2015, 37: 64–73 Students’ and junior doctors’ preparedness for the reality of practice in sub-Saharan Africa JANNEKE M. FRAMBACH 1 , BEATRIZ A. F. MANUEL 2 , AFONSO M. T. FUMO 3 , CEES P. M. VAN DER VLEUTEN 1 & ERIK W. DRIESSEN 1 1 Maastricht University, The Netherlands, 2 Eduardo Mondlane University, Mozambique, 3 Catholic University of Mozambique, Mozambique Abstract Background: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. Aim: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. Methods: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. Results: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors’ motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. Conclusion: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors’ motivation and preparedness to tackle the challenges of health care practice in this region. Introduction Health care in sub-Saharan Africa faces a disproportionate share of the global disease burden and struggles with persistent shortages of doctors: 125,000 doctors for 868 million people is scant indeed compared to Western Europe where a population half that size is served by 11 times as many doctors (Frenk et al. 2010; WHO 2011). Because of unequal distribution over sub-Saharan African countries, moreover, the physician-to-population ratio in some coun- tries rates as low as 1.1 per 100,000 (WHO 2011). Medical schools in the region cope with scarcity of qualified faculty and poor infrastructure, which prevents them from produ- cing enough graduates to fill this gap (Frenk et al. 2010; Mullan et al. 2011; Chen et al. 2012). It is moreover particularly difficult to recruit and retain graduates in rural and underserved areas where the need for care is most urgent (WHO 2011; Sherr et al. 2012). These concerns have stimulated several initiatives being taken in recent years to scale up and prioritize sub-Saharan African medical educa- tion, notably the Medical Education Partnership Initiative (WHO 2011) and the Sub-Saharan African Medical Schools Study (Mullan et al. 2011; Chen et al. 2012). Additionally, Practice points  The immense challenge for junior doctors in sub- Saharan Africa is to balance between the reality of local health care and global health care ideals, which challenges their motivation and preparedness for practice.  Innovative problem- and community-based curricula can improve sub-Saharan African doctors’ motivation, sense of preparedness for practice, and social and cognitive skills and competencies.  Positive effects of innovative curricula may be even more meaningful in low-resource settings compared with high-income settings.  Practical learning during clinical rotations is valued highly as an effective preparation for practice, but its effectiveness is compromised by a severe shortage of good clinical teachers in sub-Saharan Africa.  Curricular innovations in sub-Saharan Africa need to be backed up by joint efforts of relevant stakeholders to train more teachers and improve the infrastructure of medical schools. Correspondence: Janneke M. Frambach, Department of Educational Development and Research, FHML, Maastricht University, P.O. Box 616, NL-6200 MD Maastricht, The Netherlands. Tel: +31433885775; Fax: +31433885779; E-mail: J.Frambach@maastrichtuniversity.nl 64 ISSN 0142-159X print/ISSN 1466-187X online/15/010064–10 ß 2015 Informa UK Ltd. DOI: 10.3109/0142159X.2014.920490 Med Teach Downloaded from informahealthcare.com by University of Maastricht on 12/21/14 For personal use only.