Developing a validated instrument to assess paediatric interns in South Africa

Abstract

Background. In South Africa (SA), recently graduated medical practitioners (interns) are expected to be efficient and resilient in limited-resource contexts with multiple disease burdens. Work-based assessment in SA internship focuses on clinical skills and neglects the evaluation of non-clinical skills, which creates a daunting task for clinician supervisors expected to certify interns for independent practice. 

Objective. To develop a set of observable clinical activities as the basis for an instrument for evaluating interns during the paediatric rotation at hospitals. 

Methods. The core set of competencies was determined through a modified Delphi process. Focus group discussions were used in content validation and the proposed instrument was tested in a survey among 415 paediatric interns. The proposed instrument included several competencies and was further subjected to factor analysis. 

Results. This tool was found to be reliable, with an overall Cronbach’s alpha coefficient of 0.927. Four major factors emerged from factor analysis performed on the final list of 61 observable clinical activities, aggregated into entrustable professional activities. The factors are associated with procedural clinical skills, holistic-care skills, and emotional skills related to social competence and self-management. 

Conclusion. A locally relevant competency-based assessment tool was developed to assess paediatric interns in the SA setting. The use of validated tools as multidimensional instruments to assess both clinical and non-clinical skills is largely neglected. The study serves as a model for developing validated work-based assessment instruments responsive to local needs and supports the development of holistic clinicians in healthcare contexts with high disease burdens.