African Medical Schools Research Articles

Medical students’ perceptions of live versus recorded pathology lectures at a South African medical school during the Covid-19 pandemic: unique lessons for undergraduate pathology education in a diverse student population

Abstract Introduction/Objective The morphological depiction and interactive learning vital to the core discipline of anatomical pathology posed specific challenges during emergency remote teaching (ERT) in the COVID 19 pandemic. Using voice-over PowerPoint presentations (VoPPPs) in anatomical pathology at Wits University in Johannesburg, South Africa during this time provided a unique opportunity to determine students’ perceptions of this teaching and learning modality. Objective To determine a South African medical students’ perceptions of live lectures vs online learning with VoPPPs during the Covid-19 pandemic. Methods/Case Report A descriptive, cross-sectional, online survey was sent to 326 4th year medical students in 2020. The questionnaire consisted of closed- and open-ended questions. Descriptive and inferential statistical tests were conducted on the quantitative data. Content analysis was performed on the open-ended responses. Results (if a Case Study enter NA) The survey response rate was 56.75%. Respondents preferred the traditional lecture format to the exclusive use of VoPPPs (48.6% to 34.6%) for pathology learning. Respondents appreciated the flexibility of learning from VoPPPs, resulting in blended learning being the preferred approach (45.9% vs 44.3 for live lectures only and 9.7% for VoPPPs only, respectively). Respondents indicated a need for more effective use of VoPPPs regarding the depiction of pathology images, more opportunities for feedback, and more online learning modalities in addition to VoPPPs. Some respondents from rural areas stated that their home study environments were not conducive to online learning modalities. Conclusion Blended learning combines the interactivity possible in contact sessions with the time benefits of online learning for undergraduate pathology education. However, educators should use various online methods rather than relying solely on VoPPPs. This is especially important when considering the visual nature of pathology lectures. Where VoPPPs are used, they should be used effectively, mainly using good quality, labelled images to depict morphology. The preference for blended learning offers exciting possibilities for developing integrated learning platforms in the future, however, these must be tailored to suit the needs of students from economically and ethnically diverse backgrounds.

Assessing the presence of sustainability education in the curriculum of medical students and surgical trainees in Africa: A cross-sectional study.

Integrating sustainability principles into medical and surgical curricula raises awareness and empowers future healthcare professionals to adopt sustainable practices, reducing the environmental impact of surgical care. This study aims to assess the presence of sustainability education in African medical schools and surgical residency curricula to inform policymakers and educators in African healthcare systems. This cross-sectional study was undertaken through an online survey among medical students and surgical trainees in African countries to describe the presence of sustainability education in surgical training programs and medical curricula across Africa. The results of this survey were reported in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). A total of 141 participants from 17 countries responded to our e-survey, primarily consisting of undergraduate medical students (92.2%, n = 130). Only 9.2% of participants reported familiarity with the concept of sustainability in surgical care, and 60.3% stated that they had yet to receive any education on sustainability. Waste management was the most commonly taught sustainability topic among those who confirmed the presence of sustainability education in their curricula. Additionally, 76% of participants reported not participating in sustainability-related projects during their training. This study highlights the urgent need for comprehensive integration of sustainability principles in surgical care and identifies barriers, such as a lack of awareness and resources to this integration. Addressing these gaps and implementing the suggested approaches can lead to more environmentally conscious and socially responsible surgical systems in Africa.

What are the experiences of medical students and their trainers regarding undergraduate training in primary health care at four South African medical schools? A qualitative study.

In 1978, the World Health Organization (WHO) adopted primary health care (PHC) as the most effective strategy to meet the healthcare needs of communities. This raises the question as to the extent and nature of the training that undergraduate (UG) medical students receive in medical schools regarding PHC, following this statement. The study aim was to explore the experiences of UG medical students and their trainers regarding training in PHC in their institutions. A qualitative study was conducted among UG medical students (MBChB 4-6) and their trainers at four conveniently selected South African medical schools. A total of 16 focus group discussions (FGDs) and 27 in-depth interviews were conducted among students and their trainers, respectively. The MAXQDA 2020 (Analytics Pro) software program was used to arrange the data, resulting in 2,179 data segments, from which categories, sub-themes and themes were derived. Both the UG medical students and their trainers regarded PHC as mainly an approach to health rather than a level of care. Students were trained by specialists and generalists, received training in the undifferentiated patient, coordinated, comprehensive and continuity of care. The training in tertiary centers, conducted mainly by specialists, the implicitness of the training and the inadequacy of trainers at the PHC settings presented challenges. Students and their trainers experienced UG student training in PHC in line with the internationally recognized principles on the subject. The view by students and their trainers that PHC is an approach rather than a level of care enhanced its training across disciplines. The implicitness of the training and the tertiary learning platforms were the main challenges experienced. For optimum PHC training, more time should be dedicated to distributed training platforms with supportive specialist outreach programs in the South African medical schools.

