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Mbarara University of Science & Technology

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Dr. Francis Bajunirwe , Senior Lecturer, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda [email protected]

Dr. Bajunirwe completed his medical degree training at Makerere University in Kampala, Uganda and thereafter served as a Medical Officer in the Department of Surgery at Mbarara University Teaching Hospital. He chose a career in research and was accepted as a Fogarty fellow at Case Western Reserve University in Cleveland, Ohio under the AIDS International Training and Research Program. He completed a Master’s degree in Epidemiology under the supervision of Dr. Christopher Whalen and returned to Cleveland for a PhD program, also in Epidemiology which he completed in 2008.

On completion of his PhD, he returned to Mbarara University of Science and Technology where he assumed a position of Senior Lecturer in the Department of Community. In that same year, he received a grant from Doris Duke to implement a mobile pharmacy to deliver antiretroviral therapy to patients living in remote areas in two rural districts in south western Uganda. He supported the initiation of the Masters of Public Health at Mbarara University, and he coordinates this program to-date.

He partnered with his mentor Dr. Christopher Whalen, at Case Western Reserve University to support the successful renewal of the AITRP program and he co-directed the program that oversaw over 30 fellows receiving USA in-country training support.

His current research involves implementation of community based initiatives to expand screening for HIV and non-communicable diseases, uptake and adherence to pre-exposure prophylaxis for HIV among key populations. He has an interest in research ethics and recently supported a successful application to the NIH to start a Masters in Public Health with a concentration in research ethics at Mbarara University. He also serves as chair of the Research Ethics Committee at Mbarara University.

Dr. Stephen Asiimwe , Principal Research Scientist, Program Director [email protected]

Dr. Stephen Asiimwe is the Program Director of the Mbarara University of Science and Technology (MUST)-Massachusetts General Hospital (MGH) Global Health Collaborative (GHC). He is a Physician Scientist with many years of collaborative clinical and population based research as well as program design and implementation in Uganda. Previously, he was the Executive Director of ICOBI, a national NGO with leading community interventions and research into HIV, TB and Malaria. He has a degree in Medicine & Surgery from Makerere University in Kampala, Uganda (1999) and a Masters Degree in Epidemiology and Biostatistics from Case Western Reserve University Ohio (2006) as well as a doctorate in public health Epidemiology and Health Policy at the University of Georgia, USA (2013). Before taking on the role of Program Director, he was involved in 8-10 years of active clinical practice (general medicine, pediatrics, obstetrics/gynecology and surgery). His work seeing patients in the clinic with preventable illnesses led to his interest in population health, particularly in work related to HIV and STI prevention and management.  Stephen is now Principal and Co Principal Investigator at the Kabwohe Clinical Research Center (KCRC) and Integrated Community Based Initiatives (ICOBI) respectively in Uganda, both of which are centers of excellence in clinical and community-based medical research in Uganda that conduct, multi-center HIV prevention clinical/community trials among others. He is also an attending Clinician, and Co-Investigator, involved with teaching and collaborative research projects with colleagues at the University of Washington (Seattle), University of Georgia, Harvard Center for Global Health, Makerere University and Mbarara University of Science and Technology (MUST) in Uganda. Stephen is also an adjunct faculty and honorary lecturer of epidemiology and biostatistics at the MUST department of community health and assists train for the NIH supported MURTI program at MUST.

Dr. Joseph Ngonzi , Senior Lecturer (Obstetrics/Gynecology) and Dean-Elect, Faculty of Medicine at Mbarara University of Science and Technology [email protected]

Dr. Ngonzi is a practicing obstetrician/gynecologist in the Department of Obstetrics and Gynecology department at Mbarara University in southwestern Uganda. He has done work in HIV/AIDS among pregnant and postpartum women in Uganda. He has researched on HIV disclosure facilitators and hinderances among pregnant women in Uganda as well as on HIV Infection and risk of postpartum infection, complications and mortality in rural Uganda. He has interest in cervical cancer control among HIV infected women. His focus in gynecology work and research has been in cervical cancer screening, while his focus in Obstetrics has been in maternal safety, including management of maternal HIV infections, maternal hemorrhage and maternal sepsis.

Dr. Ngonzi has also personally witnessed numerous maternal deaths and obstetrical near misses, many of which have been caused by postpartum sepsis. These experiences have also inspired his  research interests on understanding causes of sepsis, means to prevent it, and the responsible use of antibiotics especially among HIV infected women. His research focus now is to improve maternal outcomes through appropriate antibiotic use and sepsis prevention in resource-limited settings among HIV infected and un-infected women.

Professor Sam Maling , Associate Professor of Psychiatry [email protected]

Professor Maling has a 22-year history of health care services and health professionals training in Uganda.  He is the immediate former Dean of Faculty of Medicine and Associate Professor of Psychiatry at Mbarara University of Science and Technology in which he is responsible for the training and mentorship of medical doctors, medical laboratory scientists, pharmacists, graduate nurses, physiotherapists and pharmaceutical scientists in the faculty of medicine. In addition, he oversaw and guided the curriculum review and implementation of both undergraduate and postgraduate programs in the faculty, in improving clinical training in both the hospital and community setting, student assessment and planning and implementing community based medical education.

As a faculty leader, he has nurtured both local and international collaborations and guided departments in achieving their academic missions . He is the core trainer in the Leadership Development Program in the Faculty of Medicine, MUST. He has previously been co-investigator of MEPI-Medical Education program in Uganda named Medical Education for Equitable Services to All Ugandans (MESAU) funded by NIH (Grant No. R24 TW008886 (PI-Nelson Sewankambo). Currently, he is a Co-Program Director of another NIH-funded training program: Mbarara University Research Training Initiative (MURTI) being implemented at Mbarara University of Science and Technology. As a MURTI Co-PD he is directly responsible for the mentor-mentee relationship, coordinate and oversee the mentor-mentee relationship, monitor trainee progress including their research projects and career development.  He is a member of the MURTI Program Implementation Committee and the Training Advisory Committee.  He is a fellow of the Foundation for Advancement of Medical Education and Research (FAIMER) undertaken with Sub-Saharan Africa-FAIMER Regional Institute (SAFRI) in which he underwent training in medical education principles, curriculum development, assessment, teaching, mentorship, leadership and scholarship. He is a recipient of the Rogers Fellowship under the Medical Research Council in which he studied HIV/AIDS infection among severely ill mental patients in Uganda. He also underwent a mentorship program implemented by International College of Neuropsychopharmacology (CINP). He is an author of a chapter in a book titled: Psychiatric Problems of HIV/AIDS and their Management in Africa (Eds Segane Musisi & Eugene Kinyanda) and also a chapter author in a book titled: Psychiatry for Primary Health Care in Uganda (Ed Emilio Ovuga). As a native Ugandan, he has worked as a psychiatrist in a resource-limited setting since 2002 and a physician since 1995 and regularly provide care to patients living with Alzheimer’s and other related dementias, HIV Associated Dementia and other psychiatric disorders seen in rural communities as well as clinical settings. He has also conducted and published research in southwest rural Uganda, and has partnered with international researchers in some of these efforts. In addition, he leads and coordinate the addiction, psychopharmacology and geriatric psychiatry modules to residents at the department of psychiatry.

Dr. Conrad Muzoora, Senior Lecturer in Internal Medicine [email protected]

Dr. Muzoora is a HIV physician-scientist with formal training in clinical research.  He has been involved in HIV care for the last 10 years with special interest in tuberculosis and cryptococcal meningitis. He jointly runs the TB HIV clinic and the infectious disease unit of the Medical ward at Mbarara regional referral hospital. His main research goals have been in the improving the diagnosis of Tuberculosis especially in HIV infected patients and the improved treatment of HIV-associated cryptococol meningitis. He has conducted three clinical trials involving cryptococcal meningitis and several other projects in HIV and TB. As a result of his expertise, he was invited as by the World Health Organization to participate in the writing the recently published Cryptococcal meningitis management guidelines. Additionally, Dr. Muzoora is the Mbarara site PI for two clinical trials: Ambition and RIFT.

