African Medical Schools Research Articles

A Cross Sectional Study of Medical Students’ Perception of Their Educational Environment in Ghana

Background: The quality of medical education is affected by many factors, one of which is the educational environment of medical education. However, there is paucity of studies addressing the educational environment from African medical schools. The aim of this study was to determine the clinical year students’ perceptions of their educational environment at a medical school in Ghana. This was done with the goal of identifying factors that may impact positive changes in the school.Methods: A cross-sectional study was undertaken using the DREEM questionnaire. The questionnaire was administered to students in clinical years 1, 2, & 3 at the time of the study. 298 students participated in the study by convenience sampling. Data was analyzed using SPSS version 24. The total score and the five subscales of DREEM scores were used in the final analysis.Results: A total of 298 out of 300 students completed the questionnaire out of which Fifty six percent of respondents were male. There was no significant gender differences in the total DREEM scores [F(1, 274) = 1.019, p=0.314]. The overall educational environment was positive M=117.32 ± 15.45. Areas for improvement were students’ perception of the teachers (26.09 ± 3.59) and students’ perception of the atmosphere (25.71 ± 5.62). The students’ perception of learning (30.70 ± 5.20), and students’ academic self-perceptions (21.11 ± 3.74) were positive. Students’ social self-perceptions (13.71 ± 2.99) was neutral. There was no significant difference in perception by clinical year [F(2, 274) = 0.298, p = 0.742].Conclusion: The perception of students at this Ghanaian medical school can be described as positive and negative. The school should consider the two domains with negative perceptions as areas for improvement. Students reported problem-based learning as a preferred method of teaching versus the traditional method. Attention to the learning atmosphere and student-focused learning is likely to increase perception.

Removed from Context and Complexity: Women in Early AIDS Research in the South African Medical Journal, 1980–1995

In a South African medical school in the late 2010s, future health-care professionals are told that young black women from rural areas are the drivers of HIV infection. Like AIDS narratives that have come before, this statement bluntly configures and constructs ‘women’ and reproduces, perhaps unknowingly, a patriarchal and uncritical engagement with the gendered nature of the AIDS epidemic in something akin to intellectual tunnel vision. The creation of this dominant and narrow vision began long before the AIDS epidemic; it was rooted in histories and discursive traditions of female forms repeatedly traumatised by elite medico-scientific communities. The strength of this intellectual tradition and its perpetuation is evident in articles about AIDS that appeared in the South African Medical Journal between 1980 and 1995, and are analysed in this article. In early AIDS narratives, certain women initially feature as silent sexual partners of men; ‘black’ women then appear as infecting prostitutes until attention shifts to the pregnant female form. Towards the mid 1990s, the narratives turned towards women and human rights, but, in all these representations, only certain categories of women are visible and many are completely ignored. The article reveals these silences in the medical record and explicitly notes which female forms are seen and which unseen. It explores the changing roles assigned to certain female forms as the AIDS narrative evolved and suggests that the focus on certain types of sexualities or sexual orientation were embedded in unchallenged racialised, sexist, heteronormative modes of research. Finally, the article considers how understanding the history and perpetuation of this tunnel vision could be beneficial to HIV and AIDS research and argues for the necessity of critically engaging with context and complexity in research.

Exploring a communication curriculum through a focus on social accountability: A case study at a South African medical school.

