Limpopo province has a population of about 6 million people. Although the number of psychiatry patients is not clear, a wide variety of mental disorders are reported to be increasing globally and this makes specialized treatment by staff such as psychologists and psychiatrists a basic requirement. In Limpopo province, there is a shortage of these staff especially in the public sector with a 80 to 83% vacancy rate.The province has 5 districts namely Sekhukhune, Capricorn, Waterberg, Vhembe and Mopani district. However, only 3 psychiatry hospitals currently exist in the province. These hospitals include Thabamoopo, Hayani and Evuxakeni hospital. These hospitals are generally staffed with medical officers with minimal training and experience in the care of psychiatry patients.
Among the 7 registrars, there are 5 senior registrars who are planning to write exit exams in 2023 and 2 junior registrars. The registrars rotate among the three hospitals in the Capricorn district for 6 months at a time. The registrars rotate through geriatrics, general adult psychiatry, community psychiatry, forensic psychiatry, consultation liaison psychiatry, child psychiatry and neuropsychiatry. At any 6 months rotation, there are 3 registrars at Thabamoopo hospital, 3 registrars at Mankweng hospital, and 1 registrar at Pietersburg Hospital. We do not have a neuropsychiatrist in the province, however, there are 2 neurologists who are based at Pietersburg hospital. As a result we have to learn neuropsychiatry from the neurology department. Also they see a lot more “ pure neurology” cases and one ends up having to do a lot of self studying.
We do not have a child psychiatrist in the province. Unfortunately, for this rotation, we have to travel to Gauteng province which is 300km away from Limpopo province. The rotation is for 3 months and unfortunately we have to fund ourselves starting with travel costs, accommodation etc. Mankweng and Pietersburg hospital also have a child psychiatry outpatient clinic every Wednesday, and this is usually done by registrars preferably those who have completed their child psychiatry training in Gauteng province. We do not have a child psychiatry unit in the province and this result in challenges with regard to management of difficult children or those who do not respond to outpatient treatment. We also have few facilities that can help with the care of these children leading to frustration in the family and difficulty with management.
As part of our training, we are also expected to observe and do Electroconvulsive therapies on patients. Our province does not offer this therapy both in the private and public sector. As a result, we have to travel again to Gauteng province to do these therapies which is more than 300 km meters from Limpopo province and this is not covered by the institution. We travel at our own costs and pay for our accommodation.
We are registered with the University of Limpopo which recently established a medical school about 7 years ago and has no resources for postgraduate students. We are also expected to do research as part of our training with the University in order to obtain our Masters degree in psychiatry, where we also don’t have support. We don’t receive teachings or tutorials regarding research, instead we do it ourselves with help from those colleagues who are ahead of us. In addition, the registrar is also expected to teach 4th,5th,and 6th year undergraduate medical students when they come for their clinical rotations in the psychiatry department.
Objective:
The registrar training program is for 4 years. In this period of training, the registrar is expected to write 2 sets of exams from college of medicine South Africa. This include part 1 exams which can be obtained at anytime, ideally at the beginning of registrar ship and part 2 exams, which are exit exams. Both exams are internationally recognized.
There is no formal teaching for these exams, it is mostly self-study with presentation of topics and clinical cases to the psychiatrists. We have academic meetings every Friday of the month, where these presentations are done however, this is not enough to cover most of the required learning objectives. As a result, being awarded the Rosh scholarship will be beneficial to the trainees with theoretical knowledge and practical ability to manage patients effectively. In addition, having access to the Question banks will give the trainees invaluable material to help prepare for exams. Access to this Questions will further help us among others to identify the knowledge gaps.
Rosh came highly recommended by both recently qualified psychiatrist and those preparing for exams and fellowship certificates. One of the newly qualified psychiatrist from our institution relied and used your resources and we can testify that they were really helpful. Rosh is also reported to be user-friendly as compared to its competitors. Among the question banks available, seemingly those from Rosh is the most relevant and applicable to our setting. Unlike the rest of the world which uses mainly ICD 10, South Africa uses Diagnostic and Statistical Manual (DSM5) of which we noticed its part of your references. Our University libraries cater mostly for ICD 10 based Textbooks which are not suitable for our exam preparations .
The college of medicine psychiatry exams previously used to be essay questions until recently where the format was changed to single best answer. Previously people used to rely on past papers, however the college does not have any question banks examples of the single best answer questions. This makes it difficult to study as we have limited resources. Therefore, awarding us the scholarship would be of great assistance.
In addition, world economy took a knock recently following the Covid-19 pandemic. This caused an unrest in some parts of the countries. South Africa was not spared, the inflation went through the roof where we are forced to balance between spending money on daily needs versus buying study materials. With the current Rand/Dollar(R18,19/1$) exchange, it has become almost impossible to afford anything that gets imported from outside the continent. In that context, the scholarship would really be of benefit to us.
Due to financial constraints, our University, being rural university, also opted to put a cap on the number of Journal accesses, especially the international Journals which made things even difficult for us to prepare for exams. We can only access some of these journals only when your on the university premises. This makes our training difficult as the college of psychiatry uses mainly international Journals for which our access is limited by both the University and lack of finances, so having access to your Question Bank will help bridge some of these deficits.
Apart from completing our training, the knowledge acquired from using Rosh review, will be beneficial not only to the communities that we will be serving but will also come in handy to the medical officers and registrars, enrolling in the same program. We will in the future recommend the use of this application such as Rosh review not only for psychiatry but for all other medical discipline.