Evaluation of Family Medicine District Rotation, Orientation Program, for Medical Interns

Evaluation of Family Medicine District Rotation, Orientation Program, for Medical Interns | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Family Medicine District Rotation, Orientation Program, for Medical Interns Ozoemena Joan Ibeziako, Difuro Pearl Masemola, Joyce Sikwese Musonda This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8348898/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Medical internship orientation programmes are essential for preparing novice doctors by enhancing their clinical skills and understanding of healthcare systems. In South Africa, the Family Medicine rotation was extended to six months to improve training in primary healthcare settings. This study evaluates the orientation programme introduced in 2021 for second-year medical interns in the Ekurhuleni Health District during their Family Medicine rotation. Method Using a cross-sectional survey design, end-of-orientation feedback was collected anonymously through Google Forms from 248 interns between September 2022 and November 2024, with 228 consenting participants included in the analysis. Quantitative data described participant demographics, while qualitative data underwent thematic analysis. Results Out of 311 medical interns who rotated through the department, 248 completed the evaluation form, and 228 consented to include their data in the analysis. The proportion of females was 147 (64.47%), males 80 (35.09%), and 1 (0.43%) a gender-fluid individual. Participants’ ages ranged from 24 to 37 years, with a mean of 27 years. Nearly half of the interns, 105 (46.05%), were in the last two months of the Family Medicine Ekurhuleni Health District rotation. Mostly the major specialist rotations - Paediatrics, Obstetrics and Gynaecology, Internal Medicine, and General Surgery - had some form of orientation. Key themes from the qualitative data included understanding Family Medicine and primary health care, holistic care, Family Medicine and specialist orientation programme contents, presentation quality, professional ethos and ethical practice, interns’ logbook as a learning tool, lifelong learning, and the role of Family Medicine in community care. Suggestions for improvement focused on technical infrastructure, orientation platforms, and additional practical content. The findings support continuing and enhancing a structured orientation programme to better prepare medical interns for effective clinical practice in primary health care settings. Conclusion Orientation for novice doctors is pivotal for a smooth transition from coached student to independent professional life. Medical internship orientation induction Primary health Care South Africa Figures Figure 1 BACKGROUND Studies 1 – 15 have demonstrated that orientation programmes enhance novice doctors’ clinical procedural skills and attitudes toward patient care by boosting confidence, reducing hesitation and fear, and fostering greater interest in learning. Additionally, orientation facilitates understanding of organisational culture and clarifies roles and expectations. 1 In response to the expansion and transformation of healthcare worker training, South Africa (SA) revised its two-year medical internship programme by extending the family medicine rotation (FMR) from three to six months in the second year. 16 This change aimed to enhance exposure to and training in primary healthcare (PHC) and community settings, ensuring interns gain the knowledge, skills, and competencies expected of generalists in low-resourced communities. 16 , 17 A medical intern is a newly qualified doctor who, after completing an undergraduate degree, works under supervision within a designated internship programme. 16 , 18 Studies in SA indicate that interns often feel ill-prepared to independently perform basic life-saving procedures due to unstructured and brief orientation programmes that inadequately address expectations at the primary care level. 17 , 18 One study reflected on the experiences of four medical interns in family medicine, while another qualitatively evaluated the FMR by interviewing managers, supervisors, and interns. 17 , 18 Medical internship training occurs in accredited facilities such as hospitals, PHC clinics, or community health centres (CHC) and has evolved to address gaps in knowledge and competencies, preparing novice doctors for community service. 16 Globally, internship programmes in middle-income and developed countries share similarities, typically lasting one to two years and including rotations in major disciplines like Family Medicine, Internal Medicine, Obstetrics and Gynaecology, Paediatrics, Psychiatry, Anaesthesia, and General Surgery. 17 In SA, the internship programme aligns with the healthcare system’s emphasis on PHC delivered through the district health system (DHS) and guided by the National Health Act, which provides a framework for universal health coverage. 15 Since its inception in 1950 as a one-year program governed by the South African Medical and Dental Council (SAMDC), the internship was extended to two years between 1997 and 2006 under the Health Professions Council of South Africa (HPCSA), reflecting evidence that newly graduated doctors required more practical exposure across core disciplines. 13 – 16 This extension also addressed concerns about increased maternal mortality linked to poor anaesthetic and clinical competencies among novices. 15 , 16 The structured training ensures that newly qualified practitioners gain adequate supervised experience before registering as independent medical practitioners. 13 – 15 Between 2005 and 2019, the internship training model allocated time across specialities as follows: four months each in Internal Medicine, General Surgery, and Obstetrics and Gynaecology; two months in Anaesthesia and Orthopaedics; one month in Psychiatry; and three months in FM. 13 Family Medicine, a relatively young speciality in Africa, was officially gazetted in South Africa in 2007, with the first graduates entering the DHS in 2011. 18 Since 2021, the FMR has been extended to six months in the second year of internship, making it the longest rotation 16 . This extension aims to equip doctors with the skills, knowledge, and competencies expected of generalists in low-resource settings. 13 – 16 It also aligns with SA’s transition to the National Health Insurance, an inclusive healthcare funding model designed to address historical inequalities and improve access for all citizens, supporting the country’s National Development Plan 2030 and global Sustainable Development Goal 3. 19–24 In 2021, the Family Medicine Ekurhuleni Health District (FMEHD) introduced an orientation/induction programme for second-year medical interns. Orientation consists of onboarding clinical activities and training sessions designed to familiarise interns with the Department of Health’s values, systems, policies, and detailed role expectations. 16 While induction introduces interns to the working environment, guided by codes of conduct and standard operating procedures. 16 The FMEHD programme includes orientation and induction, and will henceforth be referred to as orientation. Internationally, orientation programmes have been implemented with positive outcomes. For example, in India, orientation sessions introduced in 2008 improved interns’ knowledge and attitudes toward patient care. 25 A 2021 study in India further confirmed that structured orientation increased interns’ confidence and enhanced medical ethics and communication skills. 26 The content of the orientation program at the FMEHD is based on standardised national internship guidelines outlined in the HPCSA medical internship logbook, which specify expected knowledge, clinical skills, and attitudes for generalists. Topics covered are an overview of the Ekurhuleni district and integrated clinical service management; principles of FM and Palliative Care; ethics in medical practice and internship training; medico-legal practices, including completion of forensic form (J88); therapeutic services and scope of practice; and the HPCSA Family Medicine rotation logbook. A significant focus is placed on practical, page-by-page guidance on using the logbook to drive personal and professional development. Interns are encouraged to progressively improve consultation skills and clinical record-keeping using the Subjective, Objective, three-stage Assessment and Plan (SOAP) approach. Exposure to undifferentiated patients and chronic care follow-up integrates knowledge from major disciplines. Time spent at PHC facilities familiarises interns with the DHS organisation, structure, processes, and therapeutic health services scope of practice, including interactions with the therapeutic health professionals - social workers, dietitians, occupational therapists, speech therapists, physiotherapists, podiatrists, audiologists, clinical psychologists, and optometrists. Interns also learn about pharmaceutical stock management, equipment maintenance, clinic catchment populations, community outreach teams, disease notifications, quality assurance, and monitoring and evaluation. Interns are required to complete a quality improvement project within two months of the district FMR. The programme emphasises personal reflection, self-evaluation, supervision, and bi-directional feedback between interns and supervisors. The orientation workshop concludes with a feedback session using a Google feedback form. This study aims to evaluate the FMEHD rotation orientation programme for second-year medical interns by describing participant characteristics, analysing their feedback, and making recommendations for improvement. The findings will help ensure the orientation programme meets the expectations of novice doctors and may inform orientation programs in similar PHC settings and specialist disciplines nationwide. METHODOLOGY Study design and sampling This study is a cross-sectional survey evaluating the Google feedback forms completed by the medical interns at the end of their FMEHD orientation program. The study population included all second-year medical interns starting FMR at the community health centre (CHC) and PHC facilities in Ekurhuleni Health District (EHD) from September 2022 to November 2024. Sample size was determined using Raosoft sample size calculator that considered a 95% confidence interval, 5% margin of error and a normal distribution of 50%. 27 The total intern cohorts from September 2022 to November 2024 were 311, but only 248 participants completed the feedback Google form. Study site In 2021, FMEHD, Gauteng Province, South Africa, introduced an orientation programme for medical interns at the start of the two-month district FMR. The orientation programme is a bimonthly cycle per cohort of medical interns on the first workday. The EHD consists of three sub-districts, demarcated geographically into the North, East, and South, as depicted in Fig. 1 . (Thomas L, Buch E, Pillay Y, Jordaan J. Effectiveness of a large-scale, sustained and comprehensive community health worker program in improving population health: the experience of an urban health district in South Africa. Human Resources for Health. 2021;19(153): 1–2. Available from: doi: 10.1186/s12960-021-00696-8 . Permission obtained) Eight of the 93 fixed clinics are CHCs, where family physicians are based. The Northern subdistrict has two CHCs, and three each at the Eastern and Southern subdistricts. The district rotation comprises one month each in CHC and PHC, out of six months dedicated to the speciality of FM. The medical interns are placed at a previously determined CHC and big PHCs (a big PHC has above 5,000 monthly headcounts) for the district rotation. The medical interns spend the other four months of FMR at their base hospital (emergency department, general outpatient/family medicine clinic, and antiretroviral clinic). The orientation programme is scheduled from 08h00 to 13h00, after which there is a physical orientation at the allocated clinic. The orientation platform varies from online to in-person, depending on the venue’s logistics, the availability of a continuous source of electrical energy, and the availability of all trainers. Data collection Data was gathered using an anonymous Google feedback questionnaire drafted in English by the researchers. The questionnaire was distributed electronically by the principal investigator through interns’ supervisors, due to its wide reach and low cost, during the last ten minutes of the orientation programme. The questionnaire comprised three sections. Section A collected participants' demographic information of age, sex, base hospital, and months in the FMR; Section B included qualitative feedback questions about the orientation workshop (Table 1 ); and Section C involved providing informed consent to use the collected data to continually improve the programme. Personal data, such as the intern’s name or phone number, was not collected to ensure anonymity. The questionnaire was validated through piloting with previous cohorts not included in this analysis. Only the Google Forms from interns who completed the feedback and consented were analysed. Table 1 Feedback Questions Questions on the Feedback form, Section B Question 1 How was the orientation today? Question 2 What was the content of the orientation in the specialist departments? Question 3 What did you like most? Question 4 What was your takeaway? Question 5 What can be improved? Question 6 Any other suggestions Data analysis Data from completed Google form questionnaires were converted into a Microsoft Excel document, and a simple statistical method of analysis was used. Participants’ demographics were summarised as descriptive statistical data of frequencies and percentages. The qualitative data were thematically analysed using ATLAS.ti software. Thematic analysis consisted of repeatedly reading the feedback comments and coding recurring words or phrases. The generated codes were grouped into categories, sub-themes, and themes. RESULTS Participants demographics Out of the total cohorts of 311 medical interns that rotated through the department, 248 completed the evaluation form, and 228 consented to include their data in the analysis. The proportion of female participants was 147 (64.47%), males 80 (35.09%), and 1 (0.43%) gender fluid individuals. Participants’ ages ranged from 24 to 37 years, with a mean of 27 years. Almost half of the interns, 105 (46.05%), were in the last 2 months of FMR. Table 2 details participants’ base hospital, length of FMR during the study period, and the specialist departments where some orientation was provided, mostly the major specialist rotations - Paediatrics, Obstetrics and Gynaecology, Internal Medicine, and General Surgery. Table 2 Participants’ duration in District Rotation and Orientation Activities Parameters Frequency (n) Percentage (%) Base Hospitals where orientation took place Tembisa Provincial Tertiary hospital 76 33.30 Tambo Memorial hospital 53 23.20 Pholosong Regional hospital 31 13.60 Far East Rand Regional hospital 25 11 Months of rotation in Family medicine at study period 5 months 