Fitness for purpose of South African anaesthesiologists.

Abstract

Anaesthesiologists, like all medical specialists, should be able to function independently and appropriately to provide the service beneficial to those whom they serve. However, difficulties have been experienced with the transition from trainee to specialist, posing potential adverse effects to the patient and the practitioner. To avoid these negative occurrences, it is necessary to ensure that graduates are well prepared for their specialist roles and are fit for purpose (FFP). The practice of a medical specialist incorporates various clinical and non-clinical roles; such roles include medical expertise, scholarship, communication, collaboration, management and leadership, professionalism, and health advocacy. Graduates have reported feeling better prepared for some of these roles and less prepared for others, with deficiencies noted particularly in those that are predominantly non-technical in nature. In anaesthesiology, there is a paucity of evidence in the literature with respect to fitness for purpose (FnFP), and there has been no assessment of whether anaesthesiologists internationally or in the South African context are FFP. The aim of this step-wise study was to develop and define the concept of FnFP and explore its nature in the South African anaesthesiology context. The first step provides a literature review of FnFP, and proposes how FnFP relates to current terminologies. Step two attempts to define FnFP in the South African anaesthesiology context, culminating in a list of defining competences useful as a tool to conceptualise, and possibly to gauge FnFP henceforth. Once FnFP has been defined for South African anaesthesiology, the next step is to establish whether local (South African) graduates are considered FFP using the derived criteria. This is undertaken by exploring opinions of FnFP by teachers, examiners and graduates. The final step in this thesis assesses the temporal nature of graduate self-assessment of FnFP. This study explores and highlights contemporary terminologies in postgraduate medical education and proposes refinements that suggest consideration, and inclusion, of the concept of FnFP as a means to enhance graduate readiness for practice. Fitness for purpose in the South African anaesthesiology context is explored with the aim to ultimately address and minimise graduate deficiencies in specialist practice. This work contributes to new knowledge in the field by conceptualising and defining FnFP for local anaesthesiology, and, through the proposal of a useful list of criteria, with an accompanying graphic, defines and illustrates the concept of the FFP anaesthesiologist. It also proposes an educational tool that can be used to dynamically monitor the progress of trainees during the learning process, which may assist in addressing and remediating deficiencies timeously. Similarly, after highlighting where deficiencies in local graduates are perceived to lie, this work proposes how these may be addressed and should be explored in future research to enhance the preparedness of graduates in anaesthesiology.