BackgroundGood communication is integral to social accountability, and training is included in medical curricula internationally. In KwaZulu-Natal, training is conducted in English, in spite of most public sector patients being mother tongue isiZulu speakers. Communication challenges with patients are common, but good communication and African language teaching are not emphasised in teaching.AimThis study explored communication training and how it related to social accountability at a single institution in KwaZulu-Natal.SettingThis exploratory, qualitative case study design at the medical school explored participants’ perceptions about communication and social accountability and reviewed relevant educational documentation for evidence.MethodsPurposive sampling was used to select medical students, educators and stakeholders from the educational and service platforms. Focus group discussions and semi-structured interviews were conducted. The data were thematically analysed with reference to Boelen’s social obligation scale for medical schools.ResultsGood communication was valued, but often poorly role-modelled. Participants agreed that communication and isiZulu teaching were insufficiently supported to respond adequately to the needs of local communities. Social accountability was not well understood by students, while medical school educators and other stakeholders indicated that, despite aspirations, this goal had not yet been achieved.ConclusionsLearning isiZulu language and culture in an integrated manner in both pre-clinical and clinical phases would improve communication with patients, contribute to socially responsive health care, and better address health care needs. Incorporating a social accountability framework in curriculum review would highlight the importance of measuring health outcomes and community impacts, and so enhance the educational mission of the medical school.

Patient-centred attitudes among medical students in Mali, West Africa: a cross-sectional study

Background/objectivePatient-centred attitudes have been shown to decline during medical training in high-income countries, yet little is known about attitudes among West African medical students. We sought to measure student attitudes...

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries.

African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.

Pilot study of quality of care training and knowledge in Sub-Saharan African medical schools.

ObjectivesTo identify the level of knowledge and competencies related to quality of care during medical education in sub-Saharan African medical schools. MethodsA cross-sectional study design was utilized to examine the capacity of medical schools in sub-Saharan African (SSA) countries to teach about the concepts of quality of care and the inclusion of these concepts in their curriculum. A purposeful convenience sampling technique was used to select participants from 25 medical schools in 5 sub-Saharan African countries. Respondents included medical school deans or senior academic personnel. A survey was developed using the Institute of Medicine’s definition of quality of care as the guiding framework. Sample means and summary statistics were used to present the results of the survey responses. ResultsWhile 45% of the schools surveyed are teaching on at least one of the six domains of the Institute of Medicine’s definition of quality of care, there are some schools who report not teaching about quality at all, or that they “do not know”. Despite these low numbers, when asked about topics related to quality of care, many schools are teaching applied management related topics and almost all schools teach about equity and patient-centered care. ConclusionsThe results have important impacts both for incorporating quality of care into medical education and for practitioners. The tool developed for this study can be used in future qualitative and quantitative studies to further understanding of how to improve the teaching and learning about quality of care in medical schools. Keywords: quality of care, medical schools, sub-Saharan Africa, medical errors, healthcare improvement

Remembering old partnerships: Networking as new medical schools within BoLeSwa countries

In southern Africa, former members of the Botswana-Lesotho-Swaziland (BoLeSwa) partnership, Botswana and Lesotho, have established their first and only publicly funded medical schools in their countries. Swaziland has a private medical school. The three countries have a long history of partnership through the University of Botswana, Lesotho and Swaziland (UBLS) system − a derivative of BoLeSwa. Botswana and Lesotho are also members of a newly founded Consortium of New Southern African Medical Schools (CONSAMS). The UBLS was established in Lesotho in 1964 by a royal charter, two years before the three countries gained independence. It was founded to address manpower constraints in anticipation of their independence. The three countries had agreed to concentrate on different professional trainings, as follows: Botswana in engineering, Swaziland in agriculture, and Lesotho in medicine. CONSAMS was established as a unique collaborative approach involving south-south networks, which included south-north partnerships. This created an opportunity to strengthen medical education in the region. The BoLeSwa partnership is further strengthened by participation in CONSAMS by two of the five founding members. Other members include Mozambique, Namibia and Zambia. A sharing of resources through regional and international partnerships has been established. The sub-Saharan African Medical School Study has examined the challenges, innovations, and emerging trends in medical education in the region and has made recommendations on how to better share resources. CONSAMS is one innovative way of addressing these issues. Partnerships between the BoLeSwa countries have been strengthened through CONSAMS. This has afforded the new medical schools sharing of their limited resources.