Dr. Samson Okello, Lecturer, Department of Internal Medicine, Mbarara University of Science and Technology [email protected]

Dr. Okello’s major research interests are cardiovascular diseases and esophageal squamous cell carcinoma in Uganda. Much of his work focuses on the evaluation of peculiar local risk factors for CVD and Esophageal cancer specifically in the older adults. In addition, he has been a co- investigator for the Uganda cardiovascular disease cohort study conducting epidemiologic studies of in HIV infected and uninfected persons to estimate the interactions of traditional cardiovascular risk factors, HIV per say and antiretroviral therapy as risk factors for cardiovascular disease in rural sub-Saharan Africa. Over the past 1 year, he and his colleagues have published over six articles from their cohort. His research group’s publications have been key in informing formulation of national clinical guidelines.

Tel: 256772556546 | 256782953936 | 256772430491 | 256758556546

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Call for Applications: Graduate programmes 2024/2025

The Academic Registrar, Makerere University invites applications for admission to Graduate Programmes (Postgraduate Diplomas, Masters and Doctoral Degree Programmes) for the 2024/2025 Academic Year. Applicants should have obtained at least a first or second class degree (or its equivalent) from a recognized and chartered university/institution at the time of completion.

Please observe the “course codes” if you apply to study from MUBS-Mbarara Campus.

Strictly observe the closing date of, 31st May, 2024

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Duration: 2 years for Masters Degree Programmes

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Makerere University Business School is the leading provider of Business and Management Education that facilitates professional development promotes Entrepreneurship and Leadership in the region. The MUBS Regional Campus – Mbarara was established in 2006 by the MUBS Council, with the aim of extending Business & Management education to the people from the western region. This was further      intended to bring services nearer to the people rather than the communities come to the Main Campus in Kampala. The Regional Campus – Mbarara, continues to provide aspiring people young and old, with an opportunity to develop their talents and strength and overcome ...  Readmore

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The State of Doctoral Education in Social Sciences in Uganda: Experiences and Challenges of Doctoral Training at Mbarara University of Science and Technology 2003 - 2010

2015, Journal of Education and Practice

Related Papers

International Higher Education

Fareeda Khodabocus

Cogent Education

Charmaine Williamson

Hilligje van 't Land

Convinced that strong knowledge systems and research-based knowledge are central to national development, the IAU researched the changes taking place today in higher education institutions in sub-Saharan Africa, as part of their overall effort to improve their doctoral programmes and to enhance their research capacity and quality. IAU initially worked with six institutions in six different countries accross the continent. The report is a result of a five year project.

HIGHER EDUCATION RESEARCH & DEVELOPMENT

Wondwosen Tamrat

This study explores doctoral students’ views about the support schemes and resources deployed to run PhD programs at one public university in Ethiopia. The research used questionnaire, interview and documentary evidence as principal data collection tools and involved 164 doctoral students at four purposely selected colleges of the university. The findings reveal that the human resource, facilities, support systems, financial assistance, climate (working environment), workshop and conference opportunities, provision of special trainings, and opportunities for publication of research papers are rated by doctoral candidates as highly deficient across all the four colleges. The findings of the study further indicate that the provisions of doctoral education at the sample university is far below the demands of PhD students for a diverse scheme of support which is regarded as critical to the quality of training they receive and the timely completion of their studies. It is argued that the provision of PhD programs will continue to be seriously hampered unless a significant improvement is made in terms of overhauling both the national direction set and the support mechanisms put in place.

Le Centre pour la Communication Scientifique Directe - HAL - Inserm

Edward Stevenette

This article examines the provision of doctoral education in Ethiopia and its implications for African higher education. Despite the role given to doctoral education toward achieving economic development and improving the quality of higher education, the resources for running PhD programs are lacking in many African countries. More efforts should be directed to building institutional capacity and availing the resources needed to run successful doctoral programs.

Amutabi, M. N. (2018). Social and Political Obstacles in Pursuing PhD Degree in Africa: Interrogating the Problem of Gatekeepers and Structural Obstacles. Journal of African Interdisciplinary Studies. 2 (1), 2018: 126 – 146.

Maurice Amutabi

Students pursuing doctoral studies in African universities have to negotiate against many obstacles in order to make it. They have to go through gate keepers and many structural inhibitions. The purpose of this article is to find out why students take so long to complete their PhD studies in universities in Kenya and how the problems can be overcome. Using Kenyan universities as case studies the article looks at both public and private universities and their approaches and plans in doctoral programs, and some of the factors that may be causing delay. The article looks at the causes of delays and they can be solved. Using both qualitative and quantitative methods of research, the article looks at the challenges facing doctoral programs in Kenya such as few PhD holders and lack of research funds in many universities. In 2017, the United States graduated 67,000 PhDs while South Africa which is the highest in Africa graduated 2,000 PhDs. Kenya graduate less than 400 PhD students in the same period. Doctoral candidates in Kenyan universities take an average 10 years to graduate. Kenya currently has a shortage of 25,000 PhDs and will need to graduate 2,500 PhDs per year in the next ten years to meet the deficit, with everything remaining at constant. Delay in graduating PhD students in Kenya is raising a lot of concern and anxiety among stakeholders, especially given the advanced age at which those who graduate have. The causes of delays are many and range from the fact that many students are part time, there are sometimes conflicts among supervisors; there are cases of favouritism, problems of supervision and issues of resources. Some universities have higher attrition rates than others. Older and more established universities tend to have higher attrition compared to new ones. Therefore, dynamics of doctoral programs in Kenya differ from one university to another. What are the causes of delays in PhD programs in Kenya? Why are some programs more affected than others? To what extent are students to blame in PhD attrition? Should supervisors be blamed in delays in PhD completion? These are some of the questions that this article will be addressing.

This article's purpose is to explore the challenges and experiences PhD students in selected Ugandan state universities endure during their studies. Research methodology: The approach of the research focused on three public universities thus; Kabale University, Makerere University, and Gulu University. To explore these challenges, we undertook an extensive literature review of the external supervisors and evaluations of PhD students who attempted to submit their final dissertations. Results: The main findings of the results indicate that due to institutional, individual, and supervisory inefficiency, many students who enroll in their PhD programs at these universities are unable to graduate within the given timeframe. Limitations: The limitations of the study conclude that the problems addressed in this research and the suggestions presented provide the basis for improving university training programs and facilitating students, timely completion of the PhD program. Contribution: In terms of contribution, this research will improve scholarly writing and publication abilities, in addition to increasing the identity of doctoral education in Uganda. Evidently, there is no substantial work exploring the difficulties and challenges faced by PhD students in Uganda. Novelty: it is crucial to remember that when pursuing their PhDs, scholars are not just learning about the research topic, but are also developing fundamental skills in critical thinking, to construct their own knowledge within their own indigenous context, it is essential that they acquire the capacity to assess assertions, and evaluate arguments in a critical manner.

Institutional Research in South African Higher Education - Intersecting Contexts and Practices

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The Faculty is dedicated to training a diverse group of future leaders in academic health professions and clinical practice who will combine clinical medicine with the discovery of new knowledge through research. Currently we have six undergraduate programs: human medicine, nursing, medical laboratory sciences, pharmacy, pharmaceutical sciences and physiotherapy. Students in our programs have access to an extraordinary diversity of 23 different Masters programs: 13 Master of Medicine, 06 Master of Science (biomedical programs), Master of Medical Laboratory Science, Master of Nursing Science, Master of Pharmacy in Clinical Pharmacy, and Master of Public Health, and PhD research opportunities.The FoM at MUST is the only School in Uganda that offers Master of Nursing in Critical Care Master of Pharmacy in Clinical Pharmacy, and Master of Public Health (Research Ethics) degree programs. .

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On the 20th June 2024, the Department of Internal medicine...

Internal Medicine Department achieves a remarkable Feat with Four Residents that Successfully Defended their Dissertations on 20th June 2024

On the 5th May 2024, the Department of Physiology celebrated...

Congratulations to the Department and students of Masters of Science in Physiology upon the successful Dissertation Defense on 5th May 2024

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Impact of the Mbarara University of Science and Technology residency training on increasing access to specialty care workforce

Leevan tibaijuka.

1 Faculty of Medicine, Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda

Jonathan Kajjimu

2 Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda

Lorna Atimango

Asiphas owaraganise.

3 Infectious Diseases Research Collaboration, Kampala, Uganda

Adeline Adwoa Boatin

4 Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, United States of America

Musa Kayondo

Nixon kamukama.

5 Mbarara University of Science and Technology, Mbarara, Uganda

Joseph Ngonzi

Associated data.

