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SAQA All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.
SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED QUALIFICATION THAT HAS PASSED THE END DATE: 

Bachelor of Clinical Medical Practice 
SAQA QUAL ID QUALIFICATION TITLE
60089  Bachelor of Clinical Medical Practice 
ORIGINATOR
University of Pretoria 
PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY NQF SUB-FRAMEWORK
CHE - Council on Higher Education  HEQSF - Higher Education Qualifications Sub-framework 
QUALIFICATION TYPE FIELD SUBFIELD
National First Degree  Field 09 - Health Sciences and Social Services  Curative Health 
ABET BAND MINIMUM CREDITS PRE-2009 NQF LEVEL NQF LEVEL QUAL CLASS
Undefined  480  Level 6  NQF Level 07  Regular-Provider-ELOAC 
REGISTRATION STATUS SAQA DECISION NUMBER REGISTRATION START DATE REGISTRATION END DATE
Passed the End Date -
Status was "Reregistered" 		 SAQA 1141/23  2021-07-01  2024-06-30 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2025-06-30   2030-06-30  

In all of the tables in this document, both the pre-2009 NQF Level and the NQF Level is shown. In the text (purpose statements, qualification rules, etc), any references to NQF Levels are to the pre-2009 levels unless specifically stated otherwise.  

This qualification does not replace any other qualification and is not replaced by any other qualification. 

PURPOSE AND RATIONALE OF THE QUALIFICATION 
Purpose:
The general purpose of this three year Bachelor's qualification is to train a competent, professional health care team member with the necessary knowledge and attitudes to function effectively as a Clinical Associate (CA) to assist doctors working in district hospitals. The CA will work under the supervision of a qualified medical practitioner, performing a large variety of clinical procedures as indicated. Supervision must be continuous but should not to be construed as necessarily requiring the physical presence of the supervising doctor at the time and place that the services are rendered. This will serve to improve communication and education of the patient and enable medical practitioners to provide comprehensive medical services.

Scope of Practice:

Medical services provided by the clinical associate may include, but are not limited to:
  • Obtain patient histories and performing physical examinations.
  • Order and/or perform diagnostic and therapeutic procedures.
  • Interpret findings and formulating a diagnosis for common and emergency conditions (See addendum for common conditions).
  • Develop and implementing a treatment plan.
  • Monitor the effectiveness of therapeutic interventions.
  • Assist at surgery.
  • Offer counselling and education to meet patient needs.
  • Make appropriate referrals.

    The Clinical Associate's scope of practice is defined by the context and requirements of district hospitals with particular focus on:
  • Emergency Care.
  • Skilled Procedures.
  • Inpatient Care.

    The curriculum for the clinical associate is designed from the skills needed and common conditions seen in district hospitals in South Africa. The curriculum must ensure that the CA will have enough general skills, together with the knowledge and attitude to be flexible and fit into future needs in the district health system and the rest of the health care system of South Africa. It also means that the training should be adaptable in the future as the needs in the health system change and evolve.

    The training of the CA is also designed to provide access to training to people from marginalised communities in South Africa, especially in rural areas and informal peri-urban communities.

    The successful completion of the qualification will enable the learner to be registered with the HPCSA and practise as a Clinical Associate.

    Rationale:

    The mid-level medical worker cadre is part of the Department of Health's Resource Plan. South Africa has chosen to adopt the policy of a health care delivery system based on the Primary Health Care Approach, to increase access to quality health care for all. Presently there is a severe shortage of doctors in South Africa, especially in the rural hospitals. There are a variety of health facilities in urban and peri-urban areas which experience severe shortages of doctors and other health professionals, and unrealistic workloads. Work overload compromises the quality of service.

    At present, nurses sometimes assist doctors with their duties in the hospitals but this is not well structured, sometimes is outside the scope of practice of the nurses and in addition there is a shortage of nurses. Thus, this places strain on the nurses and leads to lower standards of nursing care.

    Thus there is a gap for a new mid-level medical worker in the district hospital, working under the supervision of a doctor to assist the doctor with various tasks and procedures.

