SAQA All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.
SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED QUALIFICATION: 

Postgraduate Diploma in Rural Medicine 
SAQA QUAL ID QUALIFICATION TITLE
110831  Postgraduate Diploma in Rural Medicine 
ORIGINATOR
Stellenbosch University 
PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY NQF SUB-FRAMEWORK
CHE - Council on Higher Education  HEQSF - Higher Education Qualifications Sub-framework 
QUALIFICATION TYPE FIELD SUBFIELD
Postgraduate Diploma  Field 09 - Health Sciences and Social Services  Preventive Health 
ABET BAND MINIMUM CREDITS PRE-2009 NQF LEVEL NQF LEVEL QUAL CLASS
Undefined  120  Not Applicable  NQF Level 08  Regular-Provider-ELOAC 
REGISTRATION STATUS SAQA DECISION NUMBER REGISTRATION START DATE REGISTRATION END DATE
Reregistered  EXCO 0821/24  2019-08-19  2027-06-30 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2028-06-30   2031-06-30  

In all of the tables in this document, both the pre-2009 NQF Level and the NQF Level is shown. In the text (purpose statements, qualification rules, etc), any references to NQF Levels are to the pre-2009 levels unless specifically stated otherwise.  

This qualification does not replace any other qualification and is not replaced by any other qualification. 

PURPOSE AND RATIONALE OF THE QUALIFICATION 
Purpose:
The purpose of the Postgraduate Diploma in Rural Medicine is to strengthen the learner's confidence and capability as a rural health care practitioner and equip them with tools for lifelong learning and reflective practice in order to make a lasting contribution as a professional to the health of a rural community.

By the end of this qualification the learner should be able to:
  • Clinically manage the range of patients at a rural district hospital with limited specialist support.
  • Work with the local health care team to strengthen and sustain effective health care delivery systems.
  • Understand appropriate public health interventions and participate in community-oriented primary care.
  • Use reflective practice to enable continuous development as a rural health practitioner.

    Rationale:
    South Africa continues to experience a critical shortage of doctors in rural areas. Only 40% of the country's doctors work in the public sector and vacancy rates are highest in rural areas. In addition, doctors working in rural hospitals require unique knowledge and skills to clinically manage the range of patients they see and to provide services that are appropriate for rural communities.

    There are a significant number of young international and South African doctors who are interested to work in the rural public health sector. Africa Health Placements, has been recruiting approximately 250 international doctors per year (mostly from the United Kingdom (UK)) to work in rural hospitals in South Africa. In addition, a proportion of the 1,200 Community Service doctors who are placed in rural hospitals have an interest in staying on at the end of their compulsory year.

    Many of these doctors find the experience of working rurally to be extremely challenging however, as their previous training often does not prepare them for the specific challenges they face. These doctors (and the clinical managers of rural facilities) have reported a clinical skills gap (particularly amongst international doctors) when practicing independently in areas such as obstetrics, anaesthetics, Human Immunodeficiency Virus (HIV)/Tuberculosis (TB) and emergency medicine. Young rural practitioners also have more responsibility for contributing to service development and quality improvement at their facilities and supporting outreach into primary care and their local communities.

    The Postgraduate Diploma in Rural Medicine intends to address this gap. Currently there is no such qualification in South Africa. There is no Masters qualification in Rural Medicine yet Doctors with a long-term vision for rural medicine, who wish to prepare themselves better for rural practice, often plan their own informal, unstructured and unrecognised programme, by completing rotations in a number of different clinical disciplines following their MBChB. The alternative for such doctors is to complete the MMed in Family Medicine, becoming specialist family physicians. However, many doctors are not yet ready to make that longer term commitment, but want to make a shorter term contribution through working in rural district hospitals, sometimes as part of the process of decision-making in terms of a longer term career trajectory.

    The Postgraduate Diploma in Family has a different focus and purpose, namely caring for patients in primary care across any sector of the health service, rather than developing skills for rural district hospital work.

    The Rural Doctors Association of Southern Africa (RuDASA) has long called for additional qualifications in this field. The WHO global policy recommendations on increasing access to health workers in remote and rural areas through improved recruitment and retention: This approach is also aligned with international trends towards what is known as rural generalist medicine and the establishment of various Postgraduate Diplomas and Masters qualifications, as well as vocational training programmes, particularly in Australia and Canada. The Centre for Rural Health has collaborated with Africa Health Placements (AHP), a non-governmental organisation involved in recruiting doctors for rural hospitals in Southern Africa, in the development of the qualification. AHP has identified this as an important gap in the field. Similarly, Doctors Without Borders (MSF) has had discussions with the Faculty of Medicine and Health Sciences about possible training programmes for their staff, of which this Postgraduate Diploma would be one possible option.

