Feasibility and Acceptability of Web-Based Structured Oral Examinations for Postgraduate Certification: Mixed Methods Preliminary Evaluation.

BACKGROUND: The COVID-19 pandemic disrupted postgraduate certification examinations globally. The Colleges of Medicine of South Africa continued hosting certification examinations through the pandemic. This was achieved by effecting a rapid transition from in-person to web-based certification examinations. OBJECTIVE: This formative evaluation explored candidates' acceptability of web-based structured oral examinations (SOEs) hosted via Zoom (Zoom Communications Inc). We also reported the audiovisual quality and technical challenges encountered while using Zoom and candidates' overall experience with these examinations conducted during the early part of the COVID-19 pandemic. Additionally, performance in web-based certification examinations was compared with previous in-person certification examinations. METHODS: This mixed methods, single-arm evaluation anonymously gathered candidates' perceptions of web-based SOE acceptability, audiovisual quality, and overall experience with Zoom using a web-based survey. Pass rates of web-based and previous in-person certification examinations were compared using chi-square tests, with a Yates correction. A thematic analysis approach was adopted for qualitative data. RESULTS: Between June 2020 and June 2021, 3105 candidates registered for certification examinations, 293 (9.4%) withdrew, 2812 (90.6%) wrote, and 2799 (99.9%) passed, and 1525 (54.2%) were invited to a further web-based SOE. Examination participation was 96.2% (n=1467). During the first web-based examination cycle (2020), 542 (87.1%) of 622 web-based SOE candidates completed the web-based survey. They reported web-based SOEs as fair (374/542, 69%) and adequately testing their clinical reasoning and insight (396/542, 73.1%). Few would have preferred real patient encounters (173/542, 31.9%) or in-person oral examinations (152/542, 28%). Most found Zoom acceptable (434/542, 80%) and fair (396/542, 73.1%) for hosting web-based SOEs. SOEs resulted in financial (434/542, 80%) and time (428/542, 79%) savings for candidates. Many (336/542, 62%) supported the ongoing use of web-based certification examinations. Only 169 technical challenges in using Zoom were reported, which included connectivity-related issues, poor audio quality, and poor image quality. The thematic analysis identified 4 themes of positive and negative experiences related to web-based SOE station design and content, examination station environment, examiner-candidate interactions, and personal benefits for candidates. Our qualitative analysis identified 10 improvements for future web-based SOEs. Candidates achieved high pass rates in web-based certification examinations in 2020 (1583/1732, 91.39%) and 2021 (850/1067, 79.66%). These were significantly higher (2020: N=8635; χ21=667; P<.001; 2021: N=7988; χ21=178; P<.001) than the previous in-person certification examination pass rate of 58.23% (4030/6921; 2017-2019). CONCLUSIONS: Web-based SOEs conducted by the Colleges of Medicine of South Africa during the COVID-19 pandemic were well received by candidates, and few technical difficulties were encountered while using Zoom. Better performance was observed in web-based examinations than in previous in-person certification examinations. These early findings support the ongoing use of this assessment method.

"We just don't have the resources": Supervisor perspectives on introducing workplace-based assessments into medical specialist training in South Africa.

BACKGROUND: South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context. METHODS: This paper reports on the qualitative data generated from a mixed methods study that employed a parallel convergent design, utilising a self-administered online questionnaire to collect data from participants. Data was analysed thematically and inductively. RESULTS: The themes that emerged were: Structural readiness for WBA; staff capacity to implement WBA; quality assurance; and the social dynamics of WBA. CONCLUSIONS: Participants demonstrated impressive levels of insight into their respective working environments, producing an extensive list of barriers and enablers. Despite significant structural and social barriers, this cohort perceives the impending implementation of WBA to be a positive development in registrar training in South Africa. We make recommendations for future research, and to the medical specialist educational leaders in SA.

FAIMER Global Faculty Development: A Sustainable Partnership Model to Advance Health Professions Education.