    This cadre of mid-level health care provider will be called a Clinical Associate (CA). The district hospital is felt to be the ideal place/setting for the CA because it has a well-defined and manageable level of care. The registration of the CA will be with the Health Professionals Council of South Africa (HPCSA). The scope of practice of the CA is envisioned to fill the gap that exists in district hospitals where a large proportion of the clinical work of doctors is related to emergency care, diagnostic and therapeutic procedures and in-patient care. The CA will be part of a team in different units in the district hospital, including the Emergency, Outpatient, Medical, Surgical, and Maternity Units as needed. In the operating theatres, the CA will assist the doctor in basic procedures such as incision and drainage and evacuations. This differs from the scope of practice of the PHCN practitioner at the clinic where first contact care, chronic care and prevention are most important.

    The Clinical Associate programme has specified exit level outcomes which can be directly related to the aspirations of the learners seeking careers as Clinical Associates and to the range of competencies required for such a career path. These outcomes also provide an explicit description for prospective employers of the competencies that can be expected of the Clinical Associates.

    This Degree will create a new career opportunity within the health care team. 
    		•

    LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    Recognition of Prior Learning (RPL):
    The institution conducts RPL in terms of the policy and guidelines of the institution to recognise other forms of formal, informal and non-formal learning and experience. In cases where learners do not comply with the formal admission requirements, the institution applies its RPL policy.

    Entry Requirements:
    The minimum entry requirement for this qualification is
  • Senior Certificate, NQF Level 4 with endorsement.
  • National Senior Certificate, NQF Level 4 granting access to Bachelor's studies.
  • National Certificate Vocational, NQF Level 4 granting access to Bachelor's studies. 
    		•

    RECOGNISE PREVIOUS LEARNING? 
    Y 

    QUALIFICATION RULES 
    Level, credits and components assigned to the qualification.

    Learning components: Number of credits allocated; NQF level:
  • Fundamental: 48; 6.
  • Core: 336; 6.
  • Electives: 32; 6.

    Total: 416.

    Two elective modules must be chosen from a list of eight modules, each module lasting 4 weeks or 160 hours and allotted 16 Credits each for a total of 32 Credits. All the credits (416) are at the level of the Qualification. This is a qualification in its own right with no overlap with another registered. 
    		•

    EXIT LEVEL OUTCOMES 
    1. Perform a patient-centred consultation across all ages in a district hospital.
    2. Apply clinical reasoning in the assessment and management of patients.
    3. Perform investigative and therapeutic procedures appropriate for a district hospital.
    4. Prescribe appropriate medication within their scope of practice.
    5. Provide emergency care.
    6. Facilitate communication and provide basic counselling.
    7. Function as an effective member of the health care team.
    8. Produce and maintain clinical records.
    9. Function as an ethical practitioner.
    10. Demonstrate ongoing learning in clinical practice.
    11. Integrate an understanding of family, community and health system in practice.

    Critical Cross-Field Outcomes:

    The Exit Level Outcomes and the associated assessment criteria listed above are consistent with the following Critical Cross-field outcomes:

    Identify and solve problems using critical and creative thinking.
  • Exit Level Outcomes: 1,2,3,4,5,9,10,11.

    Work effectively with others as a member of a team, group, organisation and community.
  • Exit Level Outcomes: 2, 6, 7, 9, 11.

    Collect, analyse, organize and critically evaluate information.
  • Exit Level Outcomes: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11.

    Communicate effectively using visual, mathematical and/or language skills in the modes of oral and/or written presentations.
  • Exit Level Outcomes: 2, 3, 4, 6, 7, 8, 11.

    Demonstrate cultural and aesthetic sensitivity in dealing with patients, colleagues and communities.
  • Exit Level Outcomes: 2, 6, 7, 9, 11.

    Demonstrate an understanding of the world as a set of related systems by recognizing that problem-solving contexts do not exist in isolation.
  • Exit Level Outcomes: 2, 7, 9, 11.

    Demonstrate ethical and professional behaviour.
  • Exit Level Outcome: 9.