    With the proposed introduction of a National Health Insurance system, it is vital that patients in rural communities have access to well-trained and skilled clinicians, who are able to perform the range of procedures required of them as generalists in rural district hospitals, within the context of understanding the nature of rural health care delivery, relating to the communities they serve and being able to take a lead in clinical governance. 
    		•

    LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    Recognition of Prior Learning (RPL):
    Processes are in line with the institution Regulation for the Recognition of Prior Learning (RPL) and Credit Accumulation and Transfer (CAT).

    In terms of Access, applicants must be medical practitioners to be eligible to enter the qualification.

    In terms of Advanced standing, consideration will be given to providing exemption to learners for up to 2 out of the 3 modules with fewer credits (Major Infectious Disease Challenges, Clinical Governance in District Health Services and Delivering Healthcare in Rural Communities), based on appropriate Postgraduate certification and/or portfolio assessment.

    In construction of a personalised learning plan for acquisition of clinical competencies as part of the major module, Clinical Skills for District Hospitals, learners who can demonstrate adequate competence in particular skills domains through an appropriate assessment may be exempted from undergoing further training in those domains.

    Entry Requirements:
    The minimum entry requirements for this qualification is:
  • Bachelor's Degree and be qualified as a medical practitioner, with at least two years of post-qualification practice as an intern doctor or equivalent.
    Or
  • Registration with the Health Professions Council of South Africa as a medical practitioner or demonstrate that they will be able to meet the requirements for such registration with the Health Professions Council of South Africa (HPCSA). 
    		•

    RECOGNISE PREVIOUS LEARNING? 
    Y 

    QUALIFICATION RULES 
    This qualification consists of the following compulsory modules at Level 8 totalling 120 Credits.

    Compulsory Modules, 120 Credits:
  • Clinical Skills for District Hospitals, 55 Credits.
  • Major Infectious Disease Challenges, 15 Credits.
  • Clinical Governance in District Health Services, 25 Credits.
  • Delivering Healthcare in Rural Communities, 25 Credits. 
    		•

    EXIT LEVEL OUTCOMES 
    1. Demonstrate an understanding of effective clinical governance in district health services and ability to implement quality improvement projects.
    2. Demonstrate relevant knowledge for generalist clinical practice in a rural district hospital and competence in procedural skills for effective clinical practice in a rural hospital.
    3. Demonstrate an understanding of unique features of delivering healthcare in rural communities and how to provide them with effective services.
    4. Demonstrate a comprehensive basic understanding of the major infectious disease challenges students are likely to encounter in a rural district hospital with a focus on Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) and Tuberculosis (TB). 

    ASSOCIATED ASSESSMENT CRITERIA 
    Associated Assessment Criteria for Exit Level Outcome 1:
  • Describe the structure of district health services, including the economic, financial, political and social factors that influence their management.
  • Contribute effectively to the good clinical governance of district health services.
  • Design and implement quality improvement projects in the rural health setting, demonstrating competency in leadership, multidisciplinary team working and systems thinking.
  • Reflect on the approach and capabilities as a leader, a manager and a rural health practitioner as a pathway to greater resilience, continued learning and professional development.

    Associated Assessment Criteria for Exit Level Outcome 2:
  • Display relevant knowledge with a focus on the following domains: emergency medicine, orthopaedics and trauma, surgery, internal medicine, paediatrics, obstetrics, and anaesthetics.
  • Demonstrate skills in the following high risk areas: emergency centre, labour ward, and the operating theatre, in relation to the above domains.
  • Show understanding of own limits in respect of functioning independently in rural district hospital and how to obtain help when needed in the context of providing healthcare for rural patients.
  • Recognise own skills and knowledge gaps in respect of these domains and describe how they will address these appropriately, through continuous learning.

    Associated Assessment Criteria for Exit Level Outcome 3:
  • Discuss the concept of rurality and the specific health needs of rural communities.
  • Describe key factors in ensuring that health services are designed appropriately for rural people.
  • Participate effectively in the delivery of community-oriented primary care.
  • Design a primary care intervention to improve health based on the specific needs of a local rural community.

    Associated Assessment Criteria for Exit Level Outcome 4:
  • Describe the diagnosis and management of people infected with HIV/AIDS and/or TB and commonly associated conditions encountered in rural health care, using current evidence-based medicine.
  • Demonstrate competence in the case management of conditions commonly associated with HIV and TB in district hospital settings.
  • Discuss the major other infectious disease challenges in an African context and describe approaches to the diagnosis and management of patients presenting with such conditions.

    Integrated Assessment:
    Multiple methods of assessment will be used, with more than one assessment being required per module. Each module will have assessment formats that are appropriate to the nature of the module.

