CHAPTER 3: CONTEXTUAL PERSPECTIVE
3.7. PROGRAMMATIC CONTEXT
3.7.1. Operating department assistance programme
The ODA programme is an extremely ‘busy’ and dense programme in which pedagogical practices, educational theories and input of various role players in the theoretical and clinical arena feature. It is also a programme where accountability is increasingly emphasised due to a highly regulated healthcare environment. In the next section a short summary of the programme’s development is provided followed by a more-in-depth look at the programme itself.
3.7.1.1. Short summary of the ODA programme development
The overall purpose of the ODA programme is to alleviate the skills shortage in operating departments with the aim to prepare the ODA with the necessary competencies to function in ever-changing environments and being able to assist the registered healthcare professional within the perioperative environment (SAQA, 2017:1-6). In response to the South African higher education policy requirements, the two-year Diploma in Operating Room Practice curriculum (which did not include the exit-level outcome of ODAs assisting the healthcare professional in anaesthesia and recovery room) (Cummings, 2008:3-4) was upgraded to a three- year diploma programme as mentioned previously. Hence, the title ‘operating room practitioner’ changed to ‘operating department assistant’ as alluded to in Chapter 2, sect. 2.4.1.7 (cf. Fig. 2.3). The curriculum was redesigned according to a qualification template developed by a task team consisting of academics at three PHEIs and the HEQC curriculum guidelines. Thus, it was necessary to add the required components (anaesthetic and recovery room modules), but to remain within the credit boundaries of 360 set by the HEQC (CHE, 2014:29). Overloading the curriculum could impact negatively on the quality and nature of the students’ learning experience and have financial implications which could impede learning (Badenhorst, 2012:4). The latter was not applicable to students registered for the ODA programme at the PHEI because no tuition fees apply and the study package includes uniforms, study materials and text books (Van Zyl, 2017a:1).
112 3.7.1.2. Programme detail
Selection criteria
The main selection criterion is a Grade 12 school certificate with an average pass mark of 50%. The following Grade 12 subjects are compulsory:
• Life or physical science – NQF level 4 with a minimum of 40%
• Mathematics – NQF level 4 with a minimum of 40%
or
• Mathematics literacy – NQF level 4 with a minimum of 50%
• English communication skills – NQF level 4 with a minimum of 40%
• Computer literacy – NQF level 3 with a minimum of 40%
The selection process also takes into account the results of psychometric testing, interviews and health assessments with student numbers largely determined by the budget amount determined by the PHEI (Van Zyl, 2017a:1).
Purpose of the programme
On completion of training, the ODA should be able to function in both the public and private sector in sterile and non-sterile areas and have the necessary cognitive, affective and psychomotor skills to create a safe therapeutic diagnostic or/and surgical environment for the patient. The ultimate aim is to supply the operating department in hospitals with competent ODAs able to assist all members of the theatre team. The ODA should be able to deliver this function in a cultural diverse operating room environment within required legislation, health and safety regulations, patient rights, confidentiality, ethics and codes of practice with sustained professional behaviour (SAQA, 2017:1).
The qualified ODA should be able to perform various roles such as a circulator (also referred to as a ‘runner’), scrub practitioner (whose role is around the surgical instrumentation and patient care), anaesthetic assistant (whose role is to prepare for anaesthesia and assist the anaesthetist) and assisting the RN in the recovery room. The scrub practitioner assists the surgeon next to the operating table whereas the circulating nurse assists the scrub practitioner. The latter is the link between the sterile team members and non-sterile areas and supplies as well as to the rest of the operating complex, nursing units and laboratories (Fuller, 2013:5; Phillips, 2007:57-63; Rothrock, 2011:12; Timmons, 2004:648). The ODAs are multi-skilled and ought to be able to multitask by switching between the circulator, scrub practitioner and AA roles all the time.
Programme level, credits and nature of the programme
The ODA programme is registered on an NQF level 6 and covers 3 600 notional learning hours over a three- year period (SAQA, 2017:1). It is competency-based and encompasses various modules (cf. Table 3.3) to equip students with the required competencies to fulfil their role and function in the operating department.
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Table 3.3: Diploma in Operating Department Assistance programme structure
Study year Module Credits allocated NQF level
Year 1
Professional Practice 1 16 5
Integrated Science (patient care, infection prevention principles, medical terminology) 1
16 5
Anatomy 1 12 5
Physiology 1 12 5
Operating Department Science 1: Circulating functions & preparation for anaesthesia
64 5
Total credits 120
Year 2
Professional Practice 2 12 6
Integrated Science (Applied Sociology and Psychology) 2 16 6
Anatomy 2 16 6
Physiology 2 16 6
Operating Department Science: Scrub functions
• Advanced Operating Room Principles, Anaesthetic & Surgical Pharmacology
• General Surgery
• Gynaecological & Obstetric Surgery • Urological Surgery
• Orthopaedic Surgery & Radiology Procedures • Ear, Nose & Throat Surgery
60 6
Total credits 120
Year 3
Professional Practice (Leadership principles) 3.1 16 7
Professional Practice (Management principles) 3.2 16 7
Operating Department Science 3: Advanced scrub functions • Diagnostic and Surgical Procedures
• Paediatric Surgery • Vascular Surgery
• Advanced Orthopaedic Surgery
60 6
Operating Department Science 3
• Advanced Anaesthetic & Recovery Room Care
16 7
Operating Department Science 3: Electives • Ophthalmic Surgery or
• Neurosurgery or
• Plastic, Reconstructive Surgery & Maxilla Facial Surgery
12 7
Total credits 120
(Source: Van Zyl, 2012:15-16)
Professional practice, microbiology, infection prevention and control, anatomy, physiology and pathology, sociology, psychology, operating department science and anaesthetic and recovery room science are modules that feature in the curriculum. Anatomy, physiology, microbiology and a basic understanding of pathology and patient care form the foundation of all practices in the operating room (Van Zyl, 2012:15-16).
