Medical education

Abstract

Your medical education quartet, which ended on March 24,1Jones R Higgs F de Angelis C et al.Changing face of medical curricula.Lancet. 2001; 357: 699-703Summary Full Text Full Text PDF PubMed Scopus (207) Google Scholar elucidates the growing need for inevitable change in delivery of medical education. The current situation in resource-rich parts of the world was the overall emphasis of the series. We believe, however, an even bigger challenge in medical education delivery is in resource-poor areas of the world. In these areas, most medical schools are in disarray, are chronically under-funded, and academic research remains a luxury.2Horton R North and South: bridging the information gap.Lancet. 2000; 355: 2231-2236Summary Full Text Full Text PDF PubMed Scopus (155) Google Scholar Paradoxically, an increasing number of these countries have developed some form of postgraduate education. As long as substantial dissatisfaction in health-care delivery continues to take an upper hand, the graduates from these institutions are likely to emigrate to resource-rich countries. Medical education in these poor areas therefore has to deliver good training covering the local disease spectrum as well as provide important basic knowledge of health priorities in resource-rich environments. It would be naïve to assume otherwise. The real challenge is how to deliver this knowledge adequately and effectively. Zambia, in sub-Saharan Africa (SSA), at its one 33-year-old medical school, has had to think hard about changing its approach to medical education.3Sims P A medical school in Zambia.J Public Health Med. 1997; 19: 137-138Crossref PubMed Scopus (4) Google Scholar The traditional didactic preclinical 4 years followed by a 3-year clinical period, has had to be modified to include computer-assisted learning, community-based education, problem-based learning, and integrated teaching. This change has been made possible through external aid funding from resource-rich countries. The past 6 years have not been easy. A poor computer-to-student ratio (15 computers for 250 students), compounded by limited access time, hinders serious computer-assisted learning. The sourcing of computers for the few academic staff is also difficult, which renders this part of medical education an underused avenue. Community-based education is given in 4-week bursts for each of the last 5 years of the undergraduate programme. The optimistic view is that of nurturing students' interest in the wellbeing and disease hierarchy of the community in which they are likely to serve. Problem-based learning and integrated teaching have been difficult because of their resource intensity. As long as financial, technical, and human resources remain elusive, implementation will be difficult. Thus, delivery here remains lecture-based, with students passively receiving information. To teach clinical, research, or corporate governance would be an additional nightmare. In resource-poor settings, we must endeavour to deliver the best we can. With projections of a double jeopardy from communicable and noncommunicable diseases in SSA region, albeit with absent data,4Cooper F Babatunde O Kaufinan J et al.Disease burden in sub-Saharan Africa: what should we conclude in the absence of data?.Lancet. 1998; 351: 208-210Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar an inevitable change to medical education will hopefully create a pool of doctors willing to rise to the challenge.