Perceptions and experiences of undergraduate medical students regarding social accountability: a cross-sectional study at a Subsaharan African medical school

BackgroundMedical schools are called to be socially accountable by medical education and healthcare system stakeholders. Social accountability is a feature of excellent medical education. Medical students are essential to the development of socially accountable medical schools. Therefore, understanding the perceptions and experiences of medical students regarding social accountability is critical for efforts to improve social accountability practices and outcomes.MethodsThis cross-sectional online questionnaire-based survey used Google Forms and involved medical students in their fourth and fifth years of study at the Makerere University School of Medicine. The survey was conducted between September 2022 and October 2023. We used a study questionnaire and a validated toolkit designed by students as part of The Training for Health Equity Collaborative to gauge a school’s progress towards social accountability in medical schools to collect data on demographics, perceptions and experiences and evaluate social accountability.ResultsOut of 555 eligible medical students, 426 responded to the online questionnaire. The response rate was 77%. The mean age of the students was 25.24 ± 4.4 years. Almost three fourths of the students were male (71.3%), and slightly less than two thirds were in their fourth year of study (65%). Almost half of the students (48.1%%) evaluated the school as doing well with regard to social accountability. The evaluation items referring to community-based research and positive impact on the community had the highest mean scores. Only 6 (3.6%) students who reported hearing of social accountability had a clear understanding of social accountability. Students receiving career guidance in secondary school was associated with evaluating social accountability in the medical school as strong (p-0.003).ConclusionsMedical students evaluated the medical school favorably forsocial accountability despite lacking a clear understanding of social accountability. Receiving career guidance in secondary school was significantly associated with a positive evaluation of social accountability.

Sociocultural factors affecting first-year medical students' adjustment to a PBL program at an African medical school.

Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students' experiences during the first semester of an undergraduate problem-based learning medical program at an African medical school. We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self-direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research-informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem-based learning process.

Knowledge, attitudes, and practices of health professions students on mentorship: a cross-sectional study at a sub-Saharan African medical school

BackgroundMentoring involves the informal conveyance of knowledge, social capital, and support, as perceived by the recipient to be pertinent to aspects of work, career, and personal or professional development. Students pursuing health-related courses need access to mentorship and its benefits during their formative academic and career states. However, in Sub-Saharan Africa, many institutions have not fully embraced this despite the benefits of mentorship.AimThe primary purpose of this study was to assess medical students’ knowledge about mentorship and explore their attitudes and practices toward mentorship.MethodologyWe held an online cross-sectional study utilizing a pre-tested self-reported questionnaire targeting health professional students in the faculty of medicine, Mbarara University of Science and Technology (MUST). The collected data were coded and summarized using descriptive statistics and thematic analysis.ResultsTwo hundred eighty-three (283) students participated in this study. Of this group, 79.9% were aware of mentorship, 61% were willing to commit 1–2 h a week for mentorship, and Zoom was the preferred mode of communication; 98.2% expressed the need for a structured student-led hybrid mentorship program.ConclusionMentorship at Mbarara University of Science and Technology was considered beneficial by health professions students in the Faculty of Medicine.RecommendationFuture studies should explore accessibility to mentorship and the effectiveness of existing mentorship processes.

Understanding of 'generalist medical practice' in South African medical schools.