The Foundation for Advancement of International Medical Education and Research (FAIMER), a member of Intealth, offers longitudinal faculty development programs (LFDPs) in health professions education (HPE) and leadership through its International FAIMER Institute (IFI) in the United States and FAIMER Regional Institutes (FRIs) globally. FAIMER fosters mutual collaboration and delineates shared responsibilities for FRI development in partnership with local institutions, using an adapted hub-and-spoke organizational design. This paper describes FAIMER's model, its sustainability, and its impacts at individual, institutional, and national levels. IFI was launched in 2001 in Philadelphia, Pennsylvania, as a 2-year part-time hybrid LFDP; with the COVID-19 pandemic onset, IFI transitioned to a fully online program. Since FAIMER's launch, 11 FRIs developed in Brazil, Chile, China, Egypt, India, Indonesia, and South Africa, each modeled on the IFI curriculum and adapted to local context. The more than 1,600 IFI and FRI graduates (fellows) from over 55 countries now form a global community of health professions educators who have shared exposure to HPE methods and assessment, leadership and management, educational scholarship and research, and project management and evaluation. Across all global locations and program formats, fellows self-reported a similar increase in knowledge and skills in HPE. All programs center on the fellows' institutional projects as experiential learning; these projects have focused primarily on educational methods and curriculum revisions. An increased quality of education was reported as the top impact resulting from fellows' projects. As a result of these programs, fellows have influenced education policy in their countries and established academic societies for HPE, thus contributing to recognition of the HPE academic specialty. FAIMER has successfully developed a sustainable model for advancing HPE globally, creating a vibrant network of health professions educators who have influenced country-specific educational policy and practice. FAIMER's model offers one approach to building global capacity in HPE.

Grief Coach, a Text-Based Grief Support Intervention: Acceptability Among Hospice Family Members.

U.S. Medicare-certified hospices must provide bereavement care to family members for 13 months following a patient's death. This manuscript describes Grief Coach, a text message program that delivers expert grief support and can assist hospices in meeting the bereavement care mandate. It also describes the first 350 Grief Coach subscribers from hospice and the results of a survey of active subscribers (n = 154) to learn whether and how they found the program helpful. The 13-month program retention rate was 86%. Among survey respondents (n = 100, response rate = 65%), 73% rated the program as very helpful, and 74% rated it as contributing to their sense of being supported in their grief. Grievers aged 65+ and males gave the highest ratings. Respondents' comments identify key intervention content that they found helpful. These findings suggest that Grief Coach may be a promising component of hospice grief support programming to meet the needs of grieving family members.

Entrustable professional activities in postgraduate general surgery training: a scoping review protocol.

INTRODUCTION: The competency-based medical education (CBME) movement continues to gain momentum in postgraduate physician training, resulting in increasing interest among surgical training programmes on how to implement it effectively. Entrustable professional activities (EPAs) were introduced to connect competencies (characteristics/abilities of learners) and the professional activities to be entrusted to them on qualification/graduation. Although reviews related to the field of general surgery have been published on specific aspects of CBME, for example, workplace-based assessment, there is a paucity of published guidance available for surgeon-educators to plan and implement CBME using an EPA framework. This scoping review aims to provide an overview of the current use of EPAs in general surgery. METHODS AND ANALYSIS: This scoping review will be based on the original five-stage approach described by Arksey and O'Malley with the addition of protocol-specific items from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews. The primary research question focuses on describing how EPAs have been used in general surgery and where potential gaps remain that warrant further study. The review will include peer-reviewed journal publications and an extensive review of grey literature sources. The following databases will be searched for published literature from 1 January 2005 to 31 December 2022: PubMed; CINAHL, Africa-Wide Information, PsycInfo and ERIC (via EBSCOhost); Scopus; and SciELO (via Web of Science). Studies that describe the use of EPAs for curriculum design, teaching and/or assessment of competence in postgraduate general surgery training will be eligible for inclusion. ETHICS AND DISSEMINATION: The institutional ethics board of the University of Cape Town has granted a waiver of formal approval requirement. The dissemination strategy includes publication of results in peer-reviewed journals, presentation at international conferences and presentation to relevant stakeholders as deemed appropriate.