113 49.56 3 months 44 19.30 1 month 22 9.65 Specialist departments with some orientation activities Paediatrics 104 21 Obstetrics & Gynaecology 94 19 Internal medicine 94 19 General Surgery 81 17 Anaesthesia 32 7 Orthopaedics 29 6 Psychiatry 28 6 All specialist departments 22 5 Analysis of qualitative data The qualitative data from participants’ evaluations of the orientation programme are thematically presented in Table 3 . Table 3 Themes Themes 1 Understanding Family Medicine and Primary Healthcare 2 District orientation Content and Preparation for Internship Roles 3 Specialist Department Orientations 4 Presentations Quality 5 Holistic Patient Care 6 Professional ethos and ethical practice 7 Lifelong Learning and Competency Development 8 Role of Family Medicine in Community and Primary Care 9 Interns’ Logbook as a Learning Tool 10 Suggestions for Improvement 11 Additional Content Recommendations 1. Understanding Family Medicine and Primary Healthcare The orientation deepened knowledge of FM scope, principles, and its central role in the healthcare system, fostering a holistic approach to patient care and community involvement. It offered insights into the structure and functioning of the clinics and challenges, clarifying expectations and objectives for the rotation. Participants gained a broader perspective on the role of primary care (PC) within the healthcare system, reappraised the holistic approach practised in FM, and enhanced their knowledge of services provided at different levels of care. Participants emphasised understanding PHC and systems, and healthcare delivery across levels. These experiences helped distinguish between hospital and district care, explained PHC objectives and operations, and showed medical interns' roles in the system. “Enlightened me about the differences between hospital-based care and district care.” (Participant 42, male, 25 years) “It has given me great insight into the opportunity we have to grow as a physician and the different areas in this rotation where we can achieve this. It has also helped to just expand our view of our healthcare system again, as we mostly function in the hospital setting this past year, and this just allows us to see how RSA (Republic of South Africa) healthcare system has multiple areas that are vital to functionality.” (Participant 121, Female, 24 years) “It opened my eyes to how a district should be working, and if we manage to do the ideal care, then the system wouldn't be overburdened in hospitals. Primary health care is the only way forward.” (Participant 199, Female, 29 years) “It’s helped me understand what care is provided at primary healthcare level and CHC level. Challenges faced at this level of care, so we are aware of what to expect and the importance of a holistic approach when dealing with patients.” (Participant 45, Female, 25 years) “The orientation today reminded me why I fell in love with medicine in the first place. Going through the ethics and family medicine principles was a perfect reminder of what our purpose is as medical doctors.” (Participant 145, Female, 28 years). 2. District Orientation Content and Preparation for Internship Roles Clear expectations, responsibilities, and competencies were communicated, the importance of professionalism, accountability, communication, and teamwork. The orientation emphasised ongoing self-directed learning and professional conduct. Participants reported that the orientation effectively conveyed expectations for CHC and PHC rotations, helping them understand their roles and expected competencies for the FMR. The orientation assisted in setting realistic goals, supported adaptation to local healthcare needs, and provided a clear rotation roadmap. They met supervisors and learned about available support systems. Additional content was on holistic patient care and ethical principles, with an emphasis on J88 form completion and medico-legal documentation, palliative care, which detailed pain assessment tools, and euthanasia. Although the principles of FM were covered during their undergraduate education, the orientation served as a valuable refresher and provided deeper knowledge and application of these principles with each patient encounter through relevant case scenarios. The value of comprehensive patient care and documentation using the SOAP format was emphasised. “..I feel better equipped. I know what is expected of me.” (Participant 14, female, 26 years) “It has helped immensely into helping us be better acclimated as to what is expected of us, what type of quality of care we are supposed to render, and how to get the most out of the system we'll be working to improve.” (Participant 113, Male, 25 years) “More acquainted with the logbook and its requirements. What is required of us as interns, the exposure we can expect to get, ethical issues, support system.” (Participant 153, Female, 25 years) “It has further substantiated the reason for family medicine and primary health care. We went over filling out a J88 and palliative care, which are topics we have not covered before in our training at the hospital.” (Participant 76, female, 26 years) “To always have the principles of family medicine in mind and also always apply them.” (Participant 114, female, 27 years) “Core principles of family med. How to clerk patients in a SOAP method, including a 3-stage assessment.” (Participant 188, female, 26 years) “Take care with the patient. From note-taking to communication and understanding the context of the patient.” (Participant 191, male, 26 years) 3. Specialist Department Orientations Orientations varied in quality and scope, covering introductions, expectations, clinical skills, and logistics. Some specialities provided comprehensive sessions on responsibilities, protocols, and departmental operations, while others were brief with limited support. Departments communicated intern expectations, roles, and responsibilities, including working hours, call duties, and communication channels, with durations ranging from 30–60 minutes to two days. Additionally, participants received information about protocols, supervision hierarchy, learning outcomes, administrative duties, and challenges. Discussions on common conditions and clinical skills, varied by hospital placement. Obstetrics and Gynaecology included ESMOE training and antenatal care, while Paediatrics covered neonatal resuscitation. Psychiatry focused on mental state examination, and Orthopaedics covered bone injuries and casting. Interns learned department layouts and organisational structure. Facility tours highlighted resources and equipment. Staff introductions included senior doctors, nurses, and specialists across departments, helping interns familiarise themselves with colleagues and the work environment. “We got a general orientation in all of them: introduction, the facility, what’s expected of us, but not as detailed as today's orientation with family medicine.” (Participant 103, female, 28 years) “Within each of the departments, we would have a 30-minute to one-hour meeting with the HOD. With the introduction, what is expected of us, how to work and learn around the department. Only family med that its orientation is more formal, with PowerPoint presentation.” (Participant 41, female, 29 years) “Largely the orientations were short and very limited, not really offering much insight or support.” (Participant 6, female, 28 years) “All were based on expectations during each of the rotations, as an intern who’s working under supervision, and the goals and competence levels to have been achieved by the end of each rotation.” (participant 7, female, 27 years) “Intern roles in the department (daily and on call) / Call rooms / Hierarchy of supervision / Conduct during meetings / Logbook / Intern allocation / Weekly schedule for the department / Relevant multidisciplinary teams / Introduction to NHLS lab.” (Participant 40, male, 25 years) “It was a two-day internship orientation and training course, whereby we received presentations of various topics covering theoretical knowledge needed for the rotation.” (Participant 54, female, 25 years) “We were introduced to the different units and wards as well as the work structure of the department. We also received study material and guidelines.” (Participant 32, male, 28 years) 4. Presentation Quality Participants perceived the orientation as informative, beneficial, and a comprehensive educational experience that provided essential knowledge for the rotation. The thoroughness was emphasised, with favourable comparisons to other departmental orientations. Participants valued the organised structure, clear expectations, and instruction on completing forms and taking patient histories. The clarity and interactivity of presentations were emphasised, providing opportunities for questions through relatable scenarios, and the comprehensive explanations relevant to their rotation were appreciated. Visual aids enhanced information retention. The orientation provided a foundation for the PHC rotations. “Orientation day was extremely helpful with regards to providing comprehensive information regarding Family Medicine, role and responsibilities of Interns. As well as knowledge and skills that interns are expected to obtain after this rotation.” (Participant 50, female, 29 years) “Incredibly, even though I was orientated in other departments, it was not as meticulous and thorough as this one. Thank you.” (Participant 66, female, 26 years) “…I am quite passionate about primary healthcare and feel it is the cornerstone of medicine and health in our country. Presentations were thorough and beautifully presented.” (Participant 197, female, 33 years) “That the presenters were well prepared, the topics were placed with us starting at the clinics and allowing us a chance for questions and feedback.” (Participant 66, female, 26 years) “The topics that were covered are aspects that we normally overlook but are important.” (Participant 100, male, 28 years) 5. Holistic Patient Care The orientation reinforced the biopsychosocial approach and, by becoming familiar with the principles of FM, helped the medical interns develop a holistic approach to patient care. Participants underscored that the holistic approach to patient care - biopsychosocial approach - remains fundamental to FM. This entails thoroughly exploring the reason for the patient to seek medical care. Interns expressed that the three-stage assessment and plan approach becomes crucial in patient encounters, facilitating comprehensive assessment and treatment, preventing illnesses and promoting health. The concept of continuous collaboration with therapeutic health services reinforces the collaborative nature of holistic care. “It is important to treat the patient holistically and not just the condition. Their home environment plays a major role, and we must try to intervene where we can.” (Participant 21, female, 26 years) “To have a biopsychosocial approach to my patient care. Making use of all resources available to improve the quality of patient care individually, and that I need to know the patients whom I'm treating.” (Participant 35, female, 28 years) “Family Medicine is a broad discipline which requires medical doctors to take a holistic approach to patient care, as well as to not forget to utilise other health care providers.” (Participant 50, female, 29 years) “That taking thorough history from the patient is very important, and that we don’t treat only what the patient presents with but we try to treat them in all different aspects, even give them the platform to open up.” (Participant 51, female, 27 years) “The importance of promoting health and respecting patients in primary health care whilst managing them holistically.” (Participant 68, female, 25 years) “It has helped me to know what to expect when I get to the primary healthcare facilities, which standards I have to uphold and how to effectively treat patients in the department. It has allowed me to shift my mindset from viewing patients as the illness with which they present to viewing them as people with emotions, beliefs, hopes and fears over and above the illness.” (Participant 126, female, 30 years) 6. Professional ethos and ethical practice The orientation covered ethical aspects of medical practice and workplace conduct. Participants learned about maintaining professionalism and effective collaboration with other healthcare professionals. They understood their roles and responsibilities better and the professional ethos they must model. Interns emphasised professionalism, ethical conduct, accountability, good communication skills, and maintaining positive relationships with colleagues and other healthcare professionals. They expressed commitment to diligent work and recognised the importance of team integration. Interns indicated that upholding professional standards would enable them to provide the best care for the patient, especially as the first point of care doctor. Participants understood the fundamental place of medical ethics in patient care. As elucidated by participant 11, “Medical ethics should be at the centre of patient care.” Some of their takeaways included harnessing communication skills that ensure proper patient consent in treatment and procedures, quality patient clinical record keeping, and being mindful of professional and ethical conduct. They must base clinical decisions on ethical principles and patient needs. Many expressed commitment to ethical, patient-centred care and recognised family physicians' role in PHC. “It is important to take responsibility for myself to be the best doctor that I can be in order to give the best care to my patients.” (Participant 10, female, 26 years ) “Accountability as an intern, Dr, even though we have supervisors, but we are also qualified doctors.” (Participant 64, male, 31 years) “Being the first point of healthcare to patients carries a big role in how/ how fast/ quality of treatment patients might receive.” (Participant 84, female, 27 years) “I understand better my commitments and expectations when serving the community. Much better than I did during hospital rotations.” (Participant 186, Gender fluid, 25 years) “Establish good working relationships with other workers, from security, cleaners, to the most senior personnel, for better outcomes in the work environment.” (Participant 210, female, 27 years) “Attitude and behaviours, responsibilities, or expectations, being respectful in a workplace.” (Participant 161, male, 27 years) “Discipline, good ethical behaviour, understanding of autonomy of patients, Batho Pele principles.” (Participant 144, male, 30 years) “Keeping Ethics in mind, being thorough in notetaking and the role of interns, legally speaking.” (Participant 146, male, 27 years) 6. Lifelong Learning and Competency Development Participants recognised the importance of ongoing self-improvement and supervision to enhance their competence throughout their careers. They understood their roles as interns and future general practitioners, while identifying areas for improvement through learning objectives. The sessions helped identify knowledge gaps and create improvement plans. Interns recognised