EXPLORING FACTORS AFFECTING THE QUALITY OF POSTGRADUATE MEDICAL EDUCATION IN SUDAN: RESIDENTS PERSPECTIVE (original) (raw)
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Abstract Postgraduate Medical Education (PGME) in Sudan started at the University of Khartoum with a postgraduate diploma in obstetrics in 1953. Following this, two other universities started providing such training: Gezira and Juba University. In 1995, the training was handed over to the Sudan Medical Specialisation Board. There is scarce research evaluating the quality of the training since the inauguration of PGME in Sudan. Permission to conduct the study was received from SMSB, and the study was reviewed and approved by the Sudanese National Technical Ethical Committee, (Certificate No. 2-12-2016). This study aimed at evaluating PGME in Sudan from stakeholder perspectives and at developing standards for improving the quality of the training. A mixed study (quantitative and qualitative) approach was used in this study by applying validated tools to evaluate the internal medicine programme in particular. The data were collected from the trainee residents (n = 189), trainers (n = 161), patients (n = 389), hospital directors (n = 6), deans of the colleges of medicines (n = 3), and representatives from the programme administration (n = 2) using surveys (for trainers and trainees). Interviews were conducted with hospital directors, deans of colleges of medicine, and programme directors, in addition to focus group discussions with the trainees (six rounds attended by 48 trainees). Further document analysis was performed to compare the curriculum, policies, and regulations with regional and international curricula and regulations. Moreover, a wiremen approach was used in the development of the standards. The statistical software used for quantitative data analysis was SPSS version 22.0 for Windows. Various descriptive statistics were employed, and coding and thematic analyses were performed to analyse the qualitative data. The preliminary data, including suggestions for improving the programme from stakeholders, were discussed with a panel of experts at the Sudan Medical Specialization Board. The evaluation revealed some strengths and areas that need improvement in the internal medicine programme, namely in the curriculum, delivery of the training, learning environment, and assessment of the trainees. Finally, the suggested standards were developed. It has been globally realised that high quality and safe patient care can only be provided if doctors are well prepared for this task through residency training, and thus the implementation of these standards could result in high quality and safe patient care.
Current Medical Issues, 2022
Objectives: This study aimed to identify the areas of strength and areas needing improvement in the internal medicine residency curriculum in a developing country - Sudan. Materials and Methods: This qualitative study was conducted at six major teaching hospitals in Sudan. Purposive sampling was used to select 48 residents who participated in six focus group discussions (FGDs). All FGDs were audio taped and lasted between 60 and 90 min. Data collection continued until theoretical saturation took place. The transcribed data were analyzed using the content analysis technique, and codes were generated and categorized into subthemes. Three emerging themes were identified: training curriculum, training in research, and assessment of residents. Results: The residents were generally satisfied with the curriculum at the planning level. They reported that the structure of the program is suitable and the duration of the curriculum appropriate; the number of patients and theoretical training in the research were considered optimum. They suggested that training in research should begin earlier in the curriculum, with time reserved for conducting research, and that assessment needs improvement. Conclusion: This study highlighted the utility of the qualitative approach in identifying residents' perspectives of their educational programs. However, the residents provided suggestions for improvement in the following areas: training curriculum, research training, and assessment. The practical recommendations from this study could be used to improve the quality of postgraduate medical training in Sudan and elsewhere.
