doctoral training in uganda: evaluation of mentoring best practices at makerere university college...

Nakanjako et al. BMC Medical Education 2014, 14:9http://www.biomedcentral.com/1472-6920/14/9

RESEARCH ARTICLE Open Access

Doctoral training in Uganda: evaluation ofmentoring best practices at Makerere universitycollege of health sciencesDamalie Nakanjako1*, Achilles Katamba1, Dan K Kaye2, Elialilia Okello3, Moses R Kamya1, Nelson Sewankambo1

and Harriet Mayanja-Kizza1

Abstract

Background: Good mentoring is a key variable for determining success in completing a doctoral program. Weidentified prevailing mentoring practices among doctoral students and their mentors, identified commonchallenges facing doctoral training, and proposed some solutions to enhance the quality of the doctoral trainingexperience for both candidates and mentors at Makerere University College of Health Sciences (MakCHS).

Methods: This cross-sectional qualitative evaluation was part of the monitoring and evaluation program fordoctoral training. All doctoral students and their mentors were invited for a half-day workshop through the MakCHSmailing list. Prevailing doctoral supervision and mentoring guidelines were summarised in a one-hour presentation.Participants were split into two homogenous students’ (mentees’) and mentors’ groups to discuss specific issuesusing a focus group discussion (FGD) guide, that highlighted four main themes in regard to the doctoral trainingexperience; what was going well, what was not going well, proposed solutions to current challenges and perceivedhigh priority areas for improvement. The two groups came together again and the note-takers from each grouppresented their data and discussions were recorded by a note-taker.

Results: Twelve out of 36 invited mentors (33%) and 22 out of 40 invited mentees (55%) attended the workshop.Mentors and mentees noted increasing numbers of doctoral students and mentors, which provided opportunitiesfor peer mentorship. Delays in procurement and research regulatory processes subsequently delayed students’projects. Similarly, mentees mentioned challenges of limited; 1) infrastructure and mentors to support basic scienceresearch projects, 2) physical office space for doctoral students and their mentors, 3) skills in budgeting and financemanagement and 4) communication skills including conflict resolution. As solutions, the team proposed skills’training, induction courses for doctoral students-mentor teams, and a Frequently Asked Questions’ document, tobetter inform mentors’, mentees’ expectations and experiences.

Conclusion: Systemic and infrastructural limitations affect the quality of the doctoral training experience atMaKCHS. Clinical and biomedical research infrastructure, in addition to training in research regulatory processes,procurement and finance management, communication skills and information technology, were highlighted ashigh priority areas for strategic interventions to improve mentoring within doctoral training of clinician scientists.

Keywords: Mentorship, Doctoral training, Supervision, Capacity building, Health care, Low and middle incomecountries, Uganda

* Correspondence: dnakanjako@gmail.com1Department of Internal Medicine, Makerere University College of HealthSciences, Kampala, UgandaFull list of author information is available at the end of the article

© 2014 Nakanjako et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

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BackgroundOver the last decade, the number of health care doctoralstudents at Makerere University College of HealthSciences (MakCHS) has increased by over 10 fold withthe increasing funding opportunities for capacity build-ing for health care and health leadership [1,2]. Fundingfor doctoral training had been realised through collabora-tive capacity building programs including among others;Medical Education Partnership Initiative (MEPI)–MedicalEducation for All Ugandans (MESAU), Training HealthResearchers into Vocational Excellence (THRIVE), MalariaCapacity Development Consortium (MCDC), MilleniumScience Initiative (MSI), Netherlands University Foundationfor International Cooperation (NUFFIC) and SwedishInternational Development Agency (SIDA). Each of thesecollaborative doctoral programs provides unique fea-tures that could be utilised to promote mentoringbest practices for doctoral students at MakCHS. Forexample, a majority of the programs combine local andinternational supervision, with mentors from partner in-stitutions, thereby providing a global perspective to thelocal doctoral training program. In addition, it is likelythat the programs face some similar challenges since theyall involve students at MakCHS and other medical schoolsin Uganda.Mentoring best practices are critical to the sustainabil-

