The Hidden Challenges of Clinical Teaching in Uganda: A Call for Action
Clinical preceptorship, the bridge between theory and practice in health professions education, faces unique challenges in resource-constrained settings like Eastern Uganda. A recent qualitative study conducted by Wani et al. (2025) among preceptors at Busitema University, Mbale College of Health Sciences, and Mbale Regional Referral Hospital sheds light on the complex interplay of facilitators and barriers in this critical aspect of medical education. But here’s where it gets controversial: while external partnerships and staff commitment are valuable enablers, their impact is often undermined by systemic issues like overcrowding, poor coordination, and resource shortages.
Facilitating Factors: A Ray of Hope
The study highlights three key facilitators of preceptorship. Firstly, support from Seed Global Health, a U.S.-based non-profit organization, has been instrumental in providing medical equipment, teaching resources, and staff training. This external partnership has not only enhanced the quality of clinical education but also brought in diverse teaching methodologies, which are often lacking in local settings. Secondly, the intrinsic motivation and willingness of hospital staff to engage in teaching, despite limited formal recognition or financial compensation, is a testament to their professional duty and commitment to developing future healthcare practitioners. Lastly, the involvement of postgraduate students in preceptorship activities, while partially aligned with their own learning requirements, reflects a strong culture of mentorship and professional stewardship.
Barriers: The Thorny Path to Effective Preceptorship
Despite these facilitators, the study reveals six significant barriers to preceptorship. The high student-to-preceptor ratio, compounded by overcrowding in clinical settings, limits opportunities for individualized supervision and feedback, thereby constraining experiential learning. Poor communication and coordination between academic institutions and teaching hospitals often result in confusion and inefficiencies, highlighting the need for formal communication frameworks. Inadequate preceptorship skills and limited pedagogical training among clinical staff further exacerbate the problem, as many preceptors lack formal preparation in educational methods, assessment, and feedback provision.
And this is the part most people miss: the shortage of models and equipment in skills labs and simulation labs is a significant barrier, limiting the ability of preceptors to provide hands-on training. This lack of resources compromises the effectiveness of clinical teaching, leaving students inadequately prepared for their roles in the healthcare system. Additionally, faculty shortages and insufficient time allocated for clinical rotations further hinder the preceptorship experience.
Implications and Recommendations: A Way Forward
The findings of this study have important implications for practice and policy in clinical education, particularly in low-resource settings like Uganda. Enhanced support and capacity-building for preceptors, including structured faculty development programs and periodic refresher training, are essential to equip them with the necessary skills and knowledge for effective clinical teaching. Establishing formal communication frameworks, such as joint coordination committees or clearly defined liaison roles, can improve alignment between academic and clinical partners, enhance placement planning, and ensure consistent learning objectives.
Managing student numbers in clinical settings through phased placements or increasing the number of trained preceptors can help alleviate overcrowding. Moreover, investment in simulation labs and skills laboratories is crucial to providing students with the practical competencies required before entering the clinical environment. However, a bold question remains: how can we ensure sustainable funding and infrastructure development to support these initiatives in resource-constrained settings?
A Thought-Provoking Question
As we reflect on the findings of this study, a controversial question arises: are we doing enough to support preceptors in their dual roles as healthcare providers and educators? The answer may lie in re-evaluating our priorities and investing in the development of a robust clinical education system that values and recognizes the contributions of preceptors. By addressing the identified barriers and leveraging the facilitators, we can create a more conducive environment for effective preceptorship, ultimately improving the quality of healthcare education and patient outcomes in Uganda and similar contexts.