Unsupervised interns ‘performing procedures’

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Published Aug 1, 2015

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Cape Town -Interns at South African hospitals are performing surgical procedures without supervision, potentially endangering their patients, according to new study published in the latest South African Medical Journal (SAMJ).

The investigation, “The state of South African internships: A national survey against HPCSA guidelines”, reported that one in every three medical interns polled said they had performed an “interventional or surgical procedure” for the first time – from start to finish – unsupervised during their two-year internship.

The report was written by Eudiet Trollip, a medical officer at Cape Town’s Victoria Hospital, and Summy Bola and Fran Parkinson, both surgical registrars in the UK.

The authors said that guidelines drawn up by the Health Professions Council of South Africa (HPCSA) state that interns should be supervised by a medical practitioner with at least three years of post-internship clinical experience.

This guideline was, however, “frequently” breached.

 

“There was significant failure in providing supervision of interns performing interventional procedures for the first time.

“This has obvious safety implications for the patient, who is receiving an inadequate level of care for procedures that carry the potential for morbidity and mortality,” the authors warned.

They argued that by performing some procedures unsupervised, interns may also learn, and repeat, operational procedures incorrectly.

Some of procedures interns did without supervision included chest drains, lumbar punctures and the administration of local anaesthetics.

Bola told Weekend Argus in an e-mail that the interns at the hospitals in question were “among the most dedicated I have ever worked with”.

The aim of the study, he stressed, was to protect teaching and supervision, so as to encourage these talented professionals to remain in the state health sector here, rather than moving to the private sector or abroad.

The findings are based on 150 questionnaires sent to doctors who had completed their internships at HPCSA-accredited hospitals between 2010 and 2013. They received 90 responses.

Of these, 56 were from medical students in the Western Cape, with 44 responses from Stellenbosch University and 12 from UCT.

Not all hospitals they contacted agreed to distribute the survey.

The anonymous questionnaire was based on the UK’s National General Medical Council training survey.

The authors did not name any hospitals in the study, and referred to their work as an “insight into how HPCSA guidelines are not being met”, rather than an “objective validation of doctor training”.

“As with any survey, self-reported data are subject to recall bias and subjectivity,” they said, but stressed that HPCSA guidelines were often breached.

“Contrary to HPCSA recommendations, over half of the interns reported that they were regularly supervised by a medical practitioner with less than three years’ post-graduation experience.

“In addition, 25.6 percent had experienced an event where they required senior help but the senior was not on the hospital premises.”

Weekend Argus contacted the HPCSA on July 22 for comment, but had received no response by the time of publication on Friday night.

The body indicated late on Friday that it would reply only on Monday.

Spokeswoman Priscilla Sekhonyana said the matter was with the council’s board.

Weekend Argus will reflect the response next weekend.

The study also reported that the majority of interns frequently worked shifts of more than 30 hours, and exceeded the recommended 80 hours of overtime per month.

This was particularly prevalent in surgery, where more than 70 percent of respondents said they worked outside contracted hours at least once or twice a week.

Asked to comment, Health Department spokeswoman Marika Champion said the department strove to “strictly adhere to the guidelines for internship training as published by the HPCSA”.

“Interns at training hospitals perform surgical procedures under the supervision of at least a registrar, and at times of both a registrar and a consultant.”

She said interns were not permitted to perform surgical procedures, or to administer anaesthesia, unsupervised.

In the “unlikely event” that interns would have to perform an operation unsupervised, the onus rested on them to indicate whether they were unable to perform the procedure.

With regard to long working hours, Champion said due to unforeseen absenteeism, “hours will be stretched temporarily due to the demands of service delivery”.

Weekend Argus

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