Thuy Bui

Specialization training in Malawi: a qualitative study on the perspectives of medical students graduating from the University of Malawi College of Medicine.

BackgroundThere is a critical shortage of healthcare workers in sub-Saharan Africa, and Malawi has one of the lowest physician densities in the region. One of the reasons for this shortage is inadequate retention of medical school graduates, partly due to the desire for specialization training. The University of Malawi College of Medicine has developed specialty training programs, but medical school graduates continue to report a desire to leave the country for specialization training. To understand this desire, we studied medical students’ perspectives on specialization training in Malawi.MethodsWe conducted semi-structured interviews of medical students in the final year of their degree program. We developed an interview guide through an iterative process, and recorded and transcribed all interviews for analysis. Two independent coders coded the manuscripts and assessed inter-coder reliability, and the authors used an “editing approach” to qualitative analysis to identify and categorize themes relating to the research aim. The University of Pittsburgh Institutional Review Board and the University of Malawi College of Medicine Research and Ethics Committee approved this study and authors obtained written informed consent from all participants.ResultsWe interviewed 21 medical students. All students reported a desire for specialization training, with 12 (57%) students interested in specialties not currently offered in Malawi. Students discussed reasons for pursuing specialization training, impressions of specialization training in Malawi, reasons for staying or leaving Malawi to pursue specialization training and recommendations to improve training.ConclusionsGraduating medical students in Malawi have mixed views of specialization training in their own country and still desire to leave Malawi to pursue further training. Training institutions in sub-Saharan Africa need to understand the needs of the country’s healthcare workforce and the needs of their graduating medical students to be able to match opportunities and retain graduating students.

Cultural implications of mentoring in sub-Saharan Africa: a qualitative study.

Although many studies have demonstrated the benefits of mentoring in academic medicine, conceptual understanding has been limited to studies performed in North America and Europe. An ecological model of mentoring in academic medicine can provide structure for a broader understanding of the role of culture in mentoring.

Physician–Patient Relationship in Type 2 Diabetes

To The Editors:— The qualitative study by Beverly and colleagues highlights the fact that both physicians and patients often assumed responsibilities for poor clinical outcomes in the treatment of type 2 diabetes. Patients felt defeated, depressed and expressed lack of self-efficacy, while physicians pointed to health system constraints and high expectations.1 Most primary care providers, according to a recent national survey by the Robert Wood Johnson Foundation, believe that unmet social needs—things like access to nutritious food, reliable transportation and adequate housing—are leading directly to worse health for all Americans.2 Additional studies are needed to explore the perceptions, attitudes and behaviors that support or impede the patient–physician relationship in diabetes or any chronic disease management, particularly the interaction of social determinants and self-management with quality measures and treatment goals.

A case of massive splenomegaly due to chronic myeloproliferative neoplasm

A 34-year-old female, HIV non-reactive, presented to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, complaining of 7 months abdominal pain. She endorsed shortness of breath and early satiety for the same duration, but denied fever, chills, night sweats, and weight loss. The remainder of her review of systems was negative. She had no significant past medical history. There were no identifiable risk factors for myeloproliferative disorders, including family history, known genetic syndromes, chemical exposure, or history of ionizing radiation. On physical exam, she was noted to have a visible spleen (figure 1) which crossed into the right upper quadrant as well as the pelvis, and was non-tender to palpation. There was no cervical or axillary lymphadenopathy. The remainder of her exam was unremarkable.

Sri Lanka’s post-tsunami health system recovery: a qualitative analysis of physician perspectives

Background The 2004 Indian Ocean tsunami caused significant damage to the health system in Sri Lanka. Rebuilding infrastructure and improving the mental health system were targets of recovery policies. Retrospective analyses of the post-tsunami health system recovery in Sri Lanka lack the perspectives of local stakeholders, including health care providers. Methods In 2014 we interviewed 23 Sri Lankan physicians from the Eastern and Southern regions. Participants were recruited with snowball sampling. We used a content analysis approach in analysing the transcriptions. Results Sri Lankan physicians critiqued governance, sustainability and equity in the health system recovery. They held leadership roles as facilitators and sustainers of specific projects but were rarely formally consulted in recovery strategic planning. They identified instances of poor coordination among partners, corruption trends, local resource mismatches, regional resource disparities and the influence of the Sri Lankan civil war. Conclusions Post-tsunami health system recovery planning and implementation in Sri Lanka did not involve local physician stakeholders in ways that have been prioritized more recently in other recovery frameworks. Despite limited formal inclusion, local physicians developed significant leadership roles that have informed their critical perspectives on the health system recovery.