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SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED QUALIFICATION THAT HAS PASSED THE END DATE: 

Bachelor of Medical Clinical Practice 
SAQA QUAL ID QUALIFICATION TITLE
74611  Bachelor of Medical Clinical Practice 
ORIGINATOR
University of the Free State 
PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY NQF SUB-FRAMEWORK
CHE - Council on Higher Education  HEQSF - Higher Education Qualifications Sub-framework 
QUALIFICATION TYPE FIELD SUBFIELD
National First Degree  Field 09 - Health Sciences and Social Services  Curative Health 
ABET BAND MINIMUM CREDITS PRE-2009 NQF LEVEL NQF LEVEL QUAL CLASS
Undefined  408  Level 6  NQF Level 07  Regular-Provider-ELOAC 
REGISTRATION STATUS SAQA DECISION NUMBER REGISTRATION START DATE REGISTRATION END DATE
Passed the End Date -
Status was "Reregistered" 		 SAQA 091/21  2021-07-01  2023-06-30 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2024-06-30   2029-06-30  

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 this three-year professional qualification is to train a competent, professional, healthcare team member with the necessary knowledge, multi-skills and attitudes to function effectively as clinical associates to assist/support/work with and under the supervision of a qualified medical practitioner by consulting patients and doing clinical procedures primarily in the district health system in South Africa. This will improve communication and education and enable medical practitioners to provide comprehensive services. After successful completion it will enable the candidate to register with the HPCSA.

Rationale:

Midlevel medical worker cadre is part the Department of Health's Human Resource Plan. Presently there is a severe shortage of doctors in South Africa, especially in rural hospitals. Nurses try to supplement the doctors' work thus neglecting their own nursing duties and patients do not receive optimal care. Work overload compromises the quality of service. There is a gap for a clinical associate working under the supervision of a doctor to relieve the doctor of certain tasks and procedures in the context of district hospitals. Clinical Associates will enable the healthcare team to deliver a better quality of care to patients.

The clinical associate will perform specific procedural, assessment and management functions in the district hospital. See attached scope of practice.

This will create a new career opportunity within the health care team.

Medical assistants trained in other countries already work in SA and are registered with HPCSA. 

LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
Learners need to have NQF Level 4 skills equivalent in reading, writing, listening and speaking in English as most of the textbooks and documentation are in English.

Recognition of Prior Learning:

Competence in clinical problem-solving and relevant clinical experience in a district hospital setting could be considered for RPL.
The university's policy on RPL will apply.

Access to the qualification:

Selection process: Candidates submitted by the Department of Health will go through a selection process and criteria will be determent by the University of the Free State.

Required:
  • Matriculation certificate, with university exemption, with English Higher grade C symbol and Mathematics SG passed.

    Strongly recommended:
  • Biology and Physical Science.

    Other recommendations:
  • Preference will be given to candidates with additional qualifications and a good academic record.
  • Individuals should come from the communities where they will be working.
  • Communities and local health authority should be involved in recruitment and selection.
  • Mature candidates are more likely to succeed, it should be recommended to recruit them rather than school leaving candidates. 
    		•

    RECOGNISE PREVIOUS LEARNING? 
    Y 

    QUALIFICATION RULES 
    Level, credits and learning components assigned to the qualification:
  • Duration: 3 years
  • NQF Level: 6
  • Total credits: 408
  • Fundamental: 32
  • Core: 344
  • Elective content: 32 
    		•

    EXIT LEVEL OUTCOMES 
    1. Perform a patient-centred consultation across all ages in a district hospital.

    2. Apply clinical reasoning in the assessment and management of patients.

    3. Perform investigative and therapeutic procedures appropriate for a district hospital.

    4. Prescribe appropriate medication in emergency situations, within scope of practice, and with consultation with other team members.

    5. Provide emergency care within the scope of practice.

    6. Facilitate communication and provide basic counselling.

    7. Function as an effective member of the health care team.

    8. Produce and maintain clinical records.

    9. Function as an ethical practitioner.

    10. Demonstrate ongoing learning in clinical practice.

    11. Integrate understanding of family, community and health system in practice.

    Critical Outcomes:

    Upon completion of this module the candidate will be capable to:
  • Identify and solve problems using critical and creative thinking (Problem-solving skills) In all assignments.
  • Work effectively with other members of the multidisciplinary and interdisciplinary team and the community (cooperative skills).
  • Organize and manage themselves and their activities responsibly and effectively (self-responsibility).
  • Collect, analyze, organize and critically evaluate information (research skills).
  • Communicate effectively using visual, symbolic and/or language skill in various modes and with different age groups. (communication skills).
  • Use science and technology effectively and critically, showing responsibility towards the environment and health of others, specifically special investigations (scientific, technological and environment literacy/skills).
  • Understand that the world is a set of related systems and that the problem solving contexts do not exist in isolation, the child is an individual, but also part of a family, community and the world (developing a macro-vision) Portfolio - Health care systems.

