It is only a few years since Makerere University introduced major changes in the way it teaches medical students but the development has caused serious concern among parents, former students and other stakeholders.

While at a recent function, Ambassador Alphonse Oseku, a senior citizen and a former Ugandan envoy to Geneva [Switzerland] expressed worry about what he called a 'time bomb' in reference to the recent changes in the way future doctors, nurses and pharmacists are being trained.

Ambassador Oseku particularly attacked what he called a shift from the traditional way of teaching where lecturers stand before students in a class every day to the now adopted system of encouraging students to search for knowledge on their own, including from things like books, the internet or photocopied material or 'handouts' as they are popularly known among university students. He said his views are shared by some people in the ministry of health.

Oseku said: "Something has got to be done about medical training at Makerere. You cannot teach a doctor through handouts. This is s disaster in the making,
"There are no lecturers. Students come from high school and are simply told to go and read handouts. You cannot tell someone who is going to be a medical doctor to simply read handouts," Ambassador Oseku went on to reminisce about Makerere's glorious past which many agree was earned because the institution achieved very high standards of excellence on the African continent.

Because of those concerns, Oseku, is agonizing over whether he should allow his daughter who was admitted to the medical school, recently renamed the college of health sciences, to study to become a doctor.

However, a visit by The Sunrise to the School of Medicine at Mulago, indicates that while indeed dramatic reforms have been introduced, they are in many ways misperceived by  members of the public like Ambassador Oseku.

Dr. Stephen Kijjambu, the Dean of the School of Medicine at Makerere's College of Health Sciences in Mulago, told The Sunrise that major changes were made some eight years that greatly transformed the way aspiring doctors were being taught.

Kijjambu explained that after more than 80 years, the medical school changed from the old teacher-centered model of learning and adopted a new model that put students at the centre stage of the learning process. The So-called SPICES model was adopted. The synonym stands for; (S) Student-centered, (P) Problem-based, (I) Integration, ( c) Community based education, (E) electives, Systematic learning.

It was a break away from the traditional British style model that perhaps many people in Uganda are used to and had come to appreciate as the best way of teaching.

Kijjambu noted that the transformation was inspired by ground-breaking research in education that was championed by the University of McMaster in Canada. Apart from the persuasive findings by Macmaster scholars, Kijjambu adds that a thorough study by the then faculty of medicine was carried out to assess the views of the stakeholders.

"We undertook a study in which we consulted all major stakeholders. Our findings showed that training is best when emphasis is shifted from the teacher teaching to the student being assisted to learn," Kijjambu added.

Having secured the backing of stakeholders, the school embarked on the reforms in 2003.
Some notable aspects of the new arrangement, Kijjambu notes, included the introduction of the Overview Lecture, a three-hour session in which a number of lecturers stand in-front of the students to give an overview of a particular problem.

Students are then given a period of about one week to research, discuss their findings in a tutorial group and make presentations to the class.

As Kijjambu explained, the overview lecture brings about several new aspects into the learning process, including the integrated nature of the courses but also a shift from a teacher-centered to student-centered teaching.

"In the past, different subjects such as human anatomy or the cardio-vascular system would be taught by different people in different semesters. But the body does not function like that. The body is an integrated whole,[hence the interdisciplinary approach]" Kijjambu notes.

In addition, whereas first and second year students were previously not allowed to go to wards, under the new learning process, students enter patient wards in their first year.
"You don't learn anatomy and leave it there.

You're exposed to it," Kijjambu adds that the level of exposure increases as a student becomes more knowledgeable. Third and fourth year students for example have 6 hours of clinical or ward-experience, twice an many hours allowed for 1st and 2nd year students.

But because of their little knowledge, the 1st and 2nd years only communicate with the patients through the qualified clinicians who may be on duty in a particular ward.

Community service
While community service was a feature in the previous training exercise, Kijjambu notes it never used to be seriously considered by either the students or the lecturers.

Now, students are required to perform 3-6 weeks of community service where they support health personnel especially in under-served rural areas to carry out immunization, health education as well as visits to households to sensitize communities on basic hygiene.

Kijjambu may perhaps be accused of blowing his own trumpet, but he notes that the students' failure rate has dramatically reduced since the introduction of the new system.
" We have had a lot of impact with community-based service. During the time when the students are in the field, attendance at health centers is higher than at other times," he adds.

Because of the longer and more active sessions students get while interacting with community patients, Kijjambu says that they have begun to experience more positive changes in attitudes among fresh graduates with more of them increasingly getting interested in working with communities they were once part of as students.

The dean says that in 2008, they carried out a review of the changes and found that the SPICES model was the best in the region. But the don acknowledges concerns expressed by many in the medical fraternity that despite close to 100 years of medical training in east Africa, the region still experiences poor health indicators such as high levels of maternal mortality and poor hygiene. blog comments powered by Disqus

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