the importance of self-directed learning, using and completing logbooks on time. They learnt to become more organised and focus on developing competency. “Structure out my plan for the next 6 months, also to realise my deficits and how to correct them.” (Participant 108, male, 28 years) “It served as a guide for me to make the most of my rotation, a guide to learning and improving my competency.” (Participant 116, male, 27 years) “The orientation helped to identify gaps in my learning and to make arrangements to further my learning. I need to improve skills and knowledge to become a better and competent doctor in the future.” (Participant 136, female, 27 years) “I liked that it was preparing us as young doctors for the future and emphasising that whatever we acquire now depends on us and to what kind of doctors we want to be in future.” (Participant 160, female, 27 years) “Learning is lifelong and needs to be self-driven. There is always room for improvement, and we are given the best opportunities to learn in environments that have ample amounts of people and conditions to learn from.” (Participant 136, female, 27 years) “The importance of having a good attitude and being willing to learn and teach ourselves throughout the rotation. That we should always go to our supervisors when we need help.” (Participant 147, female, 24 years) 7. Role of Family Medicine in Community and Primary Care Primary health care is fundamental to healthcare systems and serves as patients' first point of contact. Community collaboration ensures comprehensive care, with clinics facilitating initial healthcare engagement. Family physicians actively work with communities rather than waiting for patients. This approach treats communities, not just diseases. Family Medicine improves accessible services within and beyond facilities. Healthcare providers in Community Health Centres address diverse patient needs while delivering comprehensive, patient-centred care. “Family physicians reach out to the community. They go to the patients as opposed to awaiting patients to come to them. Prevention is better than cure.” (Participant 205, female, 26 years) “Community health care and primary health care are very important for early intervention and prevention of disease progression.” (Participant 29, female, 27 years) “Clinics are important in primary care; they are the patient’s first point of contact with the health care system.” (Participant 80, female, 26 years) “Ability to know how to access services outside the facility and what's offered within the facility . ” (Participant 89, male, 30 years) “It has helped me understand broadly how family medicine works, integrating every member of the community and health professionals and how it all falls perfectly like a jigsaw puzzle when done correctly.” (participant 119, male, 31 years) “Reminded me about the importance of family physicians in a community, as well as motivated me. It also made me feel at rest to start my rotation in the CHC.” (Participant 10, female, 26 years) 8. Interns’ Logbook as a Learning Tool Participants identified the logbook discussion as crucial during orientation. The logbook was essential for accountability and tracking progress toward competence. It serves to guide learning by establishing learning objectives, assessing outcomes, facilitating reflection, and identifying areas for growth. The logbook helps understand therapeutic professionals' roles and the district health system. Timely completion is vital for professional development and safe medical practice. The logbook remains integral throughout the medical internship. “Exposure on how the logbook should be an accountability tool in order to continually assess oneself and to become a better generalist.” (Participant 69, male, 25 years) “The detailed breakdown of the logbook and guidance on how to complete it.” (Participant 117, female, 25 years) “That the logbook is very crucial. It’s not about getting signatures, but it’s there to guide me throughout my internship and to help me grow and be a competent Dr, who can confidently and independently make the right decisions for patients’ care.” (Participant 86, female, 27 years) “To continually update my logbook in order to ensure I adequately reflect as I practice and am cognisant of any gaps in my knowledge so that I am able to actively try to fill them.” (Participant 138, male, 27 years) “What the allied health workers does, the importance of filling your logbook eg the bingo card.” (Participant 94, male, 29 years) “I need to always update my logbook and be a competent doctor who practices safe medicine.” (Participant 198, male, 27 years) “The importance of keeping track of my performance with the logbook being my reference.” (Participant 198, male, 27 years) 9. Suggestions for Improvement Participants’ feedback was overwhelmingly positive, with most describing the orientation as satisfactory and comprehensive, with no areas for improvement. They commended the orientation as "well-rounded," "perfect," and "well-organised," with one noting it was detailed and enjoyable. “I believe that the orientation was well-rounded and there is nothing to be improved.” (Participant 23, male, 30 years) “I enjoyed the presentation. I believe everyone that presented had a very detailed presentation to their best of their knowledge/ability.” (Participant 25, female, 29 years) “I think the orientation includes all the important things.” (Participant 28, female, 31 years) Strategies to enhance outcomes were suggested. Technical issues emerged as a significant concern, with participants encountering connectivity problems. Participants expressed diverse and sometimes contradicting suggestions regarding the orientation platform, influenced by their experiences of technical glitches. Recommendations included establishing dedicated internet connections, employing IT support, and utilising centralised sites. Time management needed improvement with diverging solutions. Some found the orientation too lengthy, suggesting splitting it into two days, while others suggested shortening it. Participants advocated for better time allocation for presentations and punctual starts. Some preferred in-person sessions to address network issues, reduce orientation duration, and for better interaction and productivity, while others, an online platform to address individual needs, “being post-call and attending physical makes it very harder to concentrate" (participant 78, male, 30 years). Other factors influencing preferences were physical comfort, such as the room temperature, arrangement, and surrounding noise level, and the projection appliance. “Dedicated internet connection, because we had a time problem because of internet loss.” (Participant 9, male, 26 years) “If it can be done via Zoom, allow everyone to be in a place with reliable Wi-Fi and not in one place with bad Wi-Fi on the laptop.” (participant 216, female, 27 years). “Most of the problems were just due to technology (connectivity), therefore I don’t think there’s much to improve.” (Participant 88, female, 28 years) “..Location of all speakers prior to presentation so that time is not wasted when trying to find speakers who are allocated on the agenda.” (Participant 76, female, 26 years) “Technical glitches. I think the orientation would have been better in person... Cos it took more time than expected.” (Participant 227, male, 29 years) “Punctuality of speakers. If something is set to start at 8:30 am, then it should start then to respect everyone’s time, especially those who came early.” (Participant 141, female, 25 years) “Orientation in person. Avoids non-attendance due to network issues. Long presentations, attention span challenges.” (Participant 182, female, 26 years) “It could be more helpful if it is done physically, not virtually, for it to be more interactive.” (Participant 204, male, 29 years) Regarding content, participants requested more practical advice on calls, safety protocols, and management guidelines. Some suggested an experience sharing session by a veteran intern, interdisciplinary presentations with inclusion of nurses, and more time for ethical principles. Participants preferred the orientation at the start of their six-month FM rotation and the discussion on the logbook at the start of the internship. Others suggested making PowerPoint presentations available in advance for preparation. “Just a suggestion: maybe we could have interactive questions at the end of the presentation to see if we understood certain topics.” (Participant 55, female, 26 years ) “Nothing to improve per se, but to have more time allocated in teaching about ethical principles for interns and the ethical dilemmas. And more on the laws and regulations.” (Participant 86, female, 27 years) “Shorter sessions, sharing of slides with Interns, having the logbook session at the beginning of internship (on the first day we start with our internship in the first year).” (Participant 226, male, 27 years) “I think next time it will be nice to have one of the interns to present or give feedback from each CHC how their experience have been.” (Participant 145, female, 28 years) Some participants suggested the need for more frequent and structured breaks during presentations, such as short 15-minute breaks between presentations and longer 30-minute lunch breaks. The breaks serve multiple purposes: allowing attendees to refresh mentally, stretch physically, and have refreshments. One participant noted that breaks help prevent "sleeping" (participant 37, male, 34 years) during presentations, maintaining alertness and engagement. These breaks are necessary because presentations are often "packed with information," and breaks provide time to process content. “Allowing for breaks between the presentations. The presentations were packed with a lot of information, and it was difficult to focus towards the end.” (Participant 11, female, 25 years) “Making time for at least 15-min breaks within the session just to refresh our minds. We can suffer from information overload.” (Participant 62, female, 27 years) “Appropriate stretch breaks and tea breaks in between presentations.” (Participant 69, male, 25 years) 10. Additional Content Recommendations The majority overwhelmingly had no other suggestions and felt all relevant topics were covered, and a few suggested guidelines on common primary care conditions and emergencies , such as organophosphate poisoning, prevention of sexually transmitted infections, chronic conditions, and commonly used medications, among others, could be discussed. Other minorities recommended integration of district FM orientation with other specialist disciplines, practice sessions on three-stage assessment and plan, sexual assault management, writing referral letters, and clinical governance topics like process of handling death on arrival, death certification, and relevant policy documents. “This orientation should be done at the beginning of family medicine, not only when interns go to clinics.” (Participant 140, female, 28 years) “Maybe a topic on commonly used medications and common emergencies.” (Participant 128, female, 26 years) “How to write referral notes from the clinic to the hospitals.” (Participant 120, female, 26 years) “Going through practically the SOAP and 3-stage assessment.” (Participant 45, female, 25 years) “Perhaps touching more on the quality improvement project needed and some theoretical background to the process.” (Participant 54, female, 25 years) Interestingly, another minority suggested public health principles and application, simple data interpretation, and other aspects of medical ethics, like ethics in social media, South African Social Security Agency (SASSA) grant, and applications in paediatric case scenarios. “I would like to find out more about how the public health survey QIP is done, and how the findings are implemented to better the community.” (Participant 199, female, 29 years) “Principles of public health medicine.” (Participant 46, female, 27 years) DISCUSSION This study evaluates the FMEHD orientation program for medical interns on the first day of their rotation. It emphasised the value of a structured orientation of novice doctors, its comprehensiveness, knowledge acquisition, role clarification, holistic patient care, ethics, and practical skills. This resonates with the findings in Sameer et al.’s 28 structured induction programme of resident doctors in India. The residents appreciated the comprehensive nature of the program and its relevance to their roles, although the induction was at a hospital level of care, as opposed to PHC interns’ orientation experiences. The FMEHD orientation programme notably enhanced interns' understanding of PHC systems, the holistic approach inherent to FM, and their professional roles and responsibilities. The study by Zayapragassarazan 29 elaborates that such programs are important for facilitating smooth transitions into clinical roles, enhancing professionalism, patient safety, and confidence. The emphasis on holistic patient care and bio-psycho-social approaches reflects the core principles of FM; such approaches improve patient outcomes and healthcare system efficiency. Kusnanto et al.’s 30 biopsychosocial model of illnesses in PC outlines the fact that PC clinicians are positioned to implement the biopsychosocial model to improve patient outcomes through enhanced doctor-patient relationships, empathy, and multidisciplinary care. The interns valued its practical application during the orientation. Participants’ appreciation for detailed instruction on medico-legal documentation, particularly the J88 form, and ethical principles aligns with Moodley’s 31 narration of the critical role of ethics and legal knowledge in clinical practice. Clinicians encounter a wide range of ethical dilemmas across all levels of care (primary, secondary, tertiary). Generalist medicine, as applies to PC, is ethically complex due to its holistic bio-psycho-social approach, which transcends treating just biological disease. Ethical dilemmas are complex and require holistic approaches beyond just applying principles. Healthcare practitioners must develop skills to identify and manage ethical conflicts with the same expertise as clinical problems. 