Zohray Talib

E-learning in medical education in resource constrained low- and middle-income countries

BackgroundIn the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used.MethodsResearchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators “AND” and “OR” to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles.ResultsOf the relevant articles found, most referred to e-learning in Brazil (14 articles), India (14), Egypt (10) and South Africa (10). While e-learning has been used by a variety of health workers in LMICs, the majority (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Although reasons for investing in e-learning varied, expanded access to education was at the core of e-learning implementation which included providing supplementary tools to support faculty in their teaching, expanding the pool of faculty by connecting to partner and/or community teaching sites, and sharing of digital resources for use by students. E-learning in medical education takes many forms. Blended learning approaches were the most common methodology presented (49 articles) of which computer-assisted learning (CAL) comprised the majority (45 articles). Other approaches included simulations and the use of multimedia software (20 articles), web-based learning (14 articles), and eTutor/eMentor programs (3 articles). Of the 69 articles that evaluated the effectiveness of e-learning tools, 35 studies compared outcomes between e-learning and other approaches, while 34 studies qualitatively analyzed student and faculty attitudes toward e-learning modalities.ConclusionsE-learning in medical education is a means to an end, rather than the end in itself. Utilizing e-learning can result in greater educational opportunities for students while simultaneously enhancing faculty effectiveness and efficiency. However, this potential of e-learning assumes a certain level of institutional readiness in human and infrastructural resources that is not always present in LMICs. Institutional readiness for e-learning adoption ensures the alignment of new tools to the educational and economic context.

Transforming health professions’ education through in-country collaboration: examining the consortia among African medical schools catalyzed by the Medical Education Partnership Initiative

BackgroundAfrican medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning.MethodsSemi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These interviews were recorded, transcribed and coded to identify common themes.ResultsAll of the consortia have prioritized efforts to increase the quality of medical education, support new schools in-country and strengthen relations with government. These in-country partnerships have enabled schools to pool and mobilize limited resources creatively and generate locally-relevant curricula based on best-practices. The established schools are helping new schools by training faculty and using grant funds to purchase learning materials for their students. The consortia have strengthened the dialogue between academia and policy-makers enabling evidence-based health workforce planning. All of the partnerships are expected to last well beyond the MEPI grant as a result of local ownership and institutionalization of collaborative activities.ConclusionsThe consortia described in this paper demonstrate a paradigm shift in the relationship between medical schools in four African countries. While schools in Africa have historically worked in silos, competing for limited resources, MEPI funding that was leveraged to form in-country partnerships has created a culture of collaboration, overriding the history of competition. The positive impact on the quality and efficiency of health workforce training suggests that future funding for global health education should prioritize such south-south collaborations.

Women leaders in global health

It is disappointing and rather ironic to note the lack of gender parity in leadership positions in the field of global health. Women carry a disproportionate burden of disease, comprise a large portion of the global health workforce, and in many leading universities make up the majority of global health students, even up to 84% as reported by one university. Yet, among the top 50 universities in the USA, women hold just over a third of global health faculty positions and a quarter of directorships in global health centres. The dropoff is steep and concerning, from 84% of the student body to 24% of leadership positions. In the World Health Assembly women hold only about a quarter of leadership positions, despite comprising almost 75% of the health workforce in some countries. Dhatt and colleagues spoke out on this very issue in a correspondence in The Lancet, calling on WHO leadership to take deliberate steps towards gender parity. What prevents the rise of women leaders? It’s clearly not due to a lack of interest, but rather a consequence of bottlenecks and hurdles that stifle growth and limit advancement. Several factors have been identified: inadequate guidance and mentoring, difficulty balancing family responsibilities while meeting promotion criteria (especially mid-career), and overt bias and gender discrimination in the workplace. In October 2017, Stanford University (Stanford, CA, USA) in partnership with the US National Institutes of Health and a number of leading academic and global health institutions will host a conference for Women Leaders in Global Health. This event will highlight accomplished and emerging leaders and will create a space for shared conversation to explore the challenges as well as the opportunities for women aspiring to play leadership roles in global health. The Women Leaders in Global Health conference (#WLGH17) aims to go beyond the call for parity at top leadership levels. The intention is to call for the advancement of women leaders at all levels of global health activity and to translate leadership intent into everyday actions—in communities, academia, nonprofit organisations, scientific societies, boardrooms, and government. Women currently exemplify leadership in many ways. Many overcome daily obstacles to advance health in their communities as community health workers. Others persevere in hostile work environments striving for promotion and greater responsibility. Still others provide thought leadership for global health organisations. This conference will support the diverse career paths and activities of women in global health by highlighting both senior and emerging leaders and hearing their stories. A panel titled “Men who get it” will highlight how men can engage in promoting parity. Women in Global Health, an implementing partner of the event, defines their vision for gender parity as a goal of 50–50 representation in top global health leadership positions by 2030. As the gender gap in global health closes, what else will be different? We provide seven goals (panel). In summary, the Women Leaders in Global Health conference at Stanford aims to stimulate a movement that supports women in all forms of leadership from communities to classrooms to global organisations. The women and men who will assemble will represent different cultures, geographies, and demographics. Events will provide opportunities to discuss actionable steps to bridge the gender gap at every level, as well as to network with mentors and mentees. Our expectation