ity of training clinicians, academicians, educators and re-searchers to understand and take up the critical gaps inglobal health leadership in developing countries [3,4].Mentoring for doctoral students is the alliance betweenthe doctoral student and his/her major dissertation advi-sors, supervisors and/or mentors [5]. During doctoraltraining, the mentoring process includes choosing thementor, formalizing of the mentoring alliance, discussionof the mentor/mentee roles, and the evaluation of thementoring process [5]. A good mentoring process is akey variable for determining success in completing adoctoral program. Given the high investment in doctoraltraining, the current global climate of diminishingresources and the great need for building local capacityfor higher education, understanding and examining thechallenges to students’ ability to complete their doc-toral degree requirements in a timely manner remainscritical [6].There are general guidelines for doctoral training at

MakCHS that outline the various processes ranging fromregistration to completion as well as requirements fordoctoral students and supervisors. However, imple-mentation of the doctoral guidelines faces variouschallenges that may delay completion of doctoraltraining. Considering the limited pool of mentorsat MAKCHS, it remains critical to equip doctoralsupervisors/advisors with skills to develop mutuallybeneficial mentoring relationships with their doctoral

trainees [4]. We identified prevailing mentoring practicesamong the doctoral candidates and their mentors, identifiedthe common challenges facing doctoral training, and pro-posed solutions to enhance the quality of the doctoral train-ing experience for both the candidates and mentors atMakerere University and affiliated institutions. Strategiesfrom this model could be scaled up in the region throughthe collaborative programs that involve students and men-tors from several Universities within the country, the regionand overseas.

MethodsStudy setting and participantsThis evaluation was conducted as part of the monitoringand evaluation program for doctoral training at MakCHS.A team of four faculty members attended a trainer oftrainer (TOT) course in doctoral supervision as part of theMCDC capacity building program in Africa. Upon their re-turn from Dakar, Senegal, this committee planned a men-toring workshop for all doctoral students and doctoralsupervisors/advisors within the various doctoral programsat MakCHS including; MEPI-MESAU, THRIVE, MSI andSIDA. The main aim of the workshop was to identify thebest practices that should be maintained, identify the mainchallenges, and facilitate the mentors’ and students’ teamsto propose solutions as well as identify the next highpriority areas to improve the quality of the doctoral trainingexperience at MakCHS.

ProceduresIn a cross-sectional qualitative evaluation, all doctoralstudents and their mentors were invited to a half-dayworkshop on ‘PhD supervision best practices’ throughthe college mailing list. The first hour of the workshopwas used to generate a common understanding of thegoals of the workshop, summarise the prevailing doc-toral supervision and mentoring guidelines at MakCHS,and put subsequent discussions within the institutionaloperational context. The doctoral students and supervi-sors were then split into two homogenous groups to dis-cuss specific issues for 60 minutes, as directed by thefocus group discussion (FGD) guide. The FGD guidecovered four main themes in regard to the doctoraltraining experience; what was going well, what was notgoing well, proposed solutions for the current challengesand what were considered as the highest priority areasto improve the doctoral training experience? Thesethemes were derived from the college doctoral trainingcommittee meetings on monitoring and evaluation to in-form subsequent steps in doctoral program enhance-ment. The data was recorded by a note-taker in each ofthe groups. The two groups came together again and thenote-takers from each group presented their data for a30-minute discussion by the combined team of mentors

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and mentees. The combined group discussion was alsorecorded by a note-taker. Data analysis was conductedusing the principles of thematic analysis [7-9]. Datawas analysed manually according to the pre-determined themes; summarised in tables and quotesreported verbatim. This work was done in compliancewith the Helsinki Declaration (http://www.wma.net/en/30publications/10policies/b3/index.html), with ap-proval sought from the Makerere University College ofhealth Sciences Institutional Review Board.

ResultsOverall, 12 out of 36 invited mentors (33%) and 22 outof 40 invited mentees (55%) attended the workshop,representing at least eight disciplines within the collegeof health sciences; Nursing, Basic sciences, InternalMedicine, Psychiatry, Paediatrics, Surgery, Obstetrics& Gynaecology and Public Health (Table 1). The stu-dents had between 1–7 years’ experience in the PhDprogramme and the mentors had mentoring experi-ence of 1–10 doctoral students.