31 The orientation’s focus on medico-legal documentation also addresses a known gap in many internship programs, where interns often lack formal training in this area. Rowe et al. 32 report the deficiency in medical training regarding completion of forensic documents in the quality improvement project at a CHC in Cape Town. The editorial letter underscores the necessity of equipping medical practitioners with the requisite knowledge, skills, and a dedicated attitude towards the precise completion of the J88 form. The variability in specialist department orientations, ranging from comprehensive sessions to minimal introductions, may impact interns’ preparedness and confidence, as noted by participants who found specialist orientations less thorough than those of FM. Dineen et al 33 describe that the transition to internship is characterised by substantial uncertainty primarily due to new roles and environments. Interns mainly respond by seeking help, but experience stress and self-doubt. Reducing extraneous uncertainties via structured orientation and fostering critical reflection with supervisory support can enhance interns’ uncertainty tolerance, ultimately improving their preparedness and well-being. They further recommended that orientation programmes should include simulated scenarios that mirror real intern responsibilities, emphasising multitasking, escalation, and role boundaries. A well-structured specialist orientation could improve interns' clinical skills and integration into multidisciplinary teams. Kathrotia et al 26 elucidate the internship orientation programme as a critical initiative that equips fresh medical graduates with the knowledge, skills, and confidence necessary for their transition to professional life. It enhances clinical and soft skills, ethical awareness, and professional attitudes. The study strongly recommends the inclusion of such comprehensive orientation programme before internship commencement to ensure effective and safe clinical practice. The positive reception of interactive presentations and comprehensive coverage of expectations, clinical skills, and professional ethos supports educational best practices advocating for active learning and clear communication of roles. Chang et al 34 describe active learning as an effective model for medical education, bridging theoretical knowledge with practical skills. It equips students/clinicians with critical thinking, communication, and teamwork competencies essential for complex clinical environments. The approach fosters lifelong learning and adaptability, ultimately enhancing the quality of healthcare training and patient care. Further, the interns’ recognition of lifelong learning, self-directed study, and reflective practice as key takeaways aligns with contemporary medical education frameworks promoting competency-based education and continuous professional development. 35 Participants appreciated the quality and depth of the presentations, interactiveness, and their learner-centredness. This resonates with Lui et al’s 36 elaboration of the core themes of effective orientation. According to their study, the orientation programme should employ multimodal learning through lectures, discussions, and hands-on exercises to promote engagement and knowledge retention, thus catering for learners’ preferences. Simulation training to mirror real-world practice could entail blended learning methods, including online modules and flipped classrooms, to support flexible learning. Simulation training provides a safe environment for practising clinical procedures, communication, and decision-making skills. Peer-assisted instruction provides practical knowledge and support, and this aligns with the intern’s suggestion for shared experiences by a veteran medical intern. Further, orientation should also introduce interns to multidisciplinary healthcare teams, fostering interprofessional collaboration and communication skills that enhance patient safety. This affirms this study’s reported experiences with involvement of the therapeutic team. Participants suggested aspects of improvement, such as addressing technical issues, an in-person platform to enhance interactivity, and providing practical guidance on safety and call duties, which align with Lui et al’s recommended strategies. The mixed preferences for online versus in-person formats reflect ongoing debates about optimal delivery modes for medical training, with hybrid models increasingly advocated to balance accessibility and engagement. 36 In summary, the findings corroborate existing evidence that comprehensive, well-organised, and contextually relevant orientation programmes are essential to prepare medical interns for effective clinical practice, particularly in resource-limited settings. The emphasis on ethics, medico-legal skills, holistic care, and professional development is consistent with current educational priorities. Addressing logistical and technological challenges will further enhance orientation effectiveness. Limitations Although a few studies have examined the medical interns’ orientation programme, this is an original study that describes medical interns’ orientation during district FMR. It uniquely evaluates interns’ orientation at a PHC setting where comprehensive services are provided within an integrated DHS. This study was conducted in a single district. Internship training in South Africa varies considerably between districts in terms of resources, supervision, clinical exposure, and organisational systems. Therefore, the findings may not be generalisable to rural or similar less-resourced districts where the FMR and orientation processes differ substantially. The orientation model evaluated is context-specific to Ekurhuleni and may not be feasible in districts with different staffing levels or infrastructure. The cross-sectional design captures only immediate perceptions after orientation and does not assess longer-term outcomes. Additionally, reliance on self-reported feedback may have introduced response bias, and the exclusion of non-consenting interns may have contributed to non-response. Recommendations Advocacy for a structured orientation programme for medical interns at the start of the medical internship to prepare the novices clinically, ethically, and contextually, build confidence and provide support. Standardise specialist department orientations across hospitals to ensure consistency in quality, scope, and comprehensiveness, addressing gaps identified by interns who experienced variability in these sessions. An effective orientation outcome could be attained if the program takes place at the beginning of each rotation, with relevant content, and importance is given to the educational model that enhances learners’ centeredness. Declarations Ethics approval and consent to participate Ethical approval was obtained from the University of Pretoria ethics committee (600/2024), and permission for data collection was obtained from the National Health Research Database (GP_202309_078) and the Ekurhuleni Health District ethics committee (18/10/2023/01). Consent for publication All authors granted consent for publication. Availability of Data and Materials The datasets used and/or analysed during the current study are available from the corresponding author upon a reasonable request. Competing interests The author has no competing interests. Funding The authors declared that this study received no financial support. Authors’ contribution OJI designed and conceptualised the project, analysed qualitative data, wrote up the results and discussions and general editing. DPM and JSM worked on the literature review and methodology. DPM analysed quantitative data. DPM and JSM reviewed the manuscript with critical inputs. Acknowledgements The authors acknowledge all medical interns who provide feedback on the orientation programme. Also, our appreciation goes to all Family Physicians who facilitated the diverse sections of the orientation programme. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8348898","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":575173046,"identity":"5e7d2d47-c390-494b-8d9d-0e7a584f766e","order_by":0,"name":"Ozoemena Joan 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Effectiveness of a large-scale, sustained and comprehensive community health worker program in improving population health: the experience of an urban health district in South Africa. Human Resources for Health. 2021;19(153): 1-2. Available from: doi: 10.1186/s12960-021-00696-8. Permission obtained)\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8348898/v1/1b2b859e6f9a1105e208e16c.jpg"},{"id":100796064,"identity":"5423feda-113a-4c22-95ac-d03da73115f8","added_by":"auto","created_at":"2026-01-21 13:37:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":937949,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8348898/v1/7e9bfcf3-12d0-484e-a9d3-b3d535b5d734.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluation of Family Medicine District Rotation, Orientation Program, for Medical Interns\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eStudies\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e have demonstrated that orientation programmes enhance novice doctors\u0026rsquo; clinical procedural skills and attitudes toward patient care by boosting confidence, reducing hesitation and fear, and fostering greater interest in learning. Additionally, orientation facilitates understanding of organisational culture and clarifies roles and expectations. \u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn response to the expansion and transformation of healthcare worker training, South Africa (SA) revised its two-year medical internship programme by extending the family medicine rotation (FMR) from three to six months in the second year.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This change aimed to enhance exposure to and training in primary healthcare (PHC) and community settings, ensuring interns gain the knowledge, skills, and competencies expected of generalists in low-resourced communities.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA medical intern is a newly qualified doctor who, after completing an undergraduate degree, works under supervision within a designated internship programme.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Studies in SA indicate that interns often feel ill-prepared to independently perform basic life-saving procedures due to unstructured and brief orientation programmes that inadequately address expectations at the primary care level.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e One study reflected on the experiences of four medical interns in family medicine, while another qualitatively evaluated the FMR by interviewing managers, supervisors, and interns.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMedical internship training occurs in accredited facilities such as hospitals, PHC clinics, or community health centres (CHC) and has evolved to address gaps in knowledge and competencies, preparing novice doctors for community service.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Globally, internship programmes in middle-income and developed countries share similarities, typically lasting one to two years and including rotations in major disciplines like Family Medicine, Internal Medicine, Obstetrics and Gynaecology, Paediatrics, Psychiatry, Anaesthesia, and General Surgery.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn SA, the internship programme aligns with the healthcare system\u0026rsquo;s emphasis on PHC delivered through the district health system (DHS) and guided by the National Health Act, which provides a framework for universal health coverage.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Since its inception in 1950 as a one-year program governed by the South African Medical and Dental Council (SAMDC), the internship was extended to two years between 1997 and 2006 under the Health Professions Council of South Africa (HPCSA), reflecting evidence that newly graduated doctors required more practical exposure across core disciplines.\u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This extension also addressed concerns about increased maternal mortality linked to poor anaesthetic and clinical competencies among novices.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The structured training ensures that newly qualified practitioners gain adequate supervised experience before registering as independent medical practitioners.\u003csup\u003e\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Between 2005 and 2019, the internship training model allocated time across specialities as follows: four months each in Internal Medicine, General Surgery, and Obstetrics and Gynaecology; two months in Anaesthesia and Orthopaedics; one month in Psychiatry; and three months in FM.\u003csup\u003e13\u003c/sup\u003e Family Medicine, a relatively young speciality in Africa, was officially gazetted in South Africa in 2007, with the first graduates entering the DHS in 2011.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Since 2021, the FMR has been extended to six months in the second year of internship, making it the longest rotation\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. This extension aims to equip doctors with the skills, knowledge, and competencies expected of generalists in low-resource settings.\u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e It also aligns with SA\u0026rsquo;s transition to the National Health Insurance, an inclusive healthcare funding model designed to address historical inequalities and improve access for all citizens, supporting the country\u0026rsquo;s National Development Plan 2030 and global Sustainable Development Goal 3.\u003csup\u003e19\u0026ndash;24\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn 2021, the Family Medicine Ekurhuleni Health District (FMEHD) introduced an orientation/induction programme for second-year medical interns. Orientation consists of onboarding clinical activities and training sessions designed to familiarise interns with the Department of Health\u0026rsquo;s values, systems, policies, and detailed role expectations.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e While induction introduces interns to the working environment, guided by codes of conduct and standard operating procedures.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The FMEHD programme includes orientation and induction, and will henceforth be referred to as orientation. Internationally, orientation programmes have been implemented with positive outcomes. For example, in India, orientation sessions introduced in 2008 improved interns\u0026rsquo; knowledge and attitudes toward patient care.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e A 2021 study in India further confirmed that structured orientation increased interns\u0026rsquo; confidence and enhanced medical ethics and communication skills.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e The content of the orientation program at the FMEHD is based on standardised national internship guidelines outlined in the HPCSA medical internship logbook, which specify expected knowledge, clinical skills, and attitudes for generalists. Topics covered are an overview of the Ekurhuleni district and integrated clinical service management; principles of FM and Palliative Care; ethics in medical practice and internship training; medico-legal practices, including completion of forensic form (J88); therapeutic services and scope of practice; and the HPCSA Family Medicine rotation logbook.