Bagala, John Paul MBChB; Macheka, Nyasha D. MBChB; Abebaw, Hiwot MBChB; Wen, Leana S. MD, MSc
Mr. Bagala is a medical student, Gulu University School of Medicine, Gulu, Uganda.
Mr. Macheka is a medical student, University of Zimbabwe College of Health Sciences, Harare, Uganda.
Ms. Abebaw is a medical student, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
Dr. Wen is attending physician and director of patient-centered care research, Department of Emergency Medicine, George Washington University, Washington, DC.
Funding/support: Funding and support for this work came from the Office of the U.S. Global AIDS Coordinator (OGAC), National Institutes of Health (NIH), and the Health Resources and Services Administration (HRSA).
Other disclosures: None reported.
Ethical approval: Reported as not applicable.
Disclaimers: The content is solely the responsibility of the authors and does not necessarily represent the official views of OGAC, NIH, or HRSA.
Correspondence should be addressed to Mr. Bagala, Gulu University, Faculty of Medicine, PO Box 166, Gulu, Uganda; telephone: (+256) 787-498597; e-mail: firstname.lastname@example.org.
The challenges facing medical education in Africa are well described. As the demand for physicians rises, medical schools are being tested with increasing enrollment while constrained by inadequate resources, faculty shortages, outdated infrastructure, and adherence to traditional educational methodologies.1–4
As medical students, we bear witness to the challenges in our training environment and health system. We write this paper on our own behalf as trainees in Uganda (J.P.B.), Zimbabwe (N.M.), and Ethiopia (H.A.). Our experiences are also grounded in participation in the Federation of African Medical Students’ Associations (FAMSA), an organization of 3,200 African medical students at 36 medical schools in 22 African nations, of which J.P.B. is president and N.M. and H.A. are national representatives (L.S.W. is a faculty adviser).
Over the last three years, we have had the opportunity to experience significant improvement in our training as a result of the Medical Education Partnership Initiative (MEPI). MEPI aims to strengthen Africa’s health system through investing in medical education at 13 African medical schools, including the 3 schools at which we study.5 In this paper, we describe how the increased resources and innovations have affected us as trainees, and postulate on the future of medical training in Africa.
Medicine is a practical course, but with many students and a lack of equipment, an ongoing problem at every African medical school has been limited access to practical training. For example, three years ago at Gulu University in Uganda, students were unable to complete the anatomy practical because they had no cadavers, and the biochemistry course was canceled because of a lack of reagents. At Addis Ababa University in Ethiopia, trainees reported fighting over limited copies of textbooks in the library. Those unable to access the books could not complete their assignments and were forced to retake the course.
MEPI has helped us greatly by improving access to materials and books. Although we may not have all the equipment that we would like, we can now participate in practical courses without worrying that our education may be delayed or terminated because of insufficient classroom supplies. Our libraries have much better resources; at Gulu University, for example, the number of e-books increased from 500 to 6,000. Many laboratory spaces have been upgraded. These enhancements have made a big difference in how we approach medical school. We are no longer limited by resources that are beyond our control; it is now up to us to make the best use of our education.
Computers are essential in today’s educational environment, yet, in 2010, we had limited access to them. At Gulu University, the computer lab had fewer than 20 computers that were used by more than 60 students during computer lessons. Students reported going weeks without having Internet connectivity. In 2012, with support from MEPI, more than 50 new computers were added, and wireless Internet is accessible 24/7. At the University of Zimbabwe and at Addis Ababa University, where students previously waited in line to access outdated computers with dial-up connections, MEPI has enabled the schools to install computer laboratories featuring high-speed Internet. At Addis Ababa University, every medical student is given an iPad to access e-books and other resources.
It’s an understatement to say that information technology has revolutionized our learning. The unprecedented access to new portals of knowledge allows us to take advantage of textbooks that we can read any time. We also have new possibilities of interacting with other students and professionals from around the world. This greatly supplements the knowledge that we can gain in the classroom and broadens our worldview.
