Curricular transformation of health professions education in Tanzania: The process at Muhimbili University of Health and Allied Sciences (2008–2011)

Abstract

Tanzania requires more health professionals equipped to tackle its serious health challenges. When it became an independent university in 2007, Muhimbili University of Health and Allied Sciences (MUHAS) decided to transform its educational offerings to ensure its students practice competently and contribute to improving population health. In 2008, in collaboration with the University of California San Francisco (UCSF), all MUHAS's schools (dentistry, medicine, nursing, pharmacy, and public health and social sciences) and institutes (traditional medicine and allied health sciences) began a university-wide process to revise curricula. Adopting university-wide committee structures, procedures, and a common schedule, MUHAS faculty set out to: (i) identify specific competencies for students to achieve by graduation (in eight domains, six that are inter-professional, hence consistent across schools); (ii) engage stakeholders to understand adequacies and inadequacies of current curricula; and (iii) restructure and revise curricula introducing competencies. The Tanzania Commission for Universities accredited the curricula in September 2011, and faculty started implementation with first-year students in October 2011. We learned that curricular revision of this magnitude requires: a compelling directive for change, designated leadership, resource mobilization inclusion of all stakeholders, clear guiding principles, an iterative plan linking flexible timetables to phases for curriculum development, engagement in skills training for the cultivation of future leaders, and extensive communication.

Appendix

MUHAS common competencies

Upon graduation, all our graduates, in each of their specific fields of endeavor, will be able to demonstrate the following competencies:

Relationships with patients, clients, and communities

• Establish constructive relationships and communicate effectively with patients, clients, and/or communities in order to address needs and preferences.

• Provide service appropriate to the varying backgrounds of different individuals and groups.

• Communicate health concerns and polices effectively to the public.

Relationships with colleagues

• Receive and incorporate advice from colleagues.

• Motivate colleagues.

• Contribute effectively to team goals.

• Work effectively with other health professionals.

Teaching skills

• Prepare and deliver effective health promotion messages to communities.

• Teach a course for health professionals or students.

Maintaining good practice

• Systematically evaluate one's own performance and practice.

• Regularly seek information necessary to improve professional practice (lifelong learning).

• Apply evidence-based decision making.

• Participate in applied research activities.

• Use information technology to optimize learning.

• Show leadership and managerial skills.

Working within the system and context of health care

• Show knowledge of how the health-care system functions (structures, policies, regulations, standards, and guidelines).

• Work effectively in various health-care delivery settings and systems (hospitals, government, ministries, NGOs, communities, and industry).

• Coordinate and implement health service delivery and health interventions within the health-care system.

• Incorporate considerations of cost-effectiveness into health service delivery.

• Incorporate considerations of patient cost burden into health service delivery.

• Promote quality care in health systems through audits, accreditations, and/or evaluations.

• Identify system challenges and implement potential solutions.

Professionalism

• Maintain ethical standards (confidentiality, informed consent, and avoiding practice errors and conflicts of interest).

• Apply entrepreneurial skills for advancement of practice and the profession.

• Show sensitivity and responsiveness to diversity (culture, age, socioeconomic status, gender, religion, disability etc).

• Show respect, compassion, and integrity while interacting with patients, clients, communities, and health professionals.

• Advocate and implement fair distribution of health-care resources in Tanzania.

MUHAS professional competencies

Upon graduation all our graduates in dentistry, in addition to achieving the MUHAS common competencies, will be able to:

Professional knowledge

• Employ knowledge of the structure and functions of the human body in the management of oral-facial diseases.

• Employ knowledge of the causes and mechanisms of diseases to manage congenital and acquired conditions of the oral-facial region.

• Employ knowledge of physical, psychological, and sociocultural factors in the causation and progression of diseases in order to plan an approach to prevent and manage common oral health challenges.

• Employ knowledge of clinical reasoning to solve oral-facial clinical problems.

• Employ knowledge of pathophysiology of communicable diseases prevalent in Tanzania in order to diagnose and manage patients with, for example, HIV, AIDS, and oral-facial infections.

• Employ knowledge of pathophysiology of non-communicable diseases prevalent in Tanzania in order to diagnose and manage patients with oral-facial problems.

• Employ knowledge of conditions and emergencies common to Tanzania that require oral surgery in order to manage patients with oral-facial trauma and other hard- and soft-tissue conditions.

• Employ knowledge of common childhood oral-facial conditions in Tanzania in order to appropriately manage childhood oral-facial diseases.