\u003c/p\u003e \u003cp\u003eA significant focus is placed on practical, page-by-page guidance on using the logbook to drive personal and professional development. Interns are encouraged to progressively improve consultation skills and clinical record-keeping using the Subjective, Objective, three-stage Assessment and Plan (SOAP) approach. Exposure to undifferentiated patients and chronic care follow-up integrates knowledge from major disciplines. Time spent at PHC facilities familiarises interns with the DHS organisation, structure, processes, and therapeutic health services scope of practice, including interactions with the therapeutic health professionals - social workers, dietitians, occupational therapists, speech therapists, physiotherapists, podiatrists, audiologists, clinical psychologists, and optometrists. Interns also learn about pharmaceutical stock management, equipment maintenance, clinic catchment populations, community outreach teams, disease notifications, quality assurance, and monitoring and evaluation. Interns are required to complete a quality improvement project within two months of the district FMR. The programme emphasises personal reflection, self-evaluation, supervision, and bi-directional feedback between interns and supervisors. The orientation workshop concludes with a feedback session using a Google feedback form.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate the FMEHD rotation orientation programme for second-year medical interns by describing participant characteristics, analysing their feedback, and making recommendations for improvement. The findings will help ensure the orientation programme meets the expectations of novice doctors and may inform orientation programs in similar PHC settings and specialist disciplines nationwide.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and sampling\u003c/h2\u003e \u003cp\u003eThis study is a cross-sectional survey evaluating the Google feedback forms completed by the medical interns at the end of their FMEHD orientation program. The study population included all second-year medical interns starting FMR at the community health centre (CHC) and PHC facilities in Ekurhuleni Health District (EHD) from September 2022 to November 2024. Sample size was determined using Raosoft sample size calculator that considered a 95% confidence interval, 5% margin of error and a normal distribution of 50%.\u003csup\u003e27\u003c/sup\u003e The total intern cohorts from September 2022 to November 2024 were 311, but only 248 participants completed the feedback Google form.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy site\u003c/h3\u003e\n\u003cp\u003eIn 2021, FMEHD, Gauteng Province, South Africa, introduced an orientation programme for medical interns at the start of the two-month district FMR. The orientation programme is a bimonthly cycle per cohort of medical interns on the first workday. The EHD consists of three sub-districts, demarcated geographically into the North, East, and South, as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e(Thomas L, Buch E, Pillay Y, Jordaan J. Effectiveness of a large-scale, sustained and comprehensive community health worker program in improving population health: the experience of an urban health district in South Africa. Human Resources for Health. 2021;19(153): 1\u0026ndash;2. Available from: doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12960-021-00696-8\u003c/span\u003e\u003cspan address=\"10.1186/s12960-021-00696-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Permission obtained)\u003c/p\u003e \u003cp\u003eEight of the 93 fixed clinics are CHCs, where family physicians are based. The Northern subdistrict has two CHCs, and three each at the Eastern and Southern subdistricts. The district rotation comprises one month each in CHC and PHC, out of six months dedicated to the speciality of FM. The medical interns are placed at a previously determined CHC and big PHCs (a big PHC has above 5,000 monthly headcounts) for the district rotation. The medical interns spend the other four months of FMR at their base hospital (emergency department, general outpatient/family medicine clinic, and antiretroviral clinic). The orientation programme is scheduled from 08h00 to 13h00, after which there is a physical orientation at the allocated clinic. The orientation platform varies from online to in-person, depending on the venue\u0026rsquo;s logistics, the availability of a continuous source of electrical energy, and the availability of all trainers.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData was gathered using an anonymous Google feedback questionnaire drafted in English by the researchers. The questionnaire was distributed electronically by the principal investigator through interns\u0026rsquo; supervisors, due to its wide reach and low cost, during the last ten minutes of the orientation programme. The questionnaire comprised three sections. Section A collected participants' demographic information of age, sex, base hospital, and months in the FMR; Section B included qualitative feedback questions about the orientation workshop (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e); and Section C involved providing informed consent to use the collected data to continually improve the programme. Personal data, such as the intern\u0026rsquo;s name or phone number, was not collected to ensure anonymity. The questionnaire was validated through piloting with previous cohorts not included in this analysis. Only the Google Forms from interns who completed the feedback and consented were analysed.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFeedback Questions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestions on the Feedback form, Section B\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow was the orientation today?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat was the content of the orientation in the specialist departments?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat did you like most?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat was your takeaway?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat can be improved?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestion 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAny other suggestions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData from completed Google form questionnaires were converted into a Microsoft Excel document, and a simple statistical method of analysis was used. Participants\u0026rsquo; demographics were summarised as descriptive statistical data of frequencies and percentages. The qualitative data were thematically analysed using ATLAS.ti software. Thematic analysis consisted of repeatedly reading the feedback comments and coding recurring words or phrases. The generated codes were grouped into categories, sub-themes, and themes.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipants demographics\u003c/h2\u003e \u003cp\u003eOut of the total cohorts of 311 medical interns that rotated through the department, 248 completed the evaluation form, and 228 consented to include their data in the analysis. The proportion of female participants was 147 (64.47%), males 80 (35.09%), and 1 (0.43%) gender fluid individuals. Participants\u0026rsquo; ages ranged from 24 to 37 years, with a mean of 27 years. Almost half of the interns, 105 (46.05%), were in the last 2 months of FMR.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e details participants\u0026rsquo; base hospital, length of FMR during the study period, and the specialist departments where some orientation was provided, mostly the major specialist rotations - Paediatrics, Obstetrics and Gynaecology, Internal Medicine, and General Surgery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; duration in District Rotation and Orientation Activities\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBase Hospitals where orientation took place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTembisa Provincial Tertiary hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTambo Memorial hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePholosong Regional hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFar East Rand Regional hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMonths of rotation in Family medicine at study period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eSpecialist departments with some orientation activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaediatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObstetrics \u0026amp; Gynaecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnaesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthopaedics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll specialist departments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnalysis of qualitative data\u003c/h3\u003e\n\u003cp\u003eThe qualitative data from participants\u0026rsquo; evaluations of the orientation programme are thematically presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderstanding Family Medicine and Primary Healthcare\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistrict orientation Content and Preparation for Internship Roles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialist Department Orientations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresentations Quality\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHolistic Patient Care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional ethos and ethical practice\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLifelong Learning and Competency Development\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRole of Family Medicine in Community and Primary Care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInterns\u0026rsquo; Logbook as a Learning Tool\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuggestions for Improvement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdditional Content Recommendations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e1. Understanding Family Medicine and Primary Healthcare\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe orientation deepened knowledge of FM scope, principles, and its central role in the healthcare system, fostering a holistic approach to patient care and community involvement. It offered insights into the structure and functioning of the clinics and challenges, clarifying expectations and objectives for the rotation. Participants gained a broader perspective on the role of primary care (PC) within the healthcare system, reappraised the holistic approach practised in FM, and enhanced their knowledge of services provided at different levels of care. Participants emphasised understanding PHC and systems, and healthcare delivery across levels. These experiences helped distinguish between hospital and district care, explained PHC objectives and operations, and showed medical interns' roles in the system.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Enlightened me about the differences between hospital-based care and district care.\u0026rdquo; (Participant 42, male, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It has given me great insight into the opportunity we have to grow as a physician and the different areas in this rotation where we can achieve this. It has also helped to just expand our view of our healthcare system again, as we mostly function in the hospital setting this past year, and this just allows us to see how RSA (Republic of South Africa) healthcare system has multiple areas that are vital to functionality.\u0026rdquo; (Participant 121, Female, 24 years)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It opened my eyes to how a district should be working, and if we manage to do the ideal care, then the system wouldn't be overburdened in hospitals. Primary health care is the only way forward.\u0026rdquo; (Participant 199, Female, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It\u0026rsquo;s helped me understand what care is provided at primary healthcare level and CHC level. Challenges faced at this level of care, so we are aware of what to expect and the importance of a holistic approach when dealing with patients.\u0026rdquo; (Participant 45, Female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The orientation today reminded me why I fell in love with medicine in the first place. Going through the ethics and family medicine principles was a perfect reminder of what our purpose is as medical doctors.\u0026rdquo; (Participant 145, Female, 28 years).\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003e2. District Orientation Content and Preparation for Internship Roles\u003c/b\u003e \u003c/p\u003e \u003cp\u003eClear expectations, responsibilities, and competencies were communicated, the importance of professionalism, accountability, communication, and teamwork. The orientation emphasised ongoing self-directed learning and professional conduct. Participants reported that the orientation effectively conveyed expectations for CHC and PHC rotations, helping them understand their roles and expected competencies for the FMR. The orientation assisted in setting realistic goals, supported adaptation to local healthcare needs, and provided a clear rotation roadmap. They met supervisors and learned about available support systems. Additional content was on holistic patient care and ethical principles, with an emphasis on J88 form completion and medico-legal documentation, palliative care, which detailed pain assessment tools, and euthanasia. Although the principles of FM were covered during their undergraduate education, the orientation served as a valuable refresher and provided deeper knowledge and application of these principles with each patient encounter through relevant case scenarios. The value of comprehensive patient care and documentation using the SOAP format was emphasised.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;..I feel better equipped. I know what is expected of me.\u0026rdquo; (Participant 14, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;It has helped immensely into helping us be better acclimated as to what is expected of us, what type of quality of care we are supposed to render, and how to get the most out of the system we'll be working to improve.\u0026rdquo; (Participant 113, Male, 25 years)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;More acquainted with the logbook and its requirements. What is required of us as interns, the exposure we can expect to get, ethical issues, support system.\u0026rdquo; (Participant 153, Female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It has further substantiated the reason for family medicine and primary health care. We went over filling out a J88 and palliative care, which are topics we have not covered before in our training at the hospital.\u0026rdquo; (Participant 76, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;To always have the principles of family medicine in mind and also always apply them.\u0026rdquo; (Participant 114, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Core principles of family med. How to clerk patients in a SOAP method, including a 3-stage assessment.\u0026rdquo; (Participant 188, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Take care with the patient. From note-taking to communication and understanding the context of the patient.