Undergraduate training and internship in Sudan Ibrahim H Fahal, MBBS, MD, FRCP, FRCP (Glas.), Med Ed Certificate

Courtesy of Prof. Zein A. Karrar Expansion in Medical Schools between Preface

Should Medical Education Change? Preface

Aims of the talk Aims of the talk  to provide information from reports on medical education in Sudan  to prompt discussions about future developments within medical education in Sudan Structure of the talk Structure of the talk  overview of key findings  focus on areas of concern Will Discuss

Professor Elzein Kararr, Sudan Medical Care Foundation Conference on Medical Education, Royal College of Physicians of London 2004 Dr Elsaddig Gasemallah, Towards a new medical education policy in Sudan, Khartoum 2006 ( last accessed 24 October 2006) Background Recent reports on medical education from Sudan

Years No Total PublicPrivate / – Total18624 Source M of Higher Education 2003 Courtesy of Prof. Zein A. Karrar Expansion in Medical Schools between The Present …

2002/032001/022000/0199/200097/98Year Total enrollment Total graduates Source M of Higher Education 2003 Courtesy of Prof. Zein A. Karrar Annual Enrollment and Graduates Public Medical School ( ) The Present …

Courtesy of Prof. Zein A. Karrar The Present … Annual Enrollment and Graduates Public Medical School ( )

2002/ / /200199/ /98Year Female Male Total Source M of Higher Education 2003 Courtesy of Prof. Zein A. Karrar Annual Enrollment by gender Public Medical School ( ) The Present …

2002/ / /200199/ /98Year Female Male Total Source M of Higher Education 2003 Courtesy of Prof. Zein A. Karrar The Present … Graduates by gender Public Medical School ( )

Year YearDoctors Total No Registered Total No Available in Sudan Sources: Sudan Medical Council 2004 Annual stateside Health Report 2002 Courtesy of Prof. Zein A. Karrar Retained workforce The Present …

Republic of Sudan Ministry of Higher Education and Scientific Research University of Shendi FACULTY OF MEDICINE & HEALTH SCIENCES بسم الله الرحمن الرحيم جامعة شندى كلية الطب والعلوم الصحية

MBBS Total Medicine Basic sciences Medical Laboratories Medical Laboratories Public health Nursing Total Number of Graduates

TotalTwelfthEleventhNinthseventhSixthfourthsecondFirst semester Faculty medicine M. Lab. Sc Public health Nursing Total Shendi University Faculty of Medicine & Health Sciences Students Number

Rapid expansion over a short period of time High rate of students dropout (about 50%) Higher proportion of females (50%) Failure to retain graduates (about 75%) The Present … Summary

The case for change …

Professor Elzein Kararr, Sudan Medical Care Foundation Conference on Medical Education, Royal College of Physicians of London 2004 Dr Elsaddig Gasemallah, Towards a new medical education policy in Sudan, Khartoum 2006 ( last accessed 24 October 2006) The Problem Recent reports from Sudan highlighted concerns in medical education

Key findings Areas of concern

Overview of key findings Dr Elsaddig Gasemallah, Towards a new medical education policy in Sudan ( last accessed 24 October 2006) More information in: Dr Elsaddig Gasemallah, Towards a new medical education policy in Sudan ( last accessed 24 October 2006) Institutions Institutions Admission policy Admission policy Medical teachers Medical teachers Medical students Medical students Curriculum and assessment Curriculum and assessment Patients prospective Patients prospective Identified areas of concern in medical education

Areas of concern

Concern 1: Institutions

The concern: Medical institutions were established without appraisal: The concern: Medical institutions were established without appraisal:  Lack of planning prior to implementing  Major lack of resources

Questions for today  Funding?  Human capacity?  Physical capacity?  Partnership with foreign institutes?  External examiners?  Different assessment tools?  Lack of coordination between MOH and higher education? Institutes Institutes

Medical Education regulatory bodies

GMC Universities NHS Medical Education regulatory bodies

GMC - Registration Universities - Degree NHS Medical Education regulatory bodies

GMC - Registration Universities - Degree - QAA NHS Medical Education regulatory bodies

GMC Registration Tomorrow’s Doctors Universities Degree QAA Benchmarks NHS Medical Education regulatory bodies

Qualifications Framework Programme Specification THE QUALITY ASSURANCE AGENCY (QAA) DEVELOPMENT AGENDA Benchmarking Standards

Relations between Ministries of Health (MOH) and medical education systems

Educational responsibility UndergraduatePostgraduateContinuing Medical SchoolHealth Service Medical SchoolHealth Service Medical School Courtesy of Professor Sam Leinster, Dean East Angela Medical school

Concern 2: Admission Policy

The concern: increase students intake The concern: increase students intake Poor grasp of English language. Poor grasp of English language. Government imposing special categories Government imposing special categories Profit. Profit. Lack of manpower planning Lack of manpower planning

Questions for today  numbers vs capacity  numbers vs future workforce requirement  numbers vs qualifications  numbers vs special categories Admission policy Admission policy

Concern 3: Medical teachers

The concern: Critical shortage of academics. Generally, a small number of dedicated medical teachers plus a much larger number of sessional tutors. Critical shortage of academics. Generally, a small number of dedicated medical teachers plus a much larger number of sessional tutors. Few medical schools has full time academic staff to provide and coordinate teaching and learning Few medical schools has full time academic staff to provide and coordinate teaching and learning Training for teachers is lacking in most institutes Training for teachers is lacking in most institutes

