Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

Abstract

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.

Community-Based Primary Healthcare Training for Physiotherapy Undergraduates: Perceptions of Physiotherapy Academics

“…Clinicians also felt that students were a burden and they were not remunerated for the extra involvement in clinical supervision. Similar frustrations were evident in Talib et al's (2017) study, where it was noted that the increased number of medical students placed strain on the teaching hospitals, leading to a negative effect on the student-supervisor relationship. The poor partnership dynamics on the DCT platform also posed a barrier to learning.…”

Physiotherapists’ perception of a community-based primary healthcare clinical education approach to undergraduate learning

“…Technology and communication access in the DCT sites posed barriers to learning, as students were unable to access information. [24] There has been a surge in the use of technology as a method to enhance learning; [34] however, efforts are required towards improving access to optimise this tool in resource-limited settings. In this study, student attitudinal barriers were also believed to inhibit optimal learning.…”

Decentralised clinical training of health professionals will expand the training platform and enhance the competencies of graduates

“…It enhances the quality of care for the affected communities and emphasises the inter-dependence of and mutual benefit to the healthcare system, universities and communities to develop appropriately trained graduates. [11] The third shift is a change in educational philosophy towards generalism. Deeply embedded in the traditional curriculum common to most medical schools is the domination of specialism.…”