Output in emergency care: PhD programmes should be fixed

No studies on doctoral education in African emergency medicine were found between 2011 and 2021. This is likely due to the nascency of the discipline in Africa and resonates with the other barriers to the success of African doctoral programmes.

This was the main outcome of a study titled, ‘Emergency medicine doctoral education in Africa: A scoping review of the published literature’, that appeared in the journal BMC Medical Education on 25 April 2023.

Wesley Craig from the University of Cape Town in South Africa authored the study together with colleagues Waseela Khan and Willem Stassen, and Sanjeev Rambharose from Stellenbosch University, also in South Africa.

“While Africa accounts for a significant proportion of the world population and disease and injury burden, it produces less than 1% of the total research output within the emergency care field,” the authors state.

PhD students should be upskilled

“One clear way to expand emergency care research capacity and education in Africa is through the development of well-organised doctoral programmes that do not simply focus on the completion of the doctoral thesis or research, but also aim to support and upskill the PhD student into an independent scholar through dedicated support and structured learning as integral elements within a responsive curriculum,” the authors point out.

One of the first logical steps toward developing an African emergency medicine doctoral curriculum is to understand the full scope of doctoral education curricula and frameworks already operating within Africa.

To do that, a scoping review was conducted to identify literature published between 2011 and 2021 related to the topic. Failing to find any, the researchers had to broaden the search to include doctoral education in the wider field of health sciences. Following the expanded search, a total of 235 articles were identified, and 27 articles were included in the study.

Barriers to success

“The lack of publications related to emergency medicine doctoral education is likely related to the nascency of the discipline in Africa. This is a finding in itself, and it resonates with the other barriers to the success of African doctoral programmes,” the authors point out.

Major domains identified in the literature included specific barriers to PhD success, supervision practices, transformation, collaborative learning and research capacity improvement.

“The continent’s current research incapacity may be influenced by the deficiency in qualified supervisors, poor infrastructure and the unsatisfactory use of telecommunication,” according to the article. Apart from funding constraints, the second-highest cited barrier is the lack of formal research education and training.

Contextual programmes recommended

The authors suggest several ways to strengthen doctoral programmes to improve research capacity. “The completion of novel research should not be the doctoral programme’s only focus, but rather one element of a curriculum framework that focuses on attaining competencies in research knowledge, skill and doctoral attributes in an outcomes-based curriculum design.

“Such a curriculum must transform to value an Africentric culture and identity,” the authors emphasise. To achieve this, the needs and knowledge systems of African people should be considered, and responsive curricula ensured. Simple interventions such as inductions sessions can help new students get used to the complex administrative processes at universities. Environments conducive to meaningful learning are also important.

Doctoral programmes should adopt and enforce gender policies to help alleviate the gender differences noted in PhD completion rates and research publication outputs. The authors further suggest that post-graduate and doctoral supervision experience should be a promotion criterion for clinician researcher career opportunities and motivation. In addition, clinician-researchers should stay in their health provider roles.

International collaboration

PhD programmes should be open to the idea of external supervision, especially when there are opportunities for multidisciplinary engagements. This can improve the capacity of the academic programme while exposing students to applied knowledge generation, essential to strengthening the health system.

“Interdisciplinary collaborations are potential mechanisms to develop well-rounded and independent graduates,” the authors note. African PhD programmes should be cognisant that international collaboration, while essential for capacity improvement, should not undermine opportunities for sustainable research growth within the continent.

“Indiscriminate replication of approaches from high-income countries and universities would be counter-intuitive in creating novel and superior mechanisms for delivering excellent doctoral education on the continent,” the authors state. It is, therefore, crucial to engage in the process of curriculum transformation to provide a framework that defines and guides excellence in doctoral programmes.

“African doctoral programmes should, rather, focus on creating contextual and sustainable ways of delivering excellent doctoral education,” the authors conclude.