    Lay the foundation for life-long learning and ongoing competency.
  • Exit Level Outcomes: 2, 10. 
    		•

    ASSOCIATED ASSESSMENT CRITERIA 
    Associated Assessment Criteria for Exit Level Outcome 1:
  • Patient's needs and problems are identified by effective listening.
  • A relevant history is taken.
  • An accurate and relevant physical examination is performed.
  • Diagnostic tools are used effectively.
  • Continuity of care is ensured by making arrangements for follow up.

    Associated Assessment Criteria for Exit Level Outcome 2:
  • High-risk situations and conditions in patients are timeously identified and appropriate action taken.
  • Hypotheses (differential diagnoses) are made from information obtained.
  • Collaboration with the patient occurs in all aspects of the consultation to include but not limited to initial and follow-up patient assessment, discussion of differential diagnoses and discussion of diagnostic and/or therapeutic options.
  • An assessment is made, based on information gathered from the patient including history, physical examination and investigations.
  • The assessment is contextualised within the bio-psycho-social model including preventive, promotive, curative and rehabilitative aspects.
  • The management plan is based on the assessment and includes appropriate referrals e.g. rehabilitation.
  • The assessment and management plan is reviewed on an ongoing basis by both the multidisciplinary medical team and adjusted accordingly.
  • Special investigations obtained by the multidisciplinary medical team are guided by information needed to confirm or reject a hypothesis.
  • Assessment and management decisions take cost effectiveness into consideration.
  • The results of relevant special investigations in common conditions are interpreted by the Clinical Associate in consultation with the supervising doctor.
  • The assessment and management plan is presented to the supervising doctor and justified on the basis of information obtained.

    Associated Assessment Criteria for Exit Level Outcome 3:
  • Procedures are explained/described in lay and medical terms.
  • Indications and contra-indications are listed for specific procedures.
  • The ability to prepare for a procedure, including patient preparation, is demonstrated.
  • Procedures are competently demonstrated.
  • Possible complications of the procedures are explained.
  • Follow-up and safety-netting following procedures are explained.

    Associated Assessment Criteria for Exit Level Outcome 4:
  • Demonstrates knowledge in basic pharmacology.
  • Knowledge of standard treatment guidelines and the drugs in the Essential Drug List appropriate for district hospitals, including indications, contra-indications, side effects and drug interactions is demonstrated and applied in common and important conditions.
  • Prescriptions including dosage and frequency are written correctly to comply with legal requirements and scope of practice.
  • The prescription is explained to a patient (drug literacy, adherence).
  • A history of over-the-counter, traditional, complementary and alternative drug use is taken into consideration.
  • Knowledge of non-pharmacological therapies is demonstrated.
  • Knowledge and skills to administer and dispense medication is demonstrated.

    Associated Assessment Criteria for Exit Level Outcome 5:
  • Potentially life-threatening conditions are timeously identified, evaluated and acted upon.
  • Emergency conditions are managed and referred appropriately.

    Associated Assessment Criteria for Exit Level Outcome 6:
  • Patient's needs and problems are identified by effective listening.
  • Health information is shared in appropriate cultural and language terms.
  • Amount and level of information given is appropriate.
  • A suitable environment is fostered to communicate with the patient and/or family.
  • Patient feedback and questions are facilitated.
  • Confidentiality is ensured.
  • Basic counselling skills addressing the patient's needs are demonstrated.
  • Appropriate solutions are explored.
  • Mutual decision-making is facilitated.
  • Continual support and follow-up is provided.

    Associated Assessment Criteria for Exit Level Outcome 7:
  • Understanding of the roles, functions and relationships of all the members of the district hospital team is demonstrated.
  • Enhanced team functioning through appropriate attitude and behaviour as team member or substitute team leader is demonstrated.
  • Clinical information from patients is clearly and concisely communicated to the other team members (doctor in particular).
  • Reports on patients are appropriately handed over to colleagues.

    Associated Assessment Criteria for Exit Level Outcome 8:
  • Patient records and medico-legal forms reflect all relevant information accurately and legibly.
  • Patient referral letters are answered and completed appropriately.
  • Patient statistics are accurately completed.

