Rheumatology

Academic Programmes

Academic Programmes

TEACHING/TRAINING/SUPERVISION OF HIGHER DEGREES

Teaching and evaluations
  • Undergraduate: GEMP2/3/4; dental students
  • Postgraduate: Medical registrars and Fellows
  • Other: HIV course (right to care) lectures
Supervision of Higher Degrees

PhD:
  1. A prospective study of cardiovascular disease and its risk factors in populations with rheumatoid arthritis that are at different stages of the epidemiological transition (A Solomon)
  2. The role of WNT pathway in systemic sclerosis (J Frost)
  3. The clinical utility of the Actical accelerometer in assessing physical activity and an exercise-intervention programme in rheumatois arthritis (A Prioreschi)

MSc
  1. The comet assay as measure oxidative DNA damage in systemic sclerosis (X Masuko)
  2. An interventional occupational therapy programme for hand function in systemic sclerosis (B Pereira)

MMed:
  1. Inflammatory myositis at Chris Hani Baragwanath Hospital (D Ramdass)
  2. Red cell distribution width as a marker of disease activity in rheumatoid arthritis (D Haasbroek)
  3. Experience with leflunomide as a disease modifying antirheumatic drug in rheumatoid arthritis at Chris Hani Baragwanath Hospital (K Magomero)
  4. Lung function abnormalities in systemic sclerosis at Chris Hani Baragwaanth Hospital (P Ashmore)
  5. Reasons and outcome of hospital admissions in patients with systemic lupus Erythematosus (S Karolia)
  6. Drug toxicities in African patients with rheumatoid arthritis in a tertiary care centre (J Naicker)
OUTPUTS
Fellows completing Certificate in Rheumatology Subspecialty examinations
  1. N Govind (2009)
  2. A Wadee (2010)
  3. Y Khan (2012)
  4. C Balton (2012)
  5. K Makan (2013);
  6. G Tarr (2013)
  7. L Winchow (2013)
  8. S Karolia (2013)
Higher degrees
PhD:
  1. Bridget Hodkinson: thesis entitled “Rheumatoid arthritis in South Africans” (graduated December 2012)
  2. Nimmisha Govind –thesis entitled “Genetics of Rheumatoid Arthritis in South Africans” (graduated December 2013)
MSc (by research work only)
  1. Hema Gosai: dissertation entitled “The impact of foot problems on the quality of life in Rheumatoid Arthritis” (graduated June 2009)
  2. Jacqueline Frost: dissertation entitled “Analysis of Three Genes that Contribute to Fibrosis in South African systemic sclerosis patients” (graduated July 2010)
MMed (Internal Medicine)
  1. Nimmisha Govind: research report entitled “The role of PTPN22 polymorphisms in Black South Africans with rheumatoid arthritis”,(graduated July 2011)
  2. Mohamed Amien Makda: research report entitled “C1q antibodies in Black South Africans with systemic lupus erythematosus”, (graduated December 2012)
  3. Gareth Tarr: research report entitled “HIV infection and rheumatoid arthritis”, (graduated July 2012)


MEDICAL REGISTRAR TRAINING:

SELECTION PROCESSES FOR REGISTRAR AND JUNIOR STAFF APPOINTMENTS

POST GRADUATE COMMITTEE

The Post Graduate Committee of the Department of Internal Medicine is constituted for the following purpose:
  1. Co-ordinating the training of registrars and fellows (sub speciality).
  2. Administering the Registrar and Fellow circuit.
  3. Overseeing the training of registrars and fellows.
  4. Appointment of registrars and fellows (sub speciality trainees).
REGISTRARS Appointment of Registrars
  • Registrar appointments are done twice a year for the 1st January and 1st July intakes. Only under special circumstances are registrar appointments made outside these two periods.
  • The Interview panel is made up of:
    1. Head of Department;
    2. Heads of Hospitals;
    3. Chairperson of the Committee;
    4. Consultant Representatives from the three hospitals;
    5. Human Resource personnel from the respective hospitals
    6. The registrar representative serves as support staff as well as observers.
  • The attached interview template is used by the Committee (addendum A). The candidates who score the highest are selected. In the event of candidates having the same score, the transformation criteria, stated below is use:
    • ­ Gender: Females before males;
    • ­
    • Candidates from previously disadvantaged groups are preferred
  • Registrar contracts:
    All successful candidates are requested to sign the contract, setting out the department expectations (addendum B).
Training The registrars rotate through the three academic hospitals. The time spent at each hospital is as follows:
  • CHBAH 20 months (max);
  • HJH 12 months;
  • CMJAH 12 months;
  • The final 4 months either at HJH or CMJAH.
The split between General Medicine and Subspecialities is on a 50/50 split.

