Transforming medical education in Liberia through an international community of inquiry

Abstract

A critical component of building capacity in Liberia's physician workforce involves strengthening the country's only medical school, A.M. Dogliotti School of Medicine. Beginning in 2015, senior health sector stakeholders in Liberia invited faculty and staff from U.S. academic institutions and non-governmental organizations to partner with them on improving undergraduate medical education in Liberia. Over the subsequent six years, the members of this partnership came together through an iterative, mutual-learning process and created what William Torbert et al describe as a "community of inquiry," in which practitioners and researchers pair action and inquiry toward evidence-informed practice and organizational transformation. Incorporating faculty, practitioners, and students from Liberia and the U.S., the community of inquiry consistently focused on following the vision, goals, and priorities of leadership in Liberia, irrespective of funding source or institutional affiliation. The work of the community of inquiry has incorporated multiple mixed methods assessments, stakeholder discussions, strategic planning, and collaborative self-reflection, resulting in transformation of medical education in Liberia. We suggest that the community of inquiry approach reported here can serve as a model for others seeking to form sustainable global health partnerships focused on organizational transformation.

Fig 1. Formation of a community of inquiry through an international action-inquiry partnership.

This figure depicts the individuals, institutions, and groups [26] involved in this community of inquiry after it first came together in 2015 at the direction of the Minister of Health of Liberia to support the country’s Health Workforce Program Strategy. a) In 2016, the President of Liberia asked the Ministers of Health (MoH) and Education (MoE) to improve conditions for medical students at Liberia’s only medical school, A.M. Dogliotti School of Medicine (AMD), which is part of the University of Liberia College of Health Sciences (ULCHS). The Ministers commissioned a mixed methods study from a Yale University (Yale) faculty member and her students, in collaboration with the Dean of AMD, and with facilitative partnership from program managers at the Clinton Health Access Initiative, Inc. (CHAI). The action and inquiry steps pursued by this team founded the community of inquiry, with funding from the Yale Jackson Institute for Global Affairs and, later PEPFAR/HRSA. b) The community of inquiry expanded in subsequent years to include additional faculty and students at AMD, including visiting AMD faculty from west and east African medical schools, as well as faculty, staff, and program managers from Yale, Vanderbilt University Medical Center (VUMC), Brigham and Women’s Hospital (BWH), and Liberia’s Ministry of Health, with distinct (and sometimes intermittent) funding from a variety of sources (rendered complementary by the efforts of the community of inquiry) including the World Bank, USAID, and PEPFAR/HRSA.

Fig 2. Percentage of AMD students who thought faculty display the following behaviors “most of the time” or “always” (2016).

Fig 3. Percentage of students who experienced the following conditions in medical school dorms (2016).

Fig 4. Timeline of action-inquiry to restructure medical education in Liberia.

Fig 5. Number of financial dependents reported by AMD students (2017).

This pie chart indicates the number of financial dependents reported by AMD students in 2017. Number of financial dependents ranged from 0 to more than 7. Percentage of AMD students with 0, 1, 2–4, 5–7, or more than 7 financial dependents is indicated for each category.

Fig 6. Assessment of whether incoming medical students are prepared for medical school by fifth-year medical students, medical interns, medical residents, and medical faculty.

Fig 7. AMD graduates’ self-assessment of nine physician competencies.