What was going well?Doctoral students noted the increasing numbers of doctoralstudents which provides them several opportunities forpeer support through meetings such as the ‘PhDForum’ where they meet to discuss their projects aswell as challenges. ‘The PhD forum allows us to supporteach other to deal with difficult situations’ said onedoctoral student. They also noted the gradually increasing

Table 1 Participants of the doctoral mentorshipworkshop at Makerere University College ofHealth Sciences

MentorsN = 12

Doctoral studentsN = 22

Gender

Female n (%) 5(42) 12(54)

Disciplines represented¶

Internal medicine 1 5

Psychiatry 3

Paediatrics 2

Surgery 2

Obstetrics & Gynaecology 3 5

Basic sciences 1 3

Public Health 2

Epidemiology 1 4

Nursing 1 1

Others*

*Three research administrators and one information technology expert.¶Representation of the mentors and doctoral students by discipline.

number of committed mentors for the doctoral students(Table 2).Similarly, the mentors noted the increasing number of

doctoral students as well as the increasing funding op-portunities for doctoral training at MakCHS, that en-abled more students to complete doctoral trainingwithin 3–5 years since their research is funded. ‘Withavailable funding for research projects, our students areable to complete doctoral training within 3–5 years’said one mentor. In addition, the mentors mentionedthat mentoring of doctoral students contributes to thefaculty’s score for promotion (Table 3).

‘I am encouraged to supervise and mentor doctoralstudents as it contributes to my promotion andprofessional development’, said one mentor.

What was not going well?Doctoral students mentioned the challenge of limitedphysical space for the doctoral students and some of thementors in their respective departments. One doctoralstudent said, ‘Some of our mentors still occupy the spacefor doctoral students because they do not have officespace in their respective departments’. Students identifiedunnecessary delays in the procurement processes as asticking point in the training process. ‘There are unex-plained delays in the procurement processes which, inmany cases, delay our progress’ said one doctoral stu-dent. Also mentioned, was the quite lengthy registrationprocesses, including the appointment of doctoral super-visors which also kept the students behind schedule.Lastly, the students involved in biomedical researchnoted the limited number of mentors with the skills tosupervise and mentor doctoral students in this field aswell as the limited laboratory infrastructure. One doctoralstudent said, ‘Most of us have to ship our samples abroadbecause we do not have the required facilities to do ourassays locally’ (Table 2).Similar to the students, the mentors re-echoed the un-

necessary delays in the procurement systems, more sofor laboratory-based research supplies which causedhuge delays for the basic science research projects. Inaddition, mentors highlighted the challenge of unex-plained delays by the National Drug Authority (NDA)which affected most studies involving investigationaldrugs. Furthermore, the mentors from the clinical disci-plines noted the challenge of limited human resourcesfor health care delivery when clinicians are undertakingtheir doctoral training. Lastly, it was noted that therewas limited communication between the doctoral stu-dents and their mentors which in some cases delayedthe students’ progress if he/she had unresolved chal-lenges (Table 3).

Table 2 Doctoral students’ discussions on mentoring through doctoral training at Makerere University College ofHealth Sciences

Thematic questions Responses

What is going well? ● Peer support received from the increasing number of doctoral candidates in the various disciplines.

● Available guidelines for doctoral supervision and mentoring.

● Increasing numbers of supervisors and their commitment to mentor doctoral candidates.

● PhD forum where students have opportunities to present their research projects.

What is not goingwell?

Physical space ● Limited physical space for doctoral students in their respective departments.

● Limited physical space for the mentors in their respective departments.

Procurement ● Unexplained delays in the procurement processes which, in many cases, delay the students’ progress.

Registration processes ● Lengthy registration processes including delays in appointing doctoral supervisors.

Biomedical sciences ● Limited number of mentors with the skills to supervise and mentor doctoral students.

● Limited laboratory infrastructure for biomedical research so that most students have to ship samples abroad.

Proposed solutions

Infrastructuredevelopment

● Improvement of laboratory infrastructure to support doctoral students’ projects locally.

● Infrastructure development to create office space for doctoral students during their doctoral period.

● Create office space for post-doctoral and faculty involved in mentoring doctoral students and junior faculty.

