Clinical Medical Practice (BCMP) - Wits University

CLINICAL ASSOCIATE: SCOPE OF PRACTICE

The training of Clinical Associates takes a period of three years and a Bachelor of Clinical Medical Practice (BCMP) degree qualification is awarded thereafter. The qualified Clinical Associates are to be registered with the Health Professions Council of South Africa with a defined scope of practice.

The Clinical Associate is a competent, professional member of the health care team with the necessary knowledge, skills and attitude to function effectively in the healthcare system in South Africa, working with and under the supervision of a qualified medical practitioner. The Clinical Associate may work in a public hospital or clinic, in a private hospital or private practise, for a non-governmental organisation providing health care, under the supervision of a doctor. The Clinical Associate will not function as an independent professional, and in any uncertainty will consult with the supervising doctor. Teamwork and communication skills are therefore critical.

The Clinical Associate��s practice shall 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 when such service is within the Clinical Associate��s scope of practice, forms a component of the doctor��s scope of practice, and is provided with supervision by a doctor. Clinical Associates will thus be considered the agents of their supervising doctors in the performance of all practice-related activities including the ordering of diagnostic, therapeutic, and other medical services. Clinical Associates can not open their own private medical practice, but can provide medical care in the public and private health care setting under the supervision of a medical practitioner.

The Clinical Associate��s scope of practice is defined by the context and requirements of practice setting with particular focus on:

Emergency Care
Outpatient care
Inpatient Care
Skilled Procedures

Medical services provided by the Clinical Associate may include, but are not limited to:

Obtaining a patient history and performing physical examinations
Ordering and/or performing diagnostic and therapeutic procedures
Interpreting findings and formulating a diagnosis for common and emergency conditions
Developing and implementing a treatment plan
Monitoring the effectiveness of therapeutic interventions
Assisting at surgery
Offering counselling and education to meet patient needs
Making appropriate referrals

The Clinical Associate will primarily function in the generalist domain, but this does not prevent advanced medical practice in particular areas with additional training (such as in emergency medicine, obstetrics, paediatrics, anaesthetics, surgery and psychiatry).

The Clinical Associates are to assist doctors and the healthcare team in hospitals, clinics and private practice in rural and urban areas. They are to work closely in a team with the doctor, nurses and other health care staff, under supervision of the doctor and are not replacing the doctor as independent workers. The district hospital is an ideal location for employment since there are few doctors and the workload is extremely high; the clinical associates will be most effective in this setting given their skills and competence. Clinical Associates also work in community health centres, clinics, non-governmental organisations providing health care, and for private doctor��s rooms and private clinics.

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 the Clinical Associate cannot make an assessment and plan, information gathered from the initial consultation should be clearly communicated to the supervising doctor so that together they can make an assessment and plan.

TEACHING AND LEARNING

The BCMP course structure is based on the principle of developing a sound knowledge of the medical and clinical sciences to enable you to understand medical conditions and management strategies. You will be expected to have detailed knowledge of science in areas related to the performance of procedures.

Didactic teaching will take place in the classroom as well as the district hospitals and will usually be by family practitioners, clinical associates and lectures from various departments.
Clinical skills are taught first in the clinical skills lab and classroom then performed under supervision in the district hospitals for competency.
The medical, clinical and behavioural sciences form the basis of learning and are integrated into the clinical teaching; emphasis is placed on development of skills needed to carry out clinical procedures.
Relevant scenarios of patients likely to be encountered by the clinical associate are key components; teaching is patient centred; emphasis on personal learning and clinical practice.
A clinical problem solving process is introduced; it includes medical and clinical sciences and forms the foundation for teaching, learning and evaluation.
Emphasis is placed on independent, self-directed learning.

The programme is organised into three courses, one course per year of study, designed to produce the defined outcomes. The spiral arrangement in which materials are delivered in year one and continued in year two and three, reinforces what is learnt previously and introduces new information at a deeper or higher level at an appropriate stage.

The programme consists of three courses, one to be taken in each year of the three years of study. The first year provides a scientific foundation which will be used for the integrated study of all the organ systems of the body. The second year continues this process for different stages of life with focus on common, chronic and acute medical conditions that are seen in the district hospitals. The third year develops the role of the Clinical Associate in the hospital and community.

