Background

The maintenance of competence by rural district hospital medical practitioners is a challenge faced by all countries and, most acutely, by resource-poor nations. It is a vital element in addressing the disparity between rural and urban health care in South Africa.

The wide scope of rural-district hospital practice demands updating in a variety of content areas. District hospital doctors are likely to have educational needs covering surgery, emergency and trauma, in-patient as well as out-patient care at primary service level, an understanding of the rural context and role of other health workers, public-health skills, and teamwork. Given such a broad curriculum, some prioritisation needs to be made for the content of their CPD.

Rural practitioners generally use CPD activities that are most readily available to them, namely reading journals, meeting with pharmaceutical representatives and attending lectures sponsored by the pharmaceutical industry. These are not, however, the most appropriate or effective methods of acquiring the knowledge and skills that doctors define as being useful to them. Educational strategies that have been most effective in changing clinical behaviour are: an assessment of learning needs, interactive tuition sessions with the opportunity to practice the skills learned and sequenced multifaceted activities. It is equally important to have rural practitioners engage in educational activities that can be performed within their work environment.

The aim of this study was to define expert consensus on the content and methods most suitable for the maintenance of competence by rural district hospital practitioners in the Western Cape province of South Africa. The study was carried out as a follow-up to an analysis of knowledge and skills of doctors in Western Cape district hospitals.

Method

A study was therefore designed to investigate the content and methods used for the maintenance of competence of rural district hospital practitioners in the Western Cape province of South Africa. Expert opinion was sought to evaluate the topics requiring updating and the validity of the learning methods to maintain competence in practice. This was achieved by employing the Delphi technique to reach consensus on content and methodology. Categorical data analysis and a principal factor analysis were also performed. The qualitative data were then developed into themes and presented as a conceptual framework.

Results

Consensus was reached on the principal content areas requiring updating. Methods that were found most useful were inservice learning under supervision, structured courses, small group discussions and practical workshops. Rotations in tertiary hospitals, specialist lectures, journal reading and internet learning were less supported.

Conclusions

The study provides a practical model for continuing instruction plus self-directed learning in context. Three content domains were established, namely commonly encountered areas of practice, identified gaps, and needs specific to the practitioner and setting. It was concluded that the implementation of external updating programmes should be tailored to suit practitioners, while self-directed aspects should include reflective practice. Priority areas were identified and classified, as were educational methods that could contribute towards the maintenance of competence of rural practitioners.