1. Blueprinting a new medical school:
The challenge offered by the Nelson
Mandela Metropolitan University,
South Africa
Ian Couper*, Steve Reid, Richard Cooke,
Julia Blitz, Zuki Zingela
*Centre for Rural Health, University of the Witwatersrand
and Visiting Academic, Monash School of Rural Health
2. Presenter
Disclosure
I have no conflict of
interest to disclose
I have received funding from
Monash University School of
Rural Health for this trip.
3. Background
• Strategic decision by the Nelson Mandela Metropolitan
University (NMMU): plan towards establishing a
medical school based in Port Elizabeth (PE) in the
Eastern Cape Province, South Africa.
• External Expert Reference Group (ERG) was appointed
to assist NMMU by developing a blueprint for a new
medical school that should be socially accountable and
innovative, using a model that is appropriate to the
South African context in general and the Eastern Cape
specifically.
4. Task of the ERG
• Convened in August 2013 in order to “provide a
succinct blueprint that delineates the proposed
new medical programme sufficiently to help
define a fund raising strategy, inform key
stakeholder discussions and agreements as well
as act as a starting point to the development of a
comprehensive business plan for the envisaged
programme”.
• Members selected with a strong background in
health professions education for rural and
underserved areas
– Experienced clinical academic leaders
5. Context: SA
• South Africa:
– Shortage of doctors
– Currently producing about 1200 doctors per year
– NDOH target is 3.66 generalist doctors per 10 000
population in public service (compared to 22.2 in the
UK and 17.6 in Brazil)
• Shortfall = over 4 000
– National Human Resources for Health Strategy for the
Health Sector in South Africa 2012/13-2016/17: by
2025, plan to enrol 2200 medical graduates per year
6. Context: SA vs Global
• Relationship between medical school density
and doctor density (2007 figures):
– Europe: one medical school per 1.9 million
inhabitants; dr density of 3.4/1000
– Africa: one medical school per 6.9 million
inhabitants; dr density of 0.26/1000
– South Africa: 8 medical schools = 1 per 6.4
million; dr density 0.77/1000
• NHI: who will provide the care?
7. Context: Eastern Cape
• 25 medical practitioners per 100,000 population
compared to a national average of 30
• 3.8 medical specialists compared to a national
average of 11
• Of the 1200 new doctors produced in 2012 in SA,
103 were produced in EC (through WSU)
– lowest number of new doctors produced per province
vs 3rd largest population
• PE is 5th largest city in SA
– Top 4 cities each have at least one medical school
8. ERG process
• Visits
– Discussions with internal and external stakeholders
– Visits to possible training sites, including meetings
with management and clinicians
– Engagement with faculty leadership, academics and
support staff
– Engagement with university leadership and relevant
programmes/centres
• Literature review
• International reference group meeting
9. Recommendations
• Underlying foundations
• Set of 14 principles as a basis for the blueprint
• Proposed programmes
• Strategic issues
Focus of this presentation is the principles
11. Foundations
Vision
• An innovative medical programme training
competent, accountable health professionals
with a transformative, primary health care
based approach to address the health needs
of the Eastern Cape and beyond.
12. Set of principles
Social Accountability
and Community
Engagement
Competent
caring
clinicians
with broad
skills
Excellence in
educational practice
Promotion
of access
and
diversity
13. Principles
1. Social accountability and community
engagement
– Social accountability: serving a defined reference
population
– Community engagement, in teaching, learning,
selection, curriculum development, etc.
– Primary Health Care as the foundation of the
curriculum
– A systems understanding in teaching, learning and
service
14. Principles
2. Producing competent caring clinicians with
broad skills
– Community-based and distributed learning in a range
of different health facilities and communities
– Integration of theory and practice, with early clinical
exposure and longitudinal continuity of relationships
– A biopsychosocial model of health care with a focus on
generalism and multidisciplinary teams
– A person-centred approach in relation to patients and
students
15. Principles
3. Excellence in educational practice
– Inter-professional education, with structured,
practice-based collaborative learning
– Transformative learning, to produce change
agents through service learning and competency-based
training.
– Dedication to enquiry, evidence-based practice
and ongoing learning, amongst teachers and
students.
16. Principles
4. Promotion of access and diversity
– multiple entry and exit levels into a range of degree
programmes
– targeted admission policies to focus on key groups
17. Proposed programmes
1. Bachelor of Public Health or Health Sciences
(or equivalent).
2. Bachelor of Clinical Medical Practice (to train
Clinical Associates).
3. A graduate entry Bachelor of Medicine and
Bachelor of Surgery degree.
4. A Masters in Public Health degree.
18. The sandwich approach
2. Cuban trained medical students;
WSU collaboration
(Developing the academic clinical platform)
3. The GEMP
1. Generic health science curricula;
foundational degree;
BCMP
19. Key Strategic Issues
• Development of a vision
• Ensuring access for students from disadvantaged
schools
• Integration of curricula across academic
disciplines
• Establishing a new school in the faculty
• Engagement with key decision makers
• Community consultation
• Communication, marketing and lobbying strategy
20. Difficult conversations
• The likelihood of a medical programme: journey
can be started without it
• Political engagement: need politicians on board
• NDOH: will a clear direction be given?
• Being outliers: safer to go the traditional route
• Teaching old docs new tricks: identifying the
change agents
• Statutory councils: dealing with professional
bureaucracy and entrenched interests
• Role of WSU: collaboration essential
21. Way forward
• Report submitted and presented
– Well-received by Management and Council of
NMMU
– Work plan and budget requested from Faculty of
Health Sciences
• Faculty of Heath Sciences:
– Has started integrating courses in first year
– Is planning for the Clinical Associates
– Has requested to meet with ERG again.
