- Title
- Assessing South African Medical Interns’ Experience and Confidence in Managing Obstetric Emergencies
- Creator
- Miller, Andrew
- Description
- Background: Medical doctors in South Africa are required to complete a two-year internship at training hospitals, including a four-month rotation in obstetrics and gynaecology. Following this, doctors are allocated to community service posts; many of which are at district and primary level facilities where supervision is limited. The latest triennial Saving Mothers Report identified district hospitals as the second leading site for maternal deaths of all causes. District hospital were also the leading site for maternal deaths secondary to obstetric haemorrhage and the most likely site for the lack of a skilled doctor to be identified as a factor in deaths associated with caesarean delivery. Methods: This cross-sectional descriptive study aimed to describe the self-perceived readiness of medical interns completing their training to independently manage obstetric emergencies, based on the ESMOE modules in the HPCSA internship logbook. The research assessed medical interns in the last three months of their training, using a self-administered online questionnaire, with data collection between October and December 2019. Cluster sampling of interns at training facilities throughout the country resulted in a total of 182 respondents from 17 hospitals in seven provinces in the country, with an overall response rate of 34.1%. Results: Most interns had experience with, and confidence in, the management of miscarriage and hypertension in pregnancy. However, gaps in labour ward management, pregnancy related sepsis and surgical skills were identified. Only 42.3% of respondents were confident in their ability to diagnose obstructed labour, 26.3% had performed an assisted delivery, 39.0% were confident in their knowledge of the indications and contraindications of assisted deliveries and 35.7% had been involved in the delivery of a baby with shoulder dystocia. Regarding pregnancy related sepsis, 54.4% had experience with managing a wound abscess and 29.7% were confident managing puerperal endometritis. While 78.0% felt confident to perform a caesarean section, only 28.6% had performed uterine compression sutures for uterine atony at caesarean section. Additionally, there was a statistically significant variation in scores between training hospitals. Conclusion: A gap exists between the shortcomings in district hospital obstetric services, the prioritisation of placement of community service doctors at primary care and district hospitals, and the self-perceived readiness of medical interns completing their training to safely manage obstetric emergencies. This highlights the importance of clinical support for junior doctors at district hospitals and standardisation of intern training at accredited facilities across the country.
- Description
- Thesis (Masters) -- Faculty of Health Sciences, 2021
- Date
- 2021-02
- Subject
- Obstetrical emergencies
- Type
- Masters theses, text
- Identifier
- http://hdl.handle.net/11260/6882
- Identifier
- vital:52352
- Format
- computer, online resource, application/pdf, 1 online resource (54 pages), pdf
- Publisher
- Walter Sisulu University, Faculty of Health Sciences
- Language
- English
- Rights
- Faculty of Health Sciences, All Rights Reserved, Open Access
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Collections
WSU Department of Family Medicine
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details | SOURCE1 | Dr Miller MMED_Fam Med_Dissertation.pdf | 2 MB | Adobe Acrobat PDF | View Details |