The datasets used during this study are available and have been uploaded.

Graduate tracer studies provide an avenue for assessing the impact of residency training on the distribution and access to specialty care and exploring job and professional satisfaction of alumnus. This study examined how the Mbarara University of Science and Technology (MUST) clinical residency training program influenced the spatial distribution and career paths of specialists. We conducted a mixed methods study involving an online survey and 12 in-depth interviews (IDIs) from June to September 2022. The online survey was distributed to a convenient sample of clinical residency alumnus from MUST via email and Whatsapp groups. Alumnus were mapped across the countries of current work in QGIS (version 3.16.3) using GPS coordinates. Descriptive and thematic analyses were also conducted. Ninety-five alumni (34.3%) responded to the tracer survey. The majority were males (80%), aged 31–40 years (69%), and Ugandans (72%). Most graduated after 2018 (83%) as obstetricians/gynecologists (38%) and general surgeons (19%). There was uneven distribution of specialists across Uganda and the East-African community—with significant concentration in urban cities of Uganda at specialized hospitals and academic institutions. Residency training helped prepare and equip alumnus with competencies relevant to their current work tasks (48%) and other spheres of life (45%). All respondents were currently employed, with the majority engaged in clinical practice (82%) and had obtained their first employment within six months after graduation (76%). The qualitative interviews revealed the reported ease in finding jobs after the training and the relevance of the training in enhancing the alumnus’ ability to impact those they serve in teaching, research, management, and clinical care. Graduates cited low payment, limited resources, and slow career advancement concerns. Residency training improves the graduates’ professional/career growth and the quality of health care services. Strategic specialty training addressing imbalances in subspecialties and rural areas coverage could optimize access to specialist services.

Post graduate residency training in developing countries is an important component in narrowing the global health care workforce crisis [ 1 , 2 ]. Access to specialized care greatly improves quality and safety of health care services [ 3 , 4 ]. WHO also recommends availability of competent professionals to provide routine care and management of complications for patients as a standard for improving quality of care in health facilities [ 5 , 6 ]. This can only be achieved if doctors are well prepared for this task through residency training [ 7 ].

Uganda and the East African region have significant inequalities in specialized care, with generally few medical specialists, and uneven distribution of the different medical specialties [ 8 , 9 ]. The small number is partly due to the small number of medical specialists graduating from the training institutions and the exodus of the majority of specialists in search of better pay and improved working conditions [ 10 – 12 ]. This definitely impacts the health care delivery to the population and widens the global health workforce crisis [ 6 , 13 ].

Graduate tracer studies provide data to explain the link between study programs and the job market, by exploring the employment situation of graduates in addition to their professional and personal careers, this provides indicators for their professional performance [ 14 – 16 ]. To better understand the public health impact of the post graduate training program at MUST, we aimed to document the geospatial location/distribution of the different specialties of clinical postgraduate alumni after residency training at MUST, their integration into the job market, scope of practice and current job satisfaction.

Materials and methods

Ethics statement.

The study was approved by the Research Ethics Committee of Mbarara University of Science and Technology under reference number MUST-2022-366. Individual informed consent was obtained from all study participants. The consent form ended with the following statement; “Do you agree to participate in this survey ? Yes/No (Check response below as stated) . If you agree to participate , please continue to the survey . If not , you may exit at any time . ” Study codes were used to ensure the anonymity of participants’ data. Data generated from the study shall be used for research purposes only and shall be private and confidential at all times. All principles of data transfer and principles of protection of human research participants outlined in the Declaration of Helsinki were observed.

Study setting and design

We conducted a descriptive cross-sectional and phenomenological study among the clinical postgraduate alumni of residency training programs of the Faculty of Medicine at Mbarara University of Science and Technology (MUST) from 20 th June to 11 th September 2022. The study employed mixed methods involving both quantitative and qualitative approaches—an online survey and in-depth interviews. MUST is a public university that was established in October 1989 and is located 250 kilometers from Kampala in Southwestern Uganda. MUST is affiliated to Mbarara Regional Referral Hospital (MRRH), a public health facility that serves about five million people, mainly from 10 catchment districts of southwestern Uganda and serves as a teaching hospital for MUST medical school. The clinical post-graduate programs carry out their clinical work activities at Mbarara Regional Referral Hospital. The clinical postgraduate program is run under the faculty of Medicine, which is the oldest and pioneer faculty of MUST and has grown over a period of 33 years. MUST under its Faculty of Medicine (FoM) is accredited to offer the following post-graduate programs; Obstetrics and Gynecology, Internal Medicine, Pediatrics and Child health, General Surgery, ENT, Pathology, Psychiatry, Dermatology, Emergency Medicine (2017), Anesthesia and Critical Care, Ophthalmology and Radiology. The programs are delivered through blended clinical clerkships, didactic courses and self-directed learning to ensure acquisition of competency-based knowledge and clinical skills relevant to the respective work environments.

Study population and eligibility criteria

This study targeted and included all clinical postgraduate alumni after residency training at MUST. We included residency alumni who consented to and responded to the survey.

Sample size estimation and sampling

We enrolled a convenience sample of all clinical residency alumni from MUST. The sample population included all residency alumni on the current electronic mailing lists of MUST residency alumni obtained from the academic registrar’s office and the Directorate of graduate studies (DRGT) from the time of start of the graduate training at MUST (2003) to 2017 (graduates of the year 2021). In-depth interviews (IDI) participants were conveniently sampled from survey participants who expressed willingness to be interviewed, following the researchers’ judgment during the study period to ensure a mix of specialties and years of completion of the residency training.

Data collection

A questionnaire was designed using Google Forms and shared the link with the residency alumni of MUST. The sample population included all residency alumni on the current electronic mailing lists of MUST residency alumni obtained from the academic registrar’s office and the Directorate of graduate studies (DRGT) from the time of start of the graduate training at MUST (2003) to 2017 (graduates of the year 2021). The online tracer survey was distributed to all former clinical residency graduates from MUST via email and Whatsapp platforms of clinical post-graduate alumni weekly for a period of 1 month using a Google Forms link. We obtained the following information from the online surveys; background socio-demographic information: age, sex, marital status, year of completion of residency program; transition into the labor market/ employment related characteristics: Employment situation: current job, employer, duration of current job, income, location of employment, duration from completion of residency to obtaining first job, previous employment, how many jobs switched to ever since graduation from residency, career/job satisfaction, search for employment, impact of skills obtained to the community. A Likert scale was used to assess the data on the relevance of the residency training and satisfaction with their career and professional situation. Respondents filled the form online and responses were automatically captured in Google Forms. The responses were downloaded as a CSV file.

The survey’s last item asked if participants would be willing to be contacted for an interview. In-depth interviews (IDI) participants were randomly identified from survey participants who expressed willingness to be interviewed. The randomly identified participants were emailed to arrange an interview date and time. Interviews were conducted over a secure zoom link. These semi-structured interviews aimed to deeply explore the experiences of the alumni. Each interview started by the interviewer introducing themselves and reading out the following statement: I will ask you several questions about your experiences following your completion of your postgraduate residency training at MUST , your transition to employment , your career and professional satisfaction during your current employment , and your impact to the community you serve following your residency training . Example questions asked included “How and when did you find your current and first job?” “ How easy or difficult was it to find you first job?” “How much did you need residency training to do the work you are currently doing?” “How much are you putting the skills learnt during the programme to use?” “How much do the skills learnt during the training programme impact the community you serve?” Interviews ended after clarifying all questions had been answered and participants indicated they had nothing else to share. The interviews were transcribed verbatim and reviewed for accuracy by the interviewer.

Data management and analysis

We cleaned and analyzed quantitative survey data using Stata software (Version 17.0, StataCorp, College Station, TX). We summarized the data in tables as frequencies and percentages. We summarized the Likert scale responses as bar charts using Microsoft Excel [ 17 ]. We mapped the distribution of MUST residency alumni across the region/countries of current work in QGIS (version 3.16.3) using GPS coordinates.

The interviews were analysed independently by 2 researchers using thematic analysis approach [ 18 ]. Each analyst read through each transcript several times highlighting and labelling blocks of text with related underlying meaning (codes). The identified codes were then subjected to constant comparison [ 19 ] before being merged into categories of codes with related meaning. The themes connecting the codes within each category were then identified. The 2 researchers met to discuss these themes, although there were minor differences in the labelling of themes, there was no significant differences in the themes and are reported descriptively.

