Assessing faculty development needs and perceptions for residency programs at a medical school in Rwanda

Abstract

Background

Academic institutions play an important role not only in increasing the health workforce, but also ensuring faculty are equipped to meet the rising demand on trainees to enter the workforce. Located in Kigali, Rwanda, Africa Health Sciences University (AHSU) is a newly established institution training the next generation of health professionals across medicine, nursing, midwifery, and other health domains. This study explores faculty and staff perceptions of their current skills in teaching and research and identifies ways to further strengthen faculty development initiatives.

Methods

This cross-sectional, survey-based study was conducted from August 11 to September 30, 2024, across AHSU’s three main residency clinical teaching sites. Participants included doctors, nurses, midwives, and administrators involved in educational activities. Data was collected via an anonymous questionnaire, with sections on participant demographics, job profile allocations, teaching and research skills, and faculty development preferences. Data was analyzed via descriptive statistics. Mean scores and standard deviations were calculated across Likert scale questions to evaluate central tendencies and participant response variability. The Kruskal-Wallis test was also employed for associations, with a statistical significance of p < 0.05.

Findings

230 participants completed the survey, including nurses and midwives (62.61%), medical doctors (31.74%), and administration (5.65%). Teaching skills were perceived to be stronger overall than research skills, with an average of 3.46 and 2.95 out of 4 respectively. Improving teaching and scholarship, and personal interest were the most cited motivations to engaging in faculty development programs. The perceived importance of faculty development showed significant associations with role, highest level of education, and faculty rank.

Conclusion

Strengthening faculty development in clinical academic settings has the potential to improve the overall academic environment across health sciences universities and their teaching sites. Health sciences universities should consider ways to recognize, develop, and support both their clinical and non-clinical staff engaged in academic activities. This can be done through institutional support systems, improved academic recognition frameworks, and the promotion of innovative teaching and learning methods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-07920-2.

Background

Data from the World Health Organization (WHO) indicates that while Africa holds the highest global burden of disease, it also has a significantly disproportionate share of the global health workforce [1]. To address this gap, academic institutions play an important role not only in increasing the health workforce on the continent, but also ensuring their faculty are adequately equipped to meet the rising demand on them to prepare a workforce ready to enter the field [2]. One way that this can be done is through faculty development, which consists of initiatives and programs aimed to strengthen faculty members’ capacity as educators, researchers, and academicians [3]. However, current literature indicates that there is a gap in health professional faculty development and capacity. Challenges include a lack of programs that sufficiently address the rapid changes in workforce demands, limited resources, and a lack of institutional awareness on the importance of these development initiatives [4].

In Rwanda, efforts are underway to strengthen the health workforce over the coming four years, with significant investment being made into health professional training. Launched in 2023, Rwanda’s national “4 × 4 strategy,” overseen by the Ministry of Health, aims to quadruple the health workforce over the next four years to move closer to the WHO health workforce density targets [5]. Specifically, the strategy has four priority target areas, including increasing the quantity and quality of health professionals in priority areas; recapturing local faculty and hiring visiting faculty to meet training needs; improving the capacity of training institutions and clinical teaching sites; and coordinating its implementation through national human resource for health systems [6]. Alongside this national strategy, there are efforts ongoing to ensure that the faculty teaching the future generation of the workforce is equipped with the skills needed to adequately train and assess these students and to conduct and supervise research.

Located in Kigali, Rwanda, Africa Health Sciences University (AHSU) is a newly established health sciences institution training the next generation of health professionals. It launched its first academic programs in September 2024, offering a bachelor’s degree with honors in midwifery, as well as six residency (Master of Medicine or MMed) programs with 63 students. AHSU emphasizes hands-on, competency-based teaching, supported by clinical training sites nationwide to ensure practical experience for students. The establishment of AHSU presents a unique opportunity to set a strong foundation for academic excellence and innovative clinical education. A critical component of this foundation is the development of highly skilled and motivated clinical faculty members.

