Each registrar is required to complete rotations in the core domains of family medicine, but experiences are personalized to the registrar’s unique needs. Registrars develop learning plans along with their supervising faculty at the beginning of each quarter and before every rotation so that their learning can be tailored. In addition to learning, registrars are also teaching, supervising interns as well as nurses during their clinical rotations.
Besides rotations, clinical and non-clinical topics are covered during week-long contact sessions. These intensive sessions are held at the FMSTP office at Motebang Hospital in Leribe, and speakers include FMSTP faculty as well as invited speakers from the region and around the world. Contact sessions are organized on a two-year rotating schedule. First and second year registrars attend monthly, and third and fourth year registrars attend quarterly.
The focus in the third and fourth year is on reinforcement of material, engagement with ongoing projects, and learning teaching skills. Approximately 75% of contact sessions are devoted to clinical topics and 25% devoted to non-clinical topics such as public health, leadership development, research and teaching. Check out the Timetable section to see the upcoming topics for this academic year.
Registrars complete rotations at Motebang Hospital under the supervision of Obstetrician/Gynaecologist Dr Steer-Massaro. Here, registrars gain skills in management of labour, emergency and operative obstetrics, obstetric and gynaecologic ultrasound, and operative gynaecology. The district hospital setting allows registrars to learn in an environment similar to where they normally work, with the resources they typically have.
Contact sessions focusing on issues of Obstetrics and Gynaecology explore topics such as obstetric and gynaecologic ultrasound and maternity emergencies, and utilize practice patients, mannequins, and simulations in addition to classroom learning.
Throughout the FMSTP, registrars gain exposure to the full range of ambulatory care and in-patient management of acute illnesses and chronic disease exacerbations which require in-patient care.
Core adult medicine rotations take place at Motebang Hospital under the direct supervision of FMSTP faculty. Many contact sessions also focus on adult medicine, including special focus on areas such as non-communicable diseases and palliative care. Hands-on training includes acquisition and honing of skills such as hospital procedures, point-of-care ultrasound, and advanced ECG interpretation.
Through surgical rotations and contact sessions, registrars are trained on the definitive management of minor and moderately severe trauma, including burns, common orthopaedic and general surgical procedures such as the management of compound fractures of the extremities, puncture wounds to the abdomen, bowel obstructions, and appendectomies.
Every registrar participates in clinical rotations in the areas of general surgery, orthopaedic surgery, and anaesthesia at Queen Mamohato Memorial Hospital in Maseru. Contact sessions throughout the program focus on topics such as emergency and trauma care (including Advanced Cardiac Life Saving (ACLS) and Advanced Trauma Life Saving (ATLS)), surgical skills and anaesthesia at the district hospital, and management of acute surgical emergencies.
The surgical component of the program is augmented by FMSTP’s partnership with Netherlands-based SALTHO, who send surgeons for in-person training and provide registrars with access to Incision Academy, a virtual surgery teaching program.
Training includes practical approaches to prevention, applied epidemiology, program evaluation and related statistical methods, as well as quality management and district health management. All FMSTP registrars complete quality improvement projects at their hospitals, after participating in a Problem Solving for Better Health course.
At the end of the program, each FMSTP registrar completes a capstone research thesis that flows from their quality improvement and community oriented primary care work. After gaining the skills in critical reading of medical literature, evidence-based medicine, biostatistics, and research principles, registrars are mentored through the steps of creating a health research project of their choosing.
With local faculty mentors and peers, as well as Boston University based faculty and peer mentors, each registrar creates a written thesis that can go on to be published in a regional peer-reviewed journal. Registrars are encouraged not only to publish their research, but present it locally and regionally – as many of our graduates have done.
The FMSTP paediatric curriculum includes neonatal care, well child care, and the management of acutely ill or injured children, including limited surgery. Registrars participate in clinical rotations at Motebang Hospital with FMSTP faculty and visiting paediatric specialists from the US, and at the Baylor Pediatric Center of Excellence clinic in Maseru.
Contact sessions throughout the programme focus on topics such as neonatal and paediatric emergency response and resuscitation (utilising Pediatric Advanced Life Saving (PALS), Neonatal Resuscitation Program (NRP), and Helping Babies Breathe), paediatric trauma, Integrated Management of Childhood Illness (IMCI), and the Lesotho Expanded Immunization Programme, among other topics. Guest speakers include local and international paediatricians.
Recognising the immense need for registrars to have both clinical expertise and public health skills in these areas given Lesotho’s burden of disease, the FMSTP incorporates HIV/AIDS and TB into our core areas and dedicates rotations and contact sessions to these topics. All registrars complete a rotation at the Baylor Pediatric Center of Excellence clinic in Maseru focusing on outpatient management of HIV/AIDS in children.
Inpatient management of HIV/AIDS and its complications and the many forms of tuberculosis is discussed extensively during clinical rotations at Motebang Hospital in paediatrics, adult medicine, and obstetrics. In their own districts, registrars take part in their hospitals’ second-line ART committees and other initiatives focusing on HIV and TB. Contact sessions delve into advanced HIV/AIDS management and TB care, with local and international invited speakers.
With no psychiatrists in the Lesotho Ministry of Health, often mental health care falls to family physicians. FMSTP training integrates ambulatory management of mental illness into general primary care, and trains registrars on management of acute conditions requiring hospitalization as well. The FMSTP uses the WHO’s Mental Health GAP (mhGAP) curriculum and have a partnership with Dolen Cymru (Wales-Lesotho Link), who bring Welsh family doctors to Lesotho regularly to teach our registrars these crucial skills.
This module is integrated throughout the entire FMSTP and covers the so-called art of medicine. Specific training is included on building excellent patient-doctor relationships, acting as a consultant and teacher for patients, family, community and staff, and developing leadership skills.
The community is the heart of family medicine! After learning in the classroom about family- and community-oriented primary care, FMSTP registrars undertake extensive rotations in selected community health centres with exposure to the community level.
As to assure that physicians in training understand and are committed to community-orientated care, each registrar will be attached to a health centre in their district, and work as a vital team member at community sites throughout the training. Every registrar completes a community oriented primary care project midway through the program that informs their capstone operational health systems research project.