    Developmental Outcomes:

    Upon completion of this module the candidate must be able demonstrate the capability of:
  • Reflecting on and exploring a variety of strategies to learn more effectively and to be a life long learner (learning skills).
  • Participating as a responsible citizen in the life of local, national and global communities (citizenship).
  • Being culturally and aesthetically sensitive across a range of social contexts (cultural and aesthetic sensitivity).
  • Developing entrepreneurial abilities. 
    		•

    ASSOCIATED ASSESSMENT CRITERIA 
    Associated Assessment Criteria for Exit Level Outcome 1:
  • Patient's needs and problems are identified by effective listening.
  • A relevant history is taken.
  • An accurate and relevant physical examination is performed.
  • Diagnostic tools are used effectively.
  • Continuity of care is ensured by making arrangements for follow up and review.

    Associated Assessment Criteria for Exit Level Outcome 2:
  • High-risk situations and conditions in patients are timeously identified.
  • Hypotheses are made from information obtained.
  • Collaboration with the patient occurs in all aspects of the consultation.
  • Assessment based on information (history, physical examination, side room investigations) is made.
  • Assessment is contextualised within the bio-psycho-social model including preventive, promotive, curative and rehabilitative aspects.
  • Management plan is based on the assessment and includes assistance with appropriate referrals e.g. rehabilitation.
  • Assessment and management plan is reviewed in an ongoing basis and adjusted accordingly, in collaboration with the health team.
  • Assessment and management decisions take cost effectiveness into consideration.
  • Interpret the results of relevant side room investigations in common conditions.
  • The assessment and management plan is presented to the supervising doctor and justified on the basis of information obtained.

    Associated Assessment Criteria for Exit Level Outcome 3:
  • Explain/describe the procedure in lay and medical terms.
  • List indications and contra-indications for a specific procedure.
  • Demonstrate ability to prepare for a procedure, including patient preparation.
  • Demonstrate the procedure competently.
  • Explain possible complications for the procedure.
  • Explain follow-up and safety-netting following the procedure.

    Associated Assessment Criteria for Exit Level Outcome 4:
  • Demonstrate knowledge in basic pharmacology.
  • Prescription is authenticated, interpreted, validated, dispensed and advice given to the patient as per legislative requirements.
  • The prescription is dispensed taking into account socio-economic, ethical, equity and professional practice.
  • Prescriptions are prepared as per good dispensing practice and techniques.
  • The prescription is explained to a patient (drug literacy, adherence).
  • A history of over the counter, traditional, complementary and alternative drug use is taken into consideration.
  • Knowledge of non-pharmacological therapies is demonstrated.
  • Knowledge and skills to administer and dispense medication is demonstrated.

    Associated Assessment Criteria for Exit Level Outcome 5:
  • Potentially life-threatening conditions in patients are timeously identified and evaluated.
  • Emergency conditions are managed and referred appropriately.

    Associated Assessment Criteria for Exit Level Outcome 6:
  • Patient's needs and problems are identified by effective listening.
  • Health information is shared in appropriate cultural and language terms.
  • Amount and level of information given is appropriate.
  • A suitable environment is fostered to communicate with the patient and/or family.
  • Patient feedback and questions are facilitated.
  • Confidentiality is ensured.
  • Basic counselling skills are demonstrated addressing the patient's needs.
  • Appropriate solutions are explored.
  • Mutual decision-making is facilitated.
  • Continual support and follow-up is provided.

    Associated Assessment Criteria for Exit Level Outcome 7:
  • Demonstrate understanding of the roles, functions and relationships of all the members of the district hospital team.
  • Enhance team functioning through appropriate attitude and behaviour as team member or substitute team leader.
  • Clinical information from patients is clearly and concisely communicated to the other team members (doctor in particular).
  • Patients are handed over to colleagues appropriately.

    Associated Assessment Criteria for Exit Level Outcome 8:

    Patient records and medico-legal forms reflect all relevant information accurately and legibly.
    Patient statistics are complete and accurate.

    Associated Assessment Criteria for Exit Level Outcome 9:
  • Explain to the patient the role and function of a medical assistant.
  • The basic ethical principles are applied.
  • The Batho Pele principles are applied to work situation.
  • Recognise ethical problems and manage them appropriately, and refer when necessary.
  • Statutory and professional obligations are complied with.
  • Demonstrate appropriate and sensitive attitude to patient, family, communities and colleagues.
  • Demonstrate reliability in work situations.

