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Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African
Zohray Talib1, Susan van Schalkwyk, Ian Couper
1Z. Talib is associate professor of medicine and of health policy, George Washington University School of Medicine and Health Sciences, Washington, DC. S. van Schalkwyk is professor of health professions education and director, Center for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. I. Couper is director, Ukwanda Center for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. S. Pattanaik is a doctoral student, Community Health Behavior and Education, Georgia Southern University, Statesboro, Georgia. K. Turay was senior research associate, Department of Health Policy, George Washington University, Washington, DC, at the time of this study. A.S. Sagay is professor of obstetrics and gynecology and honorary consultant obstetrician and gynecologist, University of Jos/Jos University Teaching Hospital, Jos, Nigeria. R. Baingana is a lecturer, Department of Biochemistry, Makerere University, Kampala, Uganda. S. Baird is associate professor of global health and economics, Department of Global Health, George Washington University, Washington, DC. B. Gaede is head, Department of Family Medicine, University of Kwazulu Natal, Durban, South Africa. J. Iputo is head, Department of Medical Education, Walter Sisulu University, Mthatha, Eastern Cape, South Africa. M. Kibore is a pediatrician and public health specialist, University of Nairobi, Nairobi, Kenya. R. Manongi is senior lecturer, Department of Community Health, Kilimanjaro Christian Medical Center, Moshi, Tanzania. A. Matsika is an administrator, University of Zimbabwe College of Health Sciences-Novel Education Clinical Trainees & Researchers Program, Harare, Zimbabwe. M. Mogodi is a lecturer, Department of Medical Education, Faculty of Medicine, University of Botswana, Gaborone, Botswana. J. Ramucesse is assistant professor, Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, and government advisor, Health Policies, Maputo, Mozambique. H. Ross is senior proposal writer, IntraHealth International, and adjunct professor, Department of Global Health, George Washington University, Washington, DC. M. Simuyeba is a lecturer, School of Public Health, University of Zambia, Lusaka, Zambia. D. Haile-Mariam is professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Purpose:
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.
Method:
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.
Results:
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.
Conclusions:
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.