Department of Family Medicine
The Department of Family Medicine is housed within the School of Public Health & Family Medicine (SPHFM), which is one of three Faculties comprising the University of Malawi College of Medicine.
A Family Physician is a clinical leader and works as a consultant in the primary health care team to ensure primary, continuing, comprehensive, holistic and personalised care of high-quality to individuals, families, and communities. The mission of the Department of Family Medicine is to teach learners how to provide comprehensive person-centred care, with a family and community orientation, in which the family physician responds to undifferentiated illness, and acts as a consultant to the primary health care team.(Reference)
The department started its first programmatic activity in 2011 with the launch of a 6-week required undergraduate rotation in Family Medicine as part of the MBBS IV curriculum. During the six week undergraduate experience, future doctors are exposed to the key principles of Family Medicine in the Malawi context. Through didactic lecture, and a practical attachment at a District Hospital teaching site, the students learn community-oriented and context-specific care for the whole-person.
The department partners with a number of different hospitals and health programs in order to facilitate the educational objectives. Wonderful partner sites for teaching placements include: Mangochi District Hospital, Nkhoma Hospital, Malamulo Hospital, Mulanje Mission Hospital, and Partners in Health Malawi based in Neno district in southwest Malawi.
In January 2015, the Department started the first postgraduate program for training Family Medicine doctors within Malawi. Upon completion of the 4-year curriculum, the trainee will be awarded a Masters in Medicine (MMED) in Family Medicine . Three postgraduate trainees (called “registrars”) have started the program and are based out of the Mangochi District Hospital as the primary duty station and teaching facility platform.
The Department is currently staffed by a mix of full-time and part time Faculty. Additionally, the program is grateful to partner with a number of world-class organizations outside of Malawi, including the Global Health Service Partnership (GHSP) program, in order to strengthen faculty capacity the short to medium-term.
History of Family Medicine in Malawi
The idea of “Family Medicine” or “General Practitioner” (GP) as a unique type of doctor, with its own differentiated postgraduate training, has been around for a long time. The first professional associations of Family Doctors or GPs were formed in the 1940s and 1950s in Canada, the U.K., and the U.S.A. Family Medicine or General Practitioner postgraduate training in some form exits in 65% of the worlds’ countries.
Inception of the idea of Family Medicine in Malawi and how it has evolved
The Malawi College of Medicine (COM) was founded in 1991 as a constituent college of the University of Malawi. The first postgraduate programs at COM in the form of Masters in Medicine Degrees (MMED) were started in 2005.
2008 – 2011
The Family medicine concept started as inspiration to improve the practice in rural medicine by Dr Jonny Kumwenda in early 2001. This came from the understanding that doctors sent for district attachment lacked skills to meet the challenges of the district hospital, hence most medical officers sent for community service in district hospitals became frustrated and did not remain there to work. Those who wished to remain and serve in the district hospitals lacked support and mentorship, and their career path looked bleak.
In 2008 a team comprising of academics from Edinburgh Scotland, Witwatersrand University, and Stellenbosch University from South Africa, as well as stakeholders from Malawi (see picture above) met in Blantyre, Malawi. The aim was to discuss introducing family medicine and engaging with stakeholders to start Family medicine in Malawi. The discussion was fruitful and it came up with the following realizations: the need for FM was recognised and envisaged as a vehicle for improving the primary health needs of poor Malawians. Furthermore, the role of the other key players in primary health care (PHC) was recognised, along with the need to integrate their skills into a healthcare team to improve PHC.
In 2009, the main stakeholders providing PHC in Malawi; namely Christian Hospitals Association of Malawi (CHAM) and Ministry of Health (MOH) requested consultation on the process of creating a plan for a family medicine education and training program, and how to improve primary health care . The forum realised that that to achieve the stated goal, they needed health-workers with multi skilled expertise to improve service at district hospital level and beyond = Family Medicine! This came at the same time that the World Health Organization (WHO) re-affirmed that the broad based stance of a generalist provides good skills and attitudes for provision of primary health care. Of particular note was the fact that, at the time, there was a critical human resource shortage at the national level, and even more so, critical at district hospital level. The few doctors that were placed at District hospitals in Malawi largely assumed administrative roles. Those doctors also felt poorly prepared in their training to ably face the challenges before them. The committee then confirmed their case for family medicine and drew up prerequisite and partnerships needed for starting FM in Malawi.
By March 2009, the idea of Family Medicine was agreed in principle by the Malawi Medical council. Later, exposure to international family Medicine bodies like Primafamed served as a catalyst to starting family medicine at the Malawi College of Medicine.
2011 – 2014
February 2011 saw the appointment of 1 full time and 1 part-time Lecturer in family medicine by Malawi College of Medicine. At the start of the Academic year in 2011, the first FM clerkship block was introduced in the MBBS 4th year with an aim to exposing undergraduate students to principles of family medicine .
Seen in the picture (left) , the first cohort of students completed 6 week course, with a lecture week at the College of Medicine Blantyre Campus, then proceeded to one of several District Hospital settings within Malawi to learn first hand about person-centered care at the district level, and what role Family Medicine doctors play in providing that care. The course has continued annually since that time.
The undergraduate rotation has undergone continuous updates, with the goal of improving the educational program to meet our high standards. Yearly the Faculty and core stakeholders, including Preceptors (Faculty teachers) based at the district hospital sites have met together to make sure the teaching material is updated and relevant for students. A group (picture right) is seen updating the student logbook at the end of the first year of the rotation, in April 2011.