Many studies have made the case for how community-based training can improve practical skills and instill the social mission of medical training.1,6,7 MEPI has helped to reinforce the importance of community-based training by investing in infrastructure for students to participate in these learning opportunities. At Gulu University, students undertake a six-week rotation in rural community health centers. Before MEPI, J.P.B. was posted to a health center near the South Sudan border. Because this was a remote area with no resources nearby, he and others were told to bring their own supplies, including bedding, food, and other necessities. This was a significant limitation: Because the university could not provide adequate support, only students who could afford to finance their own way could go. Now, through MEPI funding, all students are able to participate in this rotation to learn rural and refugee medicine. At Addis Ababa University, final-year students are encouraged to complete a rural community health training program. While there is a need for more students to participate, the limiting factor has been a lack of dormitory space to accommodate additional rotators. MEPI funding has helped establish new dormitories so that all interested students may participate in community-based education.
Not every student looks forward to these training experiences, but nearly all of our classmates say the training is worthwhile because they are able to apply classroom learning and strengthen their clinical skills. Even though we are students, in these extremely limited resource settings we are able to make a contribution to improve health care. Perhaps most important, we see the difficulties and the rewards of practicing medicine in the community. It helps us to understand what it really means to be a doctor.
As students we recognize the importance of research in our own advancement as doctors. Having completed a research project is a technical requirement in order to graduate from medical school, but until recently, many students have not been able to fulfill this requirement. Now, there is a MEPI-sponsored consortium in Africa that has an annual call for research proposals. Students can submit proposals and obtain funding to carry out projects. The number of students who participate in research is increasing every year. At Gulu University, none of the graduating students had worked on a research project before MEPI. Last year, 3 out of 330 students did so, and this year, 6 have submitted proposals. Dozens of medical students attended the MEPI annual symposia; those of us who do so are energized to undertake research in the future. Even if the number of students conducting research is still low, we believe that the availability of the research award and the possibility of presenting at future symposia encourage us to begin discussions with faculty. We appreciate the fact that MEPI encourages us to be both doctors and scholars committed to the pursuit of lifelong learning.
Professional Outlook and Goals
One aspect of MEPI that cannot be quantified is how much it has opened our eyes to the world. Knowing that we belong to a network of other institutions in Africa and beyond has transformed our view. We know now that the problems we face at our universities are similar across countries and that there are collaborations that can be mutually beneficial. Furthermore, participation in MEPI has instilled a sense of ownership and belonging. We are grateful to take advantage of the resources offered at our own institutions. We also see ourselves as ambassadors for MEPI in the future, by connecting with others in the worldwide MEPI community and bringing back this knowledge to improve health care in our countries.
Many of our fellow medical students talk about leaving Africa for good. This “brain drain” is a problem that we feel must be addressed by investing in training and increasing professional opportunities in our countries.8 The improvements in medical education made possible by MEPI are such critical investments that will help produce doctors who are sensitive to the needs of our communities, and who are thus more likely to stay and help Africa.
From the perspective of African medical students, MEPI has brought many needed improvements to medical education, particularly by investing in educational resources, information technology, and physical infrastructure. These investments have allowed us to concentrate on aspects that are important in our education, such as community-based learning and scientific research.
We hope that MEPI will consider innovations to three other areas. First, MEPI could help augment traditional teaching techniques with small-group sessions and mobile platforms, such as an eLearning app that tailors guidance to African contexts (an “UpToDate for Africa”). Second, MEPI could serve as a hub for connecting students across Africa. It could organize regional, in-person research symposia, facilitate online blogs and social networking, and collaborate with FAMSA and other student health professional organizations in an effort to promote mutual learning and networking. Third, MEPI might help start a new publication for African medical students to publish research and commentary. This will encourage more students to participate in self-directed learning and provide an additional forum for pan-African partnerships.
We want to conclude by expressing our sincere thanks and appreciation to the leaders and funders of MEPI. We have benefited greatly from their efforts to prepare the next generation of doctors who can competently and compassionately address our communities’ health needs. We hope that these investments are only the beginning of a greater transformation of medical education and health care in Africa.
Acknowledgments: The authors wish to acknowledge all the deeply committed medical educators and students who are working to improve health care in Africa.
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