Partnering on education for health: Muhimbili University of Health and Allied Sciences and the University of California San Francisco
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In 2005, Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania and the University of California San Francisco (UCSF) in the United States joined to form a partnership across all the schools in our institutions. Although our goal is to address the health workforce crisis in Tanzania, we have gained much as institutions. We review the work undertaken and point out how this education partnership differs from many research collaborations. Important characteristics include: (i) activities grew out of MUHAS's institutional needs, but also benefit UCSF; (ii) working across professions changed the discourse from ‘medical education’ to ‘health professions education’; (iii) challenged by gaps in our respective health-care systems, both institutions chose a new focus, interprofessional team work; (iv) despite being so differently resourced, MUHAS and UCSF seek strategies to address growing class sizes; and (v) we involved a wider range of people – faculty, administrators, students, and residents – at both institutions than is usually the case with research. This partnership has convinced us to exhort other academic leaders in the health arena to seek opportunities together to enlighten and enliven our educational enterprises.
Keywordsglobal health health professions education partnerships workforce Tanzania
Representatives of Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania and the University of California San Francisco (UCSF) in the United States (US) met in 2005 and discussed ways to work together. MUHAS, then a constituent college of the University of Dar es Salaam, was already in transition to become an independent university, and anticipating infrastructure and capacity to address national health priorities and to increase its contributions globally. In 2005, UCSF was forming Global Health Sciences (GHS), a cross-campus initiative to coordinate and raise its institutional contributions to reducing health inequities globally.1 Concerned about the imbalance of health professionals worldwide, particularly in Tanzania, we asked: Can we harness our resources to strengthen the capacity of our institutions to fulfill our missions while jointly addressing the workforce crisis?
As leaders in educating health professionals in our respective countries, and because MUHAS was preparing to review and revise its undergraduate and postgraduate curricula, MUHAS and UCSF decided to focus the partnership primarily on education. A hallmark of the collaboration is its uniquely interprofessional character. We describe the partnership and some of what we began to learn about using such a relationship to enrich health professions education, aligning it more closely with the overriding challenge to improve health worldwide.
Introducing MUHAS and UCSF
MUHAS and UCSF are both health sciences campuses with similar missions but with vastly different resources available to them. MUHAS, starting out as the Dar es Salaam School of Medicine in 1963, separated from the University of Dar es Salaam to gain its charter in 2007.2 MUHAS prepares health professionals and allied health workers, and undertakes research in its schools of dentistry, medicine, nursing, pharmacy, and public health and social sciences, and institutes of traditional medicine and allied health sciences. With about 300 faculty members, MUHAS has 2695 registered students (19 PhD, 404 postgraduate, 1437 undergraduate, and 835 diploma students). Up to 500 students graduate from the university annually.3
UCSF, founded in 1873, is one of 10 campuses of the public University of California; UCSF prepares health professionals in its schools of dentistry, medicine, nursing, pharmacy, a graduate division and numerous institutes. As UCSF does not have a school of public health, the project called on faculty across schools with expertise in public health, particularly from its school of medicine's department of epidemiology and biostatistics. With about 2400 faculty members, UCSF has approximately 2940 students enrolled in degree programs, 1620 residents (physicians, dentists, and pharmacists in training), and 1030 postdoctoral scholars.4
Both institutions had strong existing partnerships with other domestic and foreign universities, but we sought to complement those predominantly research-based alliances with a focus on education. UCSF also agreed to provide advice to MUHAS for systematizing management of contracts and grants.
Forming the Partnership and Developing Activities (2005–2008)
The authors and others initiated discussions, building on professional and personal ties. Then, in 2005 and 2006, staff and faculty from GHS/UCSF visited MUHAS and teams of rising leaders from MUHAS visited UCSF to discuss common interests and priorities.
In addition to their need to revise curricula, the MUHAS team was looking for ways to support faculty in developing teaching skills. The team was intrigued that the UCSF School of Medicine had established an Academy of Medical Educators5 that recognizes faculty for their contributions and excellence in teaching. Before creating the academy, UCSF, like MUHAS, had mainly recognized its faculty for research achievements.
To raise the profile of education at MUHAS, we agreed that UCSF would run a faculty development series focusing on themes MUHAS identified as important, for example, how to enliven large group teaching with interaction, assess students efficiently with the aid of technology, and evaluate educational programs.6,7 UCSF secured a portable optical mark recognition scanner with a software program designed to read scanned examination answer sheets and trained the MUHAS faculty to use it. This simple innovation considerably reduced the time spent by medical faculty manually marking multiple choice questions for classes of 300. Together we also developed and evaluated surgical skills simulation training sessions for medical students.8
MUHAS identified an urgent, short-term need for substitute biochemistry teachers while junior faculty in the department obtained doctorates overseas. UCSF biochemistry faculty recruited and mentored teams of two UCSF postdoctoral candidates to teach biochemistry to the MUHAS undergraduate and postgraduate students for a semester during two consecutive academic years – until sufficient MUHAS faculty had returned to the department with their PhDs.9 In 2004, for example, the department of biochemistry had one faculty member, but by 2011 it had seven faculty members. A significant contribution made by UCSF postdoctoral candidates was the introduction of small-group, case-based teaching, which was enthusiastically received by the MUHAS students.
Once MUHAS had identified the need for UCSF support in revising its curricula and developing faculty teaching capacity, we approached the Bill & Melinda Gates Foundation for longer-term support. In 2008, the Foundation awarded the partnership a ‘learning grant’, one of a set of awards to academic institutions partnering South–North.10 Thus began the MUHAS–UCSF Academic Learning Project (ALP), a three-year period of intense, joint activity.
