PLACE-BASED INNOVATIONS IN RWANDAN UNDERGRADUATE SURGICAL EDUCATION: A DISTRICT HOSPITAL CLINICAL CLERKSHIP FRAMEWORK dr.alayande@gmail.com

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PLACE-BASED INNOVATIONS IN RWANDAN UNDERGRADUATE SURGICAL EDUCATION: A DISTRICT HOSPITAL CLINICAL CLERKSHIP FRAMEWORK

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Rwanda

Oral or Poster

Surgical training in rural facilities improves provider retention and is a key feature of postgraduate programs across Central, East, and Southern Africa. However, undergraduate surgical clerkships based entirely at rural district hospitals remain rare.

The University of Global Health Equity in rural northern Rwanda piloted a junior surgical clerkship for two cohorts of third-year medical students, delivered exclusively at a rural district hospital. This experience informed the development of a structured framework for undergraduate clinical clerkships at district-level hospitals. A mixed-methods evaluation was conducted, including student and staff surveys, focus group discussions, faculty reflections, and logbook audits. Data were analyzed using grounded theory, SWOT analysis, and a modified Jabareen conceptual framework development approach. An expert panel reviewed and validated the final framework.

The resulting District Hospital Clinical Clerkship Framework integrates key strategies to strengthen rural surgical education. Strengths included hybrid delivery with simulation support, and strong collaboration between university and clinical faculty. Areas for improvement were supervision capacity, case mix and volume, and infrastructure. To address these, the framework incorporates: 1)Multi-site clerkship design with designated faculty per site; 2) Parallel upskilling of general practitioners; 3) Engagement of visiting faculty via external partnerships; 4) Continuous, structured communication with students and staff (See Figure 1).

This contextualized framework offers a practical approach to delivering high-quality undergraduate surgical training at district hospitals in sub-Saharan Africa. It ensures adequate clinical exposure, supervision, and educational standards, contributing to workforce development and rural surgical capacity.