\u0026rdquo; (Participant 191, male, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3. Specialist Department Orientations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOrientations varied in quality and scope, covering introductions, expectations, clinical skills, and logistics. Some specialities provided comprehensive sessions on responsibilities, protocols, and departmental operations, while others were brief with limited support. Departments communicated intern expectations, roles, and responsibilities, including working hours, call duties, and communication channels, with durations ranging from 30\u0026ndash;60 minutes to two days. Additionally, participants received information about protocols, supervision hierarchy, learning outcomes, administrative duties, and challenges. Discussions on common conditions and clinical skills, varied by hospital placement. Obstetrics and Gynaecology included ESMOE training and antenatal care, while Paediatrics covered neonatal resuscitation. Psychiatry focused on mental state examination, and Orthopaedics covered bone injuries and casting. Interns learned department layouts and organisational structure. Facility tours highlighted resources and equipment. Staff introductions included senior doctors, nurses, and specialists across departments, helping interns familiarise themselves with colleagues and the work environment.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We got a general orientation in all of them: introduction, the facility, what\u0026rsquo;s expected of us, but not as detailed as today's orientation with family medicine.\u0026rdquo; (Participant 103, female, 28 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Within each of the departments, we would have a 30-minute to one-hour meeting with the HOD. With the introduction, what is expected of us, how to work and learn around the department. Only family med that its orientation is more formal, with PowerPoint presentation.\u0026rdquo; (Participant 41, female, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Largely the orientations were short and very limited, not really offering much insight or support.\u0026rdquo; (Participant 6, female, 28 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;All were based on expectations during each of the rotations, as an intern who\u0026rsquo;s working under supervision, and the goals and competence levels to have been achieved by the end of each rotation.\u0026rdquo; (participant 7, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Intern roles in the department (daily and on call) / Call rooms / Hierarchy of supervision / Conduct during meetings / Logbook / Intern allocation / Weekly schedule for the department / Relevant multidisciplinary teams / Introduction to NHLS lab.\u0026rdquo; (Participant 40, male, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It was a two-day internship orientation and training course, whereby we received presentations of various topics covering theoretical knowledge needed for the rotation.\u0026rdquo; (Participant 54, female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;We were introduced to the different units and wards as well as the work structure of the department. We also received study material and guidelines.\u0026rdquo; (Participant 32, male, 28 years)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003e4. Presentation Quality\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants perceived the orientation as informative, beneficial, and a comprehensive educational experience that provided essential knowledge for the rotation. The thoroughness was emphasised, with favourable comparisons to other departmental orientations. Participants valued the organised structure, clear expectations, and instruction on completing forms and taking patient histories. The clarity and interactivity of presentations were emphasised, providing opportunities for questions through relatable scenarios, and the comprehensive explanations relevant to their rotation were appreciated. Visual aids enhanced information retention. The orientation provided a foundation for the PHC rotations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Orientation day was extremely helpful with regards to providing comprehensive information regarding Family Medicine, role and responsibilities of Interns. As well as knowledge and skills that interns are expected to obtain after this rotation.\u0026rdquo; (Participant 50, female, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Incredibly, even though I was orientated in other departments, it was not as meticulous and thorough as this one. Thank you.\u0026rdquo; (Participant 66, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;I am quite passionate about primary healthcare and feel it is the cornerstone of medicine and health in our country. Presentations were thorough and beautifully presented.\u0026rdquo; (Participant 197, female, 33 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;That the presenters were well prepared, the topics were placed with us starting at the clinics and allowing us a chance for questions and feedback.\u0026rdquo; (Participant 66, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The topics that were covered are aspects that we normally overlook but are important.\u0026rdquo; (Participant 100, male, 28 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e5. Holistic Patient Care\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe orientation reinforced the biopsychosocial approach and, by becoming familiar with the principles of FM, helped the medical interns develop a holistic approach to patient care. Participants underscored that the holistic approach to patient care - biopsychosocial approach - remains fundamental to FM. This entails thoroughly exploring the reason for the patient to seek medical care. Interns expressed that the three-stage assessment and plan approach becomes crucial in patient encounters, facilitating comprehensive assessment and treatment, preventing illnesses and promoting health. The concept of continuous collaboration with therapeutic health services reinforces the collaborative nature of holistic care.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It is important to treat the patient holistically and not just the condition. Their home environment plays a major role, and we must try to intervene where we can.\u0026rdquo; (Participant 21, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;To have a biopsychosocial approach to my patient care. Making use of all resources available to improve the quality of patient care individually, and that I need to know the patients whom I'm treating.\u0026rdquo; (Participant 35, female, 28 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Family Medicine is a broad discipline which requires medical doctors to take a holistic approach to patient care, as well as to not forget to utilise other health care providers.\u0026rdquo; (Participant 50, female, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;That taking thorough history from the patient is very important, and that we don\u0026rsquo;t treat only what the patient presents with but we try to treat them in all different aspects, even give them the platform to open up.\u0026rdquo; (Participant 51, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The importance of promoting health and respecting patients in primary health care whilst managing them holistically.\u0026rdquo; (Participant 68, female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It has helped me to know what to expect when I get to the primary healthcare facilities, which standards I have to uphold and how to effectively treat patients in the department. It has allowed me to shift my mindset from viewing patients as the illness with which they present to viewing them as people with emotions, beliefs, hopes and fears over and above the illness.\u0026rdquo; (Participant 126, female, 30 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e6. Professional ethos and ethical practice\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe orientation covered ethical aspects of medical practice and workplace conduct. Participants learned about maintaining professionalism and effective collaboration with other healthcare professionals. They understood their roles and responsibilities better and the professional ethos they must model. Interns emphasised professionalism, ethical conduct, accountability, good communication skills, and maintaining positive relationships with colleagues and other healthcare professionals. They expressed commitment to diligent work and recognised the importance of team integration. Interns indicated that upholding professional standards would enable them to provide the best care for the patient, especially as the first point of care doctor. Participants understood the fundamental place of medical ethics in patient care. As elucidated by participant 11, \u003cem\u003e\u0026ldquo;Medical ethics should be at the centre of patient care.\u0026rdquo;\u003c/em\u003e Some of their takeaways included harnessing communication skills that ensure proper patient consent in treatment and procedures, quality patient clinical record keeping, and being mindful of professional and ethical conduct. They must base clinical decisions on ethical principles and patient needs. Many expressed commitment to ethical, patient-centred care and recognised family physicians' role in PHC.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It is important to take responsibility for myself to be the best doctor that I can be in order to give the best care to my patients.\u0026rdquo; (Participant 10, female, 26 years\u003c/em\u003e \u003cb\u003e)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Accountability as an intern, Dr, even though we have supervisors, but we are also qualified doctors.\u0026rdquo; (Participant 64, male, 31 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Being the first point of healthcare to patients carries a big role in how/ how fast/ quality of treatment patients might receive.\u0026rdquo; (Participant 84, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I understand better my commitments and expectations when serving the community. Much better than I did during hospital rotations.\u0026rdquo; (Participant 186, Gender fluid, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Establish good working relationships with other workers, from security, cleaners, to the most senior personnel, for better outcomes in the work environment.\u0026rdquo; (Participant 210, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Attitude and behaviours, responsibilities, or expectations, being respectful in a workplace.\u0026rdquo; (Participant 161, male, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;Discipline, good ethical behaviour, understanding of autonomy of patients, Batho Pele principles.\u0026rdquo; (Participant 144, male, 30 years)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Keeping Ethics in mind, being thorough in notetaking and the role of interns, legally speaking.\u0026rdquo; (Participant 146, male, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e6. Lifelong Learning and Competency Development\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants recognised the importance of ongoing self-improvement and supervision to enhance their competence throughout their careers. They understood their roles as interns and future general practitioners, while identifying areas for improvement through learning objectives. The sessions helped identify knowledge gaps and create improvement plans. Interns recognised the importance of self-directed learning, using and completing logbooks on time. They learnt to become more organised and focus on developing competency.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Structure out my plan for the next 6 months, also to realise my deficits and how to correct them.\u0026rdquo; (Participant 108, male, 28 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It served as a guide for me to make the most of my rotation, a guide to learning and improving my competency.\u0026rdquo; (Participant 116, male, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The orientation helped to identify gaps in my learning and to make arrangements to further my learning. I need to improve skills and knowledge to become a better and competent doctor in the future.\u0026rdquo; (Participant 136, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I liked that it was preparing us as young doctors for the future and emphasising that whatever we acquire now depends on us and to what kind of doctors we want to be in future.\u0026rdquo; (Participant 160, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Learning is lifelong and needs to be self-driven. There is always room for improvement, and we are given the best opportunities to learn in environments that have ample amounts of people and conditions to learn from.\u0026rdquo; (Participant 136, female, 27 years)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The importance of having a good attitude and being willing to learn and teach ourselves throughout the rotation. That we should always go to our supervisors when we need help.\u0026rdquo; (Participant 147, female, 24 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e7. Role of Family Medicine in Community and Primary Care\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePrimary health care is fundamental to healthcare systems and serves as patients' first point of contact. Community collaboration ensures comprehensive care, with clinics facilitating initial healthcare engagement. Family physicians actively work with communities rather than waiting for patients. This approach treats communities, not just diseases. Family Medicine improves accessible services within and beyond facilities. Healthcare providers in Community Health Centres address diverse patient needs while delivering comprehensive, patient-centred care.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Family physicians reach out to the community. They go to the patients as opposed to awaiting patients to come to them. Prevention is better than cure.\u0026rdquo; (Participant 205, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Community health care and primary health care are very important for early intervention and prevention of disease progression.\u0026rdquo; (Participant 29, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Clinics are important in primary care; they are the patient\u0026rsquo;s first point of contact with the health care system.\u0026rdquo; (Participant 80, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Ability to know how to access services outside the facility and what's offered within the facility\u003c/em\u003e.\u003cb\u003e\u0026rdquo;\u003c/b\u003e \u003cem\u003e(Participant 89, male, 30 years)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It has helped me understand broadly how family medicine works, integrating every member of the community and health professionals and how it all falls perfectly like a jigsaw puzzle when done correctly.\u0026rdquo; (participant 119, male, 31 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Reminded me about the importance of family physicians in a community, as well as motivated me. It also made me feel at rest to start my rotation in the CHC.