Rationale

In 1995, Uganda boasted just 2 medical schools, Makerere and Mbarara. One hundred fifty physicians were trained per year for a population of >20 million. Limited residency positions were available at Makerere University; there were no fellowship positions in the country. McMaster University’s Health Sciences Faculty began visiting Uganda to teach, positively impacting postgraduate and faculty education at the 2 Ugandan medical schools. By 2000, specialty medical training and capacity building were identified as priorities at Mbarara and Makerere Schools of Medicine.

It was mutually determined that the exposure of Ugandan graduate medical trainees to the Canadian way of providing health care could also change the attitude of these young physicians, improve health care delivery in Uganda, and help change the Ugandan health care system for the better. Hematology training was identified as an initial program of interest at the time the program was initiated.

Program objectives

  1. Educate the next generation of postgraduate health care providers in Uganda.

  2. Increase networking capacity between Ugandan universities and McMaster University (Hamilton, Ontario Canada).

  3. Establish required partnerships to make the program succeed.

  4. Establish long-term collaborative links between hematologists in Uganda and Canada

Collaborative process

  1. Develop mutually satisfactory goals and objectives.

  2. Establish formal agreements for program governance.

  3. Appoint program coordinators representing both parties.

  4. Formalize an evaluation process.

  5. Build sustainable links for mentorship and clinical queries between McMaster University and Uganda.

Collaboration’s activities

  1. Provision of hands-on bedside and procedural training for Ugandan fellows and residents at McMaster University.

  2. Development of subspecialty expertise and clinical leadership among Ugandan physicians.

  3. Regular teaching visits to Uganda by McMaster University faculty for teaching, program assessment, and planning.

Timeline

  • 1995: McMaster University and the IOP visit Makerere University to investigate and initiate a collaborative educational program.

  • 1997: McMaster University Faculty of Health Sciences members visit Makerere University to teach; this becomes the first of many such visits.

  • 1999: First Ugandan trainee travels to McMaster University as a “pilot”: Francis Ssali (hematology)

  • 2000: Formal MOU signed by McMaster, Makerere, and Mbarara Universities: framework for trainee exchange established.

  • 2001: Formal resident exchange begins: Stephen Ttendo (anesthesia) from Mbarara University and Kenneth Opio (medicine) from Makerere University.

  • 2012: Side by Side Conference: redefined priorities of the collaboration as clinical fellow training.

  • 2015 to 2017: 12 clinical fellows complete training; formal evaluation launched.

  • 1999 to 2017: More than 90 Ugandan internal medicine physicians have trained at McMaster University, including all 4 of the hematologists currently practicing in the country.

Program evaluation

  • Quantitative review of trainees completing the exchange program (Table 1).

  • Mixed-method survey of returning graduates (Figure 1A-B).

  • Comprehensive evaluation of graduates’ impact in their home country (in development).

Table 1.

Quantitative trainee review

DatesResidentsFellowsTotal
2000-2004 15 17 
2005-2009 26 33 
2010-2014 14 20 
2015-2017 10 12 22 
Total 65 27 92 
DatesResidentsFellowsTotal
2000-2004 15 17 
2005-2009 26 33 
2010-2014 14 20 
2015-2017 10 12 22 
Total 65 27 92 
Figure 1.

Mixed-method survey results.

Figure 1.

Mixed-method survey results.

Trainees: strengths

  • “Generosityy of the sponsors.”

  • “Attachment to mentors within elective discipline.”

  • “The ability to have hands-on experience during the rotation with full registration.”

  • “The huge respect they show for our abilities; the effort put into providing us with diverse experiences.”

  • “The technology.”

  • “Regular visits by the program overseers to Uganda.”

Trainees: challenges

  • “The extremely cold weather, unfamiliar heavy clothing, and the food.”

  • “Making prescriptions using the vast trade names on the Canadian market.”

  • “Understanding people’s ways/culture.”

  • “Transport system—buses and trains.”

Program highlights

Graduates are effective in their home country:

  • 96% of graduates from the exchange program remain hard at work in their country of origin.

  • More than two-thirds participate in medical education; more than one-third in hospital administration or leadership.

The program exemplifies constructive collaboration: Makerere and Mbarara Universities in Uganda; McMaster University, the International Outreach Program, and St. Joseph's Health System in Canada.

Priorities are rooted in the training, procedural, administrative, and research needs of Ugandans, with training tailored to help them meet specific objectives.

McMaster University programs provide hands-on training, networking, and research opportunities, which graduates carry with them back to Uganda.

At least annual visits to Uganda by McMaster University–based coordinators and leaders of the program continually complement the Canadian-based component of training.

Ongoing “real-time” clinical and educational interactions strengthen the collaboration between McMaster University and our Uganda colleagues.

Conclusions

  • Program must be driven by “in-country” needs assessment, and growth must reflect the demands of the recipient country coupled with the capacity of the host program.

  • Regular liaison visits are critical to the sustainability of the program.

  • Coordinators representing both parties are essential.

  • Program must be built with sustainability in mind.

  • Open communication; honest feedback and learning from every success and failure.

  • Next steps: expand collaboration to other medical schools and develop additional research capacity.

Conflict-of-interest disclosure: M.C.: Alexion (speakers' bureau), Bayer (membership on an entity's Board of Directors or advisory committees), Bayer (speakers' bureau, research Funding), Boehringer Ingelheim (speakers' bureau), Leo Pharma (research funding), Pfizer (honoraria), Portola (consultancy), Shinogi (consultancy). The remaining authors declare no competing financial interests.

Correspondence: H. Ddungu, Uganda Cancer Institute, Hutchinson Center Cancer Alliance, Upper Mulago Hill Rd, P.O. Box 3935, Kampala, Uganda; e-mail: hddungu@gmail.com.