    Associated Assessment Criteria for Exit Level Outcome 10:
  • Professional strengths and weaknesses are identified by reflecting on clinical practice.
  • Clinical practice is continually improved based on identified needs through appropriate self-directed learning.

    Associated Assessment Criteria for Exit Level Outcome 11:
  • Each patient is assessed and managed within the context of his or her family and community/social/work environment.
  • An ecomap and genogram for a family is done when appropriate.
  • Knowledge of the local district health system informs practice in terms of referrals, follow-up and interaction with other team members and resource persons (e.g. pastor, traditional healer) and organisations (NGOs, hospice, crisis care).
  • Awareness of and appropriate involvement in local community oriented primary care.
  • Understand quality improvement cycle or process and participate in quality improvement activities.
  • The principles and practice of comprehensive primary health care (e.g. water, sanitation, nutrition, housing, pollution, personal health care, health programmes etc.) as it affects individuals, families and communities are understood and appropriately dealt with.

    Integrated Assessment:

    A range of formative and summative assessment methods are used that permits the learner to demonstrate applied competence. Integrated assessment methods include theory and practical skills evaluation.

    The following assessment strategies are used to ensure that Exit Level, critical and developmental outcomes are achieved:
  • Written assignments, tests and/or examinations.
  • Practical examinations e.g. OSCEs.
  • Oral examinations e.g. patient presentations.
  • Portfolio review. 
    		•

    INTERNATIONAL COMPARABILITY 
    This qualification compares favourably with similar qualifications in the international arena in terms of outcomes applicable, period for completion required and complexity.

    The following are some examples of similar international qualifications.

    In the USA physician assistants undergo a 28 month post-graduate training in a university linked with a medical school. On graduation they register with the Medical Board and then work in clinics, hospitals, both in public and private health care, under the supervision of a physician. Qualification: Maters in Clinical Science, Physician Assistant.

    In Malawi a medical assistant undergoes a three-year undergraduate course in the School for Health Sciences. On graduation they register with the Medical and Dental Council. They work in Health Centres and District Hospitals.

    In Tanzania a clinical officer undergoes three-year undergraduate course in Training Institutes attached to district hospitals. On graduation they work in health care centres and hospitals.

    All these courses have theory and practical components. 

    ARTICULATION OPTIONS 
    Horizontal articulation: Learners with this qualification may proceed to specialise in clinical practice in relevant disciplines e.g. orthopaedics, clinical forensics and palliative care.

    Vertical articulation: Various post-graduate possibilities exist e.g, medical education, public health, health management and medical ethics. 

    MODERATION OPTIONS 
    Rules and procedures for marking and moderation:

    Examinations:

    Admission to the examination: required year mark:

    A 40% year mark is required for access to the examination in the particular learning area. It is based on the average of all tests undertaken for the particular learning area. It is required that all of the tests and assignments be completed satisfactorily in order for the learner to be allowed to sit for the final examination. This is done to ensure that the learner has covered all of the work that could be the subject-matter of the examination.

    Requirements for the promotion of learners:
  • 50% constitutes a pass mark for every test, project and examination.

    Procedures:
  • All examinations are marked internally and moderated externally.
  • All final marks are ratified by the Examinations Committee.

    Tests:
  • Marking of tests is done internally solely by the Institution and marks returned to students.
  • Examiners assess the quality of the response to the written questions against a marking memorandum.

    Exemptions:

    Refer to regulations.

    Once all markers have reached consensus, the marks for the test are recorded in the computerised learner database and then printed so that a hard-copy record exists.

    Procedures and regulations of the University of the Free State will apply for the Re-evaluation of marked assessments and/or re-marks of Examinations.
    A learner may also submit a request for the remarking of a particular examination. A fee, determined by the institution, is payable for such a remark.

    Requests follow a specific procedure. The recording of the marks from a re-marked paper is done in the same way as a first-time paper.

    Rules and procedures for re-examination:

    Refer to regulations.

    Relationship of assessment of learner's achievement to programme of learning.

    The relationship between the content of the offering and the assessment thereof is regulated by a moderator. The moderator ensures that no questions are asked which are beyond the ability of a well-prepared learner. It thus follows that there is a very close relationship between the contents of the course material and its assessment.

    The learner assessments, while requiring a detailed knowledge of the course material, are much more than just being able to reproduce the contents of the course material. Rather, learners are required to apply their knowledge to questions that require thought and cognition.

    Criteria for the Appointment/Registration of Assessors/Examiners and Moderators:

    Examiners, assessors and moderators for all courses are leading experts in the discipline of health care sciences, and related fields.