Practical/clinical skills

• Gather complete and focused histories in an organized manner appropriate to the clinical situation and patient or relative's ability to understand.

• Conduct complete oral-facial and relevant physical examination in a systematic manner.

• Document the findings in an organized and comprehensive manner.

• Formulate and prioritize correct and appropriate plans for patient management.

• Use and maintain dental instruments and equipment.

• Perform common oral-facial procedures in a manner that minimizes patients’ pain associated with procedures.

• Follow universal precautions and sterile technique.

• Anticipate patients’ needs, provide appropriate patient care, participate in discharge planning, and create individualized disease management and/or prevention plans including patient self-management and behavior change.

• Demonstrate confidence and comfort with the primary provider role and the provision of longitudinal care.

Upon graduation, all our graduates in environmental health sciences, in addition to achieving the MUHAS common competencies, will be able to:

Professional knowledge

• Employ knowledge of environmental and occupational health to promote public health and prevent diseases and ill conditions.

• Employ knowledge of the causes and pathophysiology of animal-food-related illness to manage epizoonotic diseases.

• Employ knowledge of physical, psychological, and sociocultural factors in the causation and progression of diseases in order to plan an approach to prevent and manage common health challenges.

• Employ knowledge of environmental health reasoning to solve public problems.

• Employ knowledge of pathophysiology of communicable diseases prevalent in Tanzania to manage community health programs for the prevention and treatment of, for example, HIV and AIDS, malaria, TB, cholera, and water- and sanitation-related diseases.

• Employ knowledge of pathophysiology of non-communicable diseases prevalent in Tanzania in order to manage public health programs for the prevention and treatment of, for example, diabetes, heart diseases, and cancer.

• Employ knowledge of common food hygiene and safety for port-of-entry and other food stores for the safety of the population.

• Employ knowledge of research and epidemiological methods so as to be able to conduct research on public health issues.

• Employ knowledge on urban settlement patterns to solve problems of people in the slums and growing towns so as to safeguard the public health.

Practical/clinical skills

• Gather complete and focused histories in an organized manner appropriate to particular workplace situations, for example, for the safeguarding of public safety.

• Conduct complete and relevant physical examination and inspection of environmental stressors in a systematic manner.

• Document findings in an organized and comprehensive manner.

• Formulate and prioritize correct and appropriate plans for public health management.

• Perform common environmental impact assessment procedures and create proper environmental impact statements.

• Follow universal precautions and aseptic conditions during food- and water-quality management.

• Anticipate a community's needs, provide appropriate public care, participate in hazards mapping for the prevention of diseases and adverse conditions among the population.

• Demonstrate confidence and comfort with the prevention of health and safety dangers for workers at different workplaces for sustainable public health.

Upon graduation, all our graduates in medical laboratory sciences, in addition to achieving the MUHAS common competencies, will be able to:

Professional knowledge

• Apply the principles and clinical significances of advanced tests.

• Improve the laboratory-working environment by applying knowledge and skills acquired during the training.

• Improve the quality of laboratory services rendered to the society.

• Apply established safety laboratory rules.

• Assess factors that affect procedures and results and take appropriate action within predetermined limits.

• Correlate laboratory findings with clinical conditions.

• Apply problem-solving strategies to administrative, technical, and research duties at various levels.

• Design laboratory-based and community-oriented research in collaboration with others.

Practical/clinical skills

• Perform routine clinical laboratory tests.

• Interpret laboratory results of the tests.

• Manage laboratory equipment and instruments.

• Adhere to good laboratory practice.

• Demonstrate leadership and management ability.

• Implement laboratory quality management system.

Upon graduation, all our graduates in medicine, in addition to achieving the MUHAS common competencies, will be able to:

Professional knowledge

• Employ knowledge of the structure and functions of the human body in the management of diseases.

• Employ knowledge of the causes and pathophysiology of diseases to manage diseases.

• Employ knowledge of physical, psychological, and sociocultural factors in the causation and progression of diseases in order to plan an approach to prevent and manage common health challenges.

• Employ knowledge of clinical reasoning to solve clinical problems.

• Employ knowledge of pathophysiology of communicable diseases prevalent in Tanzania in order to diagnose and manage patients with, for example, HIV and AIDS, malaria, TB, and cholera.

• Employ knowledge of pathophysiology of non-communicable diseases prevalent in Tanzania in order to diagnose and manage patients with, for example, diabetes, heart diseases, or cancer.

