National University Of Rwanda Faculty Assessment: Focus Group Discussions Inis Jane Bardella, MD, FAAFP L. Miriam Dickinson, PhD Mark Hotchkiss Doug Fernald, MA Calvin Wilson, MD N. Michelle Shiver, BSE Center for Global Health University of Colorado Denver

Background  USAID funded Rwanda Medical Training Initiative – RMTI  3 Partners – UCD NUR Centura Health  Three year project,  Two Goals  Assist NUR in the sustainable development of current post-graduate programs  Assist NUR in the development and implementation of a sustainable post-graduate program in Family Medicine

Background  4 of 9 project Objectives require faculty development interventions for achievement.  Assist faculty in mastering the clinical, teaching, research and management skills necessary for medical education.  Assist in the development and implementation of processes for feedback, evaluation and improvement of medical knowledge, clinical competencies and patient interactions of learners.  Assist in the identification and ongoing development of faculty for the training of family medicine post-graduates.  Assist in the development and implementation of processes for evaluation of medical knowledge, clinical competencies and patient interactions of [family medicine] learners.

Research Objectives  Multiphase project to determine faculty needs and behaviors pre-post faculty development interventions  Aim of Phase One: Determine baseline faculty needs and behaviors in clinical care, teaching, research and management.

Methods  Semi-structure interviews with NUR administration, academic chairs – March 2007  Focus Group Discussions – FGDs  Value face-to-face communication  Clinical educators, postgraduates and support personnel  Generate consensus and prioritization  Gather both faculty development and postgraduate program needs data  Guide program development  Address project objectives

Methods  FGD Format and Content  Semi-structured interview data  Literature review  PI and project group experience  NUR Dean  22 open-ended questions  Postgraduate program strengths, weaknesses, solutions and barriers  General, clinical, teaching, research, management

Methods  Eight peer focus groups  Department chairs  Clinical faculty – Butare and Kigali (2)  Support personnel  Postgraduates – Butare (2) and Kigali  French interpreter  IRB review and approval for Exempt Status

Methods  Dean notified participants  PI lead  Flip chart to record responses  Nominal Group Process to rank responses  Data entered into an Excel database  Responses grouped and coded by theme  Descriptive statistics using SAS  Comparisons between groups

Methods - Revised  2 hours per group  6/22 questions addressed  General  Clinical  NGP for clinical weakness and solutions  Summary description rather than group and code

Results  51 participants - ENGAGED  Academic chairs – 3  CHUB clinical heads, senior instructors – 5  King Faisal clinical heads, director – 7  CHUK clinical heads, senior instructors – 6, 4  Post-graduate program support personnel – 7 (4 women)  CHUB nonsurgery post-graduates – 7 (1 women)  CHUB surgery post-graduates – 6  CHUK post-graduates – 10 (2 women)

Results  Consistency in responses across groups  Greatest overall strengths of the current post- graduate education process  Political will, government support  In country programs  Many outside partners  Many patients  Many pathologies  Many qualified applicants  Post-graduates provide care to patients  Post-graduates teach undergraduates

Results  Greatest overall weaknesses of the current post-graduate education process  Lack of faculty  Lack of hospital supplies and equipment  Lack of education and information resources  Lack of medications  Schedules not known, communicated, followed  Poor communication  Delayed salary

Results  Address these overall weaknesses  Allocate budget for supplies, equipment, resources  Collaborate to obtain supplies, equipment, resources  Solicit supplies, equipment, resources  Recruit and train more faculty

Results  Clinical, patient care, aspects of the post- graduate programs are strong  Many patients  Wide range of pathologies  Learn the common pathologies of Rwanda  Much hands on experience  Providing care to patients  Faculty commented on morning staff meeting and ward round teaching, the postgraduates did not mention this.

Results  Clinical, patient care, aspects of the post- graduate programs are weak – NGP  Lack of supplies, equipment  Lack of lab, facilities  Lack of access to information, library  Lack of medications  Lack of subspecialties

Results  Some diversity of responses  Faculty  Lack of faculty  King Faisal  Inadequate decision skills  Inadequate exam skills  Pathways, protocols  Support personnel  Doctors do not respect time  Too many patients  Post-graduates  Lack of subspecialists

Results  Address these clinical weaknesses – NGP  Allocation/collaboration by the MOH to purchase equipment and supplies

Results  Wide diversity of response ranking  Faculty  Recruit expatriate faculty  Improve the conditions of lecturers  King Faisal  Develop Rwandan standards  Rwandan evaluation system  Recruit bedside teachers  Send outside Rwanda to train  Support personnel  Teach time management  Distribute postgrads at district hospitals so patient can have care there  Post-graduates  MOH to supply medications, supplies  Go out of country for training

Conclusions  There is consensus that the strengths of the post-graduate programs are: patient volume; diversity of pathologies; hands on experience; political support.  There is fairly good agreement that the weaknesses of the post-graduate programs are: lack of supplies; equipment; information; education resources; medications; faculty.

Conclusions  The common recommendations for addressing the weaknesses center on funding from the MOH and expatriate personnel.

Limitations  Small sample size  Arranging focus groups via  Some terminology did not translate well.  Voluntary  Hierarchy of response  Nominal Group Process lost votes

Implications  Focus groups worked well in this culture.  Nominal group process is a new concept which worked fairly well.  Strategies to address the “lack ofs” must be incorporated into the development of FM and addressed systematcially.  This is a model for international faculty needs assessment.

Murakoze!