Creating Sustainable Models for Short-Term Volunteers Through the Global Health Service Partnership

Many countries in sub-Saharan Africa (SSA) have critical shortages of pediatricians who serve as both clinicians and educators. Many African medical schools increase student enrollment to address these shortages; they must also increase faculty. There is an opportunity to assist with faculty placement by tapping into a growing effort by US academic institutions to establish meaningful global health experiences for residents and faculty. Pediatric training is a key focus of the Global Health Service Partnership (GHSP). Between 2013-2015, GHSP placed 15 pediatric educators in medical/nursing schools in SSA for a one-year assignment. These educators taught 41 courses to 1600 trainees, assisted with curriculum development, worked on quality improvement projects, and enhanced teaching methods. Building on this program, a strategy to improve global health experiences is to create partnerships between US academic institutions and GHSP partner sites, where residents and faculty could rotate for shorter periods and be paired with GHSP educators embedded in the local institution. GHSP educators would serve as liaisons and supervisors, have an understanding of sites needs and challenges, and identify educational projects without overburdening local faculty. One model, between University of Washington (UW) and University of Malawi College of Medicine (CoM), demonstrated success. UW family medicine residents rotated at CoM monthly under the supervision of a Malawi-based US educator. Residents completing the rotation oriented their incoming peers and handed over ongoing educational projects. This partnership improved host provider satisfaction, established continuing professional development and quality improvement, and reduced patient referrals to the national hospital. Two UW residents chose to volunteer with GHSP after residency, creating a pipeline of volunteer faculty for the host institution. Similar partnerships between US academic institutions and GHSP could create meaningful and sustainable ways of enabling residents and faculty to serve in resource-limited settings.

Developing a competency-based medical education curriculum for the core basic medical sciences in an African Medical School.

The College of Medicine of the University of Ibadan recently revised its MBBS and BDS curricula to a competency-based medical education method of instruction. This paper reports the process of revising the methods of instruction and assessment in the core basic medical sciences directed at producing medical and dental graduates with a sound knowledge of the subjects sufficient for medical and dental practice and for future postgraduate efforts in the field or related disciplines. The health needs of the community and views of stakeholders in the Ibadan medical and dental schools were determined, and the “old” curriculum was reviewed. This process was directed at identifying the strengths and weaknesses of the old curricula and the newer competences required for modern-day medical/dental practice. The admission criteria and processes and the learning methods of the students were also studied. At the end of the review, an integrated, system-based, community-oriented, person-centered, and competency-driven curriculum was produced and approved for implementation. Four sets of students have been admitted into the curriculum. There have been challenges to the implementation process, but these have been overcome by continuous faculty development and reorientation programs for the nonteaching staff and students. Two sets of students have crossed over to the clinical school, and the consensus among the clinical teachers is that their knowledge and application of the basic medical sciences are satisfactory. The Ibadan medical and dental schools are implementing their competency-based medical education curricula successfully. The modifications to the teaching and assessment of the core basic medical science subjects have resulted in improved learning and performance at the final examinations.

Preliminary study: Predictors for success in an important premedical subject at a South African medical school

Background . Admission to Sefako Makgatho Health Sciences University, Pretoria, South Africa is determined by the student’s Matriculation (Matric) results, while the writing of the National Benchmark Test (NBT) is not compulsory. An average student pass rate of 80.1% in physiology (MB ChB II) in the past 13 years compelled this institution to investigate which criteria in the selection process could be predictors for success in physiology, a fundamental discipline for medical studies. Objectives . To compile a profile of very successful physiology students and those who failed the subject, and to identify predictors for success in physiology. Methods . A quantitative study, using Matric and available NBT results, was conducted among the MB ChB II group (N=228) of 2011. Two target groups were identified: highly successful students in physiology (n=37) and those who failed (n=46). Statistical analysis of the results was performed on SAS 9.2, Microsoft Windows (SAS Institute Inc., USA) (p-values ≤0.05 are significant) using the t-test, Fisher’s exact test and the simple linear regression test. Results . These indicated that a good Matric symbol (≥5) in English and life science and a good performance in the quantitative literacy domain of the NBT were statistically significant predictors for success in physiology. Conclusion . This preliminary study indicates the need for our institution to rethink the effectiveness of the selection criteria, redesign the selection process of students for the MB ChB course, and consider making use of the NBT.