In South Africa, medical students are expected to have acquired a generalist competence in medical practice on completion of their training. However, what the students and their preceptors understand by 'generalist medical practice' has not been established in South African medical schools. This study aimed to explore what the students and their preceptors understood by 'generalist medical practice'. Four South African medical schools: Sefako Makgatho Health Sciences University, University of KwaZulu-Natal, Walter Sisulu University and the University of the Witwatersrand. The exploratory descriptive qualitative design was used. Sixteen focus group discussions (FGDs) and 27 one-on-one interviews were conducted among students and their preceptors, respectively. Participants were recruited through purposive sampling. The inductive and deductive data analysis methods were used. The MAXQDA 2020 (Analytics Pro) software was used to arrange data, yielding 2179 data segments. Ten themes were identified: (1) basic knowledge of medicine, (2) first point of contact with all patients regardless of their presenting problems, (3) broad field of common conditions prevalent in the community, (4) dealing with the undifferentiated patient without a diagnosis, (5) stabilising emergencies before referral, (6) continuity, (7) coordinated and (8) holistic patient care, necessitating nurturance of doctor-patient relationship, (9) health promotion and disease prevention, and (10) operating mainly in primary health care settings. The understanding of 'generalist medical practice' in accordance with internationally accepted principles augurs well in training undergraduate medical students on the subject. However, interdepartmental collaboration on the subject needs further exploration.Contribution: The study's findings can be used as a guide upon which the students' preceptors and their students can reflect during the training in generalist medical practice.

Assessment of faculty development programs in African Medical Schools: A systematic review

Background: Faculty development is a critical component of medical education, playing a pivotal role in enhancing the quality of teaching, research, and clinical practice. In the context of African medical schools, where unique challenges exist, the effectiveness of faculty development programs becomes crucial. This systematic review aims to evaluate and analyze the existing literature on faculty development programs (FDPs) implemented in African medical schools. Aim: The primary focus was to assess the effectiveness, impact, and key characteristics of these programs in enhancing the teaching, research, and professional development of faculty members. Method: A comprehensive search strategy was employed to identify relevant studies published in peer-reviewed journals, conference proceedings, and grey literature databases. Inclusion criteria encompassed articles reporting on faculty development initiatives within medical schools across the African continent. The search was not restricted by publication date, ensuring a broad scope of evidence. The initial search yielded a substantial number of studies, and after screening for eligibility, a final set of articles was included in the systematic review. The identified faculty development programs varied in their structure, duration, and focus areas, encompassing pedagogical training, research capacity building, and leadership development. The outcomes assessed included changes in teaching methodologies, research productivity, and overall job satisfaction among faculty members. Conclusions: This review suggests that there is need to invest in faculty development program, create a better learning policy, by implementing these strategies, the quality of teaching, research, and clinical practice will be improved In African medical schools.

African Medical School Academic Success and Social Drug use among Undergraduate Students

Background: It has long been known that using drugs like alcohol, khat, and tobacco is one of the main causes of human suffering. It is now regarded as one of the most significant socioeconomic and public health concerns in the world. Although it has an impact on many facets of society, juvenile substance abuse is alarmingly on the rise. Objective: This study’s goal is to evaluate how social drug usage affects students’ academic performance, specifically among those who will undergraduate from Africa medical college in 2023. Methodology: A cross-sectional study that was done on an institutional level among Africa medical college undergraduates. For the current study, a sample of 173 students was selected using a straightforward random selecting procedure from nine departments. Result: This survey included a total of 173 graduating students from various departments. Overall, 97.4 women, or 64.2%, and 174.5 women, or 35.8%, were present. Social drugs were taken by 33.6% of people at some point in their life. The most often used social drugs, according to this study, were beer, khat, and cigarettes (41.8%, 40.7%, and 12.1%, respectively). The most frequent effects of social drug use on students’ academic performances were higher absenteeism from class (31.9%) and a decline in cumulative grade point (27.5%), followed by a lack of interest in routine activities (25.3%) and worsening academic performance (15.2%), according to respondents. Peer pressure and socialization (17.8%) were the two most frequent reasons given by respondents, whereas academic unhappiness (13.3%), the desire to improve academic performance (11.1%), and loss of family control (8.9%) were the least frequent. Age, Religion, Ever Social Drug Use, Current Social Drug Use, Started Using Social Drug Use, and Impact of Social Drug Use show statistically significant associations with CGPA, according to statistical analysis and p-value. Conclusion and Recommendation: The studies revealed that social drug use had a negative impact on kids’ academic performance. The most prevalent outcomes were an increase in absences from school, a drop in cumulative grade point, and a decrease of interest in everyday chores. Khat, alcohol, and cigarettes were the most popular social drugs. This finding calls for further in-depth investigation into the various challenges connected to social drug use as well as instruction by responsible organizations about the detrimental effects that social drug use has on students’ academic performance, particularly when they first enrol in college.