Quality control and assurance

Access to data was restricted to only the principal investigators (LT, JK, JN) who had the security to the Google drive folder, where the data was sent during data collection.

Demographics

In total, 303 e-mails were sent out. Twenty six (8.5%) of those mails were undelivered, which left us with 277 usable e-mails, from which we received 95 completed questionnaires. This yielded a response rate of 34.3%. Of the 95 respondents who participated in the tracer survey, majority were Obstetricians and Gynecologists (38%, n = 36), followed by General surgeons (19%, n = 18), pediatricians (9%, n = 9) and Ear Nose and Throat specialists (ENT) (6%, n = 6) ( Fig 1 ); majority were males (80%, n = 76), aged between 30–40 years (66%, n = 69), and had completed their training in the years after 2018, and had privately sponsored their post-graduate studies (36%, n = 34), others had scholarship support from fellowships, government and NGOs ( Table 1 ).

Geospatial distribution of post-graduate alumni of the clinical residency program of MUST

There was uneven distribution of clinical residency alumni of MUST across Uganda, with sparse distribution in Kenya and Rwanda. There was imbalanced distribution of the different specialties across the region with Obstetricians/Gynecologists (Obsgyn) and General surgeons more dispersed across the region compared to the sparse distribution of other specialties ( Fig 2 ).

Link to map base layer: https://www.naturalearthdata.com .

Work place locations of post graduate alumni of the MUST clinical residency program

Majority of the clinical residency alumni are distributed in the south-western, central and northern regions of Uganda, and at the different public and private Hospitals across the East African region especially in the Urban and peri-Urban settings ( Fig 3 ).

Usefulness of residency training to one’s career

The respondents generally reported that the residency training was to a large extent useful to their careers—in preparing them for their current work tasks (48%), and for tasks in other spheres of life (45%). Majority of the respondents reported that the current employment and work was to a large (40%) and very large (36%) extent appropriate to their level of training; and the career at the time of graduation had been realized to a large and very large extent in 37% and 33% of the respondents, respectively ( Fig 4 ).

Employment status of post-graduate alumni of MUST

Obtaining of first employment.

The respondents reported the following as important or very important for being employed; personality, grades at the university, reputation of the university, reputation of the university and previous work experience ( Fig 5 ).

Current job employment

All the respondents to the survey were currently employed and most were earning UGX 5–10 million (USD 1400–2800) per month (46%). Majority reported having obtained their first employment <6 months after graduation (76%). Majority had spent <1 year in their current employment (31%), followed by those who had spent >5 years (29%). Also majority had spent <1 year in their current position (36%), followed by those who had spent between 1–3 years (35%). Majority of the participants were currently employed in Uganda (67%), were involved in clinical practice/care (82%) and are public service employees (51%) ( Table 2 ).

*Participants involved in more than one work assignment.

Work orientation, job satisfaction and professional success of graduates

Overall majority of the respondents were either satisfied (43%) or very satisfied (29%) with their professional situation. They were very satisfied with; possibilities to use qualifications acquired during their studies (53%), the opportunity to benefit society (42%) and the content of work/ professional tasks (37%). Majority were also satisfied with; the opportunity of pursuing continuous learning (52%), the chance of realizing their own ideas (53%), and income (47%). However were not as satisfied about the equipment at work places, position and promotion prospects and income ( Fig 6 ). Overall, there was no significant difference in satisfaction among those in public versus private, a bigger proportion were satisfied (37% [public] versus 49% [private]) or very satisfied (30% [public] versus 29% [private sector]), (p<0.460).

In-depth interviews

Of the participating participants, 55 (58%) agreed to be contacted to be interviewed, 12 participants were randomly selected by program cohort year to allow for a variety of perspective from the participants as the program has evolved over time. We conducted 12 semi-structured in-depth interviews with several themes regarding the almuni’s post residency work experiences, their ability to put the skills obtained to use and impact communities they serve, and the challenges encountered during their work.

Post residency work experiences

Processes of finding jobs included self-led job searches, and employer led identification of employees.

“… just soon after finishing at MUST , I applied for the job and then came to the dean’s office at MUST and he recommended me so I was short listed after applying and I sat for the interview and I was given the job . ”[IDI02] “ …it was not a situation where it was advertised and then I had to compete , they just picked me and said that they think I can help them and so they invited me . ” [IDI03]

Participants reported changing job due to search for job security and for strategic positioning.

“ …the reason was more of getting a permanent job because KIU was a bit temporary and contract based , so I needed something more secure . ”[IDI06] “ …though they were paying me much better but having an opportunity to come to Mbarara under the government was even a bigger opportunity because at that time they were paying me less but I was looking at the opportunities of mentorship ad being able to come back to school with ease . ”[IDI01]

Ability to put the skills obtained to use and impact the communities served

The alumni reported relevance of their training and their ability to impact those they serve in terms of both teaching, research, management and clinical care.

“ I think I am putting these skills to use because I am doing clinical work and I also obtained some research skills that I am using to teach students skills on how to do research work” . [IDI04] “ It [Training] is actually very relevant , Kabale has never had an ENT surgeon for a long time so I should say that I was the first and for the time I have been there the number of referrals from Kabale to Mbarara referral hospital greatly reduced , so I am happy that I am able to offer help not only to the academia but also to the community . So that is how relevant my training has been” . [IDI02] “I would say that virtually everything that I learnt, I am trying to give it out. I am actually using all my skills because I learnt research and internal medicine and at the moment I am using all the skills I learnt, you know there are some people who get office jobs and don’t use their skills but personally, I am using my clinical skills as well as other knowledge to teach”. [IDI05] “ My discipline is contributing to improving the lives of mothers and children and in a way helping to maintain a healthy community that will contribute to the economic development of the country” . [IDI07] “ I put the skills almost at a daily basis , every single day I am using the skills I learnt during my post graduate training , both clinical practice and management , I have used the skills I learnt during my post graduate” . [IDI03]

Challenges encountered by the post-residency alumni at the places of employment

Several challenges have been encountered such as underpayment, lack of enough resources at work, delayed job promotions and challenging career development.

Significant under payment

The alumni reported dissatisfaction with their payment compared to the work output, for example one participant reported, “…we are not fully satisfied with the salary . It is small compared to the amount of work that we do and the training that we go through to get there…” [IDI06]

Another participant thought, they were carrying out 2 tasks/jobs, that they perceived as separate i.e., “teaching” and “clinical care”, yet they received pay for a single task; “I am teaching , I am still working as a [general] doctor [and] as a specialist so it is likes I am doing two jobs and I am only being paid for one job . ”[IDI05]

Opportunities for career advancements at the current places of employment

The alumni reported varying opinions regarding opportunities for career advancement at their different places of employment. Some reported challenging career development while others reported favorable career growth environments. The decisions to advance were however influenced by social needs and the places of acquisition of the career advancements.

“ Currently at my institution [of work] I haven’t seen much opportunity in terms of career advancement; I think the only thing I have seen is expanding my research and innovation funds which can work in the direction of career advancement , generally there is minimal opportunities . ” [IDI01] “ The opportunities are there , there are PHD scholarships and Masters Scholarships for the general staff . I think the opportunities are there” . [IDI03] “ The opportunities are limited but the connection to the outside environment is available” . [IDI11] “.. the opportunities are there only that the challenge is that at this time of life when you have already grown with a family , it becomes hard to progress because of many reasons because you may find that you could attend certain fellowships that need you to leave the country or to relocate which becomes difficult when you have a young family . ” [IDI01]

Need for promotions of specialists with the skills attained

The alumni expressed dissatisfaction with the promotion processes both in the academic and clinical spheres of practice, as stated below;

“ Considering the number of years I have spent in the university , the number of students I have taught and the supervisions I have done I am not happy because I have not been promoted while my fellow colleagues in other departments have been promoted , I think I should be at least at a level of senior lecturer . ” [IDI05] “ I have stayed long on the same level for the last nine years so the promotion has been less . ” [IDI05] “ I think the government can do better [regarding] promotions , because I am looking at someone who has officially completed and was given a study leave to go and study and then he comes with papers that show he has graduated but they fail to promote people even when there is room . So there are many people functioning at lower positions , so I think the government can do better” . [IDI09]

Inability to use the acquired skills

The alumni decried their inability to use the obtained skills, due to the unavailable facilities—equipment and medicines, which may be associated with failure to achieve the maximal productivity potential. For example one of the alumni reported, “There are some things that you can never do in a government setting because you don’t have the facilities where to do them , like accessing certain drugs and some equipment . So you end up imagining something and then that is all you can do for that but otherwise we have the patients and the cases but we are limited in that way” . [IDI01]

“ I have just been limited by equipment so there are some procedures that I can’t carry out from this side due to lack of equipment but generally speaking I can say that I am putting these skills that I learnt in my daily activities , apart from those limitations” . [IDI05] “ …you know when you are working for the government , you find that you are short of resources which can enable us to utilize our skills . That is what is challenging . ”[IDI08]

We explored the distribution and contribution to access to specialty care and described the integration of the clinical residency alumni of MUST into the job market, their current job satisfaction and the challenges experienced.