    Associated Assessment Criteria for Exit Level Outcome 9:
  • The role and function of a clinical associate is explained to the patient by the CA.
  • The basic ethical principles are applied.
  • The Batho Pele principles are applied at all times in the work situation.
  • Ethical problems are recognised and managed appropriately, and referred when necessary.
  • Statutory and professional obligations are complied with.
  • Appropriate and sensitive attitudes to patient, family, communities and colleagues are demonstrated.
  • Reliability in work situations is demonstrated.

    Associated Assessment Criteria for Exit Level Outcome 10:
  • Professional strengths and weaknesses are identified by reflecting on clinical practice by reviewing patient medical records and/or reviewing success or failure of a medical intervention.
  • Clinical practice is continually improved based on identified needs through appropriate self-directed learning.

    Associated Assessment Criteria for Exit Level Outcome 11:
  • Each patient is assessed and managed within the context of his or her family and community/social/work environment.
  • An eco-map and genogram for a family is drawn up when appropriate.
  • Knowledge of the local district health system informs practice in terms of referrals, follow-up and interaction with other team members and resource persons and organisations.
    > Range: Other team members include but are not limited to pastors and traditional healers. Organisations include but are not limited to NGOs, hospices and crisis care facilities.
  • Awareness of and appropriate involvement in local community-oriented primary care is demonstrated by means but not limited to involvement in a community-based project.
  • Understanding of quality improvement cycle or process is demonstrated by participating in quality improvement activities.
  • The principles and practice of comprehensive primary health care as it affects individuals, families and communities are understood and appropriately dealt with.
    > Range: Principles and practice of comprehensive primary health care includes but is not limited to water, sanitation, nutrition, housing, pollution, personal health care and health programmes.

    Integrated Assessment:
    A range of formative and summative assessment methods will be used to permit the learner to demonstrate applied competence. Integrated assessment methods will include both theory and practical skills evaluation to ensure that the Exit Level Outcomes and Critical Cross-field Outcomes are achieved:
  • Written assignments, tests and examinations.
  • Practical examinations such as Objective Structured Clinical Examinations (OSCEs).
  • Oral examinations such as patient presentations.
  • Portfolio review.

    For summative evaluation candidates will undergo a national examination set by the Family Medicine Education Consortium (FAMEC) which will have both theoretical and practical components. 
    		•

    INTERNATIONAL COMPARABILITY 
    This qualification will lead to the graduate registering with the HPCSA as a Clinical Associate.

    This profession has different titles in different countries, but compares favourably with similar qualifications in the international arena in terms of outcomes, period for completion required and complexity. The following are some examples of similar qualifications in other countries.

    A number of African countries have mid-level health workers.

    In Tanzania this cadre of mid-level workers is called the Medical Assistant or Clinical Officer. Post-independence in 1961, there were only 12 medical doctors in the country mainly serving urban areas and some plantations. Thus an urgent need existed for the production of additional health care workers. A multi-step system of the mid-level health care provider evolved which starts with the Medical Assistant (MA)/Clinical Officer (CO) progresses to the Assistant Medical Officer (AMO) who can then specialise, becoming an AMO Specialist in any of a number of areas including Orthopaedics, Radiology, Surgery, Dermatology, Ophthalmology and Anaesthesia. There are 107 training institutions in Tanzania under the jurisdiction of the Ministry of Health. The entry requirement for the MA/CO programme is matric with physics, chemistry, biology and English. Training for the MA/CO is three years after which time the MA/CO receives a Diploma issued by the Tanzanian Ministry of Health. Regulation of the training of MAs/COs is by the Tanganyika Medical Training Board which approves the curricula and training methods. The curriculum is of 40% theory and 60% practical. Teaching is done mainly by clinical officers and doctors after having undergone training in teaching methodology and didactics over and above their clinical qualifications. Approximately 300 COs graduate each year compared to about 50 doctors. No regulatory body exists for the practice of their profession. Graduates are usually absorbed by the government and generally work in the Primary Health settings. MAs can advance to AMOs with an additional 2 years training after having worked as a MA for a minimum of 4 years and then can specialise. The AMOs are licensed by the Tanganyika Medical Council to practise and often work in hospitals.