Advances in Medical Education and Practice
Introduction: The learning environment is an important determinant of the quality of medical education. Having a good learning climate leads to improved learning process, satisfaction with education, and helps achieve the goals of the curriculum. Assessment of the quality of learning environment helps with the identification of areas that need improvement. The aim of this study was to assess the learning environment of internal medicine training program in Ethiopia. Methods: A mixed methods study using a cross-sectional survey using Postgraduate Hospital Educational Environment Measure and a qualitative study using a focus group discussion was done on internal medicine residents from December 2020 to May 2021. Comparison of quantitative data was done using Mann-Whitney U-Test and Kruskal-Wallis H-test. P-value <0.05 was considered statistically significant. Results: A total of 100 residents participated in the study. The overall total mean score of the responses of the participants was 70.87 (±19.8) with mean perceptions of role autonomy, perceptions of teaching and perceptions of social support of 25.9 (±7.1), 27.1 (10.2) and 17.9 (±5.1), respectively. These values suggest the presence of plenty of problems in the program. Higher mean scores were reported by males and by earlier years of residency. Ten residents participated in the focus group discussion. Four recurring themes that negatively affect learning environment were identified and included excessive workload, inadequate teaching activity, nonconducive hospital physical environment and lack of diagnostic and therapeutic modalities. Conclusion: The internal medicine residency learning environment has many challenges that need immediate attention and follow-up.
Postgraduate medical education: residents rating the quality of their training. J Coll Physicians Surg Pak. 2013 Jan;23(1):72-6. doi: 01.2013/JCPSP.7276. [PubMed] PMID:23286628, 2013
Objective: To determine the residents' rating of the quality of their residency training by measuring their level of satisfaction with the various educational attributes of their training.Study Design: Cross-sectional survey.Place and Duration of Study: Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Islamabad, from September to November 2008.Methodology: Residents who had been pursuing residency training for over a period of one year were included. A comprehensive questionnaire consisting of 14 questions was employed which covered fundamental attributes of the quality of postgraduate training. A five point response scale was used to rate responses to questions. Results for each of the measures of all the included residents were added up, and then an average was calculated and scaled to a score out of 100 to form the Index Score. In this way the residents' level of agreement or disagreement with the questioned statement was measured from 'Strongly disagree' (0%) to 'Strongly agree' (100%).Results: Out of a total of 150 residents contacted, 109 answered the questionnaire. The response rate was thus 73%. Residents variably rated the various educational attributes of their residency training. Relatively favourably rated areas included regular conduct of case/ topic discussions (75.96%), consultant's supervision during interventional procedures (70.27%) and regularly holding journal clubs (69.54%). The less favourably rated areas included constructive feedback by supervisor (54.49%), consultant as role model (54.49%) and faculty as the source of learning (50.82%). Overall, the Index Score was 60.55%. Conclusion: Significant room exists for improvement in the quality of residency training as indicated by the less than desirable ratings of the various educational attributes of the residency programme. Faculty members who constitute the cornerstone of educational process are pivotal to effect the desired improvements.
Clinical training is an important process in residency academic program in different fields. In this cross-sectional descriptive study, we identified the views of clinical residents about clinical training status at Yazd University of Medical Sciences at their second-year of residency or above. We used questionnaire as the instrument for collecting information and select all residents as the sample of study. Data were analyzed using descriptive statistical tests. Clinical training status was assessed to be at an intermediate level by residents, and the areas of evaluation method, resources and facilities, training system, performance, performance of personnel of therapeutic departments, and resident’s performance received the highest score, respectively. Areas of evaluation method and facilities were determined as strengths, and areas of the performance of therapeutic department’s personnel and residents as the weaknesses of clinical training.
Sustainability, 2020
The latest developments in Sustainable Health focus on the provision of high quality medical training to health specialists, with a special focus on human factors. The need to promote effective Training Programs also reflects the job satisfaction needs of trainees. The objective of this study is to evaluate the trainees’ satisfaction with the quality of Training Programs and assess the degree of achievement based on the defined parameters to provide baseline data based on which strategies for improvement can be formulated. Our study was conducted in Saudi Arabia and our targeted population was residents in medical programs supervised by the Saudi Commission for the Health Specialties (SCFHS). The trainees’ response rate to the online survey was 27% (3696/13,688) and the key aspects of job satisfaction investigated include: Satisfaction with Academic Activities in the Center; Satisfaction with the Residents and Colleagues in the Center; Satisfaction with the Administrative Components...
