Assessment of a complementary curricular strategy for training South African physicians in a Cuban medical university.

INTRODUCTION One reason given by the South African government for establishing a physician training agreement with Cuba is that the ethical, humanistic and solidarity principles promoted in Cuban medical education are difficult to acquire in other settings. However, Cuba's general medical training program does not provide all skills needed by a general practitioner in South Africa: other competencies are required, such as management of general and gynecological or obstetrical surgical emergencies, administration of anesthesia and nursing procedures. As long as the desired humanistic values were assured, South African authorities have preferred to complement these competencies. Thus, since 2003, the Medical University of Villa Clara has applied a curricular strategy of 12 complementary courses to develop the requested additional skills, but results have not met expectations. OBJECTIVE Determine why the complementary curricular strategy has not been entirely successful and identify possible courses of action for improvement. METHODS A document review was conducted of the curricular strategy applied and of minutes of meetings between Cuban and South African counterparts to identify correspondence between requested professional skills and actions to develop them. In addition, South African students were surveyed and Cuban professors were interviewed in depth. Senior university administrators and key informants were also interviewed. Variables assessed were course quality and satisfaction of students and professors. RESULTS Some actions originally included in the curricular strategy were not implemented and there were structural weaknesses in complementary courses, primarily in objectives, teaching strategy and evaluation. Students reported insufficient practical activities and lack of relationship between content and the health situation in South Africa. Professors were dissatisfied with student levels of motivation and ability to manage their own learning. Other influencing factors were insufficient academic management and professors' lack of knowledge about the context where these future professionals would eventually practice. CONCLUSIONS Curricular strategy deficiencies detected are primarily in academic management; overcoming them could facilitate action in specific directions identified to improve the requested skill levels.