‘Rookie doctors doing surgery’ – doctor-body responds

2 August 2015

The survey which concludes that one in three South African medical interns canvassed are performing relatively minor interventional or surgical procedures without supervision is based on a small sampling and has a debatable methodology – but professional introspection is required.

This was the response yesterday from the 17 500 doctor-member South African Medical Association, (SAMA), to weekend reports that Health Professions Council of South Africa (HPCSA) guidelines stating that interns should be supervised by a medical practitioner with at least three years of post-internship experience were being ‘frequently flouted’. Over half of the interns surveyed reported that they were regularly supervised by a medical practitioner with less than three years of experience.

More than a quarter had required help from a senior but the senior had not been on the hospital premises. The study, published in the latest edition of the South African Medical Journal, (SAMJ), argued that this lack of supervision not only potentially endangers patients but results in interns learning and repeating procedures incorrectly.

Uncomplicated procedures singled out

Vice-Chairman of SAMA, Dr Mark Sonderup, said most of the survey’s 90 responses (from doctors who had completed their internships at HPCSA-accredited hospitals between 2010 and 2013) covered fairly uncomplicated procedures taught to senior medical students. 

‘Procedures like lumbar punctures, putting up drips and using local anaesthesia are not complex.  They really form part of the ‘’see one, do one, teach one’ principle in Medicine.  So, one must separate out what falls into a more basic skill attained during medical school training and an actual ‘procedure’ that needs supervision and a greater degree of skill.  Here interns possibly are being let down,’ he conceded.

He said of the survey responses, more than two-thirds were from three Universities, possibly skewing the data while the study itself was methodologically open to critique’. He explained that it would perhaps have been more helpful had the survey been broken down into responses from who had done an internship in a central versus regional hospital or an urban versus a more rural facility.

While the sample was small, it nevertheless raised the important issue of a perceived lack of senior support which was ‘an inward-looked professional issue that SAMA must deal with’.  SAMA and the Profession had an ethical duty to train the next generation of doctors correctly. Sonderup said that on the plus side, the study, (based on the UK’s National General Medical Council training survey), also highlighted many positives about South Africa’s internships, including their preparedness for Internship, support from medical officers, registrars and access to academic teaching.

Elaborating on why he thought the weekend newspaper article sensationalised the issue, Sonderup said; ‘for example as an intern I had to learn to do more highly skilled procedures such as placing a central venous line (needs a greater technical skill), dealing with new-borns, being taught to do a circumcision, caesarean sections, reducing a dislocated joint and so on.

These are important skills that must be taught and learnt.  If this is where it’s failing then it must be addressed’. The newspaper report however failed to properly distinguish between these types of procedures and lesser routine techniques.

Interns cautioned

He reassured the public that, taken as a whole, the training of doctors in South Africa remained very good. Sonderup cautioned interns that they should never feel duty-bound to tackle something they felt they could not do. ‘If they do – unless the clinical situation demands it – then they are being unnecessarily enthusiastic,’ he added.

While there was a serious shortage of doctors and specialists in South Africa, the issues raised by the survey were multi-factorial in nature and it would “simplistic’ to solely attribute the problem to shortages of staff.

Statement issued by Dr Mark Sonderup, Vice Chairperson: SAMA, August 2 2015