Modest outputs of graduates by relatively few medical schools and chronic emigration contribute to low physician presence in Sub-Saharan Africa (SSA).The Sub-Saharan African Medical School Study (SAMSS) examined the challenges, innovations, and emerging trends in medical education in SSA.SAMSS identified 168 medical schools and achieved a 72% survey response rate of the 146 schools surveyed. The Study found that countries are prioritizing medical education scale up as part of health system strengthening, and identified many innovations in pre-medical preparation, the use of expatriate faculty, and creative use of scarce research support. SAMSS also noted ubiquitous faculty shortages, weak scholastic infrastructure, and limited accreditation. Trends observed include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development.Ten recommendations provide guidance for efforts to strengthen medical education in SSA. BACKGROUND

Integrating point-of-care ultrasound (POCUS) to enhance diagnostic availability in resource-limited regions in Africa has become a main initiative for global health services in recent years. In this article, we present lessons learned from introducing POCUS as part of the Global Health Service Partnership (GHSP), a collaboration started in 2012 between the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Peace Corps and Seed Global Health to provide health care work force education and training in resource-limited countries. A cross-sectional survey of GHSP clinical educators trained to use POCUS and provided with hand-held ultrasound during their 1-y deployment during the period 2013À2017. The survey consisted of 35 questions on the adequacy of the training program and how useful POCUS was to their overall clinical and educational mission. Clinical educators engaged in a series of ultrasound educational initiatives including pre-departure training, bedside training in the host institutions, online educational modules, educational feedback on transmitted images and training of local counterparts. In this study 63 GHSP clinical educators who participated in the POCUS trainings were identified, and 49 were included at the study (78% response rate). They were assigned to academic institutions in Tanzania (n = 24), Malawi (n = 21) and Uganda (n = 18). More than 75% reported use of POCUS in clinical diagnoses and 50% in determining treatment, and 18% reported procedural application of ultrasound in their practice. The top indications for POCUS were cardiac exams, second-and third-trimester obstetric exams, lung and pleura, liver and spleen and gynecology/first-trimester obstetrics. The largest perceived barriers were lack of ultrasound knowledge by the clinical educators, lack of time, equipment security, difficulty accessing the Internet and equipment problems. We concluded that our multiphase POCUS training program has increased the utility, acceptability and usage of POCUS in resource-limited settings. (

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