Alongside the establishment of AHSU and the launch of its first academic programs, there is a need to develop the university’s faculty across all health professions and administration to ensure they are equipped with the skills needed to train the next generation of the health workforce. This study aims to explore faculty and staff perceptions of their current skills in teaching and research, as well as to identify the strengths and weaknesses of existing faculty development initiatives at AHSU’s residency teaching sites. This baseline assessment may inform interventions geared towards strengthening faculty capacity in identified gap areas.

Methods

Study setting

This study took place at AHSU’s three residency clinical teaching sites, which are all located in Rwanda, including King Faisal Hospital Rwanda (KFH), Kibuye Level 2 Teaching Hospital, and Kibungo Level 2 Teaching Hospital.

Study design

This is a cross-sectional, survey-based study conducted from August 11, 2024, until September 30, 2024. Prior to data collection, this study was ethically approved by the KFHR Institutional Review Board (Ref. # KFH/2024/237/IRB) and endorsed by the Rwanda National Ethics Committee.

Data collection

Data was collected through an anonymous questionnaire administered on Google Forms. The study tool was developed internally based on a review of the current literature. It had four main sections, including participant demographics and professional profiles, teaching and learning allocation in their job profiles, perceived skills in teaching and research, and faculty development preferences and recommendations. Questions on research skills were adapted from the validated Research Capacity and Culture Survey [7]. Participants indicated their perceived skills and interests across 4-point Likert scales, with “4” being the highest level of skill or interest. Participants meeting the inclusion criteria were recruited through internal communications and sent regular reminders with the survey link via email and professional WhatsApp groups. Before completing the survey, participants were required to indicate their consent to participate.

Sample and participants

Participants included all medical doctors, nurses, and midwives working at one of AHSU’s residency teaching sites on either a part-time or full-time basis, and who consented to participate in the study. It also included administrators involved in the educational activities of the teaching sites, including the director general, clinical leadership, and education and research staff. Administrators involved in education were included, as they lead coordination efforts across clinical faculty with regards to teaching and research. The total participant population was 899 staff across all three sites, with the majority being from KFH (62%), followed by Kibungo (19.8%) and Kibuye (17.8%).

Data analysis

Descriptive statistics were used to summarize the results, including teaching and learning allocation; perceived teaching and research skills; and faculty development preferences and recommendations. Participant demographics and professional profiles were summarized using frequencies and percentages, including highest education level, profession, teaching site, and faculty ranks. For survey items measured on a 4-point Likert scale, mean scores and standard deviations were calculated to evaluate central tendencies and participant response variability.

To explore associations between demographic variables and participants’ perceptions of teaching skills, research skills, and faculty development needs and preferences, the Kruskal-Wallis H test was employed. This non-parametric test was chosen because our dependent variables (perceived skills and preferences) were measured on an ordinal Likert scale, and the independent variables (demographic characteristics such as profession, highest education, and faculty rank) were categorical with more than two groups, thus violating the assumptions of parametric tests like ANOVA. A statistical significance of p < 0.05 was used for all analysis. Data analysis was performed using SPSS version 30.

Results

230 participants completed the survey out of a population of 899. The majority were nurses and midwives (62.61%), followed by medical doctors (31.74%). Participants represented three of AHSU’s primary teaching sites for residency programs, with the majority being employed at KFH (55.65%). Participants listed from “other” teaching sites have another primary clinical attachment outside of AHSU’s primary ones but were in the process of being engaged on a part-time basis to teach AHSU’s residents. All major clinical and departments and administration were represented, with most participants representing obstetrics and gynecology (19.13%), internal medicine (16.96%), and anesthesiology and critical care (13.91%).

Participants indicated their highest education level and whether they had an active faculty appointment at any institution. 78.26% of participants held at least a bachelor’s degree, and 18.26% held terminal tertiary degrees, including a fellowship diploma, PhD, or a Doctorate. The majority (71.30%) did not have a current faculty rank at the time of AHSU’s establishment, with most of those participants being nurses and midwives. Among the 66 participants holding a faculty rank, most were medical doctors (86.3%). Associate professors were the most common faculty rank, followed by assistant professors/senior lectures, and lecturers. (Table 1).