Advancing Global Health Equity: The Role of the Liberal Arts in Health Professional Education

AbstractMuch innovation has taken place in the development of medical schools and licensure exam processes across the African continent. Still, little attention has been paid to education that enables the multidisciplinary, critical thinking needed to understand and help shape the larger social systems in which health care is delivered. Although more than half of medical schools in Canada, the United Kingdom, and the United States offer at least one medical humanities course, this is less common in Africa. We report on the “liberal arts approach” to medical curricula undertaken by the University of Global Health Equity beginning in 2019. The first six-month semester of the curriculum, called Foundations in Social Medicine, includes courses in critical thinking and communication, African history and global political economy, medical anthropology and social medicine, psychology and health, gender and social justice, information technology and health, and community-based training. Additionally, an inquiry-based pedagogy with relatively small classes is featured within an overall institutional culture that emphasizes health equity. We identify key competencies for physicians interested in pursuing global health equity and how such competencies relate to liberal arts integration into the African medical school curriculum and pedagogical approach. We conclude with a call for a research agenda that can better evaluate the impact of such innovations on physicians’ education and subsequent practices.

South Africa’s Psychiatric training capacity in 2008 and in 2018. Has training capacity improved?

Background: There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country.Aim: To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018.Setting: South African medical schools with departments of psychiatry.Methods: A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years.Results: Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only sub-speciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant.Conclusion: While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training.Contribution: This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning.

A content analysis of two african medical schools' antibiotic stewardship curricula.

Antibiotics are precious substances that have saved millions of lives since their discovery, resulting in significant advances in modern medicine. However, antibiotic resistance and a slowdown in the discovery of new antibiotics with novel mechanisms of action are affecting the sustainability of antibiotics. The objective of this study was to describe the content of South African and Nigerian medical students' curricula with respect to prudent antimicrobial prescribing. A content analysis framework was used to identify, describe, and count the keywords, key phrases, and sentences relevant to the teaching of prudent antimicrobial prescribing in the complete curricula content of two African countries' medical schools. The courses are taught in the Graduate Entry Medical Programme (GEMP) curriculum (years 3-6) of the South African medical school and years 4-6 of the Nigerian medical school. The frequency of keywords/key phrases relevant to prudent antibiotic prescribing such as antimicrobial stewardship, mechanisms of bacterial resistance, and principles of antibiotic therapy was determined. The two curricula reviewed were found to be different. While the South African medical school uses an integrated curriculum in the GEMP (a stream where candidates with undergraduate degrees are enrolled into the 3rd year of medical school and spend 4 years), the Nigerian medical school operates a traditional (discipline based) curriculum from MBBS 1-6. A greater number of keywords and key phrases were found in the South African curriculum compared to the Nigerian curriculum in relation to prudent antibiotic prescribing and antimicrobial stewardship. The key phrase "antimicrobial stewardship" or "antibiotic stewardship" was absent in the Nigerian curriculum but appeared four times in the South African curriculum. The findings of this curriculum review suggest a need for revision of the medical curricula of the two countries, to one that will better prepare learners for antimicrobial stewardship.

South Africa's Psychiatric training capacity in 2008 and in 2018. Has training capacity improved?

There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country. To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018. South African medical schools with departments of psychiatry. A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years. Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only sub-speciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant. While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training. This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning.

Neurophobia: A Side Effect of Neuroanatomy Education?

Neuroanatomy in the medical curriculum tends to be challenging for both lecturers and students. Students and lecturers perceive the relevance and importance of neuroanatomy differently. If not taught sufficiently, students develop a dislike or fear (termed neurophobia) for the subject. This fear prevents them from being receptive to the teaching and consequently applying the neuroanatomy knowledge in the clinical environment. Information on the approach and perception of undergraduate neuroanatomy lecturers in South Africa regarding neuroanatomy in the medical curriculum is scarce and inconclusive. A study was undertaken to explore the attitudes and perceptions of neuroanatomy lecturers towards the relevance of neuroanatomy, as well as the teaching techniques and approach thereof, in the medical curriculum. In order to determine whether the lecturers' teaching approach and attitudes could be a contributing factor to neurophobia. In a cross-sectional qualitative study, neuroanatomy lecturers from the nine South African medical schools were invited to complete an anonymous online questionnaire. Results were thematically analysed and grouped. Lecturing staff from seven of the medical schools participated in this study and included fourteen respondents. The respondents classified themselves mainly as either proficient (78.6%) or experts (15.8%) in their neuroanatomy teaching experience. All the respondents acknowledged that neuroanatomy is important in their students' medical training. A lecturer's perceptions and attitude towards the subject or content, greatly affect the facilitation approaches and techniques used. This might have far- reaching consequences for students as it might impact on their attitude towards the content.