There was uneven distribution of the specialties among the respondents of the survey—Obstetrics and Gynecology, General surgery, Pediatrics and Internal medicine accounting for majority of the respondents to the survey. This is in keeping with the spatial distribution of the health workforce of the different medical specialties, with an imbalance between the established clinical specialties (like Obstetrics and Gynecology, General surgery, Pediatrics and Internal medicine) and the non-established specialties (Dermatology, Pathology, Emergency medicine, Anesthesia, Psychiatry)—which are sparsely distributed across the region, this may in the long-run impact health care delivery. The uneven distribution of the specialties is influenced by specialty career preferences of medical students and their eventual choice of career training as evidenced by prior studies [ 20 – 23 ]. There is need to avert the uneven distribution of specialties in order to ensure adequate health care delivery by attracting residents to specialties with inadequate numbers of health workforce so as to ensure a holistic improvement of healthcare.

We found that the alumni seamlessly integrated into the job market after their training—over 76% of the respondents were employed in the first 6 months of graduation and did not find a lot of difficulty in getting employed. The overall satisfaction with the professional situation was good (72%)—with majority citing usefulness of the acquired skills, benefit to society, job security and opportunity to pursue further education to be associated with their current professional situation. As much as the opportunities of employment for specialist are available, the alumni reported experiencing significant underpayment, limited resource availability for their optimum working and delayed job promotions. These are also generally the leading causes of dissatisfaction among the different human resources for health, especially in the low resource settings and therefore contribute to recurrence of industrial actions in these settings [ 24 – 26 ]. Strengthening health financing in terms of timely promotions, commensurate remunerations and provision of adequate resources/equipment, would improve the job satisfaction of the graduates especially in the cited areas of dissatisfaction [ 24 – 26 ].

There is uneven geographical distribution of clinical residency alumni of MUST in Uganda—with concentration in the south-western, central and northern regions of Uganda, and at the different private and government hospitals across the East African region. The areas of distribution mostly represent the hospitals and the training institutions in the urban centers which are usually well equipped with competitive salaries for the respective human resources. Urban areas are additionally more attractive to health care professionals, as they provide the social, cultural and professional benefits—like educational opportunities and access to amenities for their families [ 27 , 28 ]. This leaves a gap in the distribution of specialty services at remote rural areas including district-level hospitals, this will further improve rural access to specialist services and decrease referrals to the main tertiary and teaching hospitals. The inequalities in the training and distribution of specialist health work force has previously been reported across East and Southern Africa [ 1 , 11 , 12 , 29 , 30 ]. The difficulties in retention of health workers in the rural and remote settings, with preference for urban and wealthy areas affects both developed and is more pronounced in the developing countries and poses significant challenges to equitable health care delivery [ 11 , 12 , 27 ]. As much as there was evident inequalities in the urban versus rural distribution of the participants, over 2/3 of the specialists were employed in Uganda, this speaks to the context of specialist being trained and retained to provide clinical care, education and leadership as has been evidenced in other low resource settings, this consequently contributes to the reduction in the global health care workforce crisis [ 1 ].

The majority of participants are involved in clinical care and/or training and teaching as their major area of activity, this significantly directly and indirectly benefits the population served in the sense of provision of quality health care and in the training of additional health care workers to supplement on the already constrained health work force in our low resource setting. During the qualitative interviews, the participants further stressed the great relevance of the skills obtained during the residency training and their ability to impact the communities they serve in the areas of clinical care, teaching, research, and management. The long term commitment to residency training provides an opportunity to strengthen specialist capacity building at the different levels ranging from the national, regional and district level in the different areas of expertise boasted by the alumni in clinical care, research, education and leadership. These positively impact on the quality of health care of the populations served [ 2 , 31 ].

Limitations

The study sample was small, this is however dependent on the survey response rate. Our survey response rate was low, at 34.3%, compared to surveys conducted among doctors in general (averaging at 53%) [ 32 ], but comparable to specialist response rates to web-based surveys (35.0%)—citing the lack of time to respond to the surveys [ 33 ]. However low, our survey response rate would be considered appropriate to provide confident estimates [ 34 , 35 ]. Our response rate may also be explained by the fact that our survey was concurrently shared on Whatsapp platforms of the residency alumni. We additionally enriched the survey findings with qualitative in-depth interviews. The survey was voluntary and anonymous, this may be prone to sampling bias—respondents with a smooth transition to employment and in a good professional situation may be more willing to take the survey than those who had difficult transition to employment and/or poor professional situation. Our findings are from residency alumni of only a single university and may not represent the contribution to the distribution and pool of specialists from other universities. We however believe some of the experiences may be similar to those of alumni from other public universities in Uganda and the East African Community which share similar characteristics as MUST and the places of employment.

Conclusions and recommendations

This study highlights the importance of the residency training in improving the professional situation of the alumni, through providing an opportunity for career and professional growth and improvement of the quality and safety of health care services in the communities served by the graduates. It also provides insights in the need to support training and retention of specialists in specialties with inadequate numbers of health workforce and the remote rural areas including district-level hospitals, this will reduce the imbalance in the distribution of the specialists by improving rural access to specialist services and decrease referrals to the main tertiary and hospitals—consequently improving health care delivery.

Supporting information

S1 checklist, acknowledgments.

The authors acknowledge the office of the academic registrar for providing the email contacts of the residency alumni. We also acknowledge Ms. Gloria Ninsiima and Mr. Gabriel Nuwagaba for participating in data collection.

Funding Statement

This work was funded by the Mbarara University Faculty of Medicine Seed grant. LT is supported by the Mbarara University Research Capacity Initiative (MURCI) Program funded by the Fogarty International Centre of the National Institute of Health (NIH) under grant number D43TW011632. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

• PLOS Glob Public Health. 2024; 4(3): e0003021.

Decision Letter 0

18 Jan 2024

PGPH-D-23-02119

Impact of the Mbarara University of Science and Technology residency training on increasing access to specialty care workforce

PLOS Global Public Health

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This is a clear, well-written manuscript. It’s main contribution is in describing a convenience sample of providers that were trained in a residency program. I think the authors could emphasize they have a convenience sample a bit more clearly and earlier in the manuscript, because this could explain the positive affect of the responses. Regardless of this limitation, I think it makes some nice points about HRH satisfaction, geographic distribution of providers following graduation and the reasons for satisfaction or not.

Abstract: you should include the number of qualitative interviews here too. I would describe your sample as a convenience sample in the abstract as well.

How do your response rates compare to other provider surveys?

It is likely that you have (self)-selection bias in both the online survey participation as well as the in-depth interview participation and I would postulate it biases the results toward those more satisfied with the program. How might you address this selection bias or do so in future studies? For example, phone follow-up would be a way to increase response rates. The low response rates will be important to mention this as a limitation of the study.

Is there anything about the program that emphasizes OB/GYN? Or is this a feature of the job market? Providers’ interests?