The concern: Teachers are so stretched that taking time to review / evaluate / innovate is very difficult. Teachers are so stretched that taking time to review / evaluate / innovate is very difficult. Lack of pre clinical academic staff. Lack of time / resources to support them. Lack of pre clinical academic staff. Lack of time / resources to support them. As numbers of students increase, loss of either curriculum time, or small group teaching. As numbers of students increase, loss of either curriculum time, or small group teaching. As lectures are cheaper to provide than seminars, there could be pressure to abandon seminars. As lectures are cheaper to provide than seminars, there could be pressure to abandon seminars. Concern 3: Medical teachers

The concern: Medical education is a science and no longer an art Medical education is a science and no longer an art There does not seem to be a cohort of medical teachers in waiting to take over the reins in future. There does not seem to be a cohort of medical teachers in waiting to take over the reins in future. Concern 3: Medical teachers

Questions for today  How can we retain and develop existing well qualified and experienced staff? Medical teachers Medical teachers

Questions for today  How can we retain and develop existing well qualified and experienced staff?  How can we develop medical teachers to fill existing vacancies? Medical teachers Medical teachers

Questions for today  How can we retain and develop existing well qualified and experienced staff?  How can we develop medical teachers to fill existing vacancies?  How do we recruit and groom the next generation? Medical teachers Medical teachers

Questions for today  How can we retain and develop existing well qualified and experienced staff?  How can we develop medical teachers to fill existing vacancies?  How do we recruit and groom the next generation?  What CPD system to implant in medical education? Medical teachers Medical teachers

Questions for today  How can we retain and develop existing well qualified and experienced staff?  How can we develop medical teachers to fill existing vacancies?  How do we recruit and groom the next generation?  What CPD system to implant in medical education?  How do we resist threats to staff time, ?from increased student numbers and the pressures of daily living? Medical teachers Medical teachers

Concern 4: Medical students

The concern: Some Medical students are: Graduating without competencies to function as PR house officers. Graduating without competencies to function as PR house officers. High drop out rates (50% of intake) High drop out rates (50% of intake) Until recently this was not the case. It now is so. This is one area of our work that could improve. Until recently this was not the case. It now is so. This is one area of our work that could improve.

Questions for today  Do students fail to achieve core competencies Graduating without core competencies Graduating without core competencies

Questions for today  Do students fail to achieve core competencies  Is this a real issue? In practice, do students graduate having failed core competencies? Graduating without core competencies Graduating without core competencies

Questions for today  Do students fail to achieve core competencies  Is this a real issue? In practice, do students graduate having failed core competencies?  If so, do we think this is acceptable? Graduating without core competencies Graduating without core competencies

Questions for today  Do students fail to achieve core competencies  Is this a real issue? In practice, do students graduate having failed core competencies?  If so, do we think this is acceptable?  Is this a particular problem for new medical schools? Graduating without core competencies Graduating without core competencies

Concern 5: curriculum & assessment

The concern: assessment has to be fundamental part of the curriculum. The concern: assessment has to be fundamental part of the curriculum.  Are there written curricula  Has assessment been imbedded in the curricula  Does the curriculum include generic competencies

Questions for today  A more robust assessment system? Curriculum & assessment Curriculum & assessment

Questions for today  A more robust assessment system?  need for consistency in outcomes between medical schools and between students? Curriculum & assessment Curriculum & assessment

Questions for today  A more robust assessment system?  need for consistency in outcomes between medical schools and between students<  A call for a more robust external examiner system? Curriculum & assessment Curriculum & assessment

Questions for today  A more robust assessment system?  need for consistency in outcomes between medical schools and between students?  A call for a more robust external examiner system?  The need for a shared questions bank or assessment tools applied to all medical schools? Curriculum & assessment Curriculum & assessment

Questions for today  A more robust assessment system?  need for consistency in outcomes between medical schools and between students?  A call for a more robust external examiner system?  The need for a shared questions bank or assessment tools applied to all medical schools?  The need for a national assessment? Curriculum & assessment Curriculum & assessment

Concern 6: Patients prospective

The concern: Patient’s dissatisfaction with medical services is becoming apparent. The concern: Patient’s dissatisfaction with medical services is becoming apparent.  Increased public awareness  More complaints  Government is encouraging patients to complain

Questions for today  Is there a need for patient charter? Patients prospective Patients prospective

Questions for today  Is there a need for patient charter?  Can we  Can we improve Patients’ Experience? Patients prospective Patients prospective

Questions for today  Is there a need for patient charter?  Can we  Can we improve Patients’ Experience?  Can we improve communications? Patients prospective Patients prospective

To produce well trained, high quality, accredited doctors Medical Education in the Future

1.Provide patient-centered care 2.Work in interdisciplinary teams 3.Employ evidence-based practice 4.Apply quality improvement 5.Utilize informatics Medical Education in the Future

Significant changes in the process of medical education 1.Lectures decreased 2.Students as instructors 3.Use of small groups 4.Teachers as facilitators Medical Education in the Future

5.Changes in evaluation methods 6.Texts updated 7.Information management skills 8.Interactive laboratories and clinical simulations Medical Education in the Future

Summary Undergraduate medical learning, teaching and assessment has come a long way in the last decade – but there is still much to be done! Undergraduate medical learning, teaching and assessment has come a long way in the last decade – but there is still much to be done! We hope that during the course of the day, you will: We hope that during the course of the day, you will:  Reflect on the problems of medical education in Sudan  Discuss them, particularly the areas of concern  Make recommendations for future directions via the workshops

Should Medical Education Change? Finally …

1. On the whole, medical student education is very good and no significant changes are necessary. 2. On the whole, medical student education is sound and requires only minor changes. 3. Medical students education in Sudan has many good attributes but needs fundamental reform. 4. There is so much wrong with medical student education in Sudan that thorough reform is needed. Finally Finally …

Enjoy the Workshop Lastly

“It is not the strongest of the species that survives, not the most intelligent, but the one most responsive to change.” Charles Darwin