    In Malawi a medical assistant undergoes a three year undergraduate course in the School for Health Sciences. On graduation they register with the Medical and Dental Council. They work in Health Centres and district Hospital.

    In the United States, the mid-level health care provider is called a Physician Assistant (PA). The profession was started in the mid 1960's in response to the recognition that there was a shortage and uneven distribution of primary care physicians. Navy Corpsmen who had received considerable medical training during their military service during the Vietnam War were initially selected with the PA curriculum based in part on the fast-track training of doctors during World War II. The PA programme in the US has now evolved and currently consists of a curriculum that runs an average of approximately 26 months. Most programmes are in schools of allied health, academic health centres, medical schools, or four year colleges; a few are in community colleges, the military, or hospitals. The qualification is offered as either a Bachelor's Degree or a Master's Degree, although the current trend is towards making all PA programmes Master's Degrees. Many accredited PA programmes have clinical teaching affiliations with medical schools. All programmes are accredited by the Accreditation Review Commission on Education for Physician Assistants (ARC-PA). Because of the close working relationship PAs have with physicians, PAs are educated in a medical model designed to complement physician training. Education consists of classroom and laboratory instruction in the basic medical and behavioural sciences, to include anatomy, pharmacology, pathophysiology and clinical medicine. This is followed by clinical rotations in internal medicine, family medicine, surgery, paediatrics, obstetrics and gynaecology, emergency medicine and geriatric medicine.

    Once they have completed their education and prior to employment, PA's are required to pass the Physician Assistants National Certifying Examination, administered by the National Commission on Certification of Physician Assistants (NCCPA), which is open to graduates of accredited PA education programmes. Only those successfully completing the examination may use the credential "Physician Assistant-Certified". In order to remain certified, PA's must complete 100 hours of continuing medical education every 2 years and must pass a recertification examination or complete an alternative programme combining learning experiences and a take-home examination every 6 years. Some PAs subsequently pursue additional education in a speciality such a surgery, neonatology, or emergency medicine. PA Postgraduate residency training programmes are also available in some areas such as internal medicine, rural primary care, emergency medicine, surgery, paediatrics, neonatology and occupational medicine. 

    ARTICULATION OPTIONS 
    This qualification offers both possibilities of horizontal and vertical articulation.

    Horizontal Articulation:
  • Bachelor of Medical Clinical Practice, NQF Level 7.
  • Bachelor of Medicine in Clinical Practice, NQF Level 7.

    Vertical Articulation:
  • Bachelor of Clinical Medical Practice Honours, NQF Level 8. 
    		•

    MODERATION OPTIONS 
    N/A 

    CRITERIA FOR THE REGISTRATION OF ASSESSORS 
    Examiners, assessors and moderators for all courses are leading experts in the discipline of health care sciences, and related fields.

    The following criteria for the appointment of examiners and moderators are applicable:
  • Accreditation as assessors with the relevant ETQA or ETQA that has a memorandum of understanding in place with the relevant ETQA.
  • The possession of a relevant Master's Degree.
  • Relevant teaching experience at a higher education institution.
  • Experience as a practitioner in the relevant profession. 
    		•

    REREGISTRATION HISTORY 
    As per the SAQA Board decision/s at that time, this qualification was Reregistered in 2009; 2012; 2015. 

    NOTES 
    N/A 

    LEARNING PROGRAMMES RECORDED AGAINST THIS QUALIFICATION: 
     
    NONE 


    PROVIDERS CURRENTLY ACCREDITED TO OFFER THIS QUALIFICATION: 
    This information shows the current accreditations (i.e. those not past their accreditation end dates), and is the most complete record available to SAQA as of today. Some Primary or Delegated Quality Assurance Functionaries have a lag in their recording systems for provider accreditation, in turn leading to a lag in notifying SAQA of all the providers that they have accredited to offer qualifications and unit standards, as well as any extensions to accreditation end dates. The relevant Primary or Delegated Quality Assurance Functionary should be notified if a record appears to be missing from here.
     
    1. University of Pretoria 


    All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.