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Author response to Decision Letter 0

23 Jan 2024

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Decision Letter 1

23 Feb 2024

PGPH-D-23-02119R1

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Open Access

Peer-reviewed

Research Article

Impact of the Mbarara University of Science and Technology residency training on increasing access to specialty care workforce

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Faculty of Medicine, Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda

Roles Formal analysis, Investigation, Project administration, Supervision, Visualization, Writing – original draft

Affiliation Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda

Roles Supervision, Writing – review & editing

Roles Investigation, Methodology, Writing – review & editing

Affiliation Infectious Diseases Research Collaboration, Kampala, Uganda

Roles Methodology, Writing – review & editing

Affiliation Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, United States of America

Roles Funding acquisition, Investigation, Writing – review & editing

Roles Resources, Writing – review & editing

Affiliation Mbarara University of Science and Technology, Mbarara, Uganda

Roles Conceptualization, Methodology, Project administration, Writing – original draft, Writing – review & editing

Affiliations Faculty of Medicine, Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda

• Leevan Tibaijuka, 
• Jonathan Kajjimu, 
• Lorna Atimango, 
• Asiphas Owaraganise, 
• Adeline Adwoa Boatin, 
• Musa Kayondo, 
• Nixon Kamukama, 
• Joseph Ngonzi

• Published: March 20, 2024
• https://doi.org/10.1371/journal.pgph.0003021
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Graduate tracer studies provide an avenue for assessing the impact of residency training on the distribution and access to specialty care and exploring job and professional satisfaction of alumnus. This study examined how the Mbarara University of Science and Technology (MUST) clinical residency training program influenced the spatial distribution and career paths of specialists. We conducted a mixed methods study involving an online survey and 12 in-depth interviews (IDIs) from June to September 2022. The online survey was distributed to a convenient sample of clinical residency alumnus from MUST via email and Whatsapp groups. Alumnus were mapped across the countries of current work in QGIS (version 3.16.3) using GPS coordinates. Descriptive and thematic analyses were also conducted. Ninety-five alumni (34.3%) responded to the tracer survey. The majority were males (80%), aged 31–40 years (69%), and Ugandans (72%). Most graduated after 2018 (83%) as obstetricians/gynecologists (38%) and general surgeons (19%). There was uneven distribution of specialists across Uganda and the East-African community—with significant concentration in urban cities of Uganda at specialized hospitals and academic institutions. Residency training helped prepare and equip alumnus with competencies relevant to their current work tasks (48%) and other spheres of life (45%). All respondents were currently employed, with the majority engaged in clinical practice (82%) and had obtained their first employment within six months after graduation (76%). The qualitative interviews revealed the reported ease in finding jobs after the training and the relevance of the training in enhancing the alumnus’ ability to impact those they serve in teaching, research, management, and clinical care. Graduates cited low payment, limited resources, and slow career advancement concerns. Residency training improves the graduates’ professional/career growth and the quality of health care services. Strategic specialty training addressing imbalances in subspecialties and rural areas coverage could optimize access to specialist services.

Citation: Tibaijuka L, Kajjimu J, Atimango L, Owaraganise A, Boatin AA, Kayondo M, et al. (2024) Impact of the Mbarara University of Science and Technology residency training on increasing access to specialty care workforce. PLOS Glob Public Health 4(3): e0003021. https://doi.org/10.1371/journal.pgph.0003021

Editor: Abraham D. Flaxman, University of Washington, UNITED STATES

Received: October 28, 2023; Accepted: February 21, 2024; Published: March 20, 2024

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: The datasets used during this study are available and have been uploaded.

Funding: This work was funded by the Mbarara University Faculty of Medicine Seed grant. LT is supported by the Mbarara University Research Capacity Initiative (MURCI) Program funded by the Fogarty International Centre of the National Institute of Health (NIH) under grant number D43TW011632. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors declare that they have no competing interests.

Post graduate residency training in developing countries is an important component in narrowing the global health care workforce crisis [ 1 , 2 ]. Access to specialized care greatly improves quality and safety of health care services [ 3 , 4 ]. WHO also recommends availability of competent professionals to provide routine care and management of complications for patients as a standard for improving quality of care in health facilities [ 5 , 6 ]. This can only be achieved if doctors are well prepared for this task through residency training [ 7 ].

Uganda and the East African region have significant inequalities in specialized care, with generally few medical specialists, and uneven distribution of the different medical specialties [ 8 , 9 ]. The small number is partly due to the small number of medical specialists graduating from the training institutions and the exodus of the majority of specialists in search of better pay and improved working conditions [ 10 – 12 ]. This definitely impacts the health care delivery to the population and widens the global health workforce crisis [ 6 , 13 ].

Graduate tracer studies provide data to explain the link between study programs and the job market, by exploring the employment situation of graduates in addition to their professional and personal careers, this provides indicators for their professional performance [ 14 – 16 ]. To better understand the public health impact of the post graduate training program at MUST, we aimed to document the geospatial location/distribution of the different specialties of clinical postgraduate alumni after residency training at MUST, their integration into the job market, scope of practice and current job satisfaction.

Materials and methods

Ethics statement.

The study was approved by the Research Ethics Committee of Mbarara University of Science and Technology under reference number MUST-2022-366. Individual informed consent was obtained from all study participants. The consent form ended with the following statement; “Do you agree to participate in this survey ? Yes/No (Check response below as stated) . If you agree to participate , please continue to the survey . If not , you may exit at any time . ” Study codes were used to ensure the anonymity of participants’ data. Data generated from the study shall be used for research purposes only and shall be private and confidential at all times. All principles of data transfer and principles of protection of human research participants outlined in the Declaration of Helsinki were observed.

Study setting and design

We conducted a descriptive cross-sectional and phenomenological study among the clinical postgraduate alumni of residency training programs of the Faculty of Medicine at Mbarara University of Science and Technology (MUST) from 20 th June to 11 th September 2022. The study employed mixed methods involving both quantitative and qualitative approaches—an online survey and in-depth interviews. MUST is a public university that was established in October 1989 and is located 250 kilometers from Kampala in Southwestern Uganda. MUST is affiliated to Mbarara Regional Referral Hospital (MRRH), a public health facility that serves about five million people, mainly from 10 catchment districts of southwestern Uganda and serves as a teaching hospital for MUST medical school. The clinical post-graduate programs carry out their clinical work activities at Mbarara Regional Referral Hospital. The clinical postgraduate program is run under the faculty of Medicine, which is the oldest and pioneer faculty of MUST and has grown over a period of 33 years. MUST under its Faculty of Medicine (FoM) is accredited to offer the following post-graduate programs; Obstetrics and Gynecology, Internal Medicine, Pediatrics and Child health, General Surgery, ENT, Pathology, Psychiatry, Dermatology, Emergency Medicine (2017), Anesthesia and Critical Care, Ophthalmology and Radiology. The programs are delivered through blended clinical clerkships, didactic courses and self-directed learning to ensure acquisition of competency-based knowledge and clinical skills relevant to the respective work environments.

Study population and eligibility criteria

This study targeted and included all clinical postgraduate alumni after residency training at MUST. We included residency alumni who consented to and responded to the survey.

Sample size estimation and sampling

We enrolled a convenience sample of all clinical residency alumni from MUST. The sample population included all residency alumni on the current electronic mailing lists of MUST residency alumni obtained from the academic registrar’s office and the Directorate of graduate studies (DRGT) from the time of start of the graduate training at MUST (2003) to 2017 (graduates of the year 2021). In-depth interviews (IDI) participants were conveniently sampled from survey participants who expressed willingness to be interviewed, following the researchers’ judgment during the study period to ensure a mix of specialties and years of completion of the residency training.

Data collection

A questionnaire was designed using Google Forms and shared the link with the residency alumni of MUST. The sample population included all residency alumni on the current electronic mailing lists of MUST residency alumni obtained from the academic registrar’s office and the Directorate of graduate studies (DRGT) from the time of start of the graduate training at MUST (2003) to 2017 (graduates of the year 2021). The online tracer survey was distributed to all former clinical residency graduates from MUST via email and Whatsapp platforms of clinical post-graduate alumni weekly for a period of 1 month using a Google Forms link. We obtained the following information from the online surveys; background socio-demographic information: age, sex, marital status, year of completion of residency program; transition into the labor market/ employment related characteristics: Employment situation: current job, employer, duration of current job, income, location of employment, duration from completion of residency to obtaining first job, previous employment, how many jobs switched to ever since graduation from residency, career/job satisfaction, search for employment, impact of skills obtained to the community. A Likert scale was used to assess the data on the relevance of the residency training and satisfaction with their career and professional situation. Respondents filled the form online and responses were automatically captured in Google Forms. The responses were downloaded as a CSV file.

