Understanding of ‘generalist medical practice’ in South African medical schools

Abstract

Background: In South Africa, medical students are expected to have acquired a generalist competence in medical practice on completion of their training. However, what the students and their preceptors understand by ‘generalist medical practice’ has not been established in South African medical schools.

Aim: This study aimed to explore what the students and their preceptors understood by ‘generalist medical practice’.

Setting: Four South African medical schools: Sefako Makgatho Health Sciences University, University of KwaZulu-Natal, Walter Sisulu University and the University of the Witwatersrand.

Methods: The exploratory descriptive qualitative design was used. Sixteen focus group discussions (FGDs) and 27 one-on-one interviews were conducted among students and their preceptors, respectively. Participants were recruited through purposive sampling. The inductive and deductive data analysis methods were used. The MAXQDA 2020 (Analytics Pro) software was used to arrange data, yielding 2179 data segments.

Results: Ten themes were identified: (1) basic knowledge of medicine, (2) first point of contact with all patients regardless of their presenting problems, (3) broad field of common conditions prevalent in the community, (4) dealing with the undifferentiated patient without a diagnosis, (5) stabilising emergencies before referral, (6) continuity, (7) coordinated and (8) holistic patient care, necessitating nurturance of doctor–patient relationship, (9) health promotion and disease prevention, and (10) operating mainly in primary health care settings.

Conclusion: The understanding of ‘generalist medical practice’ in accordance with internationally accepted principles augurs well in training undergraduate medical students on the subject. However, interdepartmental collaboration on the subject needs further exploration.

Contribution: The study’s findings can be used as a guide upon which the students’ preceptors and their students can reflect during the training in generalist medical practice.