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

3. Courtesy of Prof. Zein A. Karrar Expansion in Medical Schools between 1924-2000 Preface

4. Should Medical Education Change? Preface

5. 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

6. 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 (www.doctorsgate.com last accessed 24 October 2006) Background Recent reports on medical education from Sudan

7. Years No Total PublicPrivate 19241-1 1978/792-3 1990216 1990 – 96 7114 1997- 2000 6424 Total18624 Source M of Higher Education 2003 Courtesy of Prof. Zein A. Karrar Expansion in Medical Schools between 1924-2000 The Present …

8. 2002/032001/022000/0199/200097/98Year 32093360239931651900 Total enrollment 1373116511761191789 Total graduates Source M of Higher Education 2003 Courtesy of Prof. Zein A. Karrar Annual Enrollment and Graduates Public Medical School (1997-2003) The Present …

9. Courtesy of Prof. Zein A. Karrar The Present … Annual Enrollment and Graduates Public Medical School (1997-2003)

10. 2002/20032001/20022000/200199/20001997/98Year 1605170412622210958Female 160416561137955942Male 32093360239931651900Total Source M of Higher Education 2003 Courtesy of Prof. Zein A. Karrar Annual Enrollment by gender Public Medical School (1997-2003) The Present …

11. 2002/20032001/20022000/200199/20001997/98Year 641521521496418Female 733533555695369Male 1373116511761191787Total Source M of Higher Education 2003 Courtesy of Prof. Zein A. Karrar The Present … Graduates by gender Public Medical School (1997-2003)

12. 20041996 Year YearDoctors 2040811648 Total No Registered 57653426 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 …

13. 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

14. MBBS 94- 95 95- 96 96-97 97- 98 98- 99 99- 2000 2000- 2001 2001- 2002 2002- 2003 Total Medicine--142431282039156 Basic sciences -----81823251 Medical Laboratories Medical Laboratories----2428302056158 Public health 82019271930306762282 Nursing81222262030356050263 Total1632557794124133209170910 Number of Graduates

15. TotalTwelfthEleventhNinthseventhSixthfourthsecondFirst semester Faculty 716677277929211097109medicine 64918112816078102 M. Lab. Sc 3015653704973 Public health 42662787493119Nursing 2092677277391351414317403Total Shendi University Faculty of Medicine & Health Sciences Students Number 2004 2005

16. 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

17. The case for change …

18. 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 (www.doctorsgate.com last accessed 24 October 2006) The Problem Recent reports from Sudan highlighted concerns in medical education

19. Key findings Areas of concern

20. Overview of key findings Dr Elsaddig Gasemallah, Towards a new medical education policy in Sudan (www.doctorsgate.com last accessed 24 October 2006) More information in: Dr Elsaddig Gasemallah, Towards a new medical education policy in Sudan (www.doctorsgate.com 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

21. Areas of concern

22. Concern 1: Institutions

23. 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

24. 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

25. Medical Education regulatory bodies

26. GMC Universities NHS Medical Education regulatory bodies

27. GMC - Registration Universities - Degree NHS Medical Education regulatory bodies

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

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

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

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

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

33. Concern 2: Admission Policy

34. 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

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

36. Concern 3: Medical teachers

37. 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

38. 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

39. 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

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

41. 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

42. 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

43. 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

44. 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

45. Concern 4: Medical students

46. 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.

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

48. 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

49. 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

50. 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

51. Concern 5: curriculum & assessment

52. 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

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

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

55. 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

56. 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

57. 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

58. Concern 6: Patients prospective

59. 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

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

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

62. 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

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

64. 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

65. 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

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

67. 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

68. Should Medical Education Change? Finally …

69. 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 …

70. Enjoy the Workshop Lastly

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