The modules build onto one another by means of a spiral, staggered approach. Students spend their time
divided into blocks of theoretical contact sessions (facilitated by the educators) and clinical rotations in the
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disciplines as indicated on their programme planner. The number of hours devoted to theory (time spent in class) decrease with each year as the clinical placement hours increase.
An innovative aspect of the programme is that the third-year students can choose between three electives (cf.
Table 3.3). Another innovative aspect is that follow-up of students in practice occur (in the workplace) by the educators who also facilitate their theoretical sessions. Mentors are also available to provide guidance during
clinical rotation and assist the students to complete the relevant and required portfolio of evidence (PoE) which is linked to the modules (Van Zyl, 2016b:1-4). Thus, during the time in the clinical setting students have the opportunity to get to know surgeons, anaesthetists, RNs, clinical facilitators and unit managers.
Table 3.4 illustrates the breakdown of the allocated teaching and learning hours during the three-year programme period and the hours spent on various teaching methods.
Table 3.4: Teaching and learning hours and hours spent on various teaching methods
Teaching and learning hours Hours spent on various teaching methods
• Classroom and theoretical assessments: 1 076 hours • Self-study: 1 124 hours
• Work-integrated learning: 1 400 hours
• Work-based learning: 1 600 hours (not credit bearing)
• Lectures (including active teaching methods): 1 000 hours (28%)
• Tutorials: 46 hours (1.2%) • Syndicate groups: 20 hours (0.8%)
• Work-integrated learning: 1 400 hours (39%) • Independent self-study: 1 124 hours (31%)
(Source: Van Zyl, 2012:37, 39-40 & 48)
It is obvious from the above listed hours that the students spend a lot of time in class. This places a burden on the educators who must also accompany the students in the hospitals during their clinical placements and conduct the students’ formative and summative assessments. Hence, the educator/student ratio is determined on a monthly basis to ensure it does not exceed the ratio of 1:15 in practice. Currently, the groups vary between 30 and 36 per group per year with 12 educators overseeing the training of approximately 110 ODAs at any given time (Coetzee, 2017).
Clinical rotation
The majority of students spend all their time in one hospital. But, if there are not enough clinical learning opportunities students are placed out to another private hospital. The time allocated to the various units and disciplines is summarised in Table 3.5.
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Table 3.5: Clinical allocation weeks of ODA students per year of study
Year 1 Year 2 Year 3
Discipline Weeks Discipline Weeks Discipline Weeks
Hospital orientation 1 Operating room: Scrub duties
- rotation through various disciplines
27 Leadership and
management
6
Nursing unit 1 Operating room: Scrub
duties
24
Operating department reception
1 Operating room: AA functions 3 Operating room: AA
functions
3
Central sterile supply department (CSSD)
3 Recovery room: RRA
functions
2
Operating room: Circulating duties
19
Operating room: AA functions 3
Total weeks 28 30 35
(Source: Mediclinic, 2016a:6-7)
The anaesthetic and recovery room content are spread over the three years. This is testimony to the complaints received from the students and clinical staff stating these modules are too ‘spread out’ and the time and hours allocated to the anaesthetic and recovery room rotation do not sufficiently allow for consolidation of knowledge. In relation to the students’ circulating and scrub allocation, the anaesthetic and recovery room placement weeks seem too limited. There seems to be too much emphasis placed on the ODAs’ circulating and scrub functions. The situation is also aggravated by students not allocated according to their programme planners.
Assessment
An integrated assessment approach comprising formative and summative assessments is followed in the ODA programme. These assessments include cognitive, psychomotor and affective aspects. The formative assessments – which include anaesthetic and recovery room assessments – can be done by means of case presentations, clinical simulations, perioperative care plans, a PoE, tests, oral presentations and also clinical assessments by means of direct observation in the workplace. The following assessment techniques are used for summative assessments: PoEs, written and oral examinations as well as clinical examinations by means of direct observation. Although the bulk of the formative assessments are done by the educators, trained clinical facilitators and mentors are allowed to assess non-crucial clinical procedures. The summative assessments are, however, done by the respective educators with the assistance of a second educator who acts as an internal moderator (Van Zyl, 2012:12-13).