Equipping medical graduates to address health systems challenges in South Africa: An expressed need for curriculum change

Background: Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) aims to enhance health systems knowledge and skills to empower medical graduates to address health systems challenges especially in rural and underserved areas.Objectives: To assess the content of health systems research (HSR) and strengthening, and understand perceptions of medical graduates and faculty about HSR in the undergraduate medical curriculum at Stellenbosch University.Methods: We defined HSR and strengthening competencies for medical graduates through a literature review and expert consultations. Learning outcomes in terms of knowledge, skill or attitude in the 64 module guides of the curriculum were compared with the competencies required. A survey of recent medical graduates assessed whether their training equipped them to address health systems challenges. Interviews with faculty assessed their views on teaching health systems competencies.Results: HSR foundational competencies were covered at a basic knowledge level, with little progression of learning levels, and several key competencies were not taught at all. Teaching was not integrated throughout the curriculum. Of 189 graduates, 63 (33.3%) agreed while 67 (35.4%) disagreed that their training prepared them to address health system challenges; 128 (67.7%) agreed on the importance of learning health systems competencies as undergraduates, and proposed learning areas of health system knowledge, leadership and management, problem solving, community service, evaluation methods and health economics. They wanted more practical, problem-oriented HSR training. Faculty supported the relevance and inclusion of HSR and strengthening in the curriculum.Conclusion: The curriculum needs adaptation to better equip students with HSR and strengthening competencies