Training medical doctors to meet the needs of rural areas

 

UL is committed to meeting the developmental needs of its communities

The University of Limpopo (UL) was constituted by a merger between the University of the North and the Medical University of Southern Africa (Medunsa) in January 2005. This resulted in the university comprising two campuses — the Medunsa and Turfloop campuses.

The Turflloop campus also incorporated the Polokwane campus which was once a satellite of Medunsa, where medical students in the fifth and sixth years of study did their clinical rotations.

Following the unbundling of the Medunsa Campus into the Sefako Makgatho Health Sciences University, the UL School of Medicine was established in 2015.


The University of Limpopo celebrated 60 years of existence at the Turfloop campus in 2019. Over these 60 years, the Faculty of Health Sciences has developed an excellent reputation for producing eminent health-care professionals in different health-care categories such as nursing, optometry, pharmacy and dietetics.

The Faculty of Health Sciences has two schools — the School of Health Care Sciences and the School of Medicine.

World-class training

The development of the School of Medicine, with its main training platform at the Polokwane/Mankweng complex, was the fruition of a plan put into operation by the University Council in 2004, in line with the government’s decision in December 2002 to create a world-class medical teaching, research and outreach facility in Polokwane.

The establishment of the school was aimed at addressing the dire shortage of medical doctors in Limpopo and South Africa as a whole.

The UL School of Medicine is the first Medical School to be established by the new democratic government

The World Health Organisation recommends a doctor to patient ratio of 1 per 1000 population to adequately meet the health needs of the community. Limpopo is a rural province with a population of 5.8-million and has a ratio of 0.164 doctors per 1 000 population. The burden of disease in rural Limpopo is made more challenging and complex by its socio-economic background. The population variation in age and gender also contributes to its unique health-care needs.

Training in rural settings exposes students to conditions that the most disadvantaged and poor communities tend to present with when visiting a health facility. The medical training is designed accordingly and supported by local health-care facilities. The establishment of a medical school in the province would go a long way to mitigating the shortage, as research has shown that many medical students that train in a particular province tend to practise in that province following graduation.

The UL School of Medicine is the first medical school to be established by the new democratic government. It received the Health Professions Council of South Africa’s accreditation to train undergraduate medical students in 2014 and started enrolling first-year bachelor of medicine and bachelor of surgery (MBChB) students in 2016.

The programme is aimed at training health professionals within a rural context, where students will be exposed to the relevant communities from the early stages of their training. This is in line with the university’s vision that states: “to be a leading African university focused on the developmental needs of its communities and epitomising academic excellence and innovativeness”.

The university has also continued to train registrars (medical practitioners who are studying to become specialists) as it had been doing while the Turfloop campus was still a satellite of the Medunsa campus.

The school offers a six-year MBChB degree that leads to qualification and registration as a medical practitioner after doing two years of internship and one year of community service.

The school also offers four or five-year master of medicine (MMed) degrees in a number of medical and surgical specialities. Registrars who satisfy the requirements of the MMed and Colleges of Medicine of South Africa fellowship, are able to register as specialists.

Students are selected from all over South Africa. The total number of students accepted per year is 60. Of the 60 available spaces, 45 are reserved for students who have completed their national senior certificates (matriculants) and 15 are reserved for graduates of health or life sciences degrees.

The admission requirements into the first year of study are a national certificate with an endorsement and meeting the admission point score requirements in life science, physical science, mathematics and English as prerequisite subjects.

Graduates with life or health science degrees are only admitted into the first year of study due to the integrated nature of the programme.

Competitive institution

A large percentage of students who apply for admission at the School come from
rural communities and townships, with a smaller percentage from urban and suburban communities. Students in the programme also hail from all racial groups in South Africa.

The school receives 4000-5000 applications for 60 available spaces. This is welcome because the university is able to select the highest calibre of students.  Since the programme is in high demand, only those students with  excellent academic performance are ultimately accepted into this noble professional course.

The first cohort of MBChB students in 2016 are now in their fifth year of study and the university is looking forward to producing its first medical practitioners to be trained locally in 2021.

The School also participates in the training of the Nelson Mandela-Fidel Castro (NMFC) students who studied in Cuba. These South African students train in Cuba for five years and come back to South Africa for integrative training for 18  months in South African medical schools.

The first cohort of these NMFC students arrived at the university in July 2018 and completed their studies in 2019.

The undergraduate programme is an integrated course that integrates the basic sciences, pathology and clinical medicine of physiological systems, making it easier for students to link all the sciences together. The curriculum was planned such that there is a horizontal and a vertical integration from the first to the sixth year of study.

The modern trend in medical training is to expose medical students to a clinical setup early in their training phases. The UL medical programme embraced this trend from its inception. This is provisioned in addition to the foundation phase traditional knowledge development in fundamental medical science.

Key partnerships

The integrated curriculum allows the students early exposure to clinical domains such as rural primary health care clinics and district hospitals. The tertiary clinical training is also ensured in advanced clinical years.

The school is fully committed to producing competent medical doctors who will be able to meet the health needs of people living in rural communities in provinces like Limpopo, as well as compete in South Africa and globally.

This integrated curriculum requires the involvement of basic science and different clinical departments in modules offered in the first and second years of the study.

In a rural university setting like UL, this can be challenging, especially where the clinical departments experience difficulties such as staff shortages.

The collaboration between the University and the Limpopo Department of Health has reduced this gap due to the purposeful recruitment and retention of specialists in different clinical disciplines.

The university has a teaching staff establishment that consists of basic medical sciences lecturers and clinicians in all major medical specialities that are jointly appointed by the Limpopo Department of Health or the National Health Laboratory Services and the UL.

Many of the clinical staff have had experience in teaching students due to the fifth and sixth-year student rotations from the Medunsa campus, and are involved in training the MMed students.

Their involvement in training at the Polokwane/Mankweng Complex has taken place since the early 1990s. The clinical training platform has also been responsible for the training of medical interns and elective students from South Africa and overseas.

The Department of Family Medicine is central to the teaching of the programme across the six years in order to strengthen the primary health care, promotive and preventive health aspects of the curriculum.

This is in line with the HPCSA’s decision to increase the rotation period of family medicine to six months during the training of medical interns.

The students are trained and rotate in the two tertiary hospitals, Mankweng and Pietersburg, and in Thabamoopo which is a psychiatric hospital.

During the family medicine rotation, students are trained in health-care centres, clinics and regional hospitals, presently Mokopane and Letaba. The University in partnership with the Limpopo Department of Health intends to expand on the training platform for medical students as the programme grows in the future.

The rotation in these community health institutions is to make sure that the students are able to attend to the undifferentiated patient and together with the clinicians, work with the patient to diagnose and treat them. The student is also able to appreciate and understand the socio-economic dynamics of disease processes.

Plans are in an advanced stage for the building of the Limpopo academic hospital and the University of Limpopo medical school next to each other and connected by a bridge at Edupark in Polokwane.

This will place Limpopo and the University on par with other provinces in terms of infrastructure for the teaching of medical and other health science students.

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