Laboratory Medicine Abroad

![Graphic][1] Doctors Without Borders —it just sounds cool. Not only does the name allude to the organization's purpose of providing medical care abroad, but it also lionizes physicians in a way, suggesting we are capable of transcending boundaries to help those near and far. I always wanted to participate in Doctors Without Borders or a similar international medical program, and I have friends in other subspecialties who seem to have plenty of opportunities to travel abroad on medical relief–type trips. I attributed these opportunities to the fact that interacting with patients on a daily basis lends itself to fieldwork in other countries. As pathologists, we are reliant on resources such equipment, instruments, reagents, and so forth in order to deliver results and render diagnoses. Consequently, our reliance on technology makes providing international support more cumbersome, especially in resource-limited countries, which of course are the ones most in need. Taking on this prohibitory mentality, I sadly resigned myself to a life sans international medical work. Luckily, my view changed once I was asked to participate in a laboratory medicine course for physicians in Sub-Saharan Africa. Under MEPI, African medical schools are strengthening and expanding their curricula. Photo by Richard Lord for Fogarty/NIH In the United States, we are spoiled in that our laboratories, especially … [1]: /embed/inline-graphic-1.gif

Identifying approaches and tools for evaluating community-based medical education programmes in Africa

Background. The US President's Emergency Plan for AIDS Relief (PEPFAR)-funded Medical Education Partnership Initiative (MEPI) aims to support medical education and research in sub-Saharan African institutions. The intention is to increase the quantity, quality and retention of graduates with specific skills addressing the health needs of their populations. While many MEPI programmes include elements of community-based education (CBE), such as community placements, clinical rotations in underserved locations, community medicine, or primary healthcare, the challenge identified by MEPI-supported schools was the need for appropriate approaches and tools to evaluate these activities. This article outlines the process of identifying tools that, with modification, could assist in the evaluation of CBE programmes in participating MEPI schools. Methods. A literature search was carried out to identify approaches and tools that could be used in Africa to evaluate CBE programmes. The search included published, peer-reviewed literature as well as grey literature and websites. Evaluation tools considered appropriate were obtained from the articles or their authors for inclusion in a compendium of example CBE evaluation tools. All tools sourced through the search were entered into a CBE evaluation matrix, which included an analysis of the tool in relation to Kirkpatrick’s four levels of evaluation. Results. Out of 37 sources included as appropriate, 8 sets of CBE evaluation tools were obtained for the compendium. Most of the evaluations were quantitative, relied on Likert-type scales, and focused on measuring CBE activities and intermediate outcomes in terms of student learning. When categorised according to the level of the evaluation, the evaluations largely focused on levels 1 and 2 of the Kirkpatrick model, as measured through students’ reactions to and learning from the CBE programmes. Tools that focused on student assessment, rather than programme evaluation, were excluded from the final set. Conclusion. With the shortage of published literature on CBE evaluation, the findings of this literature review will assist African medical schools in developing appropriate evaluation approaches and tools.

Re-writing Pre-Clinical Medical Textbooks to Reflect Local Content - A Prerequisite for Building Better Clinicians in Africa

Textbooks are vital tools in the training of medical students. In Africa, there is a huge deficit in terms of literary medical works compared to the western world. Ultimately, this leaves the aspiring African clinician at the mercy of the western authors when it comes to acquiring knowledge about local health issues. The textbooks we use in teaching preclinical medical students in Africa are by foreign authors which fail to adequately capture the local content. Poor funding of biomedical research by governments of African countries has left the output of local authors dismally low. Reliance on foreign authors in writing our pre-clinical textbooks has left some disconnect between the pre-clinical and clinical stage of the medical training in African medical schools. Paying close attention towards bridging this gap by stimulating African biomedical researchers towards developing pre-clinical medical textbooks that reflect the African peculiarities; is of topmost importance The current pre-clinical textbooks used for training medical students will need to be re-written (to fully reflect local content) if the quest for high quality clinicians in the continent will be realized.