The rotations are divided into four (4) months rotations. Each registrar is requested to submit a request for their preferred rotation before the committee draws the quarterly allocations. a. Teaching in the circuit is in the form of:
  1. Post intake ward rounds at each hospital.
  2. Follow-up ward rounds.
  3. Daily scheduled ward rounds at all three hospitals. These are allocated and monitored by the committee.
  4. Master classes for FCP II candidates conducted between the written papers and the clinicals. These are conducted by senior members of the department.
  5. Medicine Update – organised once a year by the department.
  6. Weekly departmental case presentations by registrars at each hospital
  7. Training as per each general medicine ward and sub-speciality training programme.
b. Curriculum
The department follows the core sylabys for training in Internal Medicine as determined by the College of Phycisians of South Africa.

As part of training and evaluation the department of Internal Medicine developed a Registrar Portfolio which is filled in by each Head of Unit through which the registrar has completed his training.

c. Research

Our research co-ordinator (Prof. A. Bentley); has been appointed in the department to assist and monitor all registrar research activities. The overall co-ordinator is supported by research co-ordinators / mentors at each hospital.

Research courses are currently offered by the department as well as the school.

The department has committed itself to allocate research time to our registrars requiring time off.

Tsepong Hospital

Tsepong Hospital, is one of our outreach training sites. A minimum of 2 registrars and maximum of 4 registrars rotate through Tsepong Hospital each year. Two first year registrars spend a year at Tsepong and are then transferred to the Johannesburg Complex. A further 2 senior registrars rotate on a two monthly basis at Tsepong Hospital.

The training of registrars during this period is predominantly in general medicine.

SUB SPECIALIST TRAINING (FELLOW)

Sub specialist training occurs across all divisions in the department as per sub-division reports. The Post Graduate Committee is responsible for monitoring training in these divisions.

Appointment of Sub-Specialty Fellow Staff
  • Appointment of staff for the 1st January and 1st July intakes is done by the Post Graduate Committee. The interview panel is made up as follows:
  • The Interview panel is made up of:
    1. Head of Department;
    2. Heads of Hospitals;
    3. Chairperson of the Committee;
    4. Head of the Sub Speciality as well as Heads of Sub Speciality in the different hospitals
  • The attached rubric is used for the selection of sub specialist trainees (fellows) (Addendum C).
  • The transformation principles as set out in the registrar section are used when the candidates have scored the same mark.

Training and research
The training and research supervision of the sub speciality trainees is the responsibility of the Sub Speciality Head.

Outreach Programme
Outreach programme was introduced in 2009 by the department in conjunction with Chief of Operations of the Gauteng Department of Health. This agreement necessitated the extension of Sub Specialist training from 2 years to 3 years. The division of Cardiology was excluded in this outreach programme (already requiring 3 years of training).

The Fellow spends a maximum of twelve months (cumulative) at the regional hospital and 24 months at the central hospital.

Rotations
Sub Specialist Trainees rotate through the three teaching hospitals, in their respective Sub Speciality. The rational for the rotation is to ensure that:
  1. Access to programs that may not be available at one hospital is made available to all trainees, e.g. Kidney transplants;
  2. Access to the different trainers in the department is available to all trainees in the divisions.
SUPERNUMERARY REGISTRARS AND FELLOWS

All supernumeraries in the department follow the same programme set out for registrars and fellows.

