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??Teaching Sites - Garden Route Training Complex

Introduction

The Garden Route Complex consists of the Garden Route and Central Karoo Districts and all the health facilities within them. The complex is situated in the southern and central parts of the Western Cape about 440km from Cape Town and 330km from Por t Elizabeth. The complex stretches along the magnificent Garden Route and inland over the Outeniqua and Swartberg mountains and into the Central Karoo. George is close to the Wilderness lakes, indigenous forests and the warm Indian Ocean. Mossel Bay is famous for its hospitality, summer beaches, boating, fishing, and warm climate. Knysna is a major tourist attraction due to its lagoon, oysters, arts and crafts and water sports. George is a major town with all the usual shopping malls, cinemas and restaurants. To live and work in this area is a wonderful experience.

Prof Louis Jenkins is the Head of Family Medicine at George Hospital and the Training Complex coordinator. You can contact him on louis.jenkins@westerncape.gov.za or 0837951065 or 044 8024528. Drs Elmari de Klerk-Green and Rachel Schaefer complete the team of family physicians at George regional hospital, working, teaching registrars, undergraduate students and reaching out to district hospitals and PHC clinics. Dr Martha Mekebeb is also a qualified family physician in George, working between George Hospital and the local research units (TASK and Excellentis). Dr Bernice Booysen is the family physician and Dr Tertius Ackerman is the clinical manager in the George sub-district, working in the PHC clinics and TB hospital in George. Dr Zilla North is the medical manager for the George sub-district. Drs Paul Kapp and Laurel Giddy are the family physicians, Dr Francois Potgieter is the clinical manager and Dr Andries Brink is the medical manager at Knysna sub-district and hospital. Dr Lauren Hutton is also a qualified family physician, in a MO post at Knysna hospital. Dr Johan Schoevers is the family physician and Dr Jaco Botma is the clinical manager at Mossel Bay sub-district and hospital. Dr Hermann Kruger is the family physician and Dr Erhardt Heydenrych is the clinical manager in Oudtshoorn hospital. Dr Milton Groenewald is also a qualified family physician, in a MO post at Oudtshoorn hospital. Dr Shaun Kleinhans is the family physician in Riversdal hospital and Hessequa sub-district. Here is a summary of contact persons:

George Hospital and sub-district

Prof Louis Jenkins                            HOCU and Training complex coordinator

Dr Rachel Schaefer                          Family physician

Dr Elmari De Klerk-Green               Family physician

Dr Berenice Booysen                       Family physician

Oudtshoorn hospital and sub-district

Dr Herman Kruger                           Family physician

Dr Erhardt Heydenrych                   Clinical manager

Dr Milton Groenewald                    Family physician in MO post

Mossel Bay Hospital and sub-district

Dr Johann Schoevers                       Family physician

Dr Jaco Botma                                  Clinical manager

Riversdal hospital and Hessequa sub-district                       

Dr Shaun Kleinhans                         Family physician

Dr Gideon van Tonder                     Medical manager

Knysna hospital and sub-district

Dr Paul Kapp                                       Family physician

Dr Francois Potgieter                        Clinical manager

Dr Lauren Hutton                               Family physician in MO post

Knysna and Bitou sub-district

Laurel Giddy                                     Family physician

Facilities

Every sub-district has a learning centre with appropriate IT infrastructure to facilitate learning. Surgical skills appropriate for the district hospital are honed to perfection in the local context, as seen here in Knysna hospital.

The following training facilities are included in the Complex. Six registrars work and learn at health centres and clinics associated with these hospitals.

·       George Provincial Hospital (including Department of Family Medicine)

·       Knysna District Hospital

·       Mossel Bay District Hospital

·       Oudtshoorn District Hospital 

·       Beaufort West District Hospital (once a family physician is resident)

Service-learning environment

Registrars usually spend 3-4 years at one of the district hospitals and clinics as part of the local health team, where they grow into the 6 nationally identified roles of the family physician, while keeping the 5 National Unit Standards in mind, via their portfolio of learning, and also work and learn in a primary health care clinic. If necessary, they also spend short periods of a few weeks at George Provincial Hospital in various departments, including family medicine, surgery, anaesthetics, obstetrics and gynaecology, paediatrics, internal medicine, orthopaedics and psychiatry, to acquire competencies not offered in the health sub-district. More common now is that via an extensive outreach and support programme from the George regional hospital to the district hospitals and PHC clinics, registrars join the outreaching colleagues for service and teaching opportunities. There are also medical interns and UCT students on the district platform, trained and supervised by the registrars and family physicians.