First year SCMD1001: Fundamentals of Medical and Clinical Science. The Individual.
Second year SCMD2001: Fundamentals of Clinical Medical Practice. The Family.

The first year presents biomedical and clinical sciences in the context of the systems of the human body and the response to disease.

The systems are considered in terms of homeostasis, causes of disease, body defences, endocrine function, respiration, circulation, metabolism, nutrition, movement, excretion, reproduction, nervous response, and psychosocial function incorporated throughout the year.

The principles of therapy, pharmacology, emergency response, clinical practice, professional and legal practice, ethics, counselling and communication are incorporated throughout the three year programme

The courses incorporate both didactic classroom learning and direct clinical experience with introduction to patient care from the beginning of the first year course.

The first year teaching is mainly at Wits Medical School, with one day per week at a local district hospital (South Rand District Hospital in Rosettenville or Bertha Gxowa District Hospital in Germiston). Transport to these hospitals will be provided from Wits Medical School.

All of the processes and principles initiated in the first year are applied to the study of prevalent and important clinical problems through the different stages of life. The focus turns to pathophysiology, understanding of disease, with the assessment and management of acute, common and chronic diseases in Adult Male and Female, Adolescent and Child. Further demonstration of appropriate attitudes and performance of relevant procedures are developed. The year is a combination of didactic learning and direct clinical experience.

In second year, theory is taught at the Wits Medical School and clinical teaching is done at local hospitals, namely: South Rand District Hospital, Bertha Gxowa District Hospital, Kopanong District Hospital, , Bheki Mlangeni District Hospital Thelle Mogoerane Regional Hospital and Tambo Memorial Regional Hospital. After hours clinical work is a requirement which includes nights and weekends.

Third year SCMD3003: Applied Clinical Medical Practice. The Hospital and the Community.

The course focuses on the hospital and community. The processes, skills and attitudes developed in the previous years are applied to the roles of the Clinical Associate in these environments. The student will engage in assigned clinical rotations (Internal Medicine, Surgery, Paediatrics, Emergency, Obstetrics and Gynaecology and Mental Health) and one elective rotation, in various district hospitals and tertiary teaching hospitals in Gauteng or North West provinces. After hours clinical work is a requirement, including nights and weekends.

The main method of teaching will be tutorial-based small group learning. Clinical problems will be used as triggers for learning and there will be both horizontal and vertical integration. Patient presentations, bedside teaching, expert resource sessions, practical skill sessions, seminars and ward rounds will supplement the learning.

All students are required to have an Android tablet which will be used extensively in the classroom and at clinical sites. An amount for the tablet is charged on your tuition fee account, but will be reversed for those students who have their own tablet.

All course material will be available via the Wits eLearning website. Most of the required textbooks will be available as eBooks or electronic study guides Basic medical equipment is required during the study including, blood pressure cuff, stethoscope, patella hammer, otoscope, tourniquet and safety glasses.

Prior university coursework is not provided credit for advanced entry into the BCMP degree. Nor are credits transferred during or after the BCMP degree to another degree. Given the nature of the integrated, spiral curriculum there is no separate biology, physics or chemistry course. These subjects are integrated into the programme of study as relevant for obtaining understanding and competence for medical practice, but are not transferable credits to another degree.

Student wishing to pursue a medical degree are recommended to apply to a medical programme or appropriate undergraduate science related degree for entry into a medical or bridge degree, such as the Wits Graduate Entry Medical Programme (GEMP). The BCMP undergraduate degree is not designed as an entry degree to GEMP.

For information about applying and the minimum entry requirements for the BCMP undergraduate programme, please click (here)

For more information about the BCMP programme, please contact the Division of Clinical Associates administrator, Ndivhuwo Nengwekhulu at ndivhuwo.nengwekhulu@wits.ac.za or call 0117172024.

