Structured Elective Placements in Graduate Medical Education: A Novel Approach to Increasing Posttraining Opportunities in Africa

Setting and Problem

Elective placement allows learners to pursue a topic of interest of their choice, with the intent of broadening their education.¹ During the placement, students spend time in a work setting outside the university or their activities are focused on specific content of their choice. Although work placement increases the employability of undergraduate students,² there is limited data on its benefit for graduate students. At Makerere University, in Kampala, Uganda, the Department of Paediatrics and Child Health in the College of Health Sciences offers a Master of Medicine degree (MMed) in pediatrics and child health, where an elective placement is a component of the curriculum.³ Individuals with a MMed (pediatrics and child health) degree typically practice in pediatrics or child health after graduation. Individuals accepted into the program often worked in the health care sector prior to matriculating into the program.

Innovative approaches are needed for elective placement to be beneficial to trainees, given that the majority of MMed students were employed in health care settings prior to their admission into the program.

Intervention

The elective placement in the MMed (pediatrics and child health) program is structured as a formal course with a coordinator. The course has 5 objectives: (1) enable students to get hands-on experience in settings they will work in after graduation; (2) provide an opportunity for students to apply in practice the principles and techniques theoretically learned; (3) provide opportunities for students and academic staff to interact with potential employers, which also facilitates review of the MMed curriculum; (4) develop students' understanding of the demands, responsibilities, and opportunities of employment; and (5) strengthen collaboration with Makerere University. The 4-week elective placement is at a facility of the student's choice either in Uganda or outside the country. Students are advised to choose among the following areas: clinical care, administration, research, and medical education. In addition, Department of Paediatrics and Child Health faculty set up collaborations with higher income nations aimed at exposing the students to child health in a different setting. The host institution selects a supervisor for the student during the placement, who assesses using a form provided by the department. The department also allocates a local supervisor to keep in touch with the student and, when possible, visit the student to ensure the objectives of the placement are achieved. At the end of the placement, the student writes a report on their experience using a template provided by the department. This report contributes 60% and the host supervisor's assessment contributes 40% of the final grade.³

Outcomes to Date

From the students' reports and their subsequent choices of career and work location after graduation, these structured elective placements are highly beneficial. Several students have found employment in places of their earlier elective placements or at similar institutions. A number of those with placements in higher income nations have undertaken subspecialty training in areas such as endocrinology, cardiology, nephrology, and hematology/oncology, with some going back to the host institutions of their placements for subspecialty training. Many have been retained in the Department of Paediatrics and Child Health at Makerere University, strengthening the institution's training capacity. Others have successfully competed for research grants and scholarships, including US National Institutes of Health Fogarty fellowships.⁴

From 2015 through 2017, 44 students, all with clinical jobs prior to admission to the MMed program, completed elective placements in the following areas: clinical care (n = 18), administration (n = 15), research (n = 9), and high-income country placements (n = 2). After graduation, 32 have clinical appointments, 3 are undertaking subspecialty or research fellowships, 3 are administrators, 3 have faculty positions, 2 have research jobs, and 1 is completing a PhD.

The placement program also has generated new institutional collaborations for training and research for Makerere University, and has strengthened existing ones. Given that Makerere University receives students for its MMed degree from all over Africa, the opportunities for these structured elective placements make a contribution to child health throughout the continent.