    Formative feedback is given throughout the modules. There is a Summative Assessment at the end of each module. Assessment formats include the following:
  • Logbook review (formative).
  • Self-reflection (formative).
  • Supervisor reports (formative and summative).
  • Workplace based assessment (summative).
  • Case studies (formative).
  • Online Multiple-Choice Question (MCQ) tests (formative).
  • End of module exam (summative).
  • Participation in online discussions (formative).
  • Online reflections (formative), quality improvement project report (summative).
  • Reflective report of learning (summative).
  • Community oriented primary care intervention report (summative). 
    		•

    INTERNATIONAL COMPARABILITY 
    International Graduate or Postgraduate Diplomas in Rural Medicine only exist in Australia and New Zealand (James Cook University and Griffith University in Australia and University of Otago in New Zealand). They are mostly one-year full-time or two-years part-time. These qualifications follow a similar model that provides teaching on a blend of clinical, health system and cultural domains, mostly through distance learning. Whilst there are some similar principles between those qualifications and this one, there are significant differences in content due to the context. The clinical burden of disease is different in South Africa, with more Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and trauma. Similarly, the infrastructure and local culture is different in the African context.

    Many international doctors interested in working in Africa have historically chosen to study a Diploma in Tropical Medicine and Hygiene, which are offered at the London School of Hygiene Tropical Medicine (LSHTM) and the Liverpool School of Tropical Medicine (LSTM). The LSHTM launched an East Africa version of its Diploma in 2011 which is taught in Tanzania and Uganda. These qualifications cater to a similar demographic of young international doctor but focus much more on infectious diseases and clinical research. The proposed Stellenbosch University (SU) Postgraduate Diploma would also cover tropical infectious diseases but would place more emphasis on the broader range of clinical skills required for rural practice in Africa (such as obstetrics and anaesthetics). It also focuses more on leadership and management skills, particularly around clinical governance and primary care. Finally the SU programme would be 18 months and include a 12-month clinical placement, whereas the DTM and H courses are just 3-months long.
  • Australia, James Cook University, Graduate Diploma of Rural and Remote Medicine.

    The Graduate Diploma of Rural and Remote Medicine enables doctors working in rural and remote Australia to complete a Postgraduate qualification to enhance their clinical, academic and research skills. They will develop knowledge, skills and attitudes to contribute to clinical, academic work and research relating to rural and remote medicine. Graduates will work to foster their practice through professional development and the application of evidence-based practice.

    Qualifying learners of the Graduate Diploma of Rural and Remote Medicine will be able to:
  • Demonstrate advanced and contemporary knowledge of medicine in the rural and remote context, particularly focusing on cultural, social and management concepts for rural and remote patients and communities.
  • Demonstrate advanced and current strategies and skills in health profession education in the rural and remote context.
  • Critically analyse and evaluate community, population, legislative and funding factors that influence health and health care delivery in rural and remote communities.
  • Examine policies, professional and legal statutory requirements applicable to rural medical practitioners.
  • Design, implement and communicate a minor research project in an area of relevance to rural and remote practice.
  • Evaluate and apply new and existing evidence in the chosen specialty area of relevance to rural and remote medicine.
  • Interpret principles, theories and methods of medical/health professional education for a variety of audiences through high-level written and spoken English.
  • Demonstrate personal autonomy and accountability for own professional development.
  • Expected time to complete: 1-year full-time or equivalent part-time.

    Core subjects:
  • Teaching for Learning in the Health Professions Evidence Based Health Professional Education.
  • Foundations of Rural and Remote Medicine.
  • Rural and Remote Medicine Reflections on Practice Aboriginal and Torres Strait Islander Health.
  • Graduate Diploma of Rural Medicine, Griffith University (Australia).

    Duration: 1-year full-time/2years part-time.

    The primary learning outcome for graduates of the Graduate Diploma in Rural Medicine is the ability to competently and confidently practise medicine in rural ambulatory, community and hospital contexts, taking a population health approach while also being able to respond to medical emergencies, essentially addressing the health care needs of their rural community including the culturally diverse and disadvantaged groups. 
    		•

    ARTICULATION OPTIONS 
    This qualification allows possibilities for both vertical and horizontal articulation.

    Horizontal Articulation:
  • Postgraduate Diploma in Family Medicine, Level 8.
  • Postgraduate Diploma in Occupational Medicine, Level 8.
  • Postgraduate Diploma in Medicine, Level 8.

    Vertical Articulation:
  • Master of Medicine, Level 9.
  • Master of Philosophy in Medicine, Level 9. 
    		•

    MODERATION OPTIONS 
    N/A 

    CRITERIA FOR THE REGISTRATION OF ASSESSORS 
    N/A 

    NOTES 
    N/A 

    LEARNING PROGRAMMES RECORDED AGAINST THIS QUALIFICATION: 
     
    NONE 


    PROVIDERS CURRENTLY ACCREDITED TO OFFER THIS QUALIFICATION: 
    This information shows the current accreditations (i.e. those not past their accreditation end dates), and is the most complete record available to SAQA as of today. Some Primary or Delegated Quality Assurance Functionaries have a lag in their recording systems for provider accreditation, in turn leading to a lag in notifying SAQA of all the providers that they have accredited to offer qualifications and unit standards, as well as any extensions to accreditation end dates. The relevant Primary or Delegated Quality Assurance Functionary should be notified if a record appears to be missing from here.
     
    1. Stellenbosch University 


    All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.