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18 August 2025 | Story André Damons | Photo André Damons
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

UFS research sheds light on service delivery protests in South Africa
2015-01-23

UFS research sheds light on service delivery protests in South Africa

Service delivery protests in the country have peaked during 2014, with 176 major service delivery protests staged against local government across South Africa.

A study by the University of the Free State (UFS) found that many of these protests are led by individuals who previously held key positions within the ANC and prominent community leaders. Many of these protests involved violence, and the destruction had a devastating impact on the communities involved.

This study was done by Dr Sethulego Matebesi, researcher and senior lecturer at the UFS. He focused his research on the dynamics of service delivery protests in South Africa.

Service delivery protests refer to the collective taken by a group of community members which are directed against a local municipality over poor or inadequate provision of basic services, and a wider spectrum of concerns including, for example, housing, infrastructural developments, and corruption.

These protests increased substantially from about 10 in 2004 to 111 in 2010, reaching unprecedented levels with 176 during 2014.

The causes of these protests are divided into three broad categories: systemic (maladministration, fraud, nepotism and corruption); structural (healthcare, poverty, unemployment and land issues); and governance (limited opportunities for civic participation, lack of accountability, weak leadership and the erosion of public confidence in leadership).

In his research, Dr Matebesi observed and studied protests in the Free State, Northern Cape and the North-West since 2008. He found that these protests can be divided into two groups, each with its own characteristics.

“On the one side you have highly fragmented residents’ groups that often use intimidation and violence in predominantly black communities. On the other side, there are highly structured ratepayers’ associations that primarily uses the withholding of municipal rates and taxes in predominantly white communities.”

 

Who are the typical protesters?

Dr Matebesi’s study results show that in most instances, protests in black areas are led by individuals who previously held key positions within the ANC - prominent community leaders. Generally, though, protests are supported by predominantly unemployed, young residents.

“However, judging by election results immediately after protests, the study revealed that the ANC is not losing votes over such actions.”

The study found that in the case of the structured ratepayers’ associations, the groups are led by different segments of the community, including professionals such as attorneys, accountants and even former municipal managers.

Dr Matebesi says that although many protests in black communities often turned out violent, protest leaders stated that they never planned to embark on violent protests.

“They claimed that is was often attitude (towards the protesters), reaction of the police and the lack of government’s interest in their grievances that sparked violence.”

Totally different to this is the form of peaceful protests that involves sanctioning. This requires restraint and coordination, which only a highly structured group can provide.

“The study demonstrates that the effects of service delivery protests have been tangible and visible in South Africa, with almost daily reports of violent confrontations with police, extensive damage to property, looting of businesses, and at times, the injuring or even killing of civilians. With the increase of violence, the space for building trust between the state and civil society is decreasing.”

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