Training the next generation of Africa’s doctors: why medical schools should embrace the team-based learning pedagogy

Abstract

BackgroundAs far back as 1995, the Cape Town Declaration on training Africa’s future doctor recognized the need for medical schools to adopt active-learning strategies in order to nurture holistic development of the doctor. However, medical education in Africa remains largely stuck with traditional pedagogies that emphasize the ‘hard skills’ such as knowledge and clinical acumen while doing little to develop ‘soft skills’ such as effective communication, teamwork, critical thinking or life-long learning skills.Body of abstractBy reviewing literature on Africa’s epidemiologic and demographic transitions, we establish the need for increasing the output of well-trained doctors in order to match the continent’s complex current and future healthcare needs. Challenges that bedevil African medical education such as outdated curricula, limited educational infrastructure and chronic resource constraints are presented and discussed. Furthermore, increased student enrollments, a trend observed at many schools, coupled with chronic faculty shortages have inadvertently presented specific barriers against the success of small-group active-learning strategies such as Problem-Based and Case-Based Learning. We argue that Team-Based Learning (TBL) offers a robust alternative for delivering holistic medical education in the current setting. TBL is instructor-driven and embodies key attributes that foster development of both ‘hard’ and ‘soft’ skills. We elaborate on advantages that TBL is likely to bring to the African medical education landscape, including increased learner enthusiasm and creativity, accountability, peer mentorship, deep learning and better knowledge retention. As with all new pedagogical methods, challenges anticipated during initial implementation of TBL are discussed followed by the limited pilot experiences with TBL in Africa.ConclusionFor its ability to enable a student-centered, active learning experience delivered at minimum cost, we encourage individual instructors and African medical schools at large, to adopt TBL as a complementary strategy towards realizing the goal of training Africa’s fit-for-purpose doctor.

The Training of Undergraduate Medical Students in General Medical Practice and Primary Health Care: A Scoping Review

“…A wide range of pedagogical approaches are used in the training of medical students in general medical practice and PHC [23,25,36,51,64,69]. These are mainly employed in combination as determined by a particular training institution, the settings and availability of appropriate resources [57].…”

“…This was described as entailing teaching and learning in small groups or whole-class lectures to supplement other pedagogical approaches [23,55,56]. However, on its own, it was found to be less effective, because there is no evidence that lecture attendance translates "into listening, understanding and knowledge retention" [23]. This method does not inculcate critical thinking, problem-solving, independent and selfdirected learning skills to the learners [55,57].…”

“…Another challenge is that PBL needs to be applied in a number of independent students' working groups per given class, wherein each group requires its own tutor and learning resource material. This tends to be costly compared to other methods, like the team-based learning discussed below [23].…”

“…Content mastery occurs over three phases: (1) pre-class preparation, (2) a readiness assurance test, and (3) knowledge application through group problem-solving assignments on real-life problems [23]. This approach has been recommended for low-and middle-income countries (LMICs), including African countries, as it can be employed at minimum cost [23]. African countries that have implemented it with significant success are Zimbabwe [24] and Tanzania [73].…”

“…Medical schools around the world adopt various pedagogical approaches in their UG training programs, some of which are lecture-based [22], problem-based [23], team-based [24] and competency-based [25]. The pros and cons of each approach need to be explored as well as its effectiveness and efficiency in student training in a given context.…”