DECRETO DE URGENCIA Nº 002-2011: Modifican Artículo 2 del Decreto de Urgencia Nº 001-2011

A cross-sectional analytic study amongst medical graduates was conducted to explore the reasons for, and reflections on, postgraduate training in the Master of Public Health at the University of Cape Town.

3.5.1 Eligibility and sampling

Eligible candidates who had graduated with MPHs between 2001 and 2009 or were enrolled in the MPH programme in 2010, were identified from the School of Public Health and Family Medicine MPH student database. Although the programme commenced in 1999, 2001 was the first year in which doctors graduated. For

inclusion, participants had to be doctors at the time of commencement of their MPH studies.

Because the database of MPH students kept by the programme administrators did not contain information on students’ prior degree/s, other sources were used to identify doctors amongst the students. Firstly, individual student folders held by programme administrators were reviewed for information in application letters and curricula vitae. Secondly, the University-held database of student information, ‘Peoplesoft’, was searched for documentation about previous educational qualifications at UCT to identify UCT-trained doctors.

Two doctors, who subsequently enrolled in the MMed programme, were excluded as they clearly anticipated a career as specialists, and one fulfilled criteria for inclusion in the registrar study (Chapter 4) and the other, in the specialist study (Chapter 5) undertaken. Included in the population were two doctors who withdrew from the MMed specialisation programme and joined the MPH programme during the study period.xvi

A total of 70 potential respondents were identified (Table 4). Contact emails for respondents on this ‘MPH doctor database’ were identified from the MPH student database, the internet and by asking known colleagues. At the end of this search, contact details were missing for five doctors resulting in them being uncontactable. All 65 remaining eligible respondents were invited to participate in an online survey. Signed consent forms and emailed questionnaires were stored in a password protected file held by the researcher.

xvi _{At UCT, registrars registered for MMeds complete the epidemiology track of the MPH although}

Table 4: UCT MPH students – by year of enrolmentxvii

Year Completed or in

progress Total doctors

xviii Annual percentage 1999 11 1 9% 2000 6 2 33% 2001 16 7 44% 2002 8 2 25% 2003 24 6 25% 2004 28 4 14% 2005 26 8 31% 2006 28 4 14% 2007 25 6 24% 2008 27 4 15% 2009 58 15 26% 2010 44 11 25% Total 301 70 23%

Each eligible respondent was first contacted by email to inform her/him of the intended research. An email was then later sent with a link to a University held website on the university’s electronic teaching and learning platform,‘Vula’, that hosted the questionnaire. Emails that bounced back were rechecked and if known, potential participants were contacted telephonically to ask for a reliable email

address. It is unknown what proportion of potential participants actually received the email invitation.

3.5.2 Data collection

The online questionnaire was structured so that participants had to complete a consent form before proceeding to the questionnaire. Some respondents reported that the online link did not work, and they were sent an electronic MSWord version of the questionnaire and consent form, which were then emailed back to the researcher. Completion of the online consent form allowed the tracking of respondents and non- respondents. Non-respondents were contacted twice by email, to encourage

participation. Figure 3.1 depicts the selection of the sample and response frequencies.

xvii _{This excludes students who withdrew from the programme by May 2010.}

xviii _{The figure is all students registering in the year excluding those who deregistered. This gives}

Figure 3.1: Selection and response rate of eligible respondents

The response rate was 48%. Possible selection biases were explored by comparing demographic and educational variables of respondents to all doctors on the ‘MPH doctor database’. As personal identifiers were removed from the respondents’ data set a comparison of respondents to non-respondents was not possible. Comparisons between respondents to the study population (all on the study database) were performed using Wilcoxon signed-rank tests for continuous non-normally distributed data, and z-score tests for categorical data such as proportions. Significance was at the 0.05 level.

Although there were some differences between the respondents and all eligible doctors, most were not statistically significant. Respondents (n=31), compared to all doctors (n=70), tended to be older (median age = 37 [IQR: 34-42 years] vs median age=33 [IQR: 30-36 years]; p=0.00); female (64.5%, versus 57.1%; p=0.41), qualified as doctors two years later (median year 2000 [IQR: 1994-2002] versus median year 1998 [IQR: 1991-2000]; p=0.46) and less likely to be South African (29.0%; vs 39.7%;

p=0.22). The median age on commencing studies was 33 years for both groups (IQR: 30-38). The median year for both groups starting MPH studies was 2007. Other than

respondents being older at the time of the study, they did not differ from all doctors by gender, nationality, MPH cohort, year qualifying as doctors and age starting postgraduate public health studies.

3.5.3 Study tool

The questionnaire was piloted prior to the study, to iron out logistical and

methodological issues. One study respondent completed the questionnaire and gave feedback on its understandability, repetition, gaps, as well as the time it took to complete. The questionnaire took the intended 20 minutes and minor content changes were made.

The self-administered semi-structured questionnaire contained both closed- and open-ended questions (Appendix B). Closed-ended questions gathered information about demographic, study and career information whilst open-ended questions probed respondents’ perspectives about the value of training, their undergraduate training and career intentions.

3.5.4 Data collection and analysis

The database of potential participants was constructed between December 2010 and July 2011. The survey was circulated in July 2011 and data were collected from July to August 2011. Data from the electronically completed and emailed questionnaires were extracted, manually entered into an Excel spreadsheet, and analysed by the investigator using data analysis software STATA 13.

Descriptive analyses were undertaken for variables derived from closed-ended

questions. Summary statistics were constructed, and appropriate measures of central tendency are reported for normal and non-normally distributed data. Differences in responses by demographic and training variables are reported, and t-tests, Mann- Whitney tests, chi-square tests and Spearman’s correlations were performed for hypothesis testing. Levels of significance for tests was p<0.05.

Content analysis, manually grouping responses into categories, was performed on the qualitative information elicited from the open-ended questions. Quotations that best

illustrate themes were then selected for inclusion in the manuscript. Respondents are identified by their gender (with ‘M’ being male and ‘F’ being female) and by their age in years, viz. (gender, age).