Table 1.

Participant professional profile

	n	%
Profession
Administration	13	5.65%
Medical Doctor	73	31.74%
Midwife	31	13.48%
Nurse	113	49.13%
Primary Teaching Site
King Faisal Hospital Rwanda	128	55.65%
Kibungo Level 2 Teaching Hospital	45	19.57%
Kibuye Level 2 Teaching Hospital	45	19.57%
Other	12	5.22%
Department
Administration	12	5.22%
Anesthesiology & Critical Care	32	13.91%
Emergency Medicine	23	10.00%
Internal Medicine	39	16.96%
Obstetrics and Gynecology	44	19.13%
Pediatrics & Neonatology	29	12.61%
Surgery/Operating Theatre	29	12.61%
Other	22	9.57%
Highest Degree
Advanced Diploma (A1)	50	21.74%
Bachelor’s (A0)	82	35.65%
Bachelor of Medicine, Bachelor of Surgery	7	3.04%
Master’s Degree	49	21.30%
Fellowship Diploma	23	10.00%
PhD or Doctorate	19	8.26%
Faculty Rank
Professor	0	0.00%
Associate Professor	28	12.17%
Assistant Professor/Senior Lecturer	22	9.57%
Lecturer	16	6.96%
No faculty rank	164	71.30%

Teaching and research in job profile

Participants were asked to indicate how many working days per week on average are allocated to teaching and research activities. Overall, over a third of participants allocated more time per week towards teaching activities, with 37.39% having at least 3 to 5 working days towards this. Meanwhile, most participants (71.74%) indicated that they use their free time or less than one working day per week for research activities (Table 2).

Table 2.

Time allocation to teaching and research

Weekly Time Allocation	Teaching		Research
	n	%	n	%
Less than 1 working day	91	39.57%	165	71.74%
1–2 working days	53	23.04%	36	15.65%
3–5 working days	86	37.39%	29	12.61%

Participants indicated their primary modes of teaching and could check all that apply to them. The most frequently cited included discussions (57.83%), hands-on or bedside teaching (52.17%%), and in-person lectures (43.04%). The least utilized modes of teaching were simulation-based teaching (24.35%) and flipped classrooms (5.22%) (Table 3).

Table 3.

Primary mode of teaching

Primary Mode of Teaching	n	%
Discussions	133	57.83%
Hands-on/bedside teaching	120	52.17%
In-person lectures	99	43.04%
Case-based learning	90	39.13%
One-on-one Tutoring/Mentoring	80	34.78%
Team-based learning	79	34.35%
Problem-based learning	70	30.43%
Online lectures	65	28.26%
Active learning	60	26.09%
Theatre/procedure-based teaching	58	25.22%
Simulation-based teaching	56	24.35%
Not applicable	19	8.26%
Flipped classroom	12	5.22%

Perceived teaching and research skills

Participants indicated their perceived confidence in both their teaching and research skills on a 4-point Likert scale. This included their overall skills and skills in key areas across teaching and research. In teaching, responses were categorized into three areas, including clinical/practical teaching methods, curriculum and evaluation methods, and instructional teaching methods. Participants were most confident in clinical/practical teaching methods, especially clinical or bedside teaching (3.18). Participants were least confident in instructional teaching methods, especially using artificial intelligence and technology in teaching and learning (2.96).

In research, the average confidence in overall skills was 2.95, and participants’ confidence was overall lower across perceived research skills than teaching skills. Participants were more confident in skills involving data collection, including general data collection (3.07) and finding relevant literature (2.93). They were least confident in securing research funding (2.41) and research dissemination, including writing papers for peer-reviewed journals (2.50) (Table 4).

Table 4.

Confidence in teaching and research skills

Skill	Average	SD
Overall Teaching Skills	3.46	0.82