The survey’s last item asked if participants would be willing to be contacted for an interview. In-depth interviews (IDI) participants were randomly identified from survey participants who expressed willingness to be interviewed. The randomly identified participants were emailed to arrange an interview date and time. Interviews were conducted over a secure zoom link. These semi-structured interviews aimed to deeply explore the experiences of the alumni. Each interview started by the interviewer introducing themselves and reading out the following statement: I will ask you several questions about your experiences following your completion of your postgraduate residency training at MUST , your transition to employment , your career and professional satisfaction during your current employment , and your impact to the community you serve following your residency training . Example questions asked included “How and when did you find your current and first job?” “ How easy or difficult was it to find you first job?” “How much did you need residency training to do the work you are currently doing?” “How much are you putting the skills learnt during the programme to use?” “How much do the skills learnt during the training programme impact the community you serve?” Interviews ended after clarifying all questions had been answered and participants indicated they had nothing else to share. The interviews were transcribed verbatim and reviewed for accuracy by the interviewer.

Data management and analysis

We cleaned and analyzed quantitative survey data using Stata software (Version 17.0, StataCorp, College Station, TX). We summarized the data in tables as frequencies and percentages. We summarized the Likert scale responses as bar charts using Microsoft Excel [ 17 ]. We mapped the distribution of MUST residency alumni across the region/countries of current work in QGIS (version 3.16.3) using GPS coordinates.

The interviews were analysed independently by 2 researchers using thematic analysis approach [ 18 ]. Each analyst read through each transcript several times highlighting and labelling blocks of text with related underlying meaning (codes). The identified codes were then subjected to constant comparison [ 19 ] before being merged into categories of codes with related meaning. The themes connecting the codes within each category were then identified. The 2 researchers met to discuss these themes, although there were minor differences in the labelling of themes, there was no significant differences in the themes and are reported descriptively.

Quality control and assurance

Access to data was restricted to only the principal investigators (LT, JK, JN) who had the security to the Google drive folder, where the data was sent during data collection.

Demographics

In total, 303 e-mails were sent out. Twenty six (8.5%) of those mails were undelivered, which left us with 277 usable e-mails, from which we received 95 completed questionnaires. This yielded a response rate of 34.3%. Of the 95 respondents who participated in the tracer survey, majority were Obstetricians and Gynecologists (38%, n = 36), followed by General surgeons (19%, n = 18), pediatricians (9%, n = 9) and Ear Nose and Throat specialists (ENT) (6%, n = 6) ( Fig 1 ); majority were males (80%, n = 76), aged between 30–40 years (66%, n = 69), and had completed their training in the years after 2018, and had privately sponsored their post-graduate studies (36%, n = 34), others had scholarship support from fellowships, government and NGOs ( Table 1 ).

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Geospatial distribution of post-graduate alumni of the clinical residency program of MUST

There was uneven distribution of clinical residency alumni of MUST across Uganda, with sparse distribution in Kenya and Rwanda. There was imbalanced distribution of the different specialties across the region with Obstetricians/Gynecologists (Obsgyn) and General surgeons more dispersed across the region compared to the sparse distribution of other specialties ( Fig 2 ).

Link to map base layer: https://www.naturalearthdata.com .

https://doi.org/10.1371/journal.pgph.0003021.g002

Work place locations of post graduate alumni of the MUST clinical residency program

Majority of the clinical residency alumni are distributed in the south-western, central and northern regions of Uganda, and at the different public and private Hospitals across the East African region especially in the Urban and peri-Urban settings ( Fig 3 ).

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Usefulness of residency training to one’s career

The respondents generally reported that the residency training was to a large extent useful to their careers—in preparing them for their current work tasks (48%), and for tasks in other spheres of life (45%). Majority of the respondents reported that the current employment and work was to a large (40%) and very large (36%) extent appropriate to their level of training; and the career at the time of graduation had been realized to a large and very large extent in 37% and 33% of the respondents, respectively ( Fig 4 ).

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Employment status of post-graduate alumni of MUST

Obtaining of first employment..

The respondents reported the following as important or very important for being employed; personality, grades at the university, reputation of the university, reputation of the university and previous work experience ( Fig 5 ).

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Current job employment.

All the respondents to the survey were currently employed and most were earning UGX 5–10 million (USD 1400–2800) per month (46%). Majority reported having obtained their first employment <6 months after graduation (76%). Majority had spent <1 year in their current employment (31%), followed by those who had spent >5 years (29%). Also majority had spent <1 year in their current position (36%), followed by those who had spent between 1–3 years (35%). Majority of the participants were currently employed in Uganda (67%), were involved in clinical practice/care (82%) and are public service employees (51%) ( Table 2 ).

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Work orientation, job satisfaction and professional success of graduates

Overall majority of the respondents were either satisfied (43%) or very satisfied (29%) with their professional situation. They were very satisfied with; possibilities to use qualifications acquired during their studies (53%), the opportunity to benefit society (42%) and the content of work/ professional tasks (37%). Majority were also satisfied with; the opportunity of pursuing continuous learning (52%), the chance of realizing their own ideas (53%), and income (47%). However were not as satisfied about the equipment at work places, position and promotion prospects and income ( Fig 6 ). Overall, there was no significant difference in satisfaction among those in public versus private, a bigger proportion were satisfied (37% [public] versus 49% [private]) or very satisfied (30% [public] versus 29% [private sector]), (p<0.460).

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In-depth interviews

Of the participating participants, 55 (58%) agreed to be contacted to be interviewed, 12 participants were randomly selected by program cohort year to allow for a variety of perspective from the participants as the program has evolved over time. We conducted 12 semi-structured in-depth interviews with several themes regarding the almuni’s post residency work experiences, their ability to put the skills obtained to use and impact communities they serve, and the challenges encountered during their work.

Post residency work experiences

Processes of finding jobs included self-led job searches, and employer led identification of employees.

“… just soon after finishing at MUST , I applied for the job and then came to the dean’s office at MUST and he recommended me so I was short listed after applying and I sat for the interview and I was given the job . ”[IDI02] “ …it was not a situation where it was advertised and then I had to compete , they just picked me and said that they think I can help them and so they invited me . ” [IDI03]

Participants reported changing job due to search for job security and for strategic positioning.

“ …the reason was more of getting a permanent job because KIU was a bit temporary and contract based , so I needed something more secure . ”[IDI06] “ …though they were paying me much better but having an opportunity to come to Mbarara under the government was even a bigger opportunity because at that time they were paying me less but I was looking at the opportunities of mentorship ad being able to come back to school with ease . ”[IDI01]

Ability to put the skills obtained to use and impact the communities served

The alumni reported relevance of their training and their ability to impact those they serve in terms of both teaching, research, management and clinical care.

“ I think I am putting these skills to use because I am doing clinical work and I also obtained some research skills that I am using to teach students skills on how to do research work” . [IDI04] “ It [Training] is actually very relevant , Kabale has never had an ENT surgeon for a long time so I should say that I was the first and for the time I have been there the number of referrals from Kabale to Mbarara referral hospital greatly reduced , so I am happy that I am able to offer help not only to the academia but also to the community . So that is how relevant my training has been” . [IDI02] “I would say that virtually everything that I learnt, I am trying to give it out. I am actually using all my skills because I learnt research and internal medicine and at the moment I am using all the skills I learnt, you know there are some people who get office jobs and don’t use their skills but personally, I am using my clinical skills as well as other knowledge to teach”. [IDI05] “ My discipline is contributing to improving the lives of mothers and children and in a way helping to maintain a healthy community that will contribute to the economic development of the country” . [IDI07] “ I put the skills almost at a daily basis , every single day I am using the skills I learnt during my post graduate training , both clinical practice and management , I have used the skills I learnt during my post graduate” . [IDI03]

Challenges encountered by the post-residency alumni at the places of employment

Several challenges have been encountered such as underpayment, lack of enough resources at work, delayed job promotions and challenging career development.

Significant under payment

The alumni reported dissatisfaction with their payment compared to the work output, for example one participant reported, “…we are not fully satisfied with the salary . It is small compared to the amount of work that we do and the training that we go through to get there…” [IDI06]

Another participant thought, they were carrying out 2 tasks/jobs, that they perceived as separate i.e., “teaching” and “clinical care”, yet they received pay for a single task; “I am teaching , I am still working as a [general] doctor [and] as a specialist so it is likes I am doing two jobs and I am only being paid for one job . ”[IDI05]

Opportunities for career advancements at the current places of employment

The alumni reported varying opinions regarding opportunities for career advancement at their different places of employment. Some reported challenging career development while others reported favorable career growth environments. The decisions to advance were however influenced by social needs and the places of acquisition of the career advancements.