Evaluation of a competency based medical curriculum in a Sub-Saharan African medical school

BackgroundMedical schools in Sub-Saharan Africa have adopted competency based medical education (CBME) to improve the quality of graduates trained. In 2015, Makerere University College of Health Sciences (MaKCHS) implemented CBME for the Bachelor of Medicine and Bachelor of Surgery (MBChB) programme in order to produce doctors with the required attributes to address community health needs. However, no formal evaluation of the curriculum has been conducted to determine whether all established competencies are being assessed.ObjectiveTo evaluate whether assessment methods within the MBChB curriculum address the stated competencies.MethodsThe evaluation adopted a cross-sectional study design in which the MBChB curriculum was evaluated using an Essential Course Evidence Form (ECEF) that was developed to collect information about each assessment used for each course. Information was collected on: (1) Assessment title, (2) Description, (3) Competency domain (4) Sub-competency addressed, (5) Student instructions, and (6) Grading method/details. Data were entered into a structured Access data base. In addition, face-to-face interviews were conducted with faculty course coordinators.ResultsThe MBChB curriculum consisted of 62 courses over 5 years, focusing on preclinical skills in years 1–2 and clinical skills in years 3–5. Fifty-nine competencies were identified and aggregated into 9 domains. Fifty-eight competencies were assessed at least one time in the curriculum. Faculty cited limited training in assessment as well as large student numbers as hindrances to designing robust assessments for the competencies.ConclusionCBME was successfully implemented evidenced by all but one of the 59 competencies within the nine domains established being assessed within the MBChB curriculum at MaKCHS. Faculty interviewed were largely aware of it, however indicated the need for more training in competency-based assessment to improve the implementation of CBME.

Evaluating the impact of neurosurgical rotation experience in Africa on the interest and perception of medical students towards a career in neurosurgery: a protocol for a continental, cross-sectional study.

IntroductionAfrica has the second highest neurosurgical workforce deficit globally. Despite the many recent advancements in increasing neurosurgical access in Africa, published reports have shown that the vast majority of undergraduate students have little or no exposure to neurosurgery. The lack of exposure may pose a challenge in reducing the neurosurgical workforce deficit, which is one of the long-term strategies of tackling the unmet burden of disease. Students may also miss the opportunity to appreciate the specialty and its demands as well as nurture their interest in the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery.MethodsThe cross-sectional study will be conducted through the dissemination of a self-administered e-survey hosted on Google Forms from 21st February 2021 to 20th March 2021. The survey will contain five-point Likert scale, multiple-choice and free-text questions. The structured questionnaire will have four sections with 27 items: (i) socio-demographic background, (ii) neurosurgical experience, (iii) perception towards a neurosurgical career and (iv) interest in a neurosurgical career. All consenting medical students in African medical schools who are in their clinical years (defined as fourth to sixth years or higher years of study) will be eligible. Odds ratios and their 95% confidence intervals, Wilcoxon rank-sum test, Welch t-test and adjusted logistic regression models will be used to test for associations between independent and dependent variables. Statistical significance will be accepted at P < 0.05.

Distance Learning with Virtual Case-Based Collaborative Learning: Adaptation and Acceptability of Clinical Cases from an American Academic Medical Center for Education at an African Medical School

