Botswana’s first attempt at producing locally trained doctors faces the risk of collapsing owing to areas of significant risks to the programme, says Professor Sam Leinster, a consultant engaged to evaluate the University of Botswana School of Medicine.
In a hard-hitting report to the Botswana Health Professions Council, Professor Leinster, who is making recommendations on how to enhance the quality of the School, said the decision-making structure of the School of Medicine is unclear. He has recommended that immediate action must be taken to formalise and publish the School’s committee structures to make administration more responsive.
“There is a distinct impression that the School Medicine management is continually in reactive mode. The school has faced a number of serious challenges and of necessity has had to resort to crisis management. Other than the defining of work-streams for the High Ranking Committee there does not appear to have been any structured approach to project management,” he said.
Professor Leinster said that the School needs a stronger professional administration if it is to run effectively.
“The establishment for administrators is four posts but only two are currently filled,” he observed.
He said as is good practice, it is important that roles and responsibilities of each administrator are clearly defined.
The consultant has also recommended that there should be a senior administrator who is responsible for ensuring that all of the governance procedures and administrative tasks are undertaken in a timely manner.
With regard to School curriculum, Professor Leinster said “the documentation for phase 2 does not reach the high standards of the documentation for staff and students for phase 1.”
He added that urgent action must be taken to ensure that the phase 2 documentation meets those standards.
“It is a matter of serious concern that the committee is still debating the details of the document when the first cohort of students is already one year into phase 2.”
He said learning outcomes for each clinical placement should be decided and agreed prior to students commencing their attachments.
He added that students and staff should have a clear understanding of what is expected of each student in terms of attendance, behavior, activities and learning.
“I understand that the outcomes have been agreed but are awaiting formal approval. However, meetings with clinical instructors who were expecting students suggested that they did not have a clear understanding of what is expected of the students. Implementing a core part of the core curriculum before formal approval has been received is unacceptable in terms of quality management and governance.”
The professor has further recommended that the University of Botswana School of Medicine should set up a committee with the primary responsibility of regularly reviewing the effectiveness of the admissions policy.
“Studying medicine is stressful for even the best students and a strong student support system is essential. The system described in the documents is excellent but does not appear to be working in practice. The staff believes that every student has a personal tutor, but the students are apparently entirely unaware of this.”
He has also recommended that as major stakeholders, students should be represented adequately on committees at all levels of the School and not just on the Board.
“They should be allowed real voice and be equal participants in the committees. The exceptions are the assessment committee and any consideration of confidential matters relating to individual students.”
On the risks faced by the School, Professor Leinster said recruiting of appropriately qualified staff is a big issue.
“There have been problems recruiting staff at all levels, but particularly for the clinical elements of the course. This appears to me to be the major risk to the successful delivery of the programme. The delays in finalizing the curriculum for phase 2, which has been one of the root causes of the student discontent, can be traced directly to the failure to appoint clinicians in the relevant specialties.”
He says while there appears to be a number of factors that have caused this problem, the two most important are the University’s criteria for appointment of academic staff and the compensation differential between the ministry of health clinicians and the UB clinicians of equivalent grade.
“The University must recognize that it is competing for clinical staff in a global market and market forces prevail. An urgent solution to these problems must be found. It is increasingly being recognized that market forces mean that if quality candidates are to be attracted to academic posts then the compensation package must be at least equivalent to their peers in the MOH. A system of appropriate allowances must be developed to permit this to happen.”