Pink Collar Medicine: Medical students navigating the gendered landscape of a South African medical school

Gendered work experiences have influenced decisions which determine career trajectories in professions in general and in the medical profession in particular. This study aims to bring to the centre the voices of medical students at a higher education institution, in order to gain a more nuanced view of intersecting influences of gendered factors on their undergraduate experiences in clinical training settings. Ninety four students who were in their final year of study at a South African medical school were purposively selected. In this inductive, qualitative approach, semi-structured, individual, face-to-face interviews were used to generate data. The recurring themes included as findings indicated students’ anxiety about safety, details of their interactions with teaching personnel and patients, and their anxiety to find a balance between responsibilities related to their work and family commitments. Recommendations include practical solutions such as the allocation of increased funding for the assurance of women students’ safety and the monitoring of defaulters who are guilty of gender discriminations in clinical settings.

Academic Guidance for Undergraduate Students in a South African Medical School: Can we guide them all?

Higher education institutions, including medical schools, still grapple with the challenge of poor academic performance of students. Some studies report the positive results of providing academic guidance for common challenges such as poor and/or ineffective time management, study methods, test- and exam-taking techniques and management, and the high academic workload of undergraduate medical students. However, limited detailed insights and understanding of medical students who experience more complex challenges are available. This study was conducted at a medical school in South Africa to determine undergraduate medical students’ perceptions of factors affecting their academic performance. A total of 89 semi-structured interviews were held with undergraduate medical students who were identified as having academic problems between 2012 and 2015. According to the results, more blacks, males and first- and second year students experienced poor academic performance. Prominent findings included the harsh realities and implications of lack of accommodation for black students; how poor academic performance can lead to an array of other social and psychological problems, such as withdrawal of bursaries and negative achievement emotions that some students experience. Compared to the usual objective measures of individual ability, the rich qualitative data of cases presented in this study reveal critical, real insights and understanding of students’ challenges from their own perspective.

South African medical schools: Current state of selection criteria and medical students' demographic profile.

Selection of medical students at South African (SA) medical schools must promote equitable and fair access to students from all population groups, while ensuring optimal student throughput and success, and training future healthcare practitioners who will fulfil the needs of the local society. In keeping with international practices, a variety of academic and non-academic measures are used to select applicants for medical training programmes in SA medical schools. To provide an overview of the selection procedures used by all eight medical schools in SA, and the student demographics (race and gender) at these medical schools, and to determine to what extent collective practices are achieving the goals of student diversity and inclusivity. A retrospective, quantitative, descriptive study design was used. All eight medical schools in SA provided information regarding selection criteria, selection procedures, and student demographics (race and gender). Descriptive analysis of data was done by calculating frequencies and percentages of the variables measured. Medical schools in SA make use of academic and non-academic criteria in their selection processes. The latter include indices of socioeconomic disadvantage. Most undergraduate medical students in SA are black (38.7%), followed by white (33.0%), coloured (13.4%) and Indian/Asian (13.6%). The majority of students are female (62.2%). The number of black students is still proportionately lower than in the general population, while other groups are overrepresented. Selection policies for undergraduate medical programmes aimed at redress should be continued and further refined, along with the provision of support to ensure student success.

The Creation of a Model Pediatric Ward for African American Children in 1920s Kansas City.

