5 minute read
From the Editor
MMed Mission Impossible
"How is your MMed going?” is a question that tweaks the adrenals of most South African registrars. Of course, there are always one or two outliers, who breezily bash out their dissertation in the first year, then go on to amuse themselves with a PhD for the remainder of their training. But for the rest of us mortals, the MMed project is a millstone and a long, hard slog.
In December 2015, the HPCSA issued a ruling that completion of a ‘Research Component’ during specialist training was a prerequisite for registration. This created a tsunami of additional academic administrative processes, which engulfed postgraduate offices, institutional supervisors and unsuspecting trainees. Neatly set out in the South African Committee of Medical Deans (SACOMD) document of 12 September 2017, ‘Standardisation of the Research Component of the Master of Medicine Degree - Final Recommendations’, the purpose of this component is said to be fourfold:
1. To stimulate the interest of the student in research
2. To allow students to become familiar with the knowledge and skills which underpin research
3. To stimulate the critical thinking and high-order reasoning required of a level 9 qualification in terms of the HEQSF
4. To promote scholarship within what is otherwise a technical vocational training programme
While in principle this sounds awesome, was it ever feasible? Parking Everest next to a full-time technical vocational training programme was an audacious move indeed.
SACOMD admits that since the inception of the HPCSA rule, there has been little uniformity across universities in terms of the total credits assigned to the MMed degree, the required scope, standard and credit weighting of the research component, and the provision of protected time for performance of research. ‘Supervisors and programme coordinators need to understand their role in ensuring that both informative and transformative learning occur. It is insufficient to restrict supervision to the direction of a series of sequential mechanical activities in the absence of transformative learning. However, preparation of the dissertation itself should not be unnecessarily onerous or time-consuming.
Notional hours
Up to 900 hours of activity are necessary for these learning outcomes to be met. This represents approximately 23 working week equivalents. From a practical standpoint, it would seem reasonable for this time to be made available to the student as 8-12 weeks of dedicated time (whether taken en bloc or distributed over the four years), with the remaining 50% to be undertaken alongside other activities or during own time, i.e. self-directed learning. Time devoted to the research component is effectively time removed from the clinical training component. It is essential that a balance is found which enables the purposes of the research component to be met, while not jeopardising the clinical competence of the graduating specialist.’
Let’s be frank, this balance is rarely found. In our current climate of financial austerity, with reduced healthcare workforces and increased clinical service demands, are we surprised to find our registrars at the end of their training time dangling from a wire, six inches above a floor of laser beams, with beads of sweat dripping from their foreheads?
SACOMD go on to recommend that support should be provided for the research component:
1. ‘It is critical that support structures are put in place to assist the large numbers of MMed students who are now subject to the requirement to perform the research component.
2. The major steps to be undertaken are identified as follows:
Build an environment with a strong research ethos
Nurture and support the research activities of the MMed students
Enhance supervisor capacity
Provide protected research time’
These steps are major indeed and I suspect we are all lagging behind. UCT only introduced formal registrar teaching on the principles and practice of research earlier this year. Many supervisors who have been roped in to help out, have very little research experience themselves.
And as for protected research time, what is that?
Last, SACOMD encourages us to foster enthusiasm for research. ‘It is highly desirable that the graduate emerges from the research component with a respect and enthusiasm for research, such that he or she is likely to promote the research agenda in the future, whether by personal involvement, or by support and understanding for the work of others.’
In reality, registrars who haven’t entirely submerged, are more likely to emerge from the research component with flashbacks and post-traumatic stress disorders. As supervisors, we can’t always be their Ethan Hunt, a highly skilled field agent for the Impossible Mission Force, who handles dangerous and high-stakes missions. But we can be kind, patient and supportive to all our trainees trying to conquer their MMed Everests.
The SAOJ serves as an invaluable platform to showcase the hard work of registrars, which may not otherwise enjoy visibility in higher-impact international journals. The fact that it is Department of Higher Education and Training (DHET)-accredited, means that some universities like WITS are satisfied to award the MMed degree for a paper published in the journal, without sending it on for further examination.
One of our international registrars was most recent to summit, and his dissertation on The Profile of Childhood Blindness in Cape Town finally rests in this issue. He started in the foothills with a literature review of the topic in May 2021. It may easily have taken 23 working week equivalents, but the majority of this would have been conducted alongside other activities or during his own time. Nevertheless, he is destined for new heights and is busy preparing for a vitreoretinal fellowship expedition in British Columbia in June. I hear the mountains around Whistler are challenging, but spectacular that time of year.
