Abstract
BackgroundSierra Leone, a low-income and post-conflict country, has an extreme shortage of qualified medical doctors. Given the complex challenges facing medical education in this country and the need for context-specific knowledge, the aim of this paper is to explore the undergraduate medical education experience in Sierra Leone through qualitative interviews with recent graduates.MethodsIn-depth interviews were conducted with purposively sampled junior doctors (n = 15) who had graduated from the only medical school in Sierra Leone. Additionally, semi-structured interviews were held with senior teaching staff at the School (n = 7). Interviews were conducted in October 2013. Results were thematically analysed.ResultsThe analytical framework consisted of four themes. Medical school experiences (Theme 1) were described as ‘stressful and tedious’ but also ‘interesting and enjoyable’. Various constraints were experienced linked to the Medical school capacity (Theme 2), including human (limited number of teachers, teaching skills), organisational (departmental differences, curriculum related challenges), physical (lacking teaching facilities on campus, transportation problems) and financial capacity (inadequate remunerations for teachers, most students receive scholarships). Medical school culture (Theme 3) was by some participants perceived as fearful and unfair. Findings suggest various coping strategies (Theme 4) were used at school (‘creatively’ hire extra teaching staff, teaching schedule upon availability of staff), staff (juggle multiple roles, teach flexibly), and student levels (comply with ‘hidden’ rules, negotiate teaching support from less qualified health personnel).ConclusionsThis study has provided an insight into the student perspective on medical education in Sierra Leone. Numerous capacity related concerns were identified; which are unsurprising for an educational institution in a low-income and conflict affected country. While the School, staff and students have found creative ways to deal with these constraints, participants’ accounts of stress imply more is needed. For example, findings suggest that: students could be better supported in their self-directed learning, more effort is required to ensure basic needs of students are met (like shelter and food), and the power imbalance between staff and students could be addressed. Also better alignment amongst learning objectives and assessment methods will likely diminish student distress and may, consequently, reduce exam failure and possibly drop-out.
Highlights
The global shortage and inequitable distribution of health workers severely limits the capacity of countries to delivery basic health services
Participants Fifteen junior doctors who graduated between 2006 to 2015, gave consent for the interview study together with seven senior teaching staff at the medical school in 2013. These dual perspectives generated an in-depth understanding about undergraduate medical education in Sierra Leone
Medical school experiences The experiences by junior doctors during their time in medical school was described in two ways; e.g. on the one hand as stressful and tedious, and on the other interesting and enjoyable
Summary
The global shortage and inequitable distribution of health workers severely limits the capacity of countries to delivery basic health services. Sierra Leone’s only medical school has a 45% dropout rate over the six-year degree [12], four times higher than the international average [13]. These issues affect Sierra Leone’s ability to produce enough adequately trained doctors and undermine health system stability. Sierra Leone, a low-income and post-conflict country, has an extreme shortage of qualified medical doctors. All graduates are required to undergo a two-year internship programme before gaining full registration with the Sierra Leone Medical and Dental Council and being able to apply for further education in a specialised area of medicine
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