Fit for purpose? A review of a medical curriculum and its contribution to strengthening health systems in South Africa

Background: Medical education in the 21st century needs to produce health professionals who can respond to health systems challenges and population health needs. Although research on medical education is increasing, insufficient attention is paid to the outcomes of medical training, in particular graduates’ competencies and the effects of their training on healthcare and population health in Africa.Method: This baseline study assessed whether the current Stellenbosch University medical curriculum enabled graduates to acquire health systems strengthening competencies. The teaching of competencies in public health, evidence-based healthcare, health systems and services research, and infection prevention and control was assessed through a document review of study guides and a survey of recent medical graduates.Results: We found that teaching of most competencies was included in the curriculum, but appeared fragmented with a lack of continuity across phases of the curriculum. Health systems and health leadership and management teaching was weak, and important public health competencies in human rights and health advocacy received little attention. Recent graduates said their training was ‘adequate’, but were unable to apply knowledge and skills to address health systems challenges within working environments. They wanted more integrated, practical, problem-based teaching in environments in which they would one day work, and their teachers to be role models for the competencies students were expected to acquire. This study is contributing to improvements to the medical curriculum at Stellenbosch University