Supernumerary registrars are allowed a year in which they choose a Sub Speciality they want to be exposed to. This year is usually before they write their FCP II exams.

COLLEGE OF MEDICINE EXAM RESULTS: 2009 – 2013

The following are the total College of Medicine Exam Results for Part II and Sub Specialists who have been trained in the Circuit.

EXAM20092010201120122013
FCP Part II 2713221823
Cert Cardiology (SA) Phys32332
Cert Endocrinology & Metabolism (SA) Phys21120
Cert Medical Oncology (SA) Phys12010
Cert Neprhology (SA) Phys33241
Cert Pulmonology (SA) Phys31121
Cert Rheumatology (SA) Phys13004
Cert ID (SA) Phys10100
Cert Clinical Haeamtology (SA) Phys03010
Cert Gastroenterology (SA) Phys00110
Cert Geriatrics (SA) Phys00002

FCP (SA) PART II MARCH 2009 – AUGUST 2013 –NUMBERS OF CANDIDATES FROM WITS

March 2009 FCP(SA) Part II
Wrote - 14
Passed - 13

August 2009 FCP(SA) Part II
Wrote - 15
Passed - 14

March 2010 FCP(SA) Part II
Wrote - 11
Passed - 6

August 2010 FCP(SA) Part II
Wrote - 12
Passed - 7

March 2011 FCP(SA) Part II
Wrote - 21
Passed - 13

August 2011 FCP(SA) Part II
Wrote - 15
Passed - 7

March 2012 FCP(SA) Part II
Wrote - 12
Passed - 9

August 2012 FCP(SA) Part II
Wrote - 18
Passed - 8

March 2013 FCP(SA) Part II
Wrote - 17
Passed - 14

August 2013 FCP(SA) Part II
Wrote – 24
Passed - 12

4. RESEARCH IN THE DEPARTMENT OF INTERNAL MEDICINE

The research outputs from the Department of Internal medicine include and depend on: publications, postgraduate student graduations and creating a conducive research environment

The Dept. of Internal Medicine is proud of its publication record. Overall the Department of Internal Medicine publishes more papers than any other department in the School of Clinical Medicine and more than some of the other schools. In 2010 the department received 35% of the total DNEs for publications in the school. In 2013 the department contributed to 112 accredited research publications.

Publications in the department come from three sources: there are research entities, strong individual researchers and then a lot of researchers who publish steadily. The five established research entities vary between single researchers in the Ciliated Epithelium unit (Prof C Feldman) and the Carbohydrate and Lipid research unit (Prof F Raal) to the much larger HIV research unit at Helen Joseph Hospital (Prof I Sanne). In between, in size, not necessarily in number of publications are is the Hepatitis Virus Diversity Research Program and the Soweto cardiovascular research unit. All of the units contribute substantial amounts of publications – 30% in 2013. Most of the publications thus come from staff members not contained in official research entities.

The other research endeavour is through the graduation of postgraduate students. The department has a steady graduation of registrars. This, the first year of the compulsory completion of MMEDs finds the department in a situation where only a few registrars need to be pushed to complete in time. There is also a steady stream of MSCs by dissertation and PhDs. The department graduated three PhD students in 2013.

Since the requirement for completion of the MMEDs for the registrars was introduced an active focus on improving the research environment for the registrars has been adopted. These procedures include having a part-time research coordinator to train students in research techniques. Courses are run late in the afternoon and a number of times during the year. A list of courses are attached. The department also has a number of MSc students as well as several PhD students. Three PhD students graduated in 2013.

The department also has a laboratory for genetic studies and molecular medicine work. A number of MSc and PhD studies are done in the lab but the facility is available to all researchers.

The department has started a Graduate studies committee as well as a research strategy committee (comprised of all staff who currently have a PhD) in order to set up procedures to:
  • Improve throughput of MMEDs
  • Increase number of consultants with postgraduate degrees – particularly PhDs
  • A registrar/postgraduate facility has been created with computers and a lounge area and will be supplied with all appropriate software particularly the statistical software. Thus individualized help can be given on data analysis.