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Department of Medicine, Faculty of Medicine & Health Sciences, Stell. Univ.

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Policy on Supernumerary Registrars

POLICY ON SUPERNUMERARY REGISTRARS

The Department of Medicine has played a pioneering role in the Faculty in making specialist training available to clinicians from other developing countries, thus satisfying a great international need. The training of supernumerary registrars affords the Department an opportunity to employ additional staff both in General Internal Medicine and the specialist units. Currently, the majority of these supernumerary registrars are non-South African citizens who are either self-funded or sponsored by their respective countries. This programme thus allows the Department to train these clinicians contributing to the dispersal of clinical skills and knowledge especially in sub-Saharan Africa, in line with the OSP of the Stellenbosch University.  The programme has been running successfully for several years but better planning and governance is required to ensure that the programme runs effectively and smoothly and addresses the needs of candidates and the Department while maintaining the high standards for which the Department is known.  The appointment of individuals to registrar positions within the Department will be done using the following guidelines.

Appointment

  1. A candidate wishing to join the Department as a registrar must be registered as a qualified medical practitioner in his/her own country. In the case of individuals applying to work in special units, qualification as a specialist in their own country is a requirement.
  2. All individuals must undergo an interview by a panel constituted by the Departmental Head. This panel will be racially and gender balanced and must have a representative of the Committee for Postgraduate Affairs.
  3. All candidates must complete an accredited language proficiency test. The current recommended test is the IELTS and a minimum score of 7.0 should be attained. A lower score of 6.5 may be tolerated if the interview panel is otherwise satisfied of the candidate’s language proficiency. 
  4. All supernumerary registrars must prove that they are able to sustain themselves financially for the period of their studies. 
  5.  All candidates must satisfy statutory requirements to reside and work/study in South Africa.
    1. They may only start once their HPCSA registration is official. (This may take several months.)
  6. All candidates appointments must be approved by Tygerberg Hospital management.
  7. All candidates must register with Stellenbosch University as postgraduate students. 
  8. All successful candidates will receive letters of appointment and will be required to sign a contract with the Department.

Orientation

  1. All candidates must be allowed a period of orientation:
    1. Day 1 orientation - taken to all the departments to get an idea of the hospital and who is involved.
    2. Also Day 1 - Link them to a Mentor.
    3. First 2 months in GIM firm with a South African registrar who can facilitate the supernumerary to familiarize themselves with the hospital and systems.
    4. Then 3rd month in A5 High Care as extra to assist in learning technical skills.
    5. Excuse from after-hour calls for the first month. Thereafter they do calls in the GIM firm they are in.

Allocation 

  1. All supernumerary registrars in the specialist units will be considered to be “additional” in the areas where they working. 
  2. All appointments in General Internal Medicine will be as Medical Officers for the probationary period. At the end of the period subject to a satisfactory report, candidates will join the registrar rotation. This may occur at 3 months if the report is satisfactory. From the period of appointment as a registrar the candidate will be required to fulfill all the academic requirements of our own registrars, including the College of Medicine examinations (Part 1 & 2), logbook and research assignment requirements.
    1. Research methodology course recommended to assist with MMed project
  3. The candidates will spend 9 months in General Internal Medicine first, after which they will be allowed to rotate through the special units. Once the candidates have completed their GIM rotation after 9 months, they may not necessarily be allocated as extras to the special units because they would have expected to have reached the same level of competence as our own registrars. 
  4. The number of supernumerary registrars in a division must never exceed the HPCSA recommended maximum ratio of 1 consultant for every 4 registrars in General Internal Medicine and 1 every 2 in the superspecialties. The number of registrars in a unit should never compromise the ability of the unit to train all registrars optimally.  There should be optimal exposure and sufficient access to various procedures and learning opportunities for all the registrars, especially our own.   For logistical reasons in GIM a maximum of 2 supernumerary registrars per firm will be allowed. 

Standards

  1. The first six months of candidates’ appointments will be considered probationary. If they fail to perform satisfactorily, they will be asked to leave. At the discretion of the Department, individuals may be given another 3 months probationary period to improve their performance.
  2. Evaluation after the 6 months probation:
    1. 6th year WebCT test (to ensure a solid baseline knowledge)
    2. 2 clinical cases (to ensure clinical competency going forward since patients will be exposed)
  3. The academic benchmark will be the same as expected of our registrars. In view of the challenges faced by candidates from foreign countries, certain exceptions may be made in terms of the duration of training at the discretion of the Department.
  4. Divisional heads will be required to evaluate these candidates in the same fashion as our own registrars including discussion of the performance at the Departmental quarterly assessment meeting. 

Service delivery 

  1. Supernumeraries will be expected to do the same amount of work (including afterhours) as South African Registrars. This requirement has to do with training requirements (to ensure proper exposure) and therefore we can’t compromise on it. However, although we expect equal commitment from all registrars, we will be sympathetic to the supernumerary’s position and will not lean on supernumeraries for service delivery. They will not do more than 6 calls per month and if there are extra calls, it will fall on South African registrars.

Administrative  

  1. Supernumerary registrars will have to comply generally with the same leave requirements as our registrars. However, since many would be from foreign countries, exceptions may be allowed at the discretion of the Departmental head. 
  2. On completion of their studies candidates are expected to return to their countries of origin if they are foreigners. 
M.R.Moosa
2013 Revision.

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