Dear HIFA colleagues,

As a medical student (many years ago) I was keenly aware of the fact that I would be delegated many of the routine tasks by the house officer or senior house officer. It was a valuable part of my ‘apprenticeship’. This paper highlights the major role of medical students in health care in sub-Saharan Africa. I would be interested to hear your memories (or current reflections) on being (or working with) medical students in your country.

The full text of the article is restricted access but is available on request through ResearchGate (which I have done – I’m not sure why some authors who self-archive do not make the full text of their article available immediately?):

CITATION: Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries.
Talib Z1, van Schalkwyk S, Couper I, Pattanaik S, Turay K, Sagay AS, Baingana R, Baird S, Gaede B, Iputo J, Kibore M, Manongi R, Matsika A, Mogodi M, Ramucesse J, Ross H, Simuyeba M, Haile-Mariam D.
Acad Med. 2017 Oct 17. doi: 10.1097/ACM.0000000000002003. [Epub ahead of print]

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.

Best wishes, Neil

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