Sub-specialization preferences among ophthalmology masters students in Eastern Africa

Objective: To determine the sub-specialization preferences among masters of medicine in ophthalmology in selected universities in Eastern Africa and barriers to sub-specialization. Design: This was a cross-sectional study. Method: An analysis of data obtained from 35 masters of medicine students in ophthalmology from six universities/teaching hospitals in three countries within Eastern Africa was done. Results: Approximately 69% of the respondents preferred to sub-specialize of whom 25% preferred anterior segment. Approximately 25% of those who were not willing to sub-specialize advanced inability to identify an appropriate sub-specialty area and wish to practice first as the major reasons in each case. Major benefits identified for sub-specialization were; increase their knowledge and skills (31.6%), better patient care (21.1%) and marketability of their services (26.4%). Approximately 27.8% of the respondents cited lack of support after practice(38.9%) as the major sub-specialization challenge. Over 33(94%) of the respondents said they were not aware of sponsorship opportunities. Majority of the respondents (58.3%) preferred training institutions with hands-on-training and demonstrated experience in the sub-specializations offered. Conclusion: Majority of the respondents were willing to sub-specialize and most of them preferred anterior segment. The main barrier to sub-specialization was inability to choose an area of subspecialty. Lack of support after practice and opportunities for sub-specialization, were the major challenges to sub-specialization. Consequently, awareness and information on sub-specialization and sub-specialization opportunities need to be increased as most of these students have no adequate information on sub-specialization opportunities available. to sub-specialization in ophthalmology is lacking. All these constraints will require an effective and coordinated approach with an effective institutional, resource and technical fit to be put in place in order to address these pertinent issues facing sub-specialization preferences in ophthalmology and raise its profile within the Eastern African region. As a result, the aim of the present study was to obtain information on the sub-specialization preferences in ophthalmology among Masters of Medicine in ophthalmology students across Eastern African region and understand barriers to subspecialization in ophthalmology so as to form a base for effective intervention and approach for raising the profile of sub-specialization in the region. MATERIALS AND METHODS This study used a cross-sectional study design to help provide a snapshot of the phenomena of study. Data was collected using pre-tested online questionnaire to ensure that all the students across the entire region are capable of participating in the study and providing their insight, views and opinions on the preferences and barriers to sub-specializations. The main focus of the study was in three countries; Kenya, Uganda and Tanzania. Census approach was used to enlist all the 35 Master of medicine in ophthalmology students in all the years of study in the list provided by EACO from six training institutions in the region namely: MUST, INTRODUCTION The incidence of adult as well as pediatric ocular diseases requiring sub-specialist attention has increased dramatically in sub Saharan African countries and so have their serious complications1-4. Many of these diseases could be managed and complications be avoided by better clinical care at specialized point of service5-7. However, despite this alarming trend, most of sub-Saharan African countries continue to experience inadequate human resources for various sub-specialties8,9. Among the practising ophthalmologists, reviews have indicated that the rate of sub-specialization remains unknown with all of the regional countries having less than the recommended number of 300 general ophthalmologists per 10,000 populations10,11. Many of the eye health cases emerging now are those that increasingly require sub-specialists to address especially in cases that come with increased cases of diabetes, cancer and other non-communicable diseases7,12. This underpins the need to increase the number of sub-specialist available to handle the increasing burden of eye diseases and problem at both the country and regional level. However, reviews have established that there is inadequate documentation and research on subspecialization, barriers to sub-specialization and the associated subjects in the region and whole of subSaharan Africa. As a result, basic information on the actual sub-specialization preferences and barriers East African Journal of Ophthalmology July 2013 4 Journal of Ophthalmology of Eastern Central and Southern Africa July 2014 Makerere, CCBRT, KCMC, Muhimbili and UON. Content analysis was used to explore themes emerging from the dataset in-order to have in-depth understanding of the study variables. The major limitation of the study was the small number of the respondents as the study didn’t take into account students who were not in the list of EACO. However, the study adopted online survey method to ensure that all the students in the list provided by EACO participated in the study.