Investing in community-based education to improve the quality, quantity, and retention of physicians in three African countries.

CONTEXT The Medical Education Partnership Initiative (MEPI) is a

Physician tracking in sub-Saharan Africa: current initiatives and opportunities

US 130 million program funded by the United States government supporting 13 African medical schools to increase the quantity, quality, and retention of physicians in underserved areas. This paper examines how community-based education (CBE) is evolving at MEPI schools to achieve these goals. METHODS We utilized data from the first two years of site visits and surveys to characterize CBE efforts across the MEPI network and provide detailed descriptions of three models of CBE among the MEPI programs. RESULTS There is widespread investment in CBE, with considerable diversity in the goals and characteristics of training activities among MEPI schools. Three examples described here show how schools are strengthening and evaluating different models of CBE to achieve MEPI goals. In Nigeria, students are being sent for clinical rotations to community hospitals to offload the tertiary hospital. In Uganda, the consistency and quality of teaching in CBE is being strengthened by adopting a competency-based curriculum and developing criteria for community sites. At Stellenbosch University in South Africa, students are now offered an elective year-long comprehensive rural immersion experience. Despite the diversity in CBE models, all schools are investing in e-learning and faculty development. Extensive evaluations are planned to examine the impact of CBE strategies on the health workforce and health services. DISCUSSION The MEPI program is stimulating an evolution in CBE among African medical schools to improve the quality, quantity, and retention of physicians. Identifying the strategies within CBE that are reproducible, scalable and optimize outcomes will be instructive for health professions training programs across the continent.

Building capacity in implementation science research training at the University of Nairobi

BackgroundPhysician tracking systems are critical for health workforce planning as well as for activities to ensure quality health care - such as physician regulation, education, and emergency response. However, information on current systems for physician tracking in sub-Saharan Africa is limited. The objective of this study is to provide information on the current state of physician tracking systems in the region, highlighting emerging themes and innovative practices.MethodsThis study included a review of the literature, an online search for physician licensing systems, and a document review of publicly available physician registration forms for sub-Saharan African countries. Primary data on physician tracking activities was collected as part of the Medical Education Partnership Initiative (MEPI) - through two rounds over two years of annual surveys to 13 medical schools in 12 sub-Saharan countries. Two innovations were identified during two MEPI school site visits in Uganda and Ghana.ResultsOut of twelve countries, nine had existing frameworks for physician tracking through licensing requirements. Most countries collected basic demographic information: name, address, date of birth, nationality/citizenship, and training institution. Practice information was less frequently collected. The most frequently collected practice fields were specialty/degree and current title/position. Location of employment and name and sector of current employer were less frequently collected. Many medical schools are taking steps to implement graduate tracking systems. We also highlight two innovative practices: mobile technology access to physician registries in Uganda and MDNet, a public-private partnership providing free mobile-to-mobile voice and text messages to all doctors registered with the Ghana Medical Association.ConclusionWhile physician tracking systems vary widely between countries and a number of challenges remain, there appears to be increasing interest in developing these systems and many innovative developments in the area. Opportunities exist to expand these systems in a more coordinated manner that will ultimately lead to better workforce planning, implementation of the workforce, and better health.