Procurementprocesses

● Improve the procurement systems to meet the needs of doctoral students and other scientists in biomedical research atMakerere University.

Registration processes ● Induction courses for doctoral students and their mentors, including a mandatory course on PhD supervision.

● A catalogue of frequently asked questions (FAQs) for doctoral Students and mentors should be compiled and uploadedon the institutional website.

● Regular PhD forum meetings and seminars.

Communication ● Communication skills’ training for both mentors and mentees including skills in conflict resolution.

Others ● Facilitate more seminars between mentors and doctoral students for inspiration and encouragement through thedoctoral training experience.

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Proposed solutions to improve the mentoring experienceduring doctoral trainingInfrastructure developmentDoctoral students highlighted the need for targeted in-vestment towards the improvement of laboratory infra-structure to support doctoral students’ projects locally.In addition, the students proposed physical expansion tocreate office space for the increasing numbers of doc-toral students as well as their mentors most of which arejunior and senior faculty members. ‘We do not have of-fices because previous doctoral students still occupy thespace and have nowhere to move to’ said one doctoralstudent.

Procurement processesDoctoral students proposed improvement of procure-ment systems to meet the needs of students and otherscientists in biomedical research at Makerere University(Table 2). Similarly, the mentors proposed workshopsbetween the procurement team and the scientists sothat both can appreciate and put systems in place tomeet each others’ needs in a timely fashion (Table 3).

‘We need to let the procurement team know that thesystem does not meet our needs’, said one mentor.

Registration processesDoctoral students proposed regular induction coursesfor all doctoral students and their mentors at MakCHS,including mandatory training in PhD supervision andmentorship. In addition, they felt that a catalogue of fre-quently asked questions (FAQs) for doctoral studentsshould be compiled and provided on the doctoral stu-dents’ website since many of the FAQs might cut acrossthe different disciplines. Doctoral students also encour-aged more regular seminars for doctoral students toshare their challenges and get supported with solutions.

CommunicationBoth students and mentors reported the prevailing lim-ited communication between doctoral students and theirmentors, and highlighted the need for training in com-munication skills including conflict resolution. ‘I need toknow what to do if my supervisors disagree and I fail tomove on with my project’ said one doctoral student.

Table 3 Mentors’ discussions of the current status and proposed solutions to improve mentoring through doctoraltraining at Makerere University College of Health Sciences

Thematic questions Responses

What is going well?

There are more numbers of doctoral students, which has increased the opportunities for peer support.

Supervisors of the doctoral students are more tuned to supervise and mentor students better thanbefore.

Funding opportunities for doctoral research have increased.

More students complete doctoral training within 3–5 years because of the available opportunities tofund their research projects.

Supervision of doctoral students is one of the recognised parameters for promotion.

What is not going well?

Delays in the procurement systems cause unnecessary delays in students’ research progress.

There are limited systems for international procurement of laboratory-based research supplies whichcauses huge delays for basic science research projects.

Unexplained delays by the national drug authority (NDA) for research projects including investigationaldrugs.

Limited human resource for health care when clinicians are pursuing doctoral training activities.

Limited communication between doctoral students and their mentors.

Proposed solutions

Procurement delays ● Conduct workshops between the scientists [doctoral students and mentors] and the institutionalprocurement team.

● Propose and design institutional procurement systems with provisions for international procurementof laboratory-specific equipment and consumables.

Limited communication betweenmentors and mentees

● Strategic approach to implement the institutional doctoral supervision and mentoring guidelinesamong doctoral students and mentors.

● Communication skills’ training including skills in conflict resolution.

● Induction courses for doctoral students and mentors.

● Utilisation of the College of Health Sciences’ research support centre.

Others ● Clinical departments need to relieve doctoral students of some clinical duties to allow some protectedtime for academic research training although the students might still participate in selected teachingactivities due to limited teaching staff.

● Facilitate more seminars to increase networking between doctoral students and mentors.

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High priority areas for mentoring workshops as identifiedby doctoral students and mentorsWorkshops on procurement processesThe mentors noted that it was critical to facilitate work-shops with the procurement team not only to orientatethe scientists on the relevant procurement processes butalso to orientate the procurement team on the specificneeds of the scientists at the college of health sciences inorder to foster mutual benefit.

