The Medical Education Partnership Initiative, a multi-million dollar US government initiative, recently held the Annual MEPI Symposium in Kampala Uganda. In it’s third year of a 5-year grant, the MEPI community has clearly lit up with innovations and progress abound. MEPI is now a network of over 26 medical schools in Africa, each investing in building capacity to improve the quality, quantity and retention of their graduates, while also building research capacity. Having seen the evolution of MEPI from it’s inception to this half-way point, I note 6 trends that have emerged.
It’s no coincidence that the trends nicely fit under two categories that were coined by the Lancet Commission for Health Professions Education; Institutional and Instructional trends.
1. Strategic In-Country Partnerships: Gone are the days when medical schools in Africa simply look to the North for support and direction. Instead, African medical schools are partnering with each other, to share limited resources creatively and to have a stronger voice in advocating for national health workforce reform. In Uganda and in Zambia, all in-country medical schools have formed a consortium in their respective countries even bringing together public and private schools. The Ugandan partnership is called MESAU – Medical Education for Equitable Services to All Ugandans.
2. Rapid-Scale Up of Enrollment: In response to the urgent need for health care workers, we are seeing countries and schools across the continent rapidly scale up the enrollment to medical schools. At Addis Ababa University in Ethiopia, the class sizes have increased from just over 100 to now close to 400 students per class. At Kilimanjaro Christian Medical College in Tanzania, class sizes have increased over 50%.
3. Medical Education Units are being established: As schools embrace education innovations there is a trend to establish Medical Education Units (MEUs) to support faculty development, curriculum review and to help evaluate the impact of these education investments. At the University of Zambia, the MEU is conducting a study to determine the impact of the new Skills Lab. At Stellenbosch University in South Africa the Medical Education Unit has already started a robust evaluation of the rural training program.
At the Instructional level, there are 3 additional trends:
4. Decentralization of medical education: As tertiary hospitals become congested with more and more students, and district hospitals paradoxically struggle to retain staff and provide high-quality service, the decentralization of clinical rotations seems to fill the gap. Sending students out to do core rotations in internal medicine, surgery or OB brings academic rigor and resources to the community. The district hospital docs are incentivized to stay in their jobs by the new teaching responsibilities and the rigor of teaching raises the level of care provided at the district sites. This is the story of both teachers and students at the University of Nairobi. At the University of Jos in Nigeria, they’ve creatively converted the PEPFAR supported district hospitals into teaching sites, offloading the crowded hospitals at urban hospitals.
5. Curriculum reform, embracing competency-based education; Africa is no exception as schools across the globe embrace competency-based education. In Nigeria, they have developed a nation-wide template for a competency-based medical school curriculum that takes into account the local health needs. In Uganda, all 5 schools in the country met to determine the minimum competencies that should guide all medical curricula. Coming from a western context, I found it interesting that the list included critical inquiry, population health and leadership and management skills. The latter topic of leadership in medicine begs for a global discussion on the definition of leadership as we look to the decades ahead.
6. Last but not least is the trend to embrace technology and establish elearning as a core competency of medical schools. Medical schools across the continent are preparing to embrace technology by investing in infrastructure. We are even starting to see African medical schools implement elearning programs – providing students with tablets for access to e-textbooks and point-of-care decision making tools as they are doing at the University of Botswana and at Kilimanjaro Medical College in Tanzania.
These trends demonstrate that while there certainly is a global health workforce crisis, medical schools in Africa are prepared to rise to the occasion.