Medical Journal IMJ Health, 2021
Background: Optimum learning environments (LEs) are linked with positive training outcomes for residents. However, there is few data concerning how the residents perceive the learning environments in teaching hospitals. This study aims to analyze the residents’ perceptions of their learning environments. Methods: This cross-sectional, hospital-based study was carried out between November 2020 and January 2021, using a Postgraduate Hospital Educational Environment Measurement (PHEEM) questionnaire. Statistical analysis was conducted using SPSS 20. Results: The total number was 45 participants, 40 of them successfully responded. The total Cronbach`s alpha score was 0.93, which reflects good reliability. The full-scale score was 128 out of 160, which indicates a good learning environment. The autonomy score was 44, the teachers' score was 50, and social support was 34. Finally, the overall mean score for females was 43.3 compared to 39.4 for males, with a P-value of 0.55. Furthermore, no significant difference in residents’ perceptions of their learning environment according to their training was observed in this study. Conclusion: Significant challenges in the LE were identified; more attention and effort should be given, especially to the poorly rated point in this study: the existence of an informative program, clear clinical protocols, and proper setting expectations. The lowest score was for catering, housing. A high social support score indicates a healthy workplace environment and job satisfaction.
Koomesh
Introduction: Revolution of information in medical sciences as one of the important parts ofknowledge has made the attention to medical education more critical. This study was performed toevaluate the satisfaction of Shahre-kord university medical students (interns and externs) from thequality of education in clinical courses.Materials and Methods: In this descriptive-analytical study, the rate of satisfaction of 77 medicalstudents (interns and externs) from the quality of education in Shahre-kord university clinical courseswas evaluated using a locally standardized questionnaire. The findings were classified as: high,moderate and low. Data were analyzed using SPSS software (version 11).Results: A total of 77 students completed the questionnaire. The high rate of satisfaction from thequality of education in different clinical clerkship periods was reported as follows: Internal medicine25/7%, surgery (general surgery and orthopedic) 27/4%, pediatric medicine 17/5%, gynecology 6/3%,in...
Medical education in Sudan: future perspectives
Journal of Public Health and Emergency
Being a large tropical African country, Sudan offers the Sudanese clinicians and researchers golden opportunities for research on different issues like communicable, non-communicable diseases, social and psychological sciences, in addition to medical education. With a history dating to 1924, medical education continues to evolve rapidly in Sudan. Despite its strengths and weaknesses, it had positive influences on the health system, locally and regionally (1). In this special issue, entitled "What the Future Holds for Medical Education in Sudan", we have tried to shed the light on different aspects of medical education in Sudan. For example, Diab et al. queried the capability of medical schools to provide a solution for health workforce imbalance through formal and hidden curricula. They thought that hidden curriculum devalues some specialities, and as long as it remains unopposed by the formal curriculum; students are driven away from these specialities. Moreover, although the World Federation of Medical Education (WFME) highlighted the importance of formal career advice, it is still an area of noncompliance by medical schools. Innovations in medical education were made in 1975 when Professor Bashir Hamad introduced the concept of communityoriented medical education in Africa at Gezira University (2-5). The Faculty of Medicine, Gezira University (FMUG), has a long and pioneer reputation in community-oriented medical education. Therefore, it is not surprising that the FMUG can lead social accountability in Africa and the Middle East. A review article quantified ten unique features that will qualify FMUG to lead social accountability. This review also mentioned four potential areas of innovations that FMUG can adopt in social accountability. In a review article, Ahmed et al. discussed why doctors should consider a Ph.D. degree to be independent researchers and leaders in clinical research. They explained the benefits of research for the clinicians, patients, hospitals, medical schools and the community. In another narrative review entitled "Current and future clinical research in Sudan: an opportunity for everyone to choose research in medical education, communicable and non-communicable diseases", Ahmed and his co-authors proposed steps that will enhance and strengthen research in Sudan. Realizing that investing in research will help in keeping people well, and open new venues for health services in Sudan, they highly recommend that every doctor in