| Summary: | Background
The role of district hospital doctors in South Africa includes providing effective and efficient primary health care and referral of patients to more specialist care when needed. The doctors who work in these district hospitals have varying levels of clinical and procedural skills. Much research has been done on this topic in rural areas of South Africa; however there is insufficient information on the skills of doctors in urban district hospitals. The aim of this study was therefore to conduct a self-assessment study of procedural skills of medical officers in three district hospitals in Region B, Gauteng Province, which is mostly an urban area. It is hoped that the results of this study can be used to influence the development of appropriate training programs which will capacitate Medical officers to function effectively within the district hospitals.
Methodology
The study was a descriptive cross sectional study of all the doctors in all the three district hospitals in the region during the period of October 2009-November 2009 using a self-administered questionnaire. Doctors assessed themselves on 71 procedures considered to be required at district hospital level.
Results
The results show that there was varying level of self-reported competence in procedural skills among doctors, ranging from some procedures being performed independently to some performed with support, and to some where there was even unfamiliarity with certain procedures. There was some association between perceived overall competence in procedural skills with factors such as age, gender and years of experience, but no association with place of under graduate study, discipline and Family Medicine training. There was statistically significant association between age and overall anaesthetic competence (p=0.03), gender and overall competence in surgery (p=0.03), orthopaedics (p=0.02), urology (p=0.005), years of experience and overall competence in dermatology skills (p=0.02). Junior doctors reported higher competence in anaesthesia, whilst male doctors reported higher competence in surgical, orthopaedic and urology procedures. The organizational and management structure of the hospital where the doctors are currently working was also identified as a significant factor which affected the overall reported competence.
Conclusion
The study demonstrates that there are varying level of self-reported competence in procedural skills amongst doctors in urban district hospitals. This research study identifies the need for training in the procedural skills that the doctors have identified themselves as not competent to perform. Greater clarity regarding skills required of doctors in district hospitals is needed.
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