GRADUATE OUTCOMES

BCMP Exit Level Outcome	Associated assessment criteria
1. Perform a patient-centred consultation across all ages in a district hospital.	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.
2. Apply clinical reasoning in the assessment and management of patients.	High-risk situations and conditions in patients are timeously identified and appropriate action taken. Hypotheses (differential diagnoses)are made from information obtained . Collaboration with the patient occurs in all aspects of the consultation to include but not limited to initial and follow-up patient assessment, discussion of differential diagnoses and discussion of diagnostic and/or therapeutic options. Assessment based on information gathered from the patient (history, physical examination, investigation results) is made. Assessment is contextualised within the bio-psycho-social model including preventive, promotive, curative and rehabilitative aspects. The Management plan is based on the assessment and includes appropriate referrals e.g. rehabilitation. The Assessment and Management plan is reviewed on an ongoing basis by both the multidisciplinary medical team and adjusted accordingly. Special investigations obtained by the multidisciplinary medical team are guided by information needed to confirm or reject a hypothesis. Assessment and management decisions take cost effectiveness into consideration. The results of relevant special investigations in common conditions are interpreted by the Clinical Associate in consultation with the supervising doctor. The assessment and management plan is presented to the supervising doctor and justified on the basis of information obtained.
3. Perform investigative and therapeutic procedures appropriate for a district hospital.	The procedure is explained/described in lay and medical terms. Indications and contra-indications for a specific procedure are listed. The ability to prepare for a procedure, including patient preparation, is demonstrated. The procedure is competently demonstrated. Possible complications for the procedure are explained. Follow-up and safety-netting following the procedure are explained.
4. Prescribe appropriate medication within scope of practice.	Demonstrate knowledge in basic pharmacology Knowledge of standard treatment guidelines and the drugs in the Essential Drug List appropriate for district hospitals, including indications, contra-indications, side effects and drug interactions are demonstrated and applied in common and important conditions. Prescriptions including dosage and frequency are written correctly to comply with legal requirements and scope of practice. 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.
5. Provide emergency care.	Potentially life-threatening conditions in patients are timeously identified, evaluated and acted upon. Emergency conditions are managed and referred appropriately.
6. Facilitate communication and provide basic counselling.	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 addressing the patient��s needs are demonstrated. Appropriate solutions are explored. Mutual decision-making is facilitated. Continual support and follow-up is provided.
7. Function as an effective member of the health care team.	Understanding of the roles, functions and relationships of all the members of the district hospital team are demonstrated. Enhancing team functioning through appropriate attitude and behaviour as team member or substitute team leader is demonstrated. Clinical information from patients is clearly and concisely communicated to the other team members (doctor in particular). Reports on patients are appropriately handed over to colleagues.
8. Produce and maintain clinical records.	Patient records and medico-legal forms reflect all relevant information accurately and legibly. Patient referral letters are answered and completed appropriately. Patient statistics are accurately completed.
9. Function as an ethical practitioner.	The role and function of a clinical associate is explained to the patient by the CA. The basic ethical principles are applied. The Batho Pele principles are applied at all times in the work situation. Ethical problems are recognised and managed appropriately, and referred when necessary. Statutory and professional obligations are complied with. Appropriate and sensitive attitudes to patient, family, communities and colleagues are demonstrated. Reliability in work situations is demonstrated.
10. Demonstrate ongoing learning in clinical practice.	Professional strengths and weaknesses are identified by reflecting on clinical practice by reviewing patient medical records and/or reviewing success or failure of a medical intervention. Clinical practice is continually improved based on identified needs through appropriate self-directed learning.
11. Integrate understanding of family, community and health system in practice.	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 drawn up 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 and organisations. Range: Team members include but are not limited to pastors, traditional healers. Organisations include but are not limited to NGOs, hospices, crisis care facilities. Awareness of and appropriate involvement in local community oriented primary care is demonstrated by means but not limited to involvement in a community-based project. Understanding of quality improvement cycle or process is demonstrated by participating in quality improvement activities. The principles and practice of comprehensive primary health care as it affects individuals, families and communities are understood & appropriately dealt with. Range: Principles and practice of comprehensive primary health care includes but is not limited to, water, sanitation, nutrition, housing, pollution, personal health care, health programmes

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Bachelor of Clinical Medical Practice (BCMP)

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