* Abbreviations: CMH — : Children’s Mercy Hospital WPH — : Wheatley-Provident Hospital The summer of 1919 is remembered for some of the worst race riots in American history. Dubbed the Red Summer by James Weldon Johnson, at least 25 major riots rocked American cities, and more than 52 African Americans were lynched.1 Although provocations varied, a root cause of the racial tension was the disappointment felt by African American World War I veterans. They had hoped that their military service would earn them equality at home. Instead they returned to a society where the majority of American states enforced Jim Crow racial segregation laws. As in many American cities, Kansas City hospitals, including Children’s Mercy Hospital (CMH), were racially segregated in the early 20th century. African Americans went to the “Negro hospitals,” where facilities were substandard and overcrowded.2 The mortality rate for Kansas City’s black population was nearly double that of the country’s.3 Children fared no better: the black infant mortality rate was close to double that of whites. Common causes of child death were prematurity, diarrhea, and pneumonia.4,5 Conditions were worsened by limited numbers of black physicians. The 1910 Flexner report prompted the closure of all but 2 African American medical schools, Howard University and Meharry Medical College. Although Flexner recommended coeducation for men and women, he accepted racial segregation in medical schools. Furthermore, education gaps between black and white physicians were widened when he recommended that black physicians be trained differently at a more basic level as “sanitarians” with an emphasis on “serving” their people.6,7 The overall effect was to reinforce segregated and unequal medical training, thereby limiting education and practice opportunities for African Americans.7 It was in this climate that physicians Katharine Berry Richardson and John Edward Perry … Address correspondence to Jane F. Knapp, MD, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: jknapp{at}cmh.edu

Sylvia Madeleine Watkins

Sylvia Madeleine Watkins had a reputation as an exceptionally kind and caring physician, qualities much valued by her patients. In her retirement, she committed her energies to postgraduate development in...

Medical education departments: a study of four medical schools in Sub-Saharan Africa.

BackgroundMany African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability.MethodsIn-depth interviews were conducted with the heads or directors of the four medical education departments using a structured interview protocol developed by the study group. An inductive approach to analysis of the interview transcripts was adopted as the texts were subjected to thematic content analysis.ResultsMedical education departments, also known as units or centers, were established for a range of reasons including: to support curriculum review, to provide faculty development in Health Professions Education, and to improve scholarship in learning and teaching. The reporting structures of these departments differ in terms of composition and staff numbers. Though the functions of departments do vary, all focus on improving the quality of health professions education. External and internal funding, where available, as well as educational innovations were key enablers for these departments. Challenges included establishing and maintaining the legitimacy of the department, staffing the departments with qualified individuals, and navigating dependence on external funding. All departments seek to expand the scope of their services by offering higher degrees in HPE, providing assistance to other universities in this domain, and developing and maintaining a medical education research agenda.ConclusionsThe establishment of medical education departments in Sub-Saharan Africa is a strategy medical schools can employ to improve the quality of health professions education. The creation of communities of practice such as has been done by the MEPI project is a good way to expand the network of medical education departments in the region enabling the sharing of lessons learned across the continent.

How podcasts influence medical students' learning - a descriptive qualitative study

Background: Podcasting of lectures is increasingly used in higher education. It is popular with students as it provides a modern e-learning tool that reinforces learning and facilitates engagement with learning material. Podcasts have, however, not been used much in medical education in Africa. This article explores the influence podcasts have on how students in an African medical school approach their learning material. Methods: This is a descriptive qualitative study encompassing six focus group discussions with a total of 38 students from each of the six study years in the medical programme. Results: The feedback from the students called for continuous and extensive implementation. Themes identified included: a novel way to learn; complementing classroom learning; providing ease of mind (a safety net); and the influence of the lecturer on student learning. Students did not find that podcasts negatively influenced class attendance. Enthusiastic acceptance translated into active engagement with the learning material. Discussion: The way the students used the podcasts fits the active learning double tenet of student activity and student engagement in using a particular instructional method. The podcasts allowed the students to be more adventurous in their learning and changed the way they approached their learning. Situating the learning in the students’ context and within their control played an important role in this. Conclusion: Medical education in Africa is moving towards larger classes and increasingly decentralised clinical training. Podcasts of medical lectures in medical schools in Africa are an innovative and effective tool to enhance medical students’ learning.