Identifying approaches and tools for evaluating community-based medical education programmes in Africa

BackgroundHealth care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science.MethodsThis paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training and mentoring in implementation science, builds relationships between researchers and implementers, and identifies local research priorities for implementation science.ResultsThe curriculum content includes core material in implementation science theory, methods, and experiences. The program adopts a team mentoring and supervision approach, in which fellows are matched with mentors at the University of Nairobi and partnering institutions: University of Washington, Seattle, and University of Maryland, Baltimore. A survey of program participants showed a high degree satisfaction with most aspects of the program, including the content, duration, and attachment sites. A key strength of the fellowship program is the partnership approach, which leverages innovative use of information technology to offer diverse perspectives, and a team model for mentorship and supervision.ConclusionsAs health care systems and training institutions seek new approaches to increase capacity in implementation science, the University of Nairobi Implementation Science Fellowship program can be a model for health educators and administrators who wish to develop their program and curricula.

Evaluating community-based medical education programmes in Africa: A workshop report

Background. The US Presidents Emergency Plan for AIDS Relief (PEPFAR)-funded Medical Education Partnership Initiative (MEPI) aims to support medical education and research in sub-Saharan African institutions. The intention is to increase the quantity, quality and retention of graduates with specific skills addressing the health needs of their populations. While many MEPI programmes include elements of community-based education (CBE), such as community placements, clinical rotations in underserved locations, community medicine, or primary healthcare, the challenge identified by MEPI-supported schools was the need for appropriate approaches and tools to evaluate these activities. This article outlines the process of identifying tools that, with modification, could assist in the evaluation of CBE programmes in participating MEPI schools. Methods. A literature search was carried out to identify approaches and tools that could be used in Africa to evaluate CBE programmes. The search included published, peer-reviewed literature as well as grey literature and websites. Evaluation tools considered appropriate were obtained from the articles or their authors for inclusion in a compendium of example CBE evaluation tools. All tools sourced through the search were entered into a CBE evaluation matrix, which included an analysis of the tool in relation to Kirkpatrick’s four levels of evaluation. Results. Out of 37 sources included as appropriate, 8 sets of CBE evaluation tools were obtained for the compendium. Most of the evaluations were quantitative, relied on Likert-type scales, and focused on measuring CBE activities and intermediate outcomes in terms of student learning. When categorised according to the level of the evaluation, the evaluations largely focused on levels 1 and 2 of the Kirkpatrick model, as measured through students’ reactions to and learning from the CBE programmes. Tools that focused on student assessment, rather than programme evaluation, were excluded from the final set. Conclusion. With the shortage of published literature on CBE evaluation, the findings of this literature review will assist African medical schools in developing appropriate evaluation approaches and tools.

Gender myths in global health – Authors' reply

BACKGROUND The Medical Education Partnership Initiative (MEPI) supports medical schools in Africa to increase the capacity and quality of medical education, improve retention of graduates, and promote regionally relevant research. Many MEPI programmes include elements of community-based education (CBE) such as: community placements; clinical rotations in underserved locations, community medicine, or primary health; situational analyses; or student-led research. METHODS CapacityPlus and the MEPI Coordinating Center conducted a workshop to share good practices for CBE evaluation, identify approaches that can be used for CBE evaluation in the African context, and strengthen a network of CBE collaborators. Expected outcomes of the workshop included draft evaluation plans for each school and plans for continued collaboration among participants. The workshop focused on approaches and resources for evaluation, guiding exploration of programme evaluation including data collection, sampling, analysis, and reporting. Participants developed logic models capturing inputs, activities, outputs, and expected outcomes of their programmes, and used these models to inform development of evaluation plans. This report describes key insights from the workshop, and highlights plans for CBE evaluation among the MEPI institutions. RESULTS Each school left the workshop with a draft evaluation plan. Participants agreed to maintain communication and identified concrete areas for collaboration moving forward. Since the workshops conclusion, nine schools have agreed on next steps for the evaluation process and will begin implementation of their plans. CONCLUSION This workshop clearly demonstrated the widespread interest in improving CBE evaluation efforts and a need to develop, implement, and disseminate rigorous approaches and tools relevant to the African context.

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

Authors’ reply We thank Sarah Hawkes and Kent Buse for their remarks on our Comment. They are correct in saying that men in post-transition countries bear a greater global burden of disease and live shorter lives than that of women. However, the reverse is true in the poorest of countries where, for example, maternal mortality remains very high. Moreover, although women live longer, they tend to have more debilitating chronic conditions, and self-reported health is worse in women worldwide. Our statement on the burden of disease also reflects the disproportionate social burden women have as caregivers. Even for diseases that affect men or boys, it is often women who are the caregivers. The Women Leaders in Global Health conference, to be held on Oct 12, 2017, at Stanford University, CA, USA, will be an opportunity to continue this discourse on gender parity, particularly as it relates to upward mobility for women in the field of global health.