Collaborating family physicians ensuring that the future ‘Rwanda health work force’ is competent in community medicine concepts
Dr. Namatovu Jane Frances HoD Family Medicine Makerere University (Uganda) and Assoc. Prof. Mieke Visser (University of Rwanda)
Many medical schools on the African continent are offering the shortest time possible, five years, to medical students to grasp the vast amount of knowledge, varied clinical skills and the acceptable attitudes needed to function competently in a primary care setting following their graduation. The reality is that this is very little time and therefore many concepts are merely introduced hoping that the students in their future professional lives as lifelong learners, will expound on them. The additional desired skills and attitudes related to these important concepts are hoped to be acquired through apprenticeship with professional mentors and continuous professional development (CPD) that the Rwandan Ministry of Health is starting to emphasize lately. The University of Rwanda (UR) is not an exception to this scenario.
However the Discipline of Primary Health Care (PHC), College of Medicine and Health Sciences, University of Rwanda (UR), has been committedto deliver a social and community medicine training (SOCOMED) for 5th year medical students that exposes students to the community health needs of the Rwandan community by eg visiting community health workers, social home visits, attending NCD clinics and practicing health education within communities. This training gives students the ability to understand the impact of social determinants of health, community factors that influence health, and the prevalence and severity of disease that their patients present with at the clinical setting, as well as vice versa, how disease influences the social situation of the patient.The 4 weeks training is given throughout the year to the medical students in groups of 10 -12 students, since 2012with support of the NGO Partners in Health (PIH)and since 2015with the fulltime– logistic, financial and human resources – support of PIHat their training site of Rwinkwavu and in Kigali.
To prepare the students to this training, there is in the curriculum of the Rwandan medical students, who are presently in their fourth year of studies,a two weeks course, Community Medicine. This course is taught mainly by family physicians at the UR under the responsibility of the Discipline of PHC. The overallobjective of this course is to lay the foundation of knowledge and attitudes regarding population based medical care at the community level. The teaching methods that are used to deliver the course depend on the innovativeness of the faculty. The University of Rwanda like many other tertiary institutions on the African continent, is grappling with the issues of human resources. The coordinating honorary faculty of this course, Associate Professor Mieke Visser, Discipline of PHC, UR, who herself is part-time sponsored by Partners in Health, had to therefore think out of the box in order to attract colleagues in the field of primary care to assist in the effective delivery of the course to the young medical students who are the future health workforce of Rwanda.
The East African Inter-University Council, Partners in Health and the private Dutch Peter Manschot fundwere found to be supportive to this course and provided tickets, transport costs and a small stipend for the lecturers.
This allowed that this year in March (11th to 24th) 2016 there were five family physicianslecturers with a vast wealth of experience in primary care in East Africa, from the Netherlands,honorary Associate Professor Mieke Visser, honorary Associate Professor Maaike Flinkenflogel,HoD Discipline PHC, UR and Dr. Marian Holtland,Lecturer FM Moi University, Kenya, Rwanda: Dr. Vincent Cubaka,honorary Lecturer and PhD student at UR, Sweden: Dr. Eva Arvidsson, honorary Associate Professor, UR and Uganda: Dr. Jane Frances Namatovu,HoD FM Makerere University, Uganda.The course coordinator also ensured that local content experts participated so that the course is contextual and these included: Dr. Claude Uwamungu, Dr. Vincent Karamuka and Mr. Edouard Munyamaliza who lectured and emphasized the country’s issues on non-communicable disease management, palliative care and domestic violence respectively.
During the planning sessions for the course the following teaching methods were agreed to be used: lectures, group discussions, self-directed learning, roleplays, and eLearning. The eLearning complemented the self-directed learning very well because the faculty were able to share important literature and useful sites with the learners.
The team of family physicians delivered sessions in the following areas; primary health care (PHC), health systems, community oriented primary care (COPC), community health development, basic concepts in clinical epidemiology, depression in the community, how to read a scientific article, social determinants of health, communication techniques and consultation skills, health promotion and disease prevention, behavioral change and health education, occupational and environmental health, palliative care and last but not least ‘The desired Rwandan doctor’.
Every day was crowned by two student group presentations on scheduled topics that had been given to them earlier on in the week to prepare. This allowed them to practice in a safe learning environment what they had learnt in the session on communication techniques. Each group received constructive feedback from both the peers and the faculty. According to the valuation of the two weeks long sessions, the students were very impressed by this innovation.
The statutory University assessment format is both continuous (progressive) and summative. The continuous assessment was done on a daily basis from both their attendance and group presentations, the summativeassessment comprised of a written exam that was set by all the above faculty.
Thanks to the Inter-University collaboration it was possible to give in a short period of 2 weeks the students an high standard course in a wide range of community health topics, in which they participated actively. Moreover, this collaboration of the family physicians was very informative for the members involved, it allowed them to share their strengths and weaknesses in their own parent institutions. 2 members from Kenya and Uganda had also a chance to visit the PIH Rwinkwavu training site.
Therefore the constructive way forwards for the different parties is to continue to proactively tap into each other’s strengths so that the discipline of Family Medicine/ Primary Care parse is moved forward especially on the African continent. For instance, an exchange program for the different institutions during the students’ elective period would increase the community of practice in the area of primary care and hence mentorship. Also the primary care research agenda can be strengthened through continued collaboration in order to increase the visibility of family medicine/primary care through publications of the research work in peer reviewed journals. Mentorship in research through a PhD program in family medicine/primary care is a glaring weakness that needs attention from all fronts i.e. competent supervisors or PhD mentors, funding and protected time from the potential eligible faculty.