“ Currently at my institution [of work] I haven’t seen much opportunity in terms of career advancement; I think the only thing I have seen is expanding my research and innovation funds which can work in the direction of career advancement , generally there is minimal opportunities . ” [IDI01] “ The opportunities are there , there are PHD scholarships and Masters Scholarships for the general staff . I think the opportunities are there” . [IDI03] “ The opportunities are limited but the connection to the outside environment is available” . [IDI11] “.. the opportunities are there only that the challenge is that at this time of life when you have already grown with a family , it becomes hard to progress because of many reasons because you may find that you could attend certain fellowships that need you to leave the country or to relocate which becomes difficult when you have a young family . ” [IDI01]

Need for promotions of specialists with the skills attained

The alumni expressed dissatisfaction with the promotion processes both in the academic and clinical spheres of practice, as stated below;

“ Considering the number of years I have spent in the university , the number of students I have taught and the supervisions I have done I am not happy because I have not been promoted while my fellow colleagues in other departments have been promoted , I think I should be at least at a level of senior lecturer . ” [IDI05] “ I have stayed long on the same level for the last nine years so the promotion has been less . ” [IDI05] “ I think the government can do better [regarding] promotions , because I am looking at someone who has officially completed and was given a study leave to go and study and then he comes with papers that show he has graduated but they fail to promote people even when there is room . So there are many people functioning at lower positions , so I think the government can do better” . [IDI09]

Inability to use the acquired skills

The alumni decried their inability to use the obtained skills, due to the unavailable facilities—equipment and medicines, which may be associated with failure to achieve the maximal productivity potential. For example one of the alumni reported, “There are some things that you can never do in a government setting because you don’t have the facilities where to do them , like accessing certain drugs and some equipment . So you end up imagining something and then that is all you can do for that but otherwise we have the patients and the cases but we are limited in that way” . [IDI01]

“ I have just been limited by equipment so there are some procedures that I can’t carry out from this side due to lack of equipment but generally speaking I can say that I am putting these skills that I learnt in my daily activities , apart from those limitations” . [IDI05] “ …you know when you are working for the government , you find that you are short of resources which can enable us to utilize our skills . That is what is challenging . ”[IDI08]

We explored the distribution and contribution to access to specialty care and described the integration of the clinical residency alumni of MUST into the job market, their current job satisfaction and the challenges experienced.

There was uneven distribution of the specialties among the respondents of the survey—Obstetrics and Gynecology, General surgery, Pediatrics and Internal medicine accounting for majority of the respondents to the survey. This is in keeping with the spatial distribution of the health workforce of the different medical specialties, with an imbalance between the established clinical specialties (like Obstetrics and Gynecology, General surgery, Pediatrics and Internal medicine) and the non-established specialties (Dermatology, Pathology, Emergency medicine, Anesthesia, Psychiatry)—which are sparsely distributed across the region, this may in the long-run impact health care delivery. The uneven distribution of the specialties is influenced by specialty career preferences of medical students and their eventual choice of career training as evidenced by prior studies [ 20 – 23 ]. There is need to avert the uneven distribution of specialties in order to ensure adequate health care delivery by attracting residents to specialties with inadequate numbers of health workforce so as to ensure a holistic improvement of healthcare.

We found that the alumni seamlessly integrated into the job market after their training—over 76% of the respondents were employed in the first 6 months of graduation and did not find a lot of difficulty in getting employed. The overall satisfaction with the professional situation was good (72%)—with majority citing usefulness of the acquired skills, benefit to society, job security and opportunity to pursue further education to be associated with their current professional situation. As much as the opportunities of employment for specialist are available, the alumni reported experiencing significant underpayment, limited resource availability for their optimum working and delayed job promotions. These are also generally the leading causes of dissatisfaction among the different human resources for health, especially in the low resource settings and therefore contribute to recurrence of industrial actions in these settings [ 24 – 26 ]. Strengthening health financing in terms of timely promotions, commensurate remunerations and provision of adequate resources/equipment, would improve the job satisfaction of the graduates especially in the cited areas of dissatisfaction [ 24 – 26 ].

There is uneven geographical distribution of clinical residency alumni of MUST in Uganda—with concentration in the south-western, central and northern regions of Uganda, and at the different private and government hospitals across the East African region. The areas of distribution mostly represent the hospitals and the training institutions in the urban centers which are usually well equipped with competitive salaries for the respective human resources. Urban areas are additionally more attractive to health care professionals, as they provide the social, cultural and professional benefits—like educational opportunities and access to amenities for their families [ 27 , 28 ]. This leaves a gap in the distribution of specialty services at remote rural areas including district-level hospitals, this will further improve rural access to specialist services and decrease referrals to the main tertiary and teaching hospitals. The inequalities in the training and distribution of specialist health work force has previously been reported across East and Southern Africa [ 1 , 11 , 12 , 29 , 30 ]. The difficulties in retention of health workers in the rural and remote settings, with preference for urban and wealthy areas affects both developed and is more pronounced in the developing countries and poses significant challenges to equitable health care delivery [ 11 , 12 , 27 ]. As much as there was evident inequalities in the urban versus rural distribution of the participants, over 2/3 of the specialists were employed in Uganda, this speaks to the context of specialist being trained and retained to provide clinical care, education and leadership as has been evidenced in other low resource settings, this consequently contributes to the reduction in the global health care workforce crisis [ 1 ].

The majority of participants are involved in clinical care and/or training and teaching as their major area of activity, this significantly directly and indirectly benefits the population served in the sense of provision of quality health care and in the training of additional health care workers to supplement on the already constrained health work force in our low resource setting. During the qualitative interviews, the participants further stressed the great relevance of the skills obtained during the residency training and their ability to impact the communities they serve in the areas of clinical care, teaching, research, and management. The long term commitment to residency training provides an opportunity to strengthen specialist capacity building at the different levels ranging from the national, regional and district level in the different areas of expertise boasted by the alumni in clinical care, research, education and leadership. These positively impact on the quality of health care of the populations served [ 2 , 31 ].

Limitations

The study sample was small, this is however dependent on the survey response rate. Our survey response rate was low, at 34.3%, compared to surveys conducted among doctors in general (averaging at 53%) [ 32 ], but comparable to specialist response rates to web-based surveys (35.0%)—citing the lack of time to respond to the surveys [ 33 ]. However low, our survey response rate would be considered appropriate to provide confident estimates [ 34 , 35 ]. Our response rate may also be explained by the fact that our survey was concurrently shared on Whatsapp platforms of the residency alumni. We additionally enriched the survey findings with qualitative in-depth interviews. The survey was voluntary and anonymous, this may be prone to sampling bias—respondents with a smooth transition to employment and in a good professional situation may be more willing to take the survey than those who had difficult transition to employment and/or poor professional situation. Our findings are from residency alumni of only a single university and may not represent the contribution to the distribution and pool of specialists from other universities. We however believe some of the experiences may be similar to those of alumni from other public universities in Uganda and the East African Community which share similar characteristics as MUST and the places of employment.

Conclusions and recommendations

This study highlights the importance of the residency training in improving the professional situation of the alumni, through providing an opportunity for career and professional growth and improvement of the quality and safety of health care services in the communities served by the graduates. It also provides insights in the need to support training and retention of specialists in specialties with inadequate numbers of health workforce and the remote rural areas including district-level hospitals, this will reduce the imbalance in the distribution of the specialists by improving rural access to specialist services and decrease referrals to the main tertiary and hospitals—consequently improving health care delivery.

Supporting information

S1 checklist. inclusivity in global research..

https://doi.org/10.1371/journal.pgph.0003021.s001

S1 Data. Dataset for impact of MUST residency training on increasing specialty workforce.

https://doi.org/10.1371/journal.pgph.0003021.s002

Acknowledgments

The authors acknowledge the office of the academic registrar for providing the email contacts of the residency alumni. We also acknowledge Ms. Gloria Ninsiima and Mr. Gabriel Nuwagaba for participating in data collection.

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