The MUHAS–UCSF ALP (2008–2011)
MUHAS's mission is to prepare health professionals competent to improve the health system and reduce the disease burden of the population. From recruitment of students, through their training, employment, and continuing education, MUHAS intends to help improve the health system.
Features of the Partnership Activities
The activities we undertook together developed solely out of the institutional needs MUHAS proposed to UCSF, once both institutions had learned enough about each other's common interests and strengths. The UCSF medical school, for example, had recently undergone major curricular change,18 and MUHAS leaders wanted to understand how UCSF developed competencies and overcame faculty resistance to such change. The MUHAS faculty also wanted to observe ways in which UCSF supports its faculty to deliver its curricula – introducing different forms of teaching and assessment.15 Although the MUHAS faculty visits to UCSF attracted considerable interest among UCSF administrators, faculty, and students, MUHAS teams chose the specific areas on which they wished to focus, thus determining the make-up of the UCSF core team. Having agreed on these, UCSF also approached MUHAS to collaborate, for example, in providing education projects for UCSF students and residents.19
The focus on education across professions changed the discourse at both institutions: When we formed the partnership, each school described the educational work we did together as ‘medical education’ because our respective medical schools dominated partnership leadership – being considerably larger than other schools. But because the ALP set out to support MUHAS develop curricula across its programs, we brought together teaching faculty from all our schools. It was no longer acceptable to assume that the term medical education also described the education of nurses, dentists, pharmacists, and environmental health scientists. Both schools began to use the term ‘health professions education’ extensively, and to share and learn from educational efforts across our schools – all accustomed to operating in professional isolation.
Both institutions chose, as a new focus, preparing students to deliver public health and clinical interventions as effective members of teams: Huge health challenges,20 combined with an extreme shortage of health workers in Tanzania,21 drive home the importance of preparing professional students to engage respectfully in teamwork with all types of health workers.17 Through its new curricula, MUHAS embraced a change towards teaching its professional students jointly. At UCSF, as elsewhere in the US, movement toward interprofessional education followed release of a report from the National Academy of Sciences’ Institute of Medicine on glaring failures of quality where requiring professionals to work together promised higher quality health care.22 Both institutions sought meaningful activities in which professional students across schools could engage together.
Despite being so differently resourced, MUHAS and UCSF are both challenged by growing class sizes: For MUHAS, faculty shortages are longstanding, exacerbated in the 1990s by ‘structural adjustment’ promoted by the World Bank23; for UCSF shortages, far less severe, result from recent university-wide budget cuts forced by economic constraints passed down from the state government of California. We explored together strategies to maintain educational quality, for example, by employing team-based learning.15 At MUHAS, educators began to share teaching across schools, thereby supporting each other and making better use of resources.
The nature of the activities led us to involve a wider range of people at both institutions: Whereas research projects usually involve specialized groups of researchers, this work pulled together school deans, associate deans of education, senior and junior faculty, administrators, residents, and students. Hence, the partnership infiltrated many aspects of university life at both institutions, creating several new alliances; for example, at MUHAS, a group of young faculty members came together from across the university to work with other faculty members and postgraduate students to promote excellence in teaching.16 At UCSF, for example, GHS brought together senior administrators to work with the MUHAS administrators to strategize ways of supporting faculty in their research activities.
This partnership has convinced us to exhort other academic leaders in the health arena to be brave; that is, to add to the more clearly prestigious tradition of international research collaboration renewed emphasis for working together to enlighten and enliven our educational enterprises. While funding sources for partnering on research may be more easily identified at this stage, it was not always so. And, with education, we bring different strengths to the table. Institutions in well-resourced countries benefit from technology, more forms of teaching, learning and assessment, educational scholarship – and more remunerative jobs for their graduates. But institutions in countries with much fewer resources lead in acknowledging and framing their priorities most explicitly in terms of the needs of their people. Working in parallel to the activities we describe above, the Lancet Commission on the education of health professionals has articulated many reasons to transform the ways in which we educate our health workforce – and to transform the priorities and sensibilities our graduates carry into their careers.24 Our partnership, then, serves as a case study, a source of learning for luring others down this path.
Along that path we emphasize the importance of education for teamwork across professions, and across the entire workforce – a direction now being taken up by many institutions in the education of health professionals. The teamwork involved in our experience heightened our awareness of the significance of shifting from referring by habit to ‘medical education’ to the broader term ‘health professions education’; it also sensitized us to focus on the comprehensive task of preparing all in the health sector to work together more effectively. The work of our partnership is not yet finished, as many of the innovations we introduced are in early stages of implementation. Thus, evaluation of the partnership, of the changes at MUHAS, and of what change at the pioneering university in Tanzania will mean for the country, lie ahead. Partnership could usefully be brought to this stage of work as well.
We acknowledge the many contributions of faculty, staff, students, and residents, across both our institutions, who partnered with each other in so many different and constructive ways.
- Muhimbili University of health and Allied Sciences. (2011) Annual Report 2010–2011. Dar es Salaam, Tanzania, http://www.muhas.ac.tz/index.php/annual-reports, accessed 4 September 2012.
- University of California San Francisco. (2012) Facts and figures, http://www.ucsf.edu/about/facts-figures, accessed 29 August 2012.
- University of California San Francisco. (2011) The Haile T. Debas Academy of Medical Educators, http://medschool.ucsf.edu/academy/, accessed 29 August 2011.
- Omer, S. et al (2008) Collaboration between academic institutions towards faculty development for educators. Education for Health 21 (3), Article 222, http://www.educationforhealth.net/.
- Institute of Medicine Committee on Quality of Health Care in America. (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press.Google Scholar