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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

Inaugural lecture: Prof. Annette Wilkinson
2008-04-16

A strong plea for a pursuit of “scholarship” in higher education

Prof. Annette Wilkinson of the Centre for Higher Education Studies and Development in the Faculty of the Humanities at the University of the Free State (UFS) made as strong plea for a pursuit of “scholarship” in higher education.

She said in her inaugural lecture that higher education has to deal with changes and demands that necessitate innovative approaches and creative thinking when it concerns effective teaching and learning in a challenging and demanding higher education environment. She referred to a recent research report prepared for the Council for Higher Education (CHE) which spells out the alarming situation regarding attrition rates and graduation output in South African higher education and emphasises factors leading to the situation. These factors include socio-economic conditions and shortcomings in the school and the subsequent under preparedness of a very large proportion of the current student population. However, what is regarded as one of the key factors within the sector’s control is the implementation of strategies for improving graduate output.

She said: “The CHE report expresses concern about academics’ adherence to traditional teaching practices at institutions, which have not changed significantly to make provision for the dramatic increase in diversity since the 1980s.

“Raising the profile of teaching and learning in terms of accountability, recognition and scholarship is essential for successful capacity-building,” she said. “The notion of scholarship, however, brings to the minds of many academics the burden of ‘publish or perish’. In many instances, the pressures to be research-active are draining the value put on teaching. Institutions demand that staff produce research outputs in order to qualify for any of the so-called three Rs – resources, rewards and recognition.

“These have been abundant for research, but scarce when it comes to teaching – with the status of the latter just not on the same level as that of research. From within their demanding teaching environments many lecturers just feel they do not have the time to spend on research because of heavy workloads, that their efforts are under-valued and that they have to strive on the basis of intrinsic rewards.”

She said: “It is an unfortunate situation that educational expertise, in particular on disciplinary level, is not valued, even though in most courses, as in the Programme in Higher Education Studies at the UFS, all applications, whether in assignments, projects or learning material design, are directly applied to the disciplinary context. We work in a challenging environment where the important task of preparing students for tomorrow requires advanced disciplinary together with pedagogical knowledge.”

Prof. Wilkinson argued that a pursuit of the scholarship of teaching and learning holds the potential of not only improving teaching and learning and consequently success rates of students, but also of raising the status of teaching and recognising the immense inputs of lecturers who excel in a very demanding environment. She emphasised that not all teaching staff will progress to the scholarship level or are interested in such an endeavour. She therefore suggested a model in which performance in the area of teaching and learning can be recognised, rewarded and equally valued on three distinct levels, namely the levels of excellence, expertise and scholarship. An important feature of the model is that staff in managerial, administrative and support posts can also be rewarded for their contributions on the different levels for all teaching related work.

Prof. Wilkinson also emphasised the responsibility or rather, accountability, of institutions as a whole, as well as individual staff members, in providing an environment and infrastructure where students can develop to their full potential. She said that in this environment the development of the proficiency of staff members towards the levels of excellence, expertise and scholarship must be regarded as a priority.

“If we want to improve students’ success rates the institution should not be satisfied with the involvement in professional development opportunities by a small minority, but should set it as a requirement for all teaching staff, in particular on entry into the profession and for promotion purposes. An innovative approach towards a system of continuous professional development, valued and sought after, should be considered and built into the institutional performance management system.”

As an example of what can be achieved, Prof. Wilkinson highlighted the work of one of the most successful student support programmes at the UFS, namely the Career Preparation Programme (CPP), implemented fourteen years ago, bringing opportunities to thousands of students without matric exemption. The programme is characterised by dedicated staff, a challenging resource-based approach and foundational courses addressing various forms of under preparedness. Since 1993 3 422 students gained entry into UFS degree programmes after successfully completing the CPP; since 1996 1 014 of these students obtained their degrees, 95 got their honours degrees, 18 their master’s degrees and six successfully completed their studies as medical doctors.

Prof. Wilkinson said: “I believe we have the structures and the potential to become a leading teaching-learning university and region, where excellence, expertise and scholarship are recognised, honoured and rewarded.”

 

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