# An international medical education collaborative to enhance academic and clinical capacity in South Africa: a six-year review of Discovery-Mass General Fellowship

## TL;DR

A six-year fellowship program in South Africa, supported by an international collaboration, helped train clinician-scientists and improve healthcare capacity.

## Contribution

A novel international fellowship program to build clinical and academic capacity in South Africa through mentorship and training.

## Key findings

- Fellows gained advanced research skills, clinical exposure, and mentorship through the program.
- The program had a positive impact on fellows' careers and their commitment to improving South Africa's healthcare system.
- Challenges included short training duration, reintegration difficulties, and limited hands-on clinical practice in the USA.

## Abstract

The Government of South Africa has prioritised disease prevention and improved healthcare delivery, but the country remains challenged by disease burdens and inequity of resources across the country, including the availability of clinician-specialists to meet public sector and other needs.

To address the need for more physician specialists in the country, Discovery Health of South Africa collaborated with Mass General Hospital in the USA to create a clinical and research fellowship for South African clinician-scientists. We engaged fellows in semi-structured interviews to chronicle their experience in the programme and its impact and challenges.

Six fellows were awarded the one-year fellowship between 2014 and 2022. Their specialties were in endocrinology, rheumatology, gastroenterology, anaesthesia, and obstetrics and gynecology. All fellows divided their time between research and clinical observership, with programmes individualised for the fellows and mentors in terms of time dedicated to each. The strengths of the programme included formal educational benefits; advanced research techniques, scholarship, and educational opportunities; clinical exposure; strong mentorship; expanded networks; immersive experiences; and accelerated career paths. Weaknesses comprised a relatively short period of study; challenges to reintegration in South Africa; tight budgets to live in the USA; inability to conduct clinical or hands-on practice in the USA; and desire for formal recognition of their time of study in the programme. The fellows all noted the impact of the programme on their own careers- including increased professional opportunities and expanded networks, as well as deepened commitment to and impact in strengthening the capacity of and breadth of service in South Africa’s health system.

Despite challenges to the programme, the fellowship showed the impact of and need for more similar scientific and clinical academic training programmes to build capacity in low- and middle-income countries. With persistent global shortages of health workers, creative solutions that build expertise should be further scaled.