• Employ knowledge of common surgical conditions prevalent in Tanzania for management of patients with, for example, tropical ulcer, hernia, or hydrocele.

• Employ knowledge of common obstetrics and gynecology conditions in Tanzania for management of patients with, for example, prolonged labor, abruptio placenta, or postpartum hemorrhage.

Practical/clinical skills

• Gather complete and focused histories in an organized manner, appropriate to the clinical situation and patient or relative's ability to understand.

• Conduct complete and relevant physical examination in a systematic manner.

• Document findings in an organized and comprehensive manner.

• Formulate and prioritize correct and appropriate plans for patient management.

• Perform common procedures and employ practices to minimize patients’ pain associated with procedures.

• Follow universal precautions and sterile technique.

• Anticipate patients’ needs, provide appropriate patient care, participate in discharge planning, and create individualized disease management and/or prevention plans including patient self-management and behavior change.

• Show confidence and comfort with the primary provider role and the provision of longitudinal care.

Upon graduation, all our graduates in nursing, in addition to achieving the MUHAS common competencies, will be able to:

Professional knowledge

• Employ knowledge of the structure and functions of the human body, nursing principles, and the scientific concepts necessary to provide competent nursing care.

• Employ knowledge of the causes and mechanisms of disease, as well as the application of evidence-based knowledge, in order to provide nursing care.

• Employ knowledge of physical, psychological, and sociocultural factors in the causation and progression of diseases to plan an approach in order to prevent and manage common health challenges.

• Employ knowledge of clinical practice, critical reasoning, and reflection in order to solve nursing problems in Tanzania.

• Employ knowledge of mechanisms of communicable diseases prevalent in Tanzania and provide appropriate nursing care.

• Employ knowledge of mechanisms of non-communicable diseases prevalent in Tanzania to provide relevant nursing care.

• Employ knowledge of appropriate nursing care for conditions common to Tanzania requiring surgery.

• Employ knowledge of obstetrics and gynecology conditions prevalent in Tanzania in order to provide care of patients with, for example, prolonged labor, abruptio placenta, postpartum hemorrhage, and eclampsia.

Practical/clinical skills

• Gather complete and focused patient information in an organized manner appropriate to the clinical situation and patient or relative's ability to understand.

• Conduct complete and relevant nursing assessment in a systematic manner.

• Document nursing findings in an organized and comprehensive manner.

• Formulate and prioritize correct and appropriate plans for patients’ nursing care.

• Perform common procedures and act to minimize patients’ pain associated with procedures.

• Employ universal precautions in infection-control procedures during the provision of care.

• Anticipate patients’ needs, provide appropriate patient care, participate in discharge planning, and create individualized nursing and/or prevention plans including patient self-management and behavior change.

• Show confidence and comfort with the primary provider role and the provision of longitudinal nursing care.

Upon graduation, all our graduates in pharmacy, in addition to achieving the MUHAS common competencies, will be able to:

Professional knowledge

• Employ knowledge of the structure and functions of the human body in pharmacotherapy.

• Employ knowledge of chemical composition, structure, and properties of therapeutic substances in the treatment of diseases.

• Employ knowledge of drug interactions, drug incompatibility, side effects, toxicity profiles, and antimicrobial susceptibility patterns in the appropriate selection of treatment regimens.

• Employ knowledge of clinical reasoning to solve clinical problems.

• Employ knowledge of mechanisms of communicable diseases prevalent in Tanzania in order to advise on treatment, control, and prevention.

• Employ knowledge of mechanisms of non-communicable diseases prevalent in Tanzania in order to advise on treatment, control, and prevention.

• Employ knowledge of drug and food interactions and drug incompatibility to counsel patients on adverse drug reactions and food-drug interactions.

Practical/clinical skills

• Formulate, compound, and dispense medications as prescribed.

• Review prescriptions to assure accuracy, to evaluate their suitability, and to ascertain the needed ingredients.

• Maintain records, such as pharmacy files, patient profiles, charge system files, inventories, control records for radioactive nuclei, and registries of poisons, narcotics, and controlled drugs.

• Assess the identity, strength, and purity of medications.

• Monitor and evaluate quality assurance system and implement WHO/GMP in drug industry.

• Follow universal precautions and sterile technique.

• Competently handle procurement, drug distribution and storage.

• Plan, manage, and evaluate retail and wholesale pharmacies and small- and large-scale pharmaceuticals production.