Postgraduate training in internal medicine in the Sudan: Current situation and future challenges.

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Ala Eldin Hassan Ahmed


Postgraduate training in internal medicine in the Sudan
started in 1976 under the auspices of the Postgraduate
Medical Board (PGMB), Faculty of Medicine,
University of Khartoum and was continued until
2003. By then 203 postgraduate students qualified as
Because of the establishment of many new medical
schools in the country and in order to unify training the
responsibility of post-graduate medical specialization
was moved to a new institute: the Sudan Medical
Specialization Board (SMSB). The Sudan Medical
Specialization Board started training postgraduate
doctors in internal medicine in the mid 1990s and
graduated the first batch in 1999. To date 241 trainees
graduated from the SMSB as internists. However,
the number of graduates is likely to increase over the
next few years given that the registrars in training
at present are 369. Appointment of registrars for
postgraduate training usually occurs some 3 to 6 years
after graduation from a medical school i.e. after time
spent in internship, national services and sitting and
passing part one examination. Over the last twenty
years the number of medical graduates from Sudanese
medical schools has increased by more than 5-fold and
the curve is as yet to reach a peak.
Therefore, it will
be reasonable to predict that the number of doctors
going through postgraduate training will continue
to increase. There are other factors affecting the
numbers joining the specialty training including the
trend among postgraduate doctors to specialise rather
than remain in general practice and the popularity of
the specialty.
In the past, postgraduate doctors were sent to the
United Kingdom for training, but the available training
appointments for overseas candidates became less in
recent years2 and this, coupled with major changes
in immigration rules, makes it even more difficult for
overseas graduates to find training slots
. For these
reasons, it is likely that most of postgraduate training in
internal medicine will be conducted locally. Concerns
about the state and standards of local training have
repeatedly been voiced by the general assembly of the
Sudan Association of Physicians which recommended
that the Association should look into this. Following
that, a questionnaire was prepared by the author to
survey the trainers and trainees points of view regarding
training. The findings of this survey were presented at
a pre- Association of Physicians conference workshop
in February 2006. These findings were both revealing
and interesting and may be useful to those in charge
of postgraduate medical training for future planning.
The questionnaire was completed anonymously by a
random sample of 37 consultants and 67 registrars.
The areas assessed were: clinical exposure and
supervision and this was measured by registrarbeds
ratio, number of nights on-call, and consultants
availability for ward rounds and referred clinics;
formal tuition and this was measured by number of
tutorials and formal bed side teaching rounds; and
training in interventions relevant to the sub-specialty.
The findings of the survey were not dissimilar for
consultants and registrars and, therefore, the following
results were averaged for both. Half of the registrars
in training were looking after three to seven beds each
and only 18% were looking after 13 beds or more.
Only 57% of the registrars were on-call one day per
week and the rest did less than one-in-seven on call
rota. For those on-call days, 69% of registrars were
residents and the rest were not. Thirty two percent of
the consultants were always available for the ward
rounds and only 18% were always available for the
referred clinics. Regarding formal tuition only 48%
of registrars attended one tutorial cession per week
and only 22% received formal bedside teaching. Only
30% of registrars received training in interventions.
Clearly this survey highlighted many deficiencies in
training in the areas that were investigated. These can
be summarised in that many registrars were competing
for limited training slots resulting in a low registrarbed
ratio and fewer days on-call. Also, consultant
availability and supervision were remarkably low.
There is an urgent need for more training centres
to solve the present shortage. There should also be
a plan to accommodate the predicted increments in
registrar numbers. The Sudan Medical Specialisation
Board has a system in place for selection of a hospital
as a training centre and most of the hospitals which do
not get selected do so because of lack of medical and
teaching facilities such as radiology and laboratory
services. Because of these shortages, these hospitals
are obviously also deficient in delivering satisfactory
health care. There is not a better example that training
and delivery of good health services must go hand
in hand. Improvement in training should be part
of an overall health strategy that aims to improve
delivery of health care. The beneficiary will be the
patient. There is an urgent need for a formal contract
between the Sudan Medical Specialisation Board and
the trainers. This contract should state the duties and
rights clearly.
The outcome of this survey represents what should
be the beginning of a continuous assessment process
of postgraduate medical training. The process should
also include issues such as accreditation, continuous
monitoring and revalidation of training centres.

Article Details

Medical Education


1- Ali Z. How many doctors do we need in Sudan?.
Sudan J Public Health 2006;1(3):180-91.
2- O’Dowd. Non-European doctors feel penalized
by change in UK policy. BMJ 2006;332:744.
3- New immigration rules in UK for international
medical graduates.