Local academic programme

In the Regional Hospital registrars are mentored and supervised by consultants in the relevant department. This is now only occasionally necessary, as almost all training happens in the local sub-district. In the District Hospital registrars are mentored and supervised by the Family Physician. The registrar keeps a learning portfolio, with learning plans, reports on rotations, case-based discussions, direct observations of procedural skills and consultations, and receives feedback from skills demonstrated on a daily basis as the need arises. Registrars are expected to have weekly formal meetings (learning conversations) with their supervisors to establish their learning agenda, monitor progress, present patients and reflect on their communication skills. The group of 6 registrars meet 3-4 monthly, with some of the family physicians and the complex coordinator, to discuss health topics. There are well established and resourced learning centres at Knysna, Mossel Bay and Oudtshoorn district hospitals. See the Ideal Family Medicine Training Complex document signed off by the Chief Director for Rural Health, Dr Crous, of 2018.

Research

The registrars are expected to conduct a research project, relevant to the local district health plan, and publish this as a scientific paper. Please ensure that you are familiar with the district health plan. There is also a Divisional list of research topics available. More than 40 publications have been emanating from this complex, and many projects are ongoing, including via the SUFPREN network. 

Garden Route District office

The registrars are employed at the District Office and not at the facility. This allows them freedom to rotate throughout the complex. Registrars sign a 4-year contract under the agreed terms and conditions of the Province. The following people can be consulted: District manager. District Health Offices, 3rd floor, York Park Building, St John Street, George 6530. The secretary is Ms Sharné Maritz, PA to: Mr Zee Brickels, who is the District Manager – Garden Route/Central Karoo; Tel. (044) 803-2708, Fax (044) 874-7552, E-mail: Alsharnett.Maritz@westerncape.gov.za. For post applications, Ms S. Pienaar is the contact person in HR.

The electronic portfolio of learning in postgraduate workplace-based training and assessment:
The Division of Family Medicine and Primary Health Care is developing an electronic portfolio of learning for postgraduate family medicine registrar training. We are partnering with Scorion, an educational company in the Netherlands, and the health service.
The e-portfolio is used to assess clinical learning in the workplace. The portfolio comprises of evidence of learning over the 4-year registrar period, and consists of learning plans, educational meetings, registrar reflections, supervisors' feedback and assessments, a logbook of procedural skills, and a number of direct observations of consultations, procedures, and teaching events. This is in line with international practice of assessing registrars in the workplace, to increase validity and train doctors more appropriately.

Supporting Family Medicine beyond the Garden Route

Apart from training registrars for family medicine in the Garden Route, we are also actively engaged in the following initiatives:

1. Developing an e-portfolio for national training in family medicine via the College of Family Physicians.

2. Developing Entrustable Professional Activities (EPAs) for national family medicine training via the Academy of Family Physicians.

3. Writing MCQs for the national exit examination for the College of Family Physicians.

4. Examining as external examiner for the MMed at other university programmes, such as UKZN, as well as the MMed in Southern Africa at Moi university (Kenya) and Malawi university.

5. Conduct workshops in medical education and assessment for the African continent via the Primafammed network.

6. Support MMed and PhD students in Africa, including via the AfriWon network.

7. Developing leadership and resilience in healthcare colleagues in liaison with the Stellenbosch 肆客足球 School of Business in partnership with Dr North and Prof Smit, conducting Values-Driven Leadership workshops.

8. Developing a multi-professional rural Palliative Care project in line with the national palliative care vision.

Picture Gallery

A mini-CEX assessment for the College of Family Physicians was done under College exam conditions with two examiners and the local FP supervisor in Knysna district hospital (February 2016). Proffs Bob Mash and Louis Jenkins with Dr Paul Kapp were examining the registrar, Dr Francois Potgieter, in Knysna district hospital OPD.  This registrar is the current clinical manager (2021).

Mossel Bay sub-district (2021): Dr Jaco Botma (clinical manager), Dr Johann Schoevers (family physician), Prof Bob Mash, Dr Kartik Naidoo (registrar), Dr Ts’epo Motsohi, Prof Louis Jenkins (absent: Dr Petra Bouwer)

Knysna sub-district (2021): Dr Francois Potgieter (clinical manager), Dr Andries Brink (medical manager), Dr Laurel Giddy (family physician), Prof Bob Mash, Dr Ts’epo Motsohi, Prof Louis Jenkins (absent: Dr Paul Kapp, Dr Hayden Poulter, Dr Tessa McMillan)

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Oudtshoorn sub-district (2021): Drs Herman Kruger and Milton Groenewald (family physicians), Dr Meghan Vd Linde (registrar), Dr Ts’epo Motsohi, Dr Erhardt Heydenrych (clinical manager), Prof Louis Jenkins, Dr Kobus Venter (registrar), Prof Bob Mash

Dr Poulter, registrar in Knysna hospital, doing a supervised gastroscopy on a patient, with the medical intern also learning.?

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Dr Ts'epo Motsohi, postgraduate program director, in deep conversation with Dr Herman Kruger, family physician in Oudtshoorn hospital.

Dr Petra Bouwer, family medicine registrar in Mossel Bay sub-district, consulting a patient in D'Almeida PHC clinic.

Dr Elmari De Klerk-Green, family physician at George Hospital, with Prof Bob Mash and Dr Ts'epo Motsohi from the Division of Family Medicine and Primary Care at Stellenbosch 肆客足球.