BACKGROUND : One of the reasons to develop training courses for medical mid-level workers in South Africa is a shortage of
doctors. The introduction of this new profession has led to task sharing and redefining of professional boundaries. The primary
aim of this study is to evaluate the introduction of new healthcare professionals in a rural hospital district.
METHODS : This multi-method qualitative research study used a semi-structured questionnaire to assess the effectiveness of
Clinical Associates. A review of documents from 2012 to 2015 was done including a longitudinal study of the development of the
Bachelor in Clinical Medical Practice (BCMP) programme at Shongwe hospital.
RESULTS : Three Clinical Associates in 2011 and six Clinical Associates in 2014 completed questionnaires. Student satisfaction
increased as measured with the Med IQ tool. At the end of 2013 Shongwe Clinical Learning Centre (CLC) had improved from last
position out of 17 CLCs in 2011 to position number eight in 2014.
Casualty was run by Clinical Associates and during observations it became clear that Clinical Associates were able to take
responsibility for outpatient departments (OPDs), the emergency unit and some wards with supervision by a doctor.
CONCLUSION : The introduction of the BCMP programme and the establishment of a Clinical Learning Centre in Shongwe hospital
have led to improved patient care and a more conducive environment for teaching and learning. With the availability of more
Clinical Associates vacant medical officer posts can be converted to employ Clinical Associates to serve patients without an
increase in the cost of total human resources.