    The following criteria for the appointment of examiners and moderators are applicable:
  • The possession of a relevant Masters degree.

    And
  • Relevant teaching experience at a higher education institution.

    Or
  • Experience as a practitioner in the relevant profession.

    Duties of Assessors/Examiners and Moderators:

    Examiners:
  • Are expected to set a paper that examines the entire syllabus and tests all of the important concepts presented in the course material. Standards are aimed to be as high as possible.
  • Work closely with the moderator to ensure that the standard of the examination is at the highest level possible without being unfair to the learners.
  • Examiners mark each script according to the particular memorandum.
  • Ensure that he/she meets the deadlines set by the institution.

    Moderators:
  • Work closely with the examiner to ensure that the standard of the examination is at the highest level possible without being unfair to the learners.
  • Check that none of the questions is unreasonable bearing in mind the contents of the syllabus, i.e. to check that none of the questions asked is outside the capabilities of a well-prepared learner.
  • Mark each script independently according to the particular memorandum, once it has been marked by the examiner.
  • Ensure that he/she meets the deadlines set by the institution.

    In order to ensure that the assessment is fair, reliable and valid:
  • Internal and external examiners (academics and practitioners) assess the Modules with core contents using memoranda and templates for structures orals and OSCEs.
  • External assessors are selected and appointed on academic qualification and relevant experience in research and practice.
  • Moderators submit reports according to template and reports are utilized as quality improvement tool. The regulating professional body conduct accreditation visits in which submissions in terms of which the minimum standards as required by the profession are being met.
  • Possibility of single outlet examination at the end of Study Year 3 in process of consultation. The end objective is to have one unitary exam for all B. Med. Clin. Prac. programmes in South Africa.

    Regulating professional bodies and other:
  • Health Professions Council of South Africa (HPCSA).
  • Medical and Dental Board.
  • The Registrar.
  • National external examiners from the other universities which offer similar programmes, the Colleges of Medicine of South Africa, the South African Academy of and Family Physicians and Family Physicians in private practice. 
    		•

    REREGISTRATION HISTORY 
    As per the SAQA Board decision/s at that time, this qualification was Reregistered in 2012; 2015. 

    NOTES 
    Clinical Associate Scope of Practice:

    The Clinical Associate (ClinA) is a competent, professional member of the healthcare team with the necessary knowledge, skills and attitudes to function effectively in the district health system in South Africa, primarily working with and under the supervision of a qualified medical practitioner. The ClinA will not function as an independent professional, and in any uncertainty will consult with the supervising doctor. Teamwork and communication skills are critical.

    The Clinical Associate's scope of practice will include medical services within the education, training and experience of the clinical associate delegated by the supervising doctor.

    Clinical Associates will be permitted to provide medical service delegated to them by the supervising registered medical practitioner provided such service are within their scope of practice, ClinA's will thus be considered the agents of their supervising doctors in the performance of all practice-related activities including the ordering of diagnostic, limited therapeutic, and other medical services.

    The Clinical Associate's scope of practice is defined by the context and requirements of district hospitals with particular focus on:

    1. Emergency Care.
    2. Skilled Procedures.
    3. Inpatient Care.

    Medical services provided by the clinical associate may include, but are not limited to:

    1. Obtaining patient histories and performing physical examinations.
    2. Interpreting findings and formulating a hypothesis for common and emergency conditions.
    3. Assisting in clinical procedures.
    4. Offering counselling and education to meet patient needs.
    5. Assist in making appropriate referrals.

    Due to the situation in a district hospital, the ClinA will usually have limited involvement in obstetrics and psychiatry, except in the management of emergencies. Similarly the involvement in clinical forensics will be limited.

    The Clinical Associate will primarily function in the generalist domain, but this does not prevent specialisation in particular areas with additional training in future (such as in orthopaedics, palliative care, clinical forensics).

    The scope of practice will be further guided by written clinical protocols as required by the employer.

    Supervision must be continuous but should not to be construed as necessarily requiring the physical presence of the supervising doctor at the time and place that the services are rendered.
    It is the obligation of each team of doctor and clinical associate to ensure that the clinical associate's scope of practice is identified; that delegation of medical tasks is appropriate to the clinical associate's level of competence; that the relationship of, and access to, the supervising doctor is defined; and that a process for evaluation of the clinical associate's performance is established. In cases where an assessment falls outside the scope of practice of a Clinical associate the information gathered from the initial consultation should be clearly communicated to the supervising doctor to assist in the development in an assessment plan.

    There are two categories of skills for clinical associates:

    1. Those that they should be able to do routinely.
    2. Those with which they can assist the supervising doctor that can be performed with the supervising doctor. 

    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. University of the Free State 


    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.