Browsing by Author "Burch, V C"

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    Open Access
    Formative assessment promotes learning in undergraduate clinical clerkships
    (2006) Burch, V C; Seggie, J L; Gary, N E
    Introduction. Clinical clerkships, typically situated in environments lacking educational structure, form the backbone of undergraduate medical training. The imperative to develop strategies that enhance learning in this context is apparent. This study explored the impact of longitudinal bedside formative assessment on student learning in a medical clerkship. Methods. We studied a class of 4th-year students completing a 14-week medical clerkship at the University of Cape Town in South Africa. Clinician educators assessed student performance during weekly bedside teaching sessions using blinded patient encounters (in which students had no prior knowledge of the patient’s diagnosis or access to the clinical records). Student feedback was standardised using performance rating scales. The impact of formative assessment on student learning was determined from questionnaire responses. Results. A total of 575 formative assessments took place during the study period. Students perceived blinded patient encounters to be a valuable learning activity that improved their clinical reasoning skills and assessed progress fairly. They reported that feedback helped inform them of their level of competence and learning needs, motivated them to read more, and significantly improved their participation in patient-centred learning activities. Participating clinicians agreed that this formative assessment strategy enhanced the learning potential of bedside teaching sessions. Conclusions. Longitudinal formative assessment, using blinded patient encounters, was successfully integrated into undergraduate clerkship bedside teaching. According to both students and staff this assessment strategy enhanced bedside learning and improved student participation in patientcentred learning activities during the clerkship.
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    Open Access
    Hyperglycaemic emergency admissions to a secondary level hospital in South Africa – an unnecessary financial burden
    (2007) Pepper, D J; Levitt, N S; Cleary, S; Burch, V C
    Background and objectives. Diabetes affects approximately 1 million South Africans. Hospital admissions, the largest single item of diabetes expenditure, are often precipitated by hyperglycaemic emergencies. A recent survey of a 200- bed hospital, serving approximately 1.3 million Cape Town residents, showed that hyperglycaemic emergencies comprised 25.6% of high-care unit admissions. A study was undertaken to determine the reasons for, and financial cost of, these admissions. Methods. All hyperglycaemic admissions during a 2-month period (1 September - 31 October 2005) were surveyed prospectively. Admissions were classified using the American Diabetes Association classification of hyperglycaemic emergencies. Demographic data, and the reason for, duration of and primary outcome of admission, were recorded. The following costs per admission were calculated using public sector pricing: (i) total costs; (ii) patient-specific costs; (iii) no patient- specific costs; and (iv) capital costs. Results. Sepsis (36%), non-compliance with therapy (32%) and a new diagnosis of diabetes (11%) were the predominant reasons for admission of 53 hyperglycaemic emergency cases. Mean duration of hospital stay was 4 days, with an in-hospital mortality of 7.5%. Mean cost per admission was R5 309. Clinical staff (25.8%), capital (25.6%) and overhead (34%) costs comprised 85.4% of expenditure. Discussion and recommendations. Hyperglycaemic admissions, costing more than R5 300 per patient, represent a health burden that has remained unchanged over the past 20 years. Urgently required primary care preventive strategies include early diagnosis of diabetes, timely identification and treatment of precipitating causes, specifically sepsis, and education to improve compliance.
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    Rational planning for health care based on observed needs
    (2006) Burch, V C; Benatar, S R
    A major challenge facing health care services worldwide is the need to deliver services appropriate to local community needs. In South Africa, the Department of Health has adopted the District Health System1 as the vehicle to deliver comprehensive health care to an estimated 84%2 of South Africans who do not have private health insurance. Within each health care district, community-based and hospital-based services are to be provided. District hospitals are to play a pivotal role in supporting ambulatory primary care services as well as providing a gateway to specialist health care at regional hospitals and highly specialised care (sub-specialist level) at tertiary hospitals. Documents outlining district and regional hospital service packages1,3 emphasise the need for appropriate packages of care, informed by feedback from service providers at the various levels of service delivery. To date, feedback based on systematic evaluation of service provision is limited.