\u0026rdquo; (Participant 10, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e8. Interns\u0026rsquo; Logbook as a Learning Tool\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants identified the logbook discussion as crucial during orientation. The logbook was essential for accountability and tracking progress toward competence. It serves to guide learning by establishing learning objectives, assessing outcomes, facilitating reflection, and identifying areas for growth. The logbook helps understand therapeutic professionals' roles and the district health system. Timely completion is vital for professional development and safe medical practice. The logbook remains integral throughout the medical internship.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Exposure on how the logbook should be an accountability tool in order to continually assess oneself and to become a better generalist.\u0026rdquo; (Participant 69, male, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The detailed breakdown of the logbook and guidance on how to complete it.\u0026rdquo; (Participant 117, female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;That the logbook is very crucial. It\u0026rsquo;s not about getting signatures, but it\u0026rsquo;s there to guide me throughout my internship and to help me grow and be a competent Dr, who can confidently and independently make the right decisions for patients\u0026rsquo; care.\u0026rdquo; (Participant 86, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;To continually update my logbook in order to ensure I adequately reflect as I practice and am cognisant of any gaps in my knowledge so that I am able to actively try to fill them.\u0026rdquo; (Participant 138, male, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;What the allied health workers does, the importance of filling your logbook eg the bingo card.\u0026rdquo; (Participant 94, male, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I need to always update my logbook and be a competent doctor who practices safe medicine.\u0026rdquo; (Participant 198, male, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The importance of keeping track of my performance with the logbook being my reference.\u0026rdquo; (Participant 198, male, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e9. Suggestions for Improvement\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; feedback was overwhelmingly positive, with most describing the orientation as satisfactory and comprehensive, with no areas for improvement. They commended the orientation as \"well-rounded,\" \"perfect,\" and \"well-organised,\" with one noting it was detailed and enjoyable.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I believe that the orientation was well-rounded and there is nothing to be improved.\u0026rdquo; (Participant 23, male, 30 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I enjoyed the presentation. I believe everyone that presented had a very detailed presentation to their best of their knowledge/ability.\u0026rdquo; (Participant 25, female, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think the orientation includes all the important things.\u0026rdquo; (Participant 28, female, 31 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eStrategies to enhance outcomes were suggested. Technical issues emerged as a significant concern, with participants encountering connectivity problems. Participants expressed diverse and sometimes contradicting suggestions regarding the orientation platform, influenced by their experiences of technical glitches. Recommendations included establishing dedicated internet connections, employing IT support, and utilising centralised sites. Time management needed improvement with diverging solutions. Some found the orientation too lengthy, suggesting splitting it into two days, while others suggested shortening it. Participants advocated for better time allocation for presentations and punctual starts. Some preferred in-person sessions to address network issues, reduce orientation duration, and for better interaction and productivity, while others, an online platform to address individual needs, \u003cem\u003e\u0026ldquo;being post-call and attending physical makes it very harder to concentrate\" (participant 78, male, 30 years).\u003c/em\u003e Other factors influencing preferences were physical comfort, such as the room temperature, arrangement, and surrounding noise level, and the projection appliance.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Dedicated internet connection, because we had a time problem because of internet loss.\u0026rdquo; (Participant 9, male, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If it can be done via Zoom, allow everyone to be in a place with reliable Wi-Fi and not in one place with bad Wi-Fi on the laptop.\u0026rdquo; (participant 216, female, 27 years).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Most of the problems were just due to technology (connectivity), therefore I don\u0026rsquo;t think there\u0026rsquo;s much to improve.\u0026rdquo; (Participant 88, female, 28 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;..Location of all speakers prior to presentation so that time is not wasted when trying to find speakers who are allocated on the agenda.\u0026rdquo; (Participant 76, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Technical glitches. I think the orientation would have been better in person... Cos it took more time than expected.\u0026rdquo; (Participant 227, male, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Punctuality of speakers. If something is set to start at 8:30 am, then it should start then to respect everyone\u0026rsquo;s time, especially those who came early.\u0026rdquo; (Participant 141, female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Orientation in person. Avoids non-attendance due to network issues. Long presentations, attention span challenges.\u0026rdquo; (Participant 182, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It could be more helpful if it is done physically, not virtually, for it to be more interactive.\u0026rdquo; (Participant 204, male, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Regarding content, participants requested more practical advice on calls, safety protocols, and management guidelines. Some suggested an experience sharing session by a veteran intern, interdisciplinary presentations with inclusion of nurses, and more time for ethical principles. Participants preferred the orientation at the start of their six-month FM rotation and the discussion on the logbook at the start of the internship. Others suggested making PowerPoint presentations available in advance for preparation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Just a suggestion: maybe we could have interactive questions at the end of the presentation to see if we understood certain topics.\u0026rdquo; (Participant 55, female, 26 years\u003c/em\u003e \u003cb\u003e)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;Nothing to improve per se, but to have more time allocated in teaching about ethical principles for interns and the ethical dilemmas. And more on the laws and regulations.\u0026rdquo; (Participant 86, female, 27 years)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Shorter sessions, sharing of slides with Interns, having the logbook session at the beginning of internship (on the first day we start with our internship in the first year).\u0026rdquo; (Participant 226, male, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think next time it will be nice to have one of the interns to present or give feedback from each CHC how their experience have been.\u0026rdquo; (Participant 145, female, 28 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Some participants suggested the need for more frequent and structured breaks during presentations, such as short 15-minute breaks between presentations and longer 30-minute lunch breaks. The breaks serve multiple purposes: allowing attendees to refresh mentally, stretch physically, and have refreshments. One participant noted that breaks help prevent \"sleeping\" (participant 37, male, 34 years) during presentations, maintaining alertness and engagement. These breaks are necessary because presentations are often \"packed with information,\" and breaks provide time to process content.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Allowing for breaks between the presentations. The presentations were packed with a lot of information, and it was difficult to focus towards the end.\u0026rdquo; (Participant 11, female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Making time for at least 15-min breaks within the session just to refresh our minds. We can suffer from information overload.\u0026rdquo; (Participant 62, female, 27 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Appropriate stretch breaks and tea breaks in between presentations.\u0026rdquo; (Participant 69, male, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e10. Additional Content Recommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe majority overwhelmingly had no other suggestions and felt \u003cem\u003eall relevant topics\u003c/em\u003e were covered, and a few suggested guidelines on \u003cem\u003ecommon primary care conditions and emergencies\u003c/em\u003e, such as organophosphate poisoning, prevention of sexually transmitted infections, chronic conditions, and commonly used medications, among others, could be discussed. Other minorities recommended \u003cem\u003eintegration\u003c/em\u003e of district FM orientation with other specialist disciplines, practice sessions on three-stage assessment and plan, sexual assault management, writing referral letters, and clinical governance topics like process of handling death on arrival, death certification, and relevant policy documents.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;This orientation should be done at the beginning of family medicine, not only when interns go to clinics.\u0026rdquo; (Participant 140, female, 28 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Maybe a topic on commonly used medications and common emergencies.\u0026rdquo; (Participant 128, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;How to write referral notes from the clinic to the hospitals.\u0026rdquo; (Participant 120, female, 26 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Going through practically the SOAP and 3-stage assessment.\u0026rdquo; (Participant 45, female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Perhaps touching more on the quality improvement project needed and some theoretical background to the process.\u0026rdquo; (Participant 54, female, 25 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Interestingly, another minority suggested public health principles and application, simple data interpretation, and other aspects of medical ethics, like ethics in social media, South African Social Security Agency (SASSA) grant, and applications in paediatric case scenarios.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I would like to find out more about how the public health survey QIP is done, and how the findings are implemented to better the community.\u0026rdquo; (Participant 199, female, 29 years)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Principles of public health medicine.\u0026rdquo; (Participant 46, female, 27 years)\u003c/em\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study evaluates the FMEHD orientation program for medical interns on the first day of their rotation. It emphasised the value of a structured orientation of novice doctors, its comprehensiveness, knowledge acquisition, role clarification, holistic patient care, ethics, and practical skills. This resonates with the findings in Sameer et al.\u0026rsquo;s\u003csup\u003e28\u003c/sup\u003e structured induction programme of resident doctors in India. The residents appreciated the comprehensive nature of the program and its relevance to their roles, although the induction was at a hospital level of care, as opposed to PHC interns\u0026rsquo; orientation experiences.\u003c/p\u003e \u003cp\u003eThe FMEHD orientation programme notably enhanced interns' understanding of PHC systems, the holistic approach inherent to FM, and their professional roles and responsibilities. The study by Zayapragassarazan\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e elaborates that such programs are important for facilitating smooth transitions into clinical roles, enhancing professionalism, patient safety, and confidence.\u003c/p\u003e \u003cp\u003eThe emphasis on holistic patient care and bio-psycho-social approaches reflects the core principles of FM; such approaches improve patient outcomes and healthcare system efficiency. Kusnanto et al.\u0026rsquo;s\u003csup\u003e30\u003c/sup\u003e biopsychosocial model of illnesses in PC outlines the fact that PC clinicians are positioned to implement the biopsychosocial model to improve patient outcomes through enhanced doctor-patient relationships, empathy, and multidisciplinary care. The interns valued its practical application during the orientation.\u003c/p\u003e \u003cp\u003eParticipants\u0026rsquo; appreciation for detailed instruction on medico-legal documentation, particularly the J88 form, and ethical principles aligns with Moodley\u0026rsquo;s\u003csup\u003e31\u003c/sup\u003e narration of the critical role of ethics and legal knowledge in clinical practice. Clinicians encounter a wide range of ethical dilemmas across all levels of care (primary, secondary, tertiary). Generalist medicine, as applies to PC, is ethically complex due to its holistic bio-psycho-social approach, which transcends treating just biological disease. Ethical dilemmas are complex and require holistic approaches beyond just applying principles. Healthcare practitioners must develop skills to identify and manage ethical conflicts with the same expertise as clinical problems.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe orientation\u0026rsquo;s focus on medico-legal documentation also addresses a known gap in many internship programs, where interns often lack formal training in this area. Rowe et al.\u003csup\u003e32\u003c/sup\u003e report the deficiency in medical training regarding completion of forensic documents in the quality improvement project at a CHC in Cape Town. The editorial letter underscores the necessity of equipping medical practitioners with the requisite knowledge, skills, and a dedicated attitude towards the precise completion of the J88 form.