South Africa will see a new breed of doctor emerging from university medical schools if the “modernised” curricula set to be introduced by next year live up to expectations.

A more humane, caring doctor, who is as comfortable with handling a birth at a rural clinic as treating a patient with an AIDS-related illness in a Groote Schuur or Chris Hani Baragwanath ward, is what the curriculum is aiming to produce.

Medical schools have also committed themselves to being more lenient on their entry criteria, in an effort to attract students that reflect the demographics of this country, but stringent on their exit criteria.

“I’m given to understand that the UCT curriculum change is the stuff of dinner time conversation and it goes like this – there is concern that UCT is dumbing down its curriculum, standards are falling,” said Professor Janet Seggie, Assistant Dean at the University of Cape Town’s medical school.

“Nothing could be further from our minds given the international reputation which the UCT health sciences graduate presently enjoys. We have no   intention of harming this reputation for world class excellence. We are going to be flexible on access, active in redress, but we will be rigorous on success,” Seggie said, adding that that had no intention of lowering any standards.

Professor Yosuf Veriava, senior lecturer at the University of the Witwatersrand medical school, echoes these sentiments: “Wits training will match anyone in the world. We should not be judged on whom we take in, but on out exit criteria. This is equal of better than anyone else in the world.”

In keeping with worldwide trends, UCT, Wits and the Natal University’s Nelson Mandela School of Medicine have started “ratcheting and modernising” the curriculum.

Instead of teaching students in a very specific manner where it is based on disciplines, teaching will become much more integrated. Basic sciences are integrated with the clinical side. “Students early on in their career get some feel for the relevance of what they are doing,” Veriava said.

There will also be a lot more self-learning. Previously learning was based more on tutor teaching, but now tutors will rather facilitate the learning and students will teach themselves.

The new curriculum will also allow the students to appreciate their own surroundings and the social circumstances of their patient.  

“They only know the patient in the bed, they don’t see the patient in the context of a breadwinner or a mother of three. They don’t have a real feel for the patient in his/her home, nor do they have a feel as to who will pick up the patient’s continued care once discharged,” Seggie said.

“Those who enter medical school wish to work with people and what is more, they are pretty good at it.why not give them the opportunity to engage with people from day one,” she added.  

All those interviewed agreed that HIV/AIDS was the biggest challenge facing the country, especially medical schools.  

HIV/AIDS features prominently in teaching modules right from the first year, said Natal’s Deputy Dean Dr Maila Matjila, “as one out of every three or four patients is HIV positive”.

Veriava is clear that HIV/AIDS is the worst disaster this country has ever faced.

“In virtually all medical and paediatric wards HIV/AIDS is the dominant problem.

“Students are trained in this environment, but where we may come short and this we hope to correct in the new curriculum, is to get students to develop better people and counselling skills.”

Veriava warned that there was a serious danger of doctors becoming more apathetic because there were no anti-retrovirals available to treat patients.

Describing it as “the saddest, saddest thing” Seggie said UCT had already woven HIV/AIDS into the curriculum in terms of what the students learn in infectious diseases and immunology.

“There is no way we can escape this. We have to produce very skilled AIDS practitioners,” she said.

Like UCT, Natal is extending its teaching base from the traditional academic hospitals to the secondary hospitals and clinics.  

“Most doctors want to work in the major hospitals in the urban areas when they graduate, because this is where they were trained and this is where they feel comfortable,” said Matjila.

“By extending our teaching base to smaller, outlying hospitals and related primary healthcare centres, our graduates will feel comfortable and confident to work in rural areas.”

Seggie said UCT was intent on underpinning the primary health care approach in its new curriculum.

“It sees the patient in a much more holistic context. It sees the patient in the context of the whole illness rather than a case with a specific disease,” Seggie said.

She said community service had also placed demands on the medical schools to produce a much more clinically mature, much more clinically autonomous practitioner than is required in Europe or Australia.

Matjila said community service was supposed to benefit rural areas primarily, but added that those in rural areas needed adequate support from medical institutions in urban areas.  

Despite all the unhappiness, Veriava said community service provided doctors in areas where there were shortages in the past.  

“Those people doing community service in hospitals that are adequately supervised clearly benefit. My concern is that there are doctors who were trained as interns in unsupervised, inadequate institutions and then have to do their community service in hospitals that are poorly supervised and staffed, must have had severe disadvantages.”

All three universities expressed their commitment to training more black doctors.

Matjila said some 49% of their students were African, 42% Indian and 5% white. Overall 56% are female with the highest number of women students (66%) in first year.

Wits offered more places to African students this year than ever in the past. “Despite this we may find that only 25% of our students end up being African,” Veriava said.

“We are unhappy about this, but many students opt for other areas. Also, medicine is a long course and it is difficult for students from low socio-economic circumstances to sustain themselves for this period,” Veriava said, adding that they were making more bursaries available to address this.

UCT currently has about 60% black medical students and 40% white, while about 60% is female and 40% male.  

* In a recent development Health minister Dr Manto Tshabalala-Msimang told the National Council of Provinces that Government and medical schools were “badly out of step”.

“Few university medical faculties can show real results in terms of the diversity of their student bodies.”  

Tshabalala-Msimang said the potential of medical schools to contribute to the development of the country was enormous. “But we will not reap this benefit if we do not engage each other fully and honestly.”  

She invited university administrations to meet with Government (health and education departments) to hammer out an Accord on the Transformation of Training in Health Sciences. She said the Accord should be done before the end of the year.