Clinically contextualised ECG interpretation: the impact of prior clinical exposure and case vignettes on ECG diagnostic accuracy.

BACKGROUND: ECGs are often taught without clinical context. However, in the clinical setting, ECGs are rarely interpreted without knowing the clinical presentation. We aimed to determine whether ECG diagnostic accuracy was influenced by knowledge of the clinical context and/or prior clinical exposure to the ECG diagnosis. METHODS: Fourth- (junior) and sixth-year (senior) medical students, as well as medical residents were invited to complete two multiple-choice question (MCQ) tests and a survey. Test 1 comprised 25 ECGs without case vignettes. Test 2, completed immediately thereafter, comprised the same 25 ECGs and MCQs, but with case vignettes for each ECG. Subsequently, participants indicated in the survey when last, during prior clinical clerkships, they have seen each of the 25 conditions tested. Eligible participants completed both tests and survey. We estimated that a minimum sample size of 165 participants would provide 80% power to detect a mean difference of 7% in test scores, considering a type 1 error of 5%. RESULTS: This study comprised 176 participants (67 [38.1%] junior students, 55 [31.3%] senior students, 54 [30.7%] residents). Prior ECG exposure depended on their level of training, i.e., junior students were exposed to 52% of the conditions tested, senior students 63.4% and residents 96.9%. Overall, there was a marginal improvement in ECG diagnostic accuracy when the clinical context was known (Cohen's d = 0.35, p < 0.001). Gains in diagnostic accuracy were more pronounced amongst residents (Cohen's d = 0.59, p < 0.001), than senior (Cohen's d = 0.38, p < 0.001) or junior students (Cohen's d = 0.29, p < 0.001). All participants were more likely to make a correct ECG diagnosis if they reported having seen the condition during prior clinical training, whether they were provided with a case vignette (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.24-1.71) or not (OR 1.58, 95% CI 1.35-1.84). CONCLUSION: ECG interpretation using clinical vignettes devoid of real patient experiences does not appear to have as great an impact on ECG diagnostic accuracy as prior clinical exposure. However, exposure to ECGs during clinical training is largely opportunistic and haphazard. ECG training should therefore not rely on experiential learning alone, but instead be supplemented by other formal methods of instruction.

Utility of mobile learning in Electrocardiography.

Aims: Mobile learning is attributed to the acquisition of knowledge derived from accessing information on a mobile device. Although increasingly implemented in medical education, research on its utility in Electrocardiography remains sparse. In this study, we explored the effect of mobile learning on the accuracy of electrocardiogram (ECG) analysis and interpretation. Methods and results: The study comprised 181 participants (77 fourth- and 69 sixth-year medical students, and 35 residents). Participants were randomized to analyse ECGs with a mobile learning strategy [either searching the Internet or using an ECG reference application (app)] or not. For each ECG, they provided their initial diagnosis, key supporting features, and final diagnosis consecutively. Two weeks later, they analysed the same ECGs, without access to any mobile device. ECG interpretation was more accurate when participants used the ECG app (56%), as compared to searching the Internet (50.3%) or neither (43.5%, P = 0.001). Importantly, mobile learning supported participants in revising their initial incorrect ECG diagnosis (ECG app 18.7%, Internet search 13.6%, no mobile device 8.4%, P < 0.001). However, whilst this was true for students, there was no significant difference amongst residents. Internet searches were only useful if participants identified the correct ECG features. The app was beneficial when participants searched by ECG features, but not by diagnosis. Using the ECG reference app required less time than searching the Internet (7:44 ± 4:13 vs. 9:14 ± 4:34, P < 0.001). Mobile learning gains were not sustained after 2 weeks. Conclusion: Whilst mobile learning contributes to increased ECG diagnostic accuracy, the benefits were not sustained over time.