During the years of development and improvement of the undergraduate program, the idea of postgraduate training was never far from the surface. Most of the 2012 saw the start of the development of a postgraduate curriculum. Critical to this process was the development of training sites as well as trainers and securing funding for the program. Continuing in 2013, in conjunction with the International Training and Education Center for Health, a curriculum was formalized for the postgraduate program and submitted to the University of Malawi Faculty Senate. In early 2014 the University of Malawi Faculty Senate approved the Curriculum for the MMED Program in Family Medicine.
2015 and Beyond
In January 2015 the first class of registrars started training based at the district level at the Mangochi District Hospital. (Pictured below) the 3 registrars embarked on a 4 year program that will teach them to be leaders in the health system. The staffing at the Magochi District Hospital site include a Full-time Faculty lecturer, and 2 Physician volunteers from the United States which is part of a partnership with the Global Health Service Partnership program, which is a joint program of SEED Global Health and the United States Peace Corps.
Currently, there are plans to recruit a second class of registrars into the program. The plan is to increase the number of registrars in the program, and also expand the number of training sites. Potential district hospital training locations that have been considered in the next phase of MMED program expansion as training sites include Nkhoma Mission Hospital and Neno District Hospital.
We are happy to connect with anyone regarding further details or questions!
Family Medicine Research Priorities
Family Medicine is a relatively new clinical specialty in the country of Malawi. The training produces a broadly capable physician specialist with competencies in a range of clinical areas including: adult, pediatric, obstetric, and surgical disciplines, as well as competences in public health and district leadership.
Dean School of Public Health & Family Medicine, Kamija Phiri PhD, teaching MMED registrars
Globally there is a strong interest in the strengthening of primary care health delivery systems. There is a belief that a family doctor can add great value to health service delivery as a part of the district health team. To that end the Malawi Ministry of Health has planned that 2 Family Doctors should be posted at the district hospital level. At this point there is not a robust body of literature describing the value that family medicine trained physicians contribute to health delivery in sub-Saharan Africa. Examples of the burgeoning literature on Family Medicine in the African context can be found here.
A goal of this research theme for the Department of Family Medicine is to develop this type of evidence as part of implementation of the new postgraduate training program.
Thematic Areas of Research for Department include:
Developing the plan
- Conceptual research: Defining FM in Malawian context.
- Family Medicine in Clinical Service Provision at the District – Example: Does family medicine presence improve care of Non-communicable disease (NCD) care.
- Needs evaluation and assessment: focus of FM in dealing with population needs using bottom-up approach.
- An exploration of the role of government, policy, universities and rural clinical academics in supporting and developing rural clinical academic leadership and training
- Describing and analysing functional district training sites (with a particular emphasis on facilitating and constraining factors.
For further detail, a PowerPoint presentation on the Research Agenda of the Department can be found here: Malawi Family Medicine_Research Agenda_July 2015
Collaborations welcomed. Please email HOD for further inquiry – Dr. Martha Makwero.
Undergraduate (MBBS) Program
The clerkship in Family Medicine aims to introduce students to a thinking process that puts the family and the context of a patient’s illness at the centre of person-centered care. By giving the student responsibility to take history from the patient or guardian, perform a physical examination, writing the findings and participating in the process of further investigations and treatment under the guidance of a qualified clinical teacher, family medicine allows students to learn principles of holistic care and translate theoretical medical knowledge into practical skills. The module also gives students an opportunity to experience and to practice integrated primary care medicine that is responsive to patients, their families and communities.
The Family Medicine clerkship, a six week rotation, starting with lectures at the main campus followed by four weeks spent at a clinical preceptor site and a final week at campus. The aim of the clerkship is to expose you to the practice of family medicine and primary care in the setting of a district or rural site.
In this rotation, students will learn different models of consultation, communication, principles of chronic care and continuity of care, Integrated Management of Childhood Illness (IMCI), adolescent health, family health, geriatric care, palliative care, and ethics in the context of primary care.
This clerkship is distinct from others in the MBBS curriculum. The patients students evaluate may not have seen a health care worker before ―i.e., they are undifferentiated. They may have no diagnosis or may be presenting with new symptoms, giving the student an opportunity to make first impressions. Each of the patients students evaluate are considered as an integrated whole, and all of his/her problems will be attended to within the context of his/her family and community.
During the district hospital attachment the students are expected to be self-directed with a large portion of their learning. The student logbook, acts as a learning diary for students’ to record undifferentiated cases, antenatal visits, chronic care consultations and much more. Guided by the logbook, the student is encouraged to think of every patient encounter as a learning opportunity.
Postgraduate (MMED) Program
The postgraduate training program in Family Medicine started with the first trainees at the University Of Malawi College Of Medicine in January 2015. The postgraduate program is four (4) years in length, and upon successful completion leads to the award of a Masters of Medicine (MMED) degree as laid forth and approved by the University of Malawi. The MMED-Family Medicine is a specialist qualification at par with other clinical specialties in Medicine in Malawi.
The aim of the MMED-Family Medicine program is to provide high quality postgraduate education in family medicine, which will produce specialists who have the broad range of competencies necessary in the management of the primary care team and in the provision of integrated, comprehensive, continuous and person-centred care.