\u003c/p\u003e \u003cp\u003e The variability in specialist department orientations, ranging from comprehensive sessions to minimal introductions, may impact interns\u0026rsquo; preparedness and confidence, as noted by participants who found specialist orientations less thorough than those of FM. Dineen et al\u003csup\u003e33\u003c/sup\u003e describe that the transition to internship is characterised by substantial uncertainty primarily due to new roles and environments. Interns mainly respond by seeking help, but experience stress and self-doubt. Reducing extraneous uncertainties via structured orientation and fostering critical reflection with supervisory support can enhance interns\u0026rsquo; uncertainty tolerance, ultimately improving their preparedness and well-being. They further recommended that orientation programmes should include simulated scenarios that mirror real intern responsibilities, emphasising multitasking, escalation, and role boundaries. A well-structured specialist orientation could improve interns' clinical skills and integration into multidisciplinary teams. Kathrotia et al\u003csup\u003e26\u003c/sup\u003e elucidate the internship orientation programme as a critical initiative that equips fresh medical graduates with the knowledge, skills, and confidence necessary for their transition to professional life. It enhances clinical and soft skills, ethical awareness, and professional attitudes. The study strongly recommends the inclusion of such comprehensive orientation programme before internship commencement to ensure effective and safe clinical practice.\u003c/p\u003e \u003cp\u003eThe positive reception of interactive presentations and comprehensive coverage of expectations, clinical skills, and professional ethos supports educational best practices advocating for active learning and clear communication of roles. Chang et al\u003csup\u003e34\u003c/sup\u003e describe active learning as an effective model for medical education, bridging theoretical knowledge with practical skills. It equips students/clinicians with critical thinking, communication, and teamwork competencies essential for complex clinical environments. The approach fosters lifelong learning and adaptability, ultimately enhancing the quality of healthcare training and patient care. Further, the interns\u0026rsquo; recognition of lifelong learning, self-directed study, and reflective practice as key takeaways aligns with contemporary medical education frameworks promoting competency-based education and continuous professional development.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eParticipants appreciated the quality and depth of the presentations, interactiveness, and their learner-centredness. This resonates with Lui et al\u0026rsquo;s\u003csup\u003e36\u003c/sup\u003e elaboration of the core themes of effective orientation. According to their study, the orientation programme should employ multimodal learning through lectures, discussions, and hands-on exercises to promote engagement and knowledge retention, thus catering for learners\u0026rsquo; preferences. Simulation training to mirror real-world practice could entail blended learning methods, including online modules and flipped classrooms, to support flexible learning. Simulation training provides a safe environment for practising clinical procedures, communication, and decision-making skills. Peer-assisted instruction provides practical knowledge and support, and this aligns with the intern\u0026rsquo;s suggestion for shared experiences by a veteran medical intern. Further, orientation should also introduce interns to multidisciplinary healthcare teams, fostering interprofessional collaboration and communication skills that enhance patient safety. This affirms this study\u0026rsquo;s reported experiences with involvement of the therapeutic team. Participants suggested aspects of improvement, such as addressing technical issues, an in-person platform to enhance interactivity, and providing practical guidance on safety and call duties, which align with Lui et al\u0026rsquo;s recommended strategies. The mixed preferences for online versus in-person formats reflect ongoing debates about optimal delivery modes for medical training, with hybrid models increasingly advocated to balance accessibility and engagement.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn summary, the findings corroborate existing evidence that comprehensive, well-organised, and contextually relevant orientation programmes are essential to prepare medical interns for effective clinical practice, particularly in resource-limited settings. The emphasis on ethics, medico-legal skills, holistic care, and professional development is consistent with current educational priorities. Addressing logistical and technological challenges will further enhance orientation effectiveness.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAlthough a few studies have examined the medical interns\u0026rsquo; orientation programme, this is an original study that describes medical interns\u0026rsquo; orientation during district FMR. It uniquely evaluates interns\u0026rsquo; orientation at a PHC setting where comprehensive services are provided within an integrated DHS.\u003c/p\u003e \u003cp\u003eThis study was conducted in a single district. Internship training in South Africa varies considerably between districts in terms of resources, supervision, clinical exposure, and organisational systems. Therefore, the findings may not be generalisable to rural or similar less-resourced districts where the FMR and orientation processes differ substantially. The orientation model evaluated is context-specific to Ekurhuleni and may not be feasible in districts with different staffing levels or infrastructure. The cross-sectional design captures only immediate perceptions after orientation and does not assess longer-term outcomes. Additionally, reliance on self-reported feedback may have introduced response bias, and the exclusion of non-consenting interns may have contributed to non-response.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAdvocacy for a structured orientation programme for medical interns at the start of the medical internship to prepare the novices clinically, ethically, and contextually, build confidence and provide support.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStandardise specialist department orientations across hospitals to ensure consistency in quality, scope, and comprehensiveness, addressing gaps identified by interns who experienced variability in these sessions.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAn effective orientation outcome could be attained if the program takes place at the beginning of each rotation, with relevant content, and importance is given to the educational model that enhances learners\u0026rsquo; centeredness.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the University of Pretoria ethics committee (600/2024), and permission for data collection was obtained from the National Health Research Database (GP_202309_078) and the Ekurhuleni Health District ethics committee (18/10/2023/01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors granted consent for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available\u003c/p\u003e\n\u003cp\u003efrom the corresponding author upon a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author has no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that this study received no financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOJI designed and conceptualised the project, analysed qualitative data, wrote up the results and discussions and general editing. DPM and JSM worked on the literature review and methodology. DPM analysed quantitative data. DPM and JSM reviewed the manuscript with critical inputs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge all medical interns who provide feedback on the orientation programme. Also, our appreciation goes to all Family Physicians who facilitated the diverse sections of the orientation programme.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are availablefrom the corresponding author upon a reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBakht N., Zaidi S.S.N., Abbas R., Nawaz H., Rahman M.U., Aslam F. (2015) Induction Training for Hospital Interns \u0026ndash; Helping Dears‟ Caught in Headlights. 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Available from doi:10.1186/s12909-023004605-6\u003c/li\u003e\n \u003cli\u003eRoss A, Naidoo S S Cand Dlamini S. (2018). An evaluation of the medical internship programme at King Edward VIII hospital, South Africa in 2016. S Afr Fam Prac. 2018;60(6):187-91.\u003c/li\u003e\n \u003cli\u003eNkabinde T C, Ross A, Reid S, Nkwanyana N M.Internship training adequately prepares South African medical graduates for community service \u0026ndash; with exceptions. S Afr Med J.2013;103(12):930-4. Available at doi:10.7196/samj.6702.\u003c/li\u003e\n \u003cli\u003eZhao Y, Musitia P, Boga M, Gathara D, Nicodemo C, English M. Tools for measuring medical internship experience: a scoping review. Hum Resour Health. 2021;19(1):1- 12. [cited 2023 Jan 5]. Available from: DOI: 10.1186/s12960-021-00554-7.\u003c/li\u003e\n \u003cli\u003eVon Pressentin K B, Esterhuizen T M. 2017. Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators. Afr J Prm Health Care Fam Med:9(1). Available at https://doi.org/10.4102/phcfm.v9i1.1298.\u003c/li\u003e\n \u003cli\u003eMukwena N V and Manyisa Z M. Factors influencing the preparedness for the implementation of the national health insurance scheme at a selected hospital in Gauteng Province, South Africa. BMC Health Serv Res. 2022;22(1):1006. Available from doi: P10.1186/s12913-022-08367-7.\u003c/li\u003e\n \u003cli\u003eNational Department of Health, South Africa. National Health Insurance for South Africa. Pretoria: NDoH.2017. Available from: https://www.gov.za\u0026gt;gcis_document\u0026gt;201707.\u003c/li\u003e\n \u003cli\u003eGoel A, Verkant R, Kumar A, Adkoli B V, Sood R.Structured internship orientation programme for undergraduate students: Easy transition to clinical work. Natl Med J India. 2010;23(3):160-2.\u003c/li\u003e\n \u003cli\u003eKathrotia R, Huda F, Rao S, Bahadur A, Kant R and Naithani M. Internship Orientation: An Essential Facilitatory Bridging Step for Medical Students. Avicenna J Med. 2021;11(2):77-83. Available from doi:10.4103/ajm.ajm_202_20.\u003c/li\u003e\n \u003cli\u003eRaosoft Sample Size Calculator [Computer Program]. Raosoft, Inc., Seattle, WA 2004. [Cited 2024 Mar 11]. Available from http:// www raosoft.com\u0026gt;samplesize.\u003c/li\u003e\n \u003cli\u003eSameer M, Pillai JS, Sahoo B. Induction training programme of resident doctors: The need of the hour. J Family Med Prim Care. 2025;14:296-310. [cited 2025 Dec 2]. Available from: doi: 10.4103/jfmpc.jfmpc_1099_24.\u003c/li\u003e\n \u003cli\u003eZayapragassarazan Z. Asian Journal of Education and Training. 2017;3(2):105-109, [cited 2025 Dec 2]. Available from: doi:10.20448/journal.522.2017.32.105.109.\u003c/li\u003e\n \u003cli\u003eKusnanto H, Agustian D, Hilmanto D. 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Building active learning in medical education: how to bridge vision with real practice. Proceedings of the Shevchenko Scientific Society. Medical Sciences 2024;2(76). [cited 2025 Dec 2]. Available from: https://doi.org/10.25040/ntsh.\u003c/li\u003e\n \u003cli\u003eBurke AE, Sklansky DJ, Haftel HM, Mitchell A, Mann KJ. Competency-based medical education and the education continuum: Establishing a framework for lifelong learning, Current Problems in Pediatric and Adolescent Health Care. 2024;54(9). [cited 2025 Dec 2]. Available from: https://doi.org/10.1016/j.cppeds.2024.101642.\u003c/li\u003e\n \u003cli\u003eLui JK, Walsh KF, Philbin M. Strategies of effective intern orientation. The Clinical Teacher. 2020;17(6):600-605. [cited 2025 Dec 2]. Available from: https://doi.org/10.1111/tct.13151.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical internship, orientation, induction, Primary health Care, South Africa","lastPublishedDoi":"10.21203/rs.3.rs-8348898/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8348898/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedical internship orientation programmes are essential for preparing novice doctors by enhancing their clinical skills and understanding of healthcare systems. In South Africa, the Family Medicine rotation was extended to six months to improve training in primary healthcare settings. This study evaluates the orientation programme introduced in 2021 for second-year medical interns in the Ekurhuleni Health District during their Family Medicine rotation.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eUsing a cross-sectional survey design, end-of-orientation feedback was collected anonymously through Google Forms from 248 interns between September 2022 and November 2024, with 228 consenting participants included in the analysis. Quantitative data described participant demographics, while qualitative data underwent thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of 311 medical interns who rotated through the department, 248 completed the evaluation form, and 228 consented to include their data in the analysis. The proportion of females was 147 (64.47%), males 80 (35.09%), and 1 (0.43%) a gender-fluid individual. Participants\u0026rsquo; ages ranged from 24 to 37 years, with a mean of 27 years. Nearly half of the interns, 105 (46.05%), were in the last two months of the Family Medicine Ekurhuleni Health District rotation. Mostly the major specialist rotations - Paediatrics, Obstetrics and Gynaecology, Internal Medicine, and General Surgery - had some form of orientation. Key themes from the qualitative data included understanding Family Medicine and primary health care, holistic care, Family Medicine and specialist orientation programme contents, presentation quality, professional ethos and ethical practice, interns\u0026rsquo; logbook as a learning tool, lifelong learning, and the role of Family Medicine in community care. Suggestions for improvement focused on technical infrastructure, orientation platforms, and additional practical content. The findings support continuing and enhancing a structured orientation programme to better prepare medical interns for effective clinical practice in primary health care settings.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOrientation for novice doctors is pivotal for a smooth transition from coached student to independent professional life.\u003c/p\u003e","manuscriptTitle":"Evaluation of Family Medicine District Rotation, Orientation Program, for Medical Interns","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 09:10:19","doi":"10.21203/rs.3.rs-8348898/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-04T11:52:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230252285591691469826764102071407731714","date":"2026-01-25T10:26:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T09:37:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-15T07:26:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-14T23:42:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-14T23:40:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-12T20:45:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ace2826-e986-4eb2-9e31-a4b5f91bc12a","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T09:10:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 09:10:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8348898","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8348898","identity":"rs-8348898","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}