Training in finance management and budgetingIdentified as high-priority, was the need to equip doctoralstudents with skills to design, implement and manage theirbudgets in good alignment with their research projects.

Research regulatory proceduresThe team emphasised the need for scheduled meetingswith research regulatory bodies to share feedback from

the researchers and vise-versa. A case in point was theNational Drug Authority (NDA), which was sighted as acommon cause of unexplained delays in approval of re-search involving investigational drugs. The mentors pro-posed follow-up meetings to engage NDA managementand come up with more appreciable timelines as well asstrategies to support the two bodies to meet the desiredtimelines and avoid unnecessary delays to the researchwork. Besides NDA, doctoral students needed ongoingtraining in human subjects’ research as well as regularupdates on the research regulatory processes by the In-stitutional Review Boards (IRBs) and Uganda NationalCouncil for Science and Technology (UNCST).

Communication skillsWith communication challenges highlighted by both thedoctoral students’ and mentors’ groups, training in com-munication skills was noted as an important skill to keep

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doctoral students, mentors, collaborators and the entireresearch team in harmony in order to achieve the com-mon goals of their research teams (Table 4). ‘We needempowerment and a forum to handle conflict amicablyso that it does not interfere with our progress’ said onedoctoral student.

Limited human resource for health care delivery‘The high load of clinical rounds and calls leaves mewith little time for my doctoral training activities’ saidone doctoral student. ‘However, there are few clinicianson my ward and patients need me’ the doctoral studentadded. The mentors suggested that clinical duties shouldbe reduced for doctoral students to allow them pro-tected time to pursue their training activities. One men-tor said, ‘The doctoral student does not have to doclinical duties and coordinate an entire course but he/she can participate in student tutorials, seminars andexaminations’.

DiscussionPeer support and collaboration with mentors improvesretention and completion in doctoral programsBoth doctoral students and mentors identified with theincreasing numbers of doctoral students and mentors.With increasing numbers, trainees reported the benefitof peer support through doctoral seminars to share chal-lenges and innovative solutions. Our data is consistentwith reports from a survey among 108 doctoral studentsin eight universities in the USA where half of all doctoralstudents were failing to complete their programs. Inthe latter survey, peer mentoring through cohorts ofdoctoral students and doctoral faculty was used to im-prove retention in doctoral programs [10]. In addition,there is evidence that networking and psychological sup-port increased students’ productivity and satisfactionwith their graduate school experience [11]. Similarly, in

Table 4 High priority areas for doctoral training workshops a

High priority areas Mentors

Procurement processes ● Workshops with the procurement team to stand encourage mutual benefit

National Drug Authority(NDA) regulatoryprocesses

● Meetings with NDA to review and design suencourage timely review and feedback.

● Orientation on other research regulatory proInstitutional Review Boards (IRB) and the UgaScience and Technology (UNCST).

Communication skills ● Communication seminars

● Inspirational talks to doctoral students

● Inspirational talks to mentors

this study, both doctoral students and mentors advocatedfor regular inspirational and peer support activities.

Skills’ trainingBoth doctoral students and mentors identified a gap intheir communication skills and highlighted conflict reso-lution as a high priority area to be addressed in order toimprove the doctoral training experience. Conflict mayarise in cases of unmet expectations from the mentor/mentee, failure to meet timelines, unusual demandsfrom mentees, mentees frustrations and absence of asystematic framework for resolving such conflict. Ourfindings mirror recent reports that disagreements be-tween doctoral student-mentor pairs slow students’progress and increase attrition rates among doctoralstudents [12]. Thus, good communication between thedoctoral student and mentor would empower studentsto take major responsibility in decision-making andconfidently navigate through the high demands andchallenges within their respective disciplines [13]. Inaddition, it is important to note that close communica-tion and collaboration between students and facultyimproves task completion whilst it promotes teambuilding practices [10]. We therefore recommend em-phasis on communication training as well as interactiveactivities to promote networking among doctoral stu-dents and mentors.Cross-cutting multidisciplinary courses including re-

search regulatory compliance, budgeting and financemanagement should be encouraged to equip doctoralstudents with project management skills. Similarly, thedoctoral students need knowledge and skills to handlethe institutional procurement systems, another area thataffects students’ progress [6]. A multi-disciplinary ap-proach is clearly needed to mentor and prepare doctoralstudents for the multi-disciplinary challenges in globalhealth leadership.

