Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future.

BACKGROUND: Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction. METHOD: An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with. RESULTS: Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed. CONCLUSIONS: Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments.

E-Learning for Medical Education in Sub-Saharan Africa and Low-Resource Settings: Viewpoint.

E-learning has been heralded as a revolutionary force for medical education, especially for low-resource countries still suffering from a dire lack of health care workers. However, despite over two decades of e-learning endeavors and interventions across sub-Saharan Africa and other low- and middle-income countries, e-learning for medical education has not gained momentum and continues to fall short of the anticipated revolution. Many e-learning interventions have been cul-de-sac pilots that have not been scaled up but rather terminated after the pilot phase. This is usually a result of not adopting a system-wide approach, which leads to insufficient scope of training, insufficient technological maintenance and user support, unattainably high expectations, and unrealistic financial planning. Thus, a multitude of e-learning evaluations have failed to provide scientifically sound evidence of the effectiveness of e-learning for medical education in low-resource countries. Instead, it appears that technological development has overwhelmed rather than revolutionized medical education. The question of how to push e-learning into a higher gear in low-resource countries persists. Provision of e-learning as a technology is insufficient. E-learning needs to be vigorously and sustainably integrated into the local educational setting and aligned with national strategies and other national endeavors and interventions. Adhering to a standardized framework for the implementation and evaluation of e-learning endeavors is key, especially to bridge the gap in robust evidence that should also guide e-learning implementations. The primary objective of e-learning for medical education is to strengthen the health system in order to serve the population's health care needs and expectations. Currently, medical e-learning does not measure up to its potential or do justice to medical students in low-resource countries. Technology may help unfold the potential of e-learning, but an all-encompassing change is needed. This can only be achieved through a joint effort that follows a systematic and standardized framework, especially for implementation and evaluation.

Medical education departments: a study of four medical schools in Sub-Saharan Africa.

BACKGROUND: Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability. METHODS: In-depth interviews were conducted with the heads or directors of the four medical education departments using a structured interview protocol developed by the study group. An inductive approach to analysis of the interview transcripts was adopted as the texts were subjected to thematic content analysis. RESULTS: Medical education departments, also known as units or centers, were established for a range of reasons including: to support curriculum review, to provide faculty development in Health Professions Education, and to improve scholarship in learning and teaching. The reporting structures of these departments differ in terms of composition and staff numbers. Though the functions of departments do vary, all focus on improving the quality of health professions education. External and internal funding, where available, as well as educational innovations were key enablers for these departments. Challenges included establishing and maintaining the legitimacy of the department, staffing the departments with qualified individuals, and navigating dependence on external funding. All departments seek to expand the scope of their services by offering higher degrees in HPE, providing assistance to other universities in this domain, and developing and maintaining a medical education research agenda. CONCLUSIONS: The establishment of medical education departments in Sub-Saharan Africa is a strategy medical schools can employ to improve the quality of health professions education. The creation of communities of practice such as has been done by the MEPI project is a good way to expand the network of medical education departments in the region enabling the sharing of lessons learned across the continent.

Increasing the quality and capacity of education: the challenge for the 21st century.

CONTEXT: Abraham Flexner's 1910 report to the Carnegie Foundation was a successful attempt to improve the quality of health care by reforming the education of health care providers. It was accompanied by a significant reduction in the number of medical schools and an increase in the quality of those schools that remained. Although the report's focus on quality was laudable and appropriate to the times, we now face a significant shortage and maldistribution of health care workers, particularly in countries with the highest burden of disease. Hence, we see the challenges for the 21st century to involve increasing both capacity and quality. DISCUSSION: In our view, these two goals can be achieved through three research-driven educational reforms. Firstly, many educational methodologies are retained based on tradition and new methods are adopted based on fashion. Educational research must become the basis for educational practice. Secondly, educational methodology is often focused on improving quality and does not consider resource utilisation, which reduces its relevance and utility. Educational research must focus on quality and efficiency. Thirdly, one form of educational quality control is provided by accreditation processes. Some of these processes are so prescriptive that they are a barrier to improvement and for none is there evidence of effectiveness. Accreditation processes should be based on data about what is effective and efficient. CONCLUSIONS: Just as Flexner argued for a scientific basis in the practice of medicine, we argue for a scientific basis in the practice of education. In our view, this is the way to meet the challenges of the 21st century.

The Case Anatomical Knowledge Index (CAKI): a novel method used to assess anatomy content in clinical cases.

There are concerns in the literature that the use of case-based teaching of anatomy could be compromising the depth and scope of anatomy learned by students in a problem-based learning curriculum. Poor selection of clinical cases that are used as vehicles for teaching/learning anatomy may be the root problem because some clinical cases do not provide enough opportunities to learn anatomy and are, therefore, inappropriate for case-based teaching. Although anatomy educators are expected to respond to the identified deficiencies of case-based anatomy teaching, making sure that students acquire sufficient anatomical knowledge to practice safely and successfully, there are no tools available that can help improve the selection of clinical cases for case-based teaching. The author proposes a composite index, which incorporates considerations of anatomical knowledge for evaluating clinical cases/conditions for suitability in case-based anatomy teaching. The development of the case anatomical knowledge index (CAKI) using a modified Guttman procedure is described. The scalability of the index was measured using the coefficient of reproducibility. A total of 47 clinicians participated in the validation activities that measured interrater and intraclass reliability. The CAKI was able to consistently discriminate between clinical cases/conditions with higher demand for anatomical knowledge than those with lower demand for anatomical knowledge. A review of the literature suggests that such an index has not been previously reported. Given the concerns about the depth and scope of anatomy learning in case-based teaching, these findings have international relevance.