Table 3 Negative impressions of postgraduate specialization training in Malawi

Learning environment

Limited variety of cases

Students felt that they are exposed to a limited variety of cases, which limited their ability to form broad differential diagnoses

“If you are not careful, there is this knee jerk reaction where every fever is malaria, every cough is TB, every headache is meningitis…exposure to other disease processes makes a difference.”

Same teachers throughout training—limited knowledge

Students discussed that being exposed to the same teachers throughout their training limited their pool of teachers and available knowledge

“It’s a bit too much for some people. You go through your [medical school training] with the same consultants. Then you do your internship training with those same people. And then you do your master’s program under those same people. So, you’re limited for who you can go to for knowledge. And if it’s someone you don’t get along with, it makes it difficult.”

Same teachers throughout training—bias

Students discussed how having the same teachers throughout their training can perpetuate biases

“The tutors here already have a biased view towards the students that they have seen through the years.”

Halted progression of registrars

Students noticed that some registrars have not progressed through their training and graduated on time

“Some registrars don’t seem to be progressing. I hear some registrars have even given up. I don’t want to go through the same. I want to progress.”

Limited scope of training

Students perceived that the training in Malawi only trains registrars to practice in Malawi, limiting the scope of their training

“These programs are designed to train people for the country they are in, specifically the MMed here. You want to have doctors in Malawi. So the objective may not necessarily be to have the best MMed program in the region…you end up saying, 'Would that be adequate?’ I don’t think it is.”

Limited credentials—unable to work in other countries

Students desired to have the credentials to work anywhere in the world once they are done with their specialization training

“There is a catch to the programs, as if you are limited to work in sub-Saharan Africa. [Fellow students] are not really in favor of that, because I think most people want to work abroad in different countries. I think they feel the programs are holding them back.”

Difficult learning environment

Students perceived the learning environment as unnecessarily difficult

“Most people are reluctant to do their masters here because they are making it really tough.”

Limited number of specialties

Students wanted more opportunities for specialization in Malawi

“Here in Malawi, there are only a few specializations. So they are very limited compared to the different specialties I saw outside of the country.”

Contractual obligations

Students felt the contractual obligation to government scholarships was excessive

“I would like to shy away from the programs that they’re offering because of the contractual clause that you have to be in service to the government.”

Consultant shortages

Students perceived that there were not enough clinicians to handle the clinical and teaching responsibilities

“I don’t think there are enough local consultants in most of our departments for them to say that we have adequate doctors to teach our new doctors.”

Working environment

Overworked

Students felt that the registrars worked harder than was reasonable

“We see our registrars. They are there for quite long and they are overworked.”

Not appreciated

Students perceived that there was a lack of appreciation for the work that is being done by the registrars

“There are lots of patients to see, and maybe they feel that are not appreciated at the end of the day…Everyone is frustrated at the end of the day because it is just a lot of workload.”

Compensation

Students felt that the amount of money paid to registrars was inadequate to pay for expenses

“When you compare the money that [registrars] earn per annum to the cost of school and everything else, you can’t afford it. So you need a scholarship to do postgraduate training, but to get those scholarships is really quite hard.”