A consortium approach to competency-based undergraduate medical education in Uganda: process, opportunities and challenges.

BACKGROUND: Uganda, like the rest of Africa, is faced with serious health challenges including human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS), other infectious diseases and increasing non-communicable diseases, yet it has a significant shortage of health workers. Even the few health workers available may lack desired competencies required to address current and future health challenges. Reducing Uganda's disease burden and addressing health challenges requires Ugandan medical schools to produce health workers with the necessary competencies. This study describes the process which a consortium of Ugandan medical schools and the Medical Education Partnership for Equitable Services to all Ugandans (MESAU) undertook to define the required competencies of graduating doctors in Uganda and implement competency-based medical education (CBME). METHODS: A retrospective qualitative study was conducted in which document analysis was used to collect data employing pre-defined checklists, in a desktop or secondary review of various documents. These included reports of MESAU meetings and workshops, reports from individual institutions as well as medical undergraduate curricula of the different institutions. Thematic analysis was used to extract patterns from the collected data. RESULTS: MESAU initiated the process of developing competencies for medical graduates in 2011 using a participatory approach of all stakeholders. The process involved consultative deliberations to identify priority health needs of Uganda and develop competencies to address these needs. Nine competence domain areas were collaboratively identified and agreed upon, and competencies developed in these domains. DISCUSSION: Key successes from the process include institutional collaboration, faculty development in CBME and initiating the implementation of CBME. The consortium approach strengthened institutional collaboration that led to the development of common competencies desired of all medical graduates to address priority health challenges in Uganda. It is important that the MESAU consortium continues engaging all stakeholders in medical education to support the implementation and sustainability of CBME in Uganda.

Mammography: a review of records in the Department of Radiology at a National Referral Hospital in Uganda.

INTRODUCTION: Breast cancer is one of the leading cancers amongst women world-wide. Although mortality has been reduced and survival rates increased in developed countries, mortality rates from breast cancer are still a major health challenge for many developing countries. In Uganda, there are no screening programmes and in many cases mammography is used for diagnostic purposes. The purpose of this study was to describe the clinical presentations and mammographic breast density patterns amongst women that presented to the radiology department for mammography at a national referral hospital. METHODS: This was a retrospective study carried out at Mulago Hospital in Uganda between January 2011 and January 2012. Records for patients who had mammography during this period were reviewed. RESULTS: The total number of patients was 382 with a mean age of 46 years. Majority presented with breast pain and masses. Mammograms done were normal in majority of the women with fatty breast density dominating. In Uganda, mammography was mainly performed for diagnostic purposes. CONCLUSION: There is no mammography screening programme in Uganda and many women cannot access the service due to its limited availability and costs despite its significance in breast cancer management. There is therefore need for governments in Uganda, but in other areas as well to support regular mammography screening as a way of reducing mortality from breast cancer.