Content analysis of the South African MMed mini-dissertation

Abstract

Research The decision by the Health Professionals Council of South Africa (HPCSA) to regulate a research component in the form of a mini-dissertation (Master of Medicine (MMed)) for specialist registration, was accorded a mixed reception when implemented in 2011. While most South African (SA) surgical registrars consider research an important component of their careers, [1] some view the research requirement as an imposition on their clinical training time and were sufficiently incensed to legally challenge the decree. [2] There also appears to be divergent understandings of the purpose of the MMed among the SA specialist trainer cohort. [3-5] The HPCSA ruling, introduced to solve existing problems of variations between training centres, correspondingly addressed a number of research-related and clinically meaningful concerns. Anaesthetists in the USA warn that the status of their profession is at risk of becoming a trade union if research training is not enhanced. [6] European family physicians fail to see the direct association between research and clinical reality, limiting their ability to practise evidence-based medicine, [7] while psychiatrists at the University of Maryland, Baltimore, USA, highlight the serious shortage of physician researchers, which impacts the profession at large. [8] It is important, at this point, to understand that SA is not alone in incorporating a research component into the trainee specialist programme. In other parts of the world, similar steps have been taken to integrate research training in specialist curricula, thereby preparing trainees for future challenges. It is unsurprising that they have also encountered comparable sticking points and wrestle with similar conflicting stances. [7,9-15] Given the robust discussion about the appropriateness of the MMed in specialty training, [2-5,16] it is surprising that, 9 years after the implementation of the HPCSA decree, the extent and nature of the SA MMed remain unstudied. It therefore seems an appropriate time to take stock of the MMed by presenting evidence-based information about the current composition of the research output. Such information will assist in identifying strengths and deficiencies in the research programme and provide facts for monitoring, reviewing and decision-making on policy, and programme and project performance of trainee specialist research. Should future changes be implemented, evidence such as that provided here can serve as a reference for determining change. Finally, details on current MMed mini-dissertations can assist candidates to improve the structure of their dissertations and offer a glimpse of the quality and relevance of institutional research. Therefore, the following descriptive study was undertaken to provide basic information on qualifying SA MMed mini-dissertations sampled between 1996 and 2018. Methods This was a record review of SA MMed mini-dissertations downloaded from local (www.netd.ac.za) and global (www.ndltd.org) electronic theses and dissertation websites. University library repositories of the 8 universities that train registrars were similarly searched until each inquiry revealed proportionally more spurious targets than strikes, whereafter the search was discontinued. Acceptable evidence of MMed research competency has many permutations. Cochrane reviews [17] and reprints of a single published paper in pdf format [18] were encountered, apart from the typical mini-dissertation in monograph or publication-ready format. To obtain a uniform study sample that could provide all the desired data, two inclusion criteria were applied: • The output had to be identified as an MMed and/or include the Colleges of Medicine of SA (CMSA) specialty discipline. • The MMed had to be in either monograph or publication-ready format. Background. There is no baseline information on the South African (SA) MMed mini-dissertation, which became a compulsory (and controversial) research component for specialist registration in 2011. Objective. To obtain evidence-based information regarding the current composition of the research output of the MMed mini-dissertation. Methods. SA MMed mini-dissertations (N=307) were downloaded from electronic theses and dissertation websites and 8 university repositories that provide specialist training. Fourteen variables were noted for each mini-dissertation, the data were entered into an Excel (2016) (Microsoft, USA) spreadsheet and analysed using descriptive statistics. Results. The 307 mini-dissertations, representing 24 of the Colleges of Medicine of SA, were submitted from 1996 to 2018, mainly in monograph format (76%) and almost equally divided between prospective and retrospective studies. Observational studies predominated, with meta-analyses, systematic reviews and randomised controlled trials comprising 5% of the sample. Although quantitative investigations dominated (82%), just less than half of these used statistics to test variables. Confirmed ethical compliance improved from 41% in pre-2011 dissertations to 83% for dissertations submitted during 2015-2018. Conclusions. This study provides descriptive data on the SA MMed mini-dissertation. Comparisons indicate that the MMed research component compares favourably with the content and research approach of similar international specialist trainee research outputs.