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Prof Hanneke Brits
Prof Gert van Zyl, Dean for the Faculty of Health Sciences, Prof Hanneke Brits, a family medicine specialist at the Free State Department of Health, as well as the Department of Family Medicine at the University of the Free State (UFS), Prof Anthea Rhoda, Deputy Vice-Chancellor: Academic, and Prof Nicholas Pearce, Head of the School of Clinical Medicine before the inaugural lecture.

Universities have an obligation to ensure that their assessments are sound and defendable when they confer degrees for professional qualifications, such as in medicine. Can institutions confidently defend these results and what are the implications if they pass a student who is not competent?

These were some of the questions Prof Hanneke Brits, a family medicine specialist at the Free State Department of Health, as well as the Department of Family Medicine, at the University of the Free State (UFS), addressed during her inaugural lecture on Tuesday (12 August). The UFS, she concluded at the end of her lecture, titled To pass or not to pass: Can we confidently defend the outcome of our assessments? can defend its clinical assessments with the implementation of effective workplace-based assessment and trained examiners. 

 

The implications of passing incompetent students 

According to Prof Brits, who has supervised numerous undergraduate and postgraduate student research projects, she chose this topic because decisions have consequences. She gave an overview of the assessments in the clinical years of the undergraduate medical programme. In so doing, she also answered other questions including what may happen when universities pass students who are not competent and what may happen if they fail competent students. When the university passed a candidate, she said, that candidate may register with a professional body like the Health Professions Council of South Africa to work as a doctor. 

“What are the implications if we fail to fail a student who is not competent? The implications are that patients may suffer if they are treated by an incompetent doctor, which may lead to the doctor running into trouble if it is found that their work is not up to standard. This may further lead the faculty being labelled as poor for training substandard doctors. 

“The throughput rate of the university may go down and the university may not get subsidy for the students. The student must repeat his module with a lot of emotional and financial burden. They public may suffer because there are not enough healthcare professionals to treat them. Therefore, we must get this right,” she said. 

When assessing students, assessors should start at the bottom: students should know, then they should know how, then they should show how and then they must do. All assessments should meet the basic requirements of validity, reliability, fairness, educational impact and feasibility, explains Prof Brits. 

 

Workplace-based training and assessment

During her PhD study, she looked specifically at assessments in the clinical years of the undergraduate medical programme. “It is quite complicated,” said Prof Brits, “to do assessment for professional qualifications as you need to obey to the rules and regulations of the Department of Education, the Department of Health, the Health Professions Council of South Africa, the Colleges of Medicine of South Africa because they are our examining body, as well as our own university rules and international assessment guidelines and best practices.” 

She compiled a framework to measure what they do at the UFS and found that the decision reliability was excellent – meaning the students that passed during the year passed at the end of the year and those that failed, failed. The reliability of some of the methods used for the final assessment was not good, however, if more assessments with supplementary exams were included, it was better. 

The conclusion of her study was that the UFS mostly complied with the regulations of the regulatory bodies. The recommendation from this study was to implement workplace-based assessment (WBA) to improve both the validity and reliability of assessments and to make it more defendable. Prof Brits explained that WBA is where students get regular assessment and feedback while they work and receive training in hospitals or clinics. “For example, the student is seeing a patient in the emergency department who was stabbed with a knife on his hand. Is the student able to assess the severity, can the student manage the wound and what about follow-up? 

“The advantage of WBA is that we train in real life situations and manage conditions that occur commonly. In real life situations, students use many senses while learning, e.g., seeing, hearing, touching, smelling, which all enhance knowledge retention. It is important that students receive feedback and that we document these encounters. To ensure a holistic approach to the management of patients we use Entrustable Professional Activities or EPAs – something that I can trust a person to do. It is a combination of knowledge, skills and attitudes.”

News Archive

Is milk really so well-known, asks UFS’s Prof. Osthoff
2011-03-17

Prof. Garry Osthoff
Photo: Stephen Collett

Prof. Garry Osthoff opened a whole new world of milk to the audience in his inaugural lecture, Milk: the well-known (?) food, in our Department of Microbial, Biochemical and Food Biotechnology of the Faculty of Natural and Agricultural Sciences.

Prof. Osthoff has done his research in protein chemistry, immuno-chemistry and enzymology at the Council for Scientific and Industrial Research (CSIR) in Pretoria and post-doctoral research at the Bowman-Grey School of Medicine, North Carolina, USA. That was instrumental in establishing food chemistry at the university.
 
He is involved in chemical aspects of food, with a focus on dairy science and technology. He is also involved in the research of cheese processing as well as milk evolution and concentrated on milk evolution in his lecture. Knowledge of milk from dairy animals alone does not provide all the explanations of milk as food.
 
Some aspects he highlighted in his lecture were that milk is the first food to be utilised by young mammals and that it is custom-designed for each species. “However, mankind is an opportunist and has found ways of easy access to food by the practice of agriculture, where plants as well as animals were employed or rather exploited,” he said.
 
The cow is the best-known milk producer, but environmental conditions forced man to select other animals. In spite of breeding selection, cattle seem not to have adapted to the most extreme conditions such as high altitudes with sub-freezing temperatures, deserts and marshes.
 
Prof. Osthoff said the consumption of the milk as an adult is not natural; neither is the consumption of milk across species. This practice of mankind may often have consequences, when signs of malnutrition or diseases are noticed. Two common problems are an allergy to milk and lactose intolerance.
 
Allergies are normally the result of an immune response of the consumer to the foreign proteins found in the milk. In some cases it might help to switch from one milk source to another, such as switching from cow’s milk to goat’s milk.
 
Prof. Osthoff said lactose intolerance – the inability of adult humans to digest lactose, the milk sugar – is natural, as adults lose that ability to digest lactose. The symptoms of the condition are stomach cramps and diarrhoea. This problem is mainly found in the warmer climates of the world. This could be an indication of early passive development of dairy technology. In these regions milk could not be stored in its fresh form, but in a fermented form, in which case the lactose was pre-digested by micro-organisms, and the human population never adapted to digesting lactose in adulthood.
 
According to Prof. Osthoff, it is basically the lactose in milk that has spurred dairy technology. Its fermentation has resulted in the development of yoghurts and all the cheeses that we know. In turn, the intolerance to lactose has spurred a further technological solution: lactose-free milk is currently produced by pre-digestion of lactose with enzymes.
 
It was realised that the milks and products from different species differed in quality aspects such as keeping properties and taste. It was also realised that the nutritional properties differed as well as their effects on health. One example is the mentioned allergy against cow’s milk proteins, which may be solved by the consumption of goat’s milk. The nutritional benefits and technological processing of milk aroused an interest in more information, and it was realised that the information gained from human milk and that of the few domesticated species do not provide a complete explanation of the properties of milk as food. Of the 250 species of milk which have been studied, only the milk of humans and a few domesticated dairy animals has been studied in detail.

Media Release
15 March 2011
Issued by: Lacea Loader
Director: Strategic Communication
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: news@ufs.ac.za

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