senior doctor was important when it came to learning procedures. In most hospitals, the junior doctors perceived the backup cover available to them as adequate. Consensus existed as to the value of such an intern year and its importance in gaining procedural skills. At the start of the year, most interns experienced a lack of confidence, together with a sense of fear that they might not be adequately prepared to do the work expected of them. Confidence seemed to grow as the year progressed, and this was linked to experience and the successful completion of procedures, as well as adequate backup. It was found that, by the end of the year, graduates from different universities with varying emphasis on practical skills all performed at a similar level. Conclusion: The findings of this study affirm the literature in suggesting that skills training at university needs to be standardised by the introduction of a core curriculum in procedural skills. Learning outcomes should be fashioned around the relevant competencies required in the pre-registration year. It is vital for the training of new doctors that the internship year be optimised in terms of opportunities and backup as part of a strategy to improve skills training. The value of regional hospitals in teaching junior doctors clinical skills is emphasised.