Faculty of Health Sciences, Walter Sisulu University: Training Doctors from and for Rural South African Communities

Introduction The South African health system has disturbing inequalities, namely few black doctors, a wide divide between urban and rural sectors, and also between private and public services. Most medical training programs in the country consider only applicants with higher-grade preparation in mathematics and physical science, while most secondary schools in black communities have limited capacity to teach these subjects and offer them at standard grade level. The Faculty of Health Sciences at Walter Sisulu University (WSU) was established in 1985 to help address these inequities and to produce physicians capable of providing quality health care in rural South African communities. Intervention Access to the physician training program was broadened by admitting students who obtained at least Grade C (60%) in mathematics and physical science at standard grade, and who demonstrated appropriate personal attributes. An innovative curriculum, combining problem-based learning with community-based education (PBL/CBE) in small tutorial group settings, was also adopted. This approach was aimed at educating and graduating a broader cohort of students, while training future doctors to identify, analyze, and treat health problems in the rural South African context. Outcomes To date, 745 doctors (72% black Africans) have graduated from the program, and 511 students (83% black Africans) are currently enrolled. After the PBL/CBE curriculum was adopted, the attrition rate for black students dropped from 23% to <10%. The progression rate rose from 67% to >80%, and the proportion of students graduating within the minimum period rose from 55% to >70%. Many graduates are still completing internships or post-graduate training, but preliminary research shows that 36% percent of graduates practice in small towns and rural settings. Further research is underway to evaluate the impact of their training on health services in rural Eastern Cape Province and elsewhere in South Africa. Conclusions The WSU program increased access to medical education for black students who lacked opportunities to take advanced math and science courses prior to enrolling in medical school. Innovative admission requirements and adoption of a PBL/CBE curriculum have made the WSU program one of the top training programs for black African doctors in South Africa.