t Makerere University College of Health Sciences

Doctoral students

reamline the processes ● Finance management and budgetingmodules

pport systems to ● Ongoing training in Human Subjects’Research

cesses such asnda National Council for

● Induction workshops for doctoralcandidates and their mentors

● Compile a frequently asked questions(FAQ) document on the doctoral students’website

● Training on conflict resolution and publicrelations

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Infrastructural development and human resource capacityInfrastructure and human resource remains critical to theadvancement of higher education in developing countries.Limited human resource capacity for health care deliverymakes it challenging for clinicians to combine clinical du-ties with doctoral training. There is clearly need for trainingof more clinicians and researchers to meet the overwhelm-ing demand for clinical care and subsequently increase thepool of mentors [4]. Sustainable research capacity buildingin developing countries requires multi-level training andsupportive institutional infrastructure to empower Africanscientists to ask and answer regionally relevant researchquestions [2,4]. Investments to develop an academicenvironment are timely to increase scientists’ accessto equipped research laboratories, internet connectivity, ref-erence libraries, international journals, e-books, and accessto world experts as mentors; among other needs [2]. Simi-larly, there is need for equivalent efforts to retain thetrained professionals to mitigate the prevalent brain drainas locally trained clinicians, scientists and academicians mi-grate to work abroad in avoidance of the infrastructure andlogistical challenges in developing countries [14-16].

LimitationsThis study was limited to data collected during theworkshop that was attended by approximately a third ofthe doctoral students and their mentors. This samplewas representative of the doctoral students and mentorsat MakCHS since invitations were sent to the entire col-lege email list. The 33% response rate from mentors isslightly higher than our previous response rate of 22%when a mentorship survey was conducted among men-tors and mentees through the Uganda Fogarty Alumni[4]. The strength of the study was seeking opinions fromboth mentors and mentees in homogenous FGDs toallow discussion of a wide range of issues. We did nottape-record or video-record FGDs since it was not partof routine monitoring and evaluation of the doctoraltraining program. However all participants’ responseswere recorded by the note-takers verbatim. In addition,recorded data was presented in the subsequent teamdiscussion to allow additions and clarifications.

ConclusionSystemic and infrastructural limitations affect the qualityof the doctoral training experience at MaKCHS. Clinicaland biomedical research infrastructure, in addition totraining in research regulatory processes, procurementand finance management, communication skills and in-formation technology were highlighted as high priorityareas for strategic interventions to improve mentoringwithin doctoral training programs.

Competing interestsThe authors do not report any competing interests.

Authors’ contributionDN, AK, DKK, EO, MK, HMK and NS conceptualised the idea, DN, AK, EO, DKKand HMK contributed to the data analysis and interpretation. DN drafted themanuscript. All authors reviewed the manuscript and approved the finalversion for publication.

AcknowledgementsThe authors acknowledge funding from Malaria Capacity DevelopmentConsortium (MCDC) that supported a Trainer of Trainer course on doctoralsupervision for four faculty members at MakCHS. The authors would like tothank the Wellcome–funded Training Health Researchers into VocationalExcellence (THRIVE) program that supported this evaluation workshop andthe various doctoral programs that support doctoral training at MakCHSincluding MEPI-MESAU, MCDC, SIDA and NUFFIC. The funding agencies hadno role in the data analysis and decision to publish the manuscript.

Author details1Department of Internal Medicine, Makerere University College of HealthSciences, Kampala, Uganda. 2Department of Obstetrics and Gynaecology,Makerere University College of Health Sciences, Kampala, Uganda.3Department of Psychiatry, Makerere University College of Health Sciences,Kampala, Uganda.

Received: 26 August 2013 Accepted: 8 January 2014Published: 13 January 2014

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doi:10.1186/1472-6920-14-9Cite this article as: Nakanjako et al.: Doctoral training in Uganda:evaluation of mentoring best practices at Makerere university college ofhealth sciences. BMC Medical Education 2014 14:9.

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