Sudan should engage in research activities so that current and future patients can benefit from the outcomes of these research activities. During the pandemic of COVID-19, the appreciation and enthusiasm for research and medical teaching increased not only in Sudan but worldwide. However, the research output in Sudan was not to a satisfactory level. The challenges and barriers related to the culture and customs that influence the chance for men and women to participate in academic medicine in Sudan were highlighted in this special issue. Furthermore, possible solutions to overcome these problems at different levels (individuals, research teams, universities, government and the issue of perception and promotion of research culture) were suggested. Currently, the Sudan Medical Specialization Board (SMSB) is the only postgraduate body in Sudan for the training of medical doctors at the postgraduate level. In this special issue, the researchers proposed that SMSB offers an MD-Ph.D. programme at the postgraduate level with a duration of 6-7 years, with a Ph.D. in clinical epidemiology. They detailed the essential skills and features that are needed for a successful epidemiologist who will graduate from the Sudanese postgraduate programme of MD-Ph.D. The structure and the future directions of the graduates of the MD-Ph.D. programmes and how they can bring significant benefits for the conduction of research in Sudan were documented. Not exclusively, the MD-Ph.D. programme in Sudan will lead to the establishment of new generations of clinical scientists who will be able to shed light on the behaviour of different diseases in Sudan, including COVID-19, and how to apply appropriate strategies in management and prevention. The articles included in this special issue reflect the authors' viewpoints, opinions, or suggested ideas. As editors, we believe that the future holds a lot for medical education in Sudan through revised curricula, social accountability, and active engagement of clinicians in researching diverse areas according to the health system needs. This special issue is written in accordance with the Journal of Public Health and Emergency reporting guidelines.
Nigerian Journal of Medicine
IntroductIon The World Federation of Medical Education defines Postgraduate Medical Education (PME) as "the phase of medical education in which doctors develop competencies under supervision after completion of their basic medical qualification, and it is the final preparation step for certification and/or licensure of specialist doctors." [1] In Nigeria, the duration of training ranges from 4 to 7 years or more, depending on several factors including the specialty in question, success at the postgraduate exams, delayed accreditation by the postgraduate colleges, incessant industrial action, and disruptions in training, as observed during the height of the COVID-19 pandemic and the associated lockdown in Nigeria. During residency training, trainees are expected to develop substantial knowledge and advanced skills (competencies) under the supervision of mentors or consultants in their chosen specialties, enabling them to practice at high levels of proficiency (as Consultants) upon completing the programme. [2] Before 1973, Nigerian doctors who wanted residency training either went to the United States, the United Kingdom, or other European countries. In an effort to develop the medical human resource capacity from Background: Obtaining feedback from trainees is important in the evaluation and evolution of Postgraduate Medical Education (PME), and policies made based on their felt needs would go a long way in making residency training a worthwhile experience. This pilot study aimed to assess resident doctors' perception of the training content, atmosphere, and organization using the Scan of Postgraduate Educational Environment Domains (SPEED) tool. Methodology: This was a cross-sectional study conducted amongst resident doctors at Babcock University Teaching Hospital (BUTH) in Nigeria, between May and August 2019. A self-administered questionnaire was used to collect participants' sociodemographic data, their perception of PME in their respective departments, as well as the strengths and weaknesses of the training programmes. Validity and reliability indices were assessed, and descriptive, inferential, and correlational analyses were run where appropriate. Results: The mean score for the resident doctors' perception of training content, atmosphere, and organization was 4.0 ± 0.4, 4.2 ± 0.5 and 3.69 ± 0.60 respectively, out of a maximum of 5, indicating a positive perception of training in BUTH. The major strengths perceived by most residents were good inter-personal relations between residents and their trainers, as well as conducive learning and work environment; while the weaknesses include poor remuneration and limited staffing which hampers rotations. Conclusion: Resident doctors in BUTH mostly had a positive outlook on their training. This study serves as a reference point for local policy change (in BUTH), and a framework from which future studies on PME can emerge.