Continuous renewal

The last standard called for flexibility to the changing needs of society, education, information technology, and biomedical advances. In order to detect these forever changing needs continuous monitoring and evaluation with appropriate tools is required. Such tools could be based on an initial evaluation method such as the one that was developed for this study.

2.4 Chapter Summary

As there were no SA undergraduate medical rehabilitation training programmes or evaluation tools available in the literature, articles related to the clinical environment in which the programme is delivered, the status of rehabilitation as a speciality and educational principles locally and internationally were explored.

These were presented in this chapter according to the nine areas of the WFMEs Global Standards for basic medical education which was used as a framework for this study. Furthermore the Whitebook of Physical and Rehabilitation Medicine, a consensus document on the practice and training in PM&R in Europe, which also conferred with North American thinking, covered the main themes found in the international literature regarding medical undergraduate rehabilitation training programmes.

Linkage to the general and rehabilitative components of the health system was first discussed. Firstly, the WHO definitions of impairment, activity limitations and participation restrictions, collectively termed disability, as contained in the ICF, was given. This underscores the scope of disability and thus rehabilitation and supports the educational principal of teaching rehabilitation across the curriculum rather than in an isolated programme.

From the ICF it is clear that not only medical interventions influence the outcome of a patient with a health condition. Functional and social variables play an important role. This calls for team work and challenges traditional medical model approaches in teaching, health care and specialist driven medical schools. In SA this challenge is augmented by

rehabilitation not being a registered speciality. Internationally even though PM&R is a registered speciality, it is poorly recognised.

The 2001 SA population census aimed to measure the impact of impairment on function and confirmed that persons with disabilities are encountered at all levels of health care. All doctors in SA begin their careers in clinical settings, and even if later involved in academic or administrative practice need to be taught about disability and rehabilitation at an undergraduate level. The community as a teaching platform, which is considered to be a modern educational principle thus follows. This platform encourages interdisciplinary learning and the undifferentiated nature of the cases calls for problem based learning. How it is delivered, within available resources were further standards that needed to be considered. Medical model thinking would support teaching of medical students by rehabilitation trained doctors but teamwork which is central to rehabilitation encompasses teaching by all rehabilitation professionals. Due to the chronic nature of disability, patients with disability may become experts and thus also teachers when embracing a bio psychosocial model.

The rest of the nine areas of the standards covered a range of educational aspects. The first area addressed the alignment of the programme’s objectives with the faculty’s mission. The second covered educational methods and activities used to deliver the programme in addition to linkage with the health system. The assessment of students was discussed in area three. The fourth area referred to the selection of students, especially those with disabilities and covered student satisfaction. Area five addressed aspects related to staff and that clinicians involved in teaching need to be trained and rewarded appropriately. The sixth area looked at resources to deliver and develop the programme. Area seven considered components of programme evaluation, eight, governance and administrative of the programme and nine pulled the standards together calling for ongoing evaluation and feedback to stakeholders.

This chapter enriched the WFME standards as a framework against which the MBChB Rehabilitation programme of the US was evaluated. The standards proved to be comprehensive and were made relevant to this study through the inclusion of the general clinical and specialised rehabilitation context. Indicators were drawn from this expanded and rehabilitation specific framework from which research methods and tools were developed to conduct this study.

Chapter 3

Development of the Indicators

3.1 Introduction

The literature discussed in the previous chapter provided a detailed picture of the clinical and academic context of this study. In this chapter the nine areas of the WFME Global Standards for basic medical education are used as the framework onto which the literature is hinged. The essence of global non-medical frameworks (e.g. HEQC criteria for programme design), global medical frameworks (e.g. IIME core competencies or GMER, British GMC’s Principles of good medical education and training) and articles evaluating under and post graduate, rehabilitation and other relevant training, programmes and activities are pulled together with the WFME standards providing a set of indicators for the evaluation of an undergraduate rehabilitation programme.

This chapter first describes the process of developing the indicators after which the indicators in each of the nine areas is briefly described, fulfilling objective 1. A succinct list of the indicators is provided in appendix 6b. These indicators formed the basis from which the research methods and tools were developed. Data obtained using the tools determined the compliance of the US MBChB Rehabilitation programme against these indicators.