Perceptions of postgraduate family medicine supervision at decentralised training sites, South Africa

Abstract

Background: Specialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa. The strong emphasis on workplace-based learning for speciality training makes it vital to gain in-depth insights into registrar supervision. Previous studies have explored aspects of supervision at decentralised sites in high-income countries, however, little is known about the benefits and constraints of decentralised postgraduate supervision in low- to middle-income countries, especially in Africa.

Aim: This study aimed to explore family physicians' and registrars' perceptions of the strengths and challenges of clinical and educational supervision across decentralised training sites.

Setting: The study was conducted across two provinces at five decentralised training sites affiliated with the University of the Witwatersrand, Johannesburg.

Methods: This qualitative study involved semi-structured interviews with a purposive sample of 11 FPs and 11 registrars. The data were thematically analysed.

Results: Two of the four themes identified, 'supervision is context-specific and supervisor-dependent', and 'the nature of engagement matters', involved strengths and challenges. The other two, 'supervision is not ideal' and 'the training environment is challenging', focussed on challenges.

Conclusion: Supervisors and registrars described the postgraduate FM supervision as context-specific and supervisor-dependent. Supervisors displayed good clinical-teacher characteristics and supervisory relationships. However, several challenges, including registrars' workload, resource shortages and a lack of standardisation across training sites, need to be addressed. Regular faculty development is essential for supervisors to be aware of relevant aspects of, and current trends in, postgraduate training.

Keywords: clinical supervision; decentralised clinical training; educational supervision; family medicine registrar; family physician; postgraduate training; workplace-based learning.