We aimed to determine whether a Case-Based Collaborative Learning (CBCL) curriculum, developed from the clinical experience of U.S.-based clinicians in collaboration with Rwandan medical faculty, is acceptable, feasible to implement, and effective as a virtual educational tool for medical students in a resource-limited, global health setting. In this CBCL distance learning education, students were actively engaged and understood the case material and asked probing and insightful questions. Course evaluations showed that 106 of the 120 total student responses (88.3%) said that the difficulty level was “about right”, while only 11/120 (9.2%) said it was “too easy” and 3/120 (2.5%) said it was “too hard” providing evidence that even though the cases were largely based on clinical encounters at an American academic medical center, they are understandable, and at the appropriate level of difficulty for Rwanda-based medical students. Qualitative analysis from student comments found the CBCL method most helpful for students to develop diagnostic frameworks, and the practice of clinical reasoning using CBCL was engaging and interactive. This method of a virtual, international CBCL approach, was feasible, effective, and acceptable for students. A large majority of students found the sessions to be of appropriate difficulty and engaging. From the global health and inter-cultural exchange perspective, this collaboration demonstrates feasibility and acceptability of international partnerships. Using virtual, video conferencing technology, similar future collaborations can improve capacity building in lower-resource settings.

Medical students’ perceptions of global health at the University of Cape Town, South Africa: The gap between interest and education

Background. Global health competencies are an increasingly important part of medical training; however, there is currently no integrated formal global health curriculum at South African (SA) medical schools, and perceptions of medical students towards global health have not been reported. Objectives. To describe SA medical students’: (i) perceptions of global health; (ii) access to global health education (GHE); (iii) awareness of global surgery as a global health priority; and (iv) perceived relevance of select medical specialties to global health. Methods. Medical students at the University of Cape Town (UCT), SA, were invited to complete a 35-item survey over 2 months in 2018. The survey was designed on REDCap (Research Electronic Data Capture) and distributed by email. All responses were anonymised and self-reported. Results. Of 1 640 medical students, 245 (18%) completed the survey. Only 66 (27%) reported GHE in medical school, whereas 213 (87%) reported a career interest in global health. Childhood in a rural setting was a positive predictor of a career interest in global health, while lack of medical resources and infrastructure in resource-limited communities was the most commonly cited barrier to a career in global health. Most students identified family medicine and infectious diseases as the two most important specialties in global health delivery. The majority of students had limited insight into global surgery, which ranked low as a past and future global health priority. Conclusion. UCT medical students are interested in global health careers, but lack formalised GHE or global surgery education during their medical studies to support and encourage integrating global health into their future careers.

An Experience on Facts about Teaching Forensic Medicine to Undergraduate Medical Students in South Africa

South Africa is struggling with an enormous amount of forensic pathology services because there is an extreme pressure on forensic pathologists to deal with the high number of medicolegal autopsies in the country. There are only five dozen forensic pathologists in South Africa who have to handle at least 80 000 autopsies per year. Medical officers, who have only received training as undergraduates in medical school, are expected to conduct these autopsies. Therefore, undergraduate teaching and training must be strong enough so that these young graduates can handle cases without any compromise in the quality of the outcome.This report is going to highlight the necessity of teaching forensic medicine at undergraduate level in South African medical schools. It will also discuss the shortcomings in medical school teaching programmes.

Bibliometrics to assess the productivity and impact of medical research

Background: Bibliometrics is the use of statistical and mathematical analysis to assess research production and quality. These metrics provide important insights into the quality and impact of research by applying standardised metrics. However, there are inherent limitations in their application. Objective: We aimed to review existing bibliometric indices and assess their comparative utility in the assessment of medical researchers. We specifically aimed to evaluate the utility of the h-index in identifying young or developing medical researchers with future research potential. Method: We conducted a focussed literature review on commonly used bibliometrics. To explore the utility of these metrics we then used them to evaluate a sample of researchers from a South African medical school faculty. Researchers were ranked with the following metrics: number of publications; h-index; citations per paper; citations per paper per year; and m-index. The h-index, citations and publication counts were drawn from ResearchGate and, if not available, from Google Scholar. The top 20 researchers, based on publication count, were then analysed further. Results: We identified 145 researchers for analysis of which 37 were excluded due to an inability to obtain additional information. Higher time-dependent metrics (publication count, citation count, h-index) were directly proportional to years since first publication. Indices that corrected for time, such as the m-index, provided more insight and better discrimination in identifying younger researchers with greater research potential. Conclusion: Bibliometrics have utility as part of the assessment of academic output but may be subject to time-dependent bias. Research quality is best measured using the h-index, g-index and m-index. The h-index is limited by being time dependent and field specific and overlooks highly cited papers. Bibliometrics that account for time, such as the m-index, should be considered in the early identification of young researchers, ideally accompanied by critical peer review.