Original Research

Investigating competencies needed by European-trained doctors in rural South African hospitals

James R. Barnacle, Oliver Johnson, Ian Couper
African Journal of Primary Health Care & Family Medicine | Vol 12, No 1 | a2322 | DOI: https://doi.org/10.4102/phcfm.v12i1.2322 | © 2020 James R. Barnacle, Oliver Johnson, Ian Couper | This work is licensed under CC Attribution 4.0
Submitted: 11 December 2019 | Published: 25 August 2020

About the author(s)

James R. Barnacle, Department of Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
Oliver Johnson, Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; and, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
Ian Couper, Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa

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Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.

Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).

Setting: Rural district hospitals in South Africa.

Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.

Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.

Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.


medical education; rural medicine; foreign-qualified doctors; clinical skills; competencies; European-trained doctors


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