All is not well with Africa’s medical education, says study

The COVID-19 pandemic has degraded medical education in most universities in Africa and there are indicators that the problem could worsen the existing shortage of doctors and other healthcare workers, according to a survey of about 700 medical students in 33 countries on the continent.

In turn, this could increase poor quality care and deaths, an earlier study about the impact of COVID-19 on medical education has also warned.

The latest survey results included in a study titled ‘COVID-19 and medical education in Africa: A cross-sectional analysis of the impact on medical students’, was conducted by researchers at the United States-based University of Michigan’s Medical School and its collaborators at St Paul’s Hospital Millennium Medical College in the Ethiopian capital, Addis Ababa.

It found that learning decreased as universities shifted online.

To understand how COVID-19’s impact affected the students, Dr Elizabeth Holman, the associate director of assessment and evaluation at the University of Michigan Medical School and her associates developed a 39-item anonymous electronic survey and distributed it widely to medical school students across Africa through the social networks of the International Federation of Medical Students’ Associations that included Facebook, WhatsApp and Telegram.

“The survey assessed class structure changes and timing, patient interactions, examination administration, learning environment satisfaction, mental health impacts and volunteer opportunities and engagement,” stated the study published on 9 November.

Severe disruptions to education

When asked about disruptions to their education, 80%, of students said their classes were suspended for varied lengths of time during the pandemic and only 59% had resumed their classes by October 2021, either through online, hybrid or contact modes.

But, whereas 83% of students felt they were in a supportive learning environment before the pandemic, this dropped to 32% since lockdowns were enforced in March last year.

In this context, the number of students seeing patients as part of education had significantly dropped from 72% to 19% in less than one year.

Questioned about their satisfaction with various learning aspects, students said academic interaction between them and lecturers had gone down.

Whereas 76% of students were able to reach lecturers for academic engagement before the onset of the COVID-19 pandemic, by October last year this interchange of ideas had dropped to 29%.

During the same period, the time available for academics also dropped from about 66% to 43%.

According to the report, only 37% of students were satisfied with teaching materials that they were getting during COVID-19 as compared to 80% before the pandemic, while peer-to-peer learning activities dropped from about 80% to less than 30%.

Specifically asked about the overall teaching environment before and during the COVID-19 pandemic, 33% of students reported being dissatisfied with the ease of reaching faculty for questions, compared with only 8% of students reporting dissatisfaction before the pandemic.

Still, before COVID-19, 6% of students were dissatisfied with faculty preparedness for classes but, since the start of the epidemic, this figure has shot up to 37%.

Although 57% of the students were positive about the increased flexibility of time ushered through greater application of online learning, 65% of students cited technological issues, mostly related to low internet connections and availability of remote learning equipment.

About 60% of students reported decreased connection with their classmates, while 50% cited decreased availability of professors.

Responding to questions on their mental health as a result of the pandemic, 44% of students reported a negative change, 23% said there was a positive change and 34% reported no change.

Health education strained

According to Holman and the other researchers, the findings of the study are pointers that all is not well with Africa’s medical education that is expected to train doctors and other health professionals to cater for about 1.4 billion people experiencing 25% of the global disease.

The study argues that Africa has 1.3% of the world’s healthcare workers, which is about 2.3 healthcare workers for every 1,000 persons, currently the lowest for any region in the world.

“Estimates suggest that the current training is insufficient to even maintain the current density of healthcare workers and the shortage is likely to be made worse by the inability of the medical education systems to deal with the impacts of the COVID-19 epidemic,” stated the study.

Highlighting the problem further, the study noted that 11 African countries have no medical school, while 24 countries have one medical school each.

Total estimates indicate that there are 143 medical schools in all of Sub-Saharan Africa graduating about 100,000 healthcare workers annually.

Students from 107 medical schools across the continent responded to the electronic survey.

The study suggests that medical schools’ disruptions caused by the COVID-19 pandemic could have impaired the quality of clinical training by presenting learning and teaching challenges to students and staff.

A similar observation was made in March this year by Dr Edmund Ndudi Ossai, a lecturer in community health at Ebonyi State University in Nigeria and Dr Osondu Ogbuoji, an assistant research professor at Duke University in North Carolina in the United States, in a contribution entitled, ‘Redressing the impact of COVID-19 on medical education in Africa: The need for collective action’.

The two academics argued that the impact of the COVID-19 epidemic on medical education in Africa was likely to create incentives for students to drop out and eventually practise as quacks in their local communities without completing their education and professional training.

“Since healthcare worker activities are poorly regulated in many African countries, the result will be an increase in the number of quacks providing healthcare, leading to an increase in poor-quality care and amenable deaths on the continent,” stated the report.

They stressed that the COVID-19 pandemic exposed Africa’s weakness for rapid research and updates in many medical schools on the continent. “Whereas the pace of research and development for COVID-19 is fast, medical schools in Africa have not shown the ability to keep up with the pace,” said Ossai and Ogbuoji in their commentary.

The two reports appear to be a cautious notice that COVID-19 may be doing damage to healthcare systems on the continent that will be hard to repair in the near future.