Note from Dr. Katy Miller

As a fellow in adolescent medicine, I am very lucky to have been able to pursue global health opportunities throughout my training. For the past four years, I have been able to spend time in eastern Uganda at Mbale Regional Referral Hospital and Busitema University, the medical school located in Mbale. The medical school is part of a national effort to increase capacity in health sciences, and this particular school is relatively new – Busitema University graduated its first class of medical students just last year.  

Adolescent health is of huge international importance, especially as adolescents continue to increase as a proportion of the general population. An estimated 1 in 3 Ugandans are between the ages of 10-24. There are enormous payoffs if we invest in adolescent health: in addition to improved outcomes for adolescents right now, we also see improved health in maternal and infant mortality, and for the future generation that benefits from improved health in their parents. Unfortunately, adolescent health has been relatively neglected in terms of funding on a global scale – less than 2% of international aid targets adolescents. This is also reflected in access to training in adolescent health and medicine – very few programs in low and middle income countries provide specific training in adolescent health. Until this year, the medical students at Busitema University did not receive formal training in adolescent health or medicine.  

As part of my fellowship in adolescent medicine at the University of Minnesota, I have been fortunate to work with exceptional mentors in Uganda. Dr. Sabrina Kitaka is a Ugandan physician, who works at Makerere University and runs the adolescent health clinic in Kampala. I have also worked with Dr. Peter Olupot-Olupot, a clinician and PhD at Busitema University and the Mbale Clinical Research Institute. With Dr. Kitaka’s mentorship and Dr. Olupot-Olupot’s collaboration, we have developed a pilot curriculum in adolescent health and medicine designed specifically for low and middle income countries. It has been a long process: the first needs assessment was performed in 2018 with key informant interviews and a general survey of interest at Busitema University. In 2019, we performed a formal needs assessment with focus groups and surveys. Both needs assessments identified that medical trainees and clinicians are interested in receiving additional training in adolescent health and medicine. Based on these results, our team developed a pilot curriculum for medical students at Busitema University.  

In February of this year, we piloted our curriculum with Dr. Olupot-Olupot and Dr. Meredithe McNamara, an adolescent medicine fellow at the University of Illinois. We included six key topics: introduction to adolescent health and national health policy, approach to working with adolescents (including a review of adolescent friendly services and the psychosocial interview), menstrual health, contraception, sexually transmitted infections, and mental health/substance use. The pilot curriculum was taught to final year medical students, who received academic credit for the elective.

While we’re still running analyses on the evaluations, the early results look very positive! All of the students reported that they would recommend the course to colleagues, and the majority (93%) thought it was applicable to their health setting and available resources. Several participants wrote in under “comments” that the course should be mandatory training for all medical students.  

Our next steps for the curriculum include adapting it based on the specific feedback from students, having experts in the field review the final version, and publishing it for dissemination. We hope that the curriculum can be useful as a template for other medical schools in the region, and to increase provider training and capacity in adolescent health. While it’s been a long three-year process with another year to go, it has been a wonderful opportunity for me. I am so grateful to have worked with so many exceptional Ugandan colleagues and mentors, and so appreciative that my division and department have let me continue the work I began in 2018.