Effectiveness of blended learning versus lectures alone on ECG analysis and interpretation by medical students.

BACKGROUND: Most medical students lack confidence and are unable to accurately interpret ECGs. Thus, better methods of ECG instruction are being sought. Current literature indicates that the use of e-learning for ECG analysis and interpretation skills (ECG competence) is not superior to lecture-based teaching. We aimed to assess whether blended learning (lectures supplemented with the use of a web application) resulted in better acquisition and retention of ECG competence in medical students, compared to conventional teaching (lectures alone). METHODS: Two cohorts of fourth-year medical students were studied prospectively. The conventional teaching cohort (n = 67) attended 4 hours of interactive lectures, covering the basic principles of Electrocardiography, waveform abnormalities and arrhythmias. In addition to attending the same lectures, the blended learning cohort (n = 64) used a web application that facilitated deliberate practice of systematic ECG analysis and interpretation, with immediate feedback. All participants completed three tests: pre-intervention (assessing baseline ECG competence at start of clinical clerkship), immediate post-intervention (assessing acquisition of ECG competence at end of six-week clinical clerkship) and delayed post-intervention (assessing retention of ECG competence 6 months after clinical clerkship, without any further ECG training). Diagnostic accuracy and uncertainty were assessed in each test. RESULTS: The pre-intervention test scores were similar for blended learning and conventional teaching cohorts (mean 31.02 ± 13.19% versus 31.23 ± 11.52% respectively, p = 0.917). While all students demonstrated meaningful improvement in ECG competence after teaching, blended learning was associated with significantly better scores, compared to conventional teaching, in immediate (75.27 ± 16.22% vs 50.27 ± 17.10%, p <  0.001; Cohen's d = 1.58), and delayed post-intervention tests (57.70 ± 18.54% vs 37.63 ± 16.35%, p <  0.001; Cohen's d = 1.25). Although diagnostic uncertainty decreased after ECG training in both cohorts, blended learning was associated with better confidence in ECG analysis and interpretation. CONCLUSION: Blended learning achieved significantly better levels of ECG competence and confidence amongst medical students than conventional ECG teaching did. Although medical students underwent significant attrition of ECG competence without ongoing training, blended learning also resulted in better retention of ECG competence than conventional teaching. Web applications encouraging a stepwise approach to ECG analysis and enabling deliberate practice with feedback may, therefore, be a useful adjunct to lectures for teaching Electrocardiography.

Determining electrocardiography training priorities for medical students using a modified Delphi method.

BACKGROUND: Although electrocardiography is considered a core learning outcome for medical students, there is currently little curricular guidance for undergraduate ECG training. Owing to the absence of expert consensus on undergraduate ECG teaching, curricular content is subject to individual opinion. The aim of this modified Delphi study was to establish expert consensus amongst content and context experts on an ECG curriculum for medical students. METHODS: The Delphi technique, an established method of obtaining consensus, was used to develop an undergraduate ECG curriculum. Specialists involved in ECG teaching were invited to complete three rounds of online surveys. An undergraduate ECG curriculum was formulated from the topics of ECG instruction for which consensus (i.e. ≥75% agreement) was achieved. RESULTS: The panellists (n = 131) had a wide range of expertise (42.8% Internal Medicine, 22.9% Cardiology, 16% Family Medicine, 13.7% Emergency Medicine and 4.6% Health Professions Education). Topics that reached consensus to be included in the undergraduate ECG curriculum were classified under technical aspects of performing ECGs, basic ECG analysis, recognition of the normal ECG and abnormal rhythms and waveforms and using electrocardiography as part of a clinical diagnosis. This study emphasises that ECG teaching should be framed within the clinical context. Course conveners should not overload students with complex and voluminous content, but rather focus on commonly encountered and life-threatening conditions, where accurate diagnosis impacts on patient outcome. A list of 23 "must know" ECG diagnoses is therefore proposed. CONCLUSION: A multidisciplinary expert panel reached consensus on the ECG training priorities for medical students.

Development of a CanMEDS-based instrument for evaluating medical students' perceptions of the key competencies of a socially accountable healthcare practitioner.

INTRODUCTION: Numerous frameworks and tools have been developed to assist medical schools striving to achieve their social accountability mandate. The purpose of this study was to design an instrument to evaluate medical students' perceptions of the key competencies of a 'socially accountable' healthcare practitioner using widely accepted frameworks which contain clear measurable outcomes. METHODS: The instrument was designed in three phases: selection of a competency-based framework, development of items, and validation of the instrument through exploratory factor analysis. Medical students in the 6­year medical degree program at the University of Cape Town, South Africa were invited to participate in the study. Descriptive and inferential statistical analysis was performed using Stata/SE version 13.1. RESULTS: Of 619 students invited to participate in the study, 484 (78%) responded. The CanMEDS framework was selected for designing the instrument, which comprised 35 statements reflecting five competencies for each CanMEDS role. Exploratory factor analysis of the student responses yielded a 28-item instrument. There was a significant difference in overall Perceptions of Social Accountability Instrument (PSAI) scores between men and women (p = 0.002) but no significant difference between the overall PSAI scores for students in the respective years of study. DISCUSSION: This study describes the design of an instrument to evaluate medical students' perceptions of the essential competencies of socially accountable healthcare practitioners. Used longitudinally, the data may provide evidence of the successes of our programs and identify areas where further improvements are required.

Is computer-assisted instruction more effective than other educational methods in achieving ECG competence amongst medical students and residents? A systematic review and meta-analysis.

OBJECTIVES: It remains unclear whether computer-assisted instruction (CAI) is more effective than other teaching methods in acquiring and retaining ECG competence among medical students and residents. DESIGN: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: Electronic literature searches of PubMed, databases via EBSCOhost, Scopus, Web of Science, Google Scholar and grey literature were conducted on 28 November 2017. We subsequently reviewed the citation indexes for articles identified by the search. ELIGIBILITY CRITERIA: Studies were included if a comparative research design was used to evaluate the efficacy of CAI versus other methods of ECG instruction, as determined by the acquisition and/or retention of ECG competence of medical students and/or residents. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data from all eligible studies and assessed the risk of bias. After duplicates were removed, 559 papers were screened. Thirteen studies met the eligibility criteria. Eight studies reported sufficient data to be included in the meta-analysis. RESULTS: In all studies, CAI was compared with face-to-face ECG instruction. There was a wide range of computer-assisted and face-to-face teaching methods. Overall, the meta-analysis found no significant difference in acquired ECG competence between those who received computer-assisted or face-to-face instruction. However, subanalyses showed that CAI in a blended learning context was better than face-to-face teaching alone, especially if trainees had unlimited access to teaching materials and/or deliberate practice with feedback. There was no conclusive evidence that CAI was better than face-to-face teaching for longer-term retention of ECG competence. CONCLUSION: CAI was not better than face-to-face ECG teaching. However, this meta-analysis was constrained by significant heterogeneity amongst studies. Nevertheless, the finding that blended learning is more effective than face-to-face ECG teaching is important in the era of increased implementation of e-learning. PROSPERO REGISTRATION NUMBER: CRD42017067054.

2018 Consensus framework for good assessment.

Introduction: In 2010, the Ottawa Conference produced a set of consensus criteria for good assessment. These were well received and since then the working group monitored their use. As part of the 2010 report, it was recommended that consideration be given in the future to preparing similar criteria for systems of assessment. Recent developments in the field suggest that it would be timely to undertake that task and so the working group was reconvened, with changes in membership to reflect broad global representation.Methods: Consideration was given to whether the initially proposed criteria continued to be appropriate for single assessments and the group believed that they were. Consequently, we reiterate the criteria that apply to individual assessments and duplicate relevant portions of the 2010 report.Results and discussion: This paper also presents a new set of criteria that apply to systems of assessment and, recognizing the challenges of implementation, offers several issues for further consideration. Among these issues are the increasing diversity of candidates and programs, the importance of legal defensibility in high stakes assessments, globalization and the interest in portable recognition of medical training, and the interest among employers and patients in how medical education is delivered and how progression decisions are made.

Pre-University education curriculum reform and the generic learning skills of medical school entrants: Lessons learned from South Africa.

Background: Pre-university education curriculum changes may increase the skills and knowledge gap between secondary (high school) and tertiary (university) education that have been identified as having a major impact on the success of students from underresourced educational backgrounds. This study investigated the impact of extensive pre-university curriculum revision on the generic learning skills of entrants to South African medical schools, which admit students directly from high school. Methods: In this prospective study, students entering four medical schools during 2008-2011 were surveyed to determine their practice of and confidence in information handling, managing own learning, technical and numeracy skills, and computer, organizational, and presentation skills in the 12-month preceding entry. The 2008 entrants were the final cohort of the old secondary school curriculum. The mean levels of practice or confidence of entrants to the four medical schools, during 2008-2011, were compared using analysis of variance. The Bonferroni's test was used for further pair-wise comparison of cohorts of students either entering in different years or different institutions. Results: While entrants at the four medical schools did not demonstrate a consistent or sustained change in their practice of or confidence in each skill category over the period of study, there were some significant differences between entrants at the respective institutions. Furthermore, entrants to one medical school were consistently less confident of their skills, despite more practice. These findings are best accounted for by the long-standing history of inequitably resourced pre-university education in South Africa. Discussion: These findings highlight the need for close monitoring of the impact of pre-university education changes on the learning skill profiles of university entrants, in order to design effective university programs which enable students from diverse backgrounds to participate and adequately meet curricula demands.

Is computer-assisted instruction more effective than other educational methods in achieving ECG competence among medical students and residents? Protocol for a systematic review and meta-analysis.

INTRODUCTION: Although ECG interpretation is an essential skill in clinical medicine, medical students and residents often lack ECG competence. Novel teaching methods are increasingly being implemented and investigated to improve ECG training. Computer-assisted instruction is one such method under investigation; however, its efficacy in achieving better ECG competence among medical students and residents remains uncertain. METHODS AND ANALYSIS: This article describes the protocol for a systematic review and meta-analysis that will compare the effectiveness of computer-assisted instruction with other teaching methods used for the ECG training of medical students and residents. Only studies with a comparative research design will be considered. Articles will be searched for in electronic databases (PubMed, Scopus, Web of Science, Academic Search Premier, CINAHL, PsycINFO, Education Resources Information Center, Africa-Wide Information and Teacher Reference Center). In addition, we will review citation indexes and conduct a grey literature search. Data extraction will be done on articles that met the predefined eligibility criteria. A descriptive analysis of the different teaching modalities will be provided and their educational impact will be assessed in terms of effect size and the modified version of Kirkpatrick framework for the evaluation of educational interventions. This systematic review aims to provide evidence as to whether computer-assisted instruction is an effective teaching modality for ECG training. It is hoped that the information garnered from this systematic review will assist in future curricular development and improve ECG training. ETHICS AND DISSEMINATION: As this research is a systematic review of published literature, ethical approval is not required. The results will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement and will be submitted to a peer-reviewed journal. The protocol and systematic review will be included in a PhD dissertation. PROSPERO REGISTRATION NUMBER: CRD42017067054; Pre-results.

A comparison of physician emigration from Africa to the United States of America between 2005 and 2015.

BACKGROUND: Migration of health professionals has been a cause for global concern, in particular migration from African countries with a high disease burden and already fragile health systems. An estimated one fifth of African-born physicians are working in high-income countries. Lack of good data makes it difficult to determine what constitutes "African" physicians, as most studies do not distinguish between their country of citizenship and country of training. Thus, the real extent of migration from African countries to the United States (US) remains unclear. This paper quantifies where African migrant physicians come from, where they were educated, and how these trends have changed over time. METHODS: We combined data from the Educational Commission for Foreign Medical Graduates with the 2005 and 2015 American Medical Association Physician Masterfiles. Using a repeated cross-sectional study design, we reviewed the available data, including medical school attended, country of medical school, and citizenship when entering medical school. RESULTS: The outflow of African-educated physicians to the US has increased over the past 10 years, from 10 684 in 2005 to 13 584 in 2015 (27.1% increase). This represents 5.9% of all international medical graduates in the US workforce in 2015. The number of African-educated physicians who graduated from medical schools in sub-Saharan countries was 2014 in 2005 and 8150 in 2015 (304.6% increase). We found four distinct categorizations of African-trained physicians migrating to the US: (1) citizens from an African country who attended medical school in their own country (86.2%, n = 11,697); (2) citizens from an African country who attended medical school in another African country (2.3%, n = 317); (3) US citizens who attended medical school in an African country (4.0%, n = 537); (4) citizens from a country outside Africa, and other than the United States, who attended medical school in an African country (7.5%, n = 1013). Overall, six schools in Africa provided half of all African-educated physicians. CONCLUSIONS: The number of African-educated physicians in the US has increased over the past 10 years. We have distinguished four migration patterns, based on citizenship and country of medical school. The majority of African graduates come to the US from relatively few countries, and from a limited number of medical schools. A proportion are not citizens of the country where they attended medical school, highlighting the internationalization of medical education.

The impact of a faculty development programme for health professions educators in sub-Saharan Africa: an archival study.

BACKGROUND: In 2008 the sub-Saharan FAIMER Regional Institute launched a faculty development programme aimed at enhancing the academic and research capacity of health professions educators working in sub-Saharan Africa. This two-year programme, a combination of residential and distance learning activities, focuses on developing the leadership, project management and programme evaluation skills of participants as well as teaching the key principles of health professions education-curriculum design, teaching and learning and assessment. Participants also gain first-hand research experience by designing and conducting an education innovation project in their home institutions. This study was conducted to determine the perceptions of participants regarding the personal and professional impact of the SAFRI programme. METHODS: A retrospective document review, which included data about fellows who completed the programme between 2008 and 2011, was performed. Data included fellows' descriptions of their expectations, reflections on achievements and information shared on an online discussion forum. Data were analysed using Kirkpatrick's evaluation framework. RESULTS: Participants (n=61) came from 10 African countries and included a wide range of health professions educators. Five key themes about the impact of the SAFRI programme were identified: (1) belonging to a community of practice, (2) personal development, (3) professional development, (4) capacity development, and (5) tools/strategies for project management and/or advancement. CONCLUSION: The SAFRI programme has a positive developmental impact on both participants and their respective institutions.

Generic learning skills in academically-at-risk medical students: a development programme bridges the gap.

BACKGROUND: Widening access to medical students from diverse educational backgrounds is a global educational mandate. The impact, on students' generic learning skills profiles, of development programmes designed for students at risk of attrition is unknown. AIMS: This study investigated the impact of a 12-month Intervention Programme (IP) on the generic learning skills profile of academically-at-risk students who, after failing at the end of the first semester, completed the IP before entering the second semester of a conventional medical training programme. METHODS: This prospective study surveyed medical students admitted in 2009 and 2010, on entry and on completion of first year, on their reported practice and confidence in information handling, managing own learning, technical and numeracy, computer, organisational and presentation skills. RESULTS: Of 414 first year students, 80 (19%) entered the IP. Levels of practice and confidence for five of the six skills categories were significantly poorer at entry for IP students compared to conventional stream students. In four categories these differences were no longer statistically significant after students had completed the IP; 62 IP students (77.5%) progressed to second year. CONCLUSIONS: A 12-month development programme, the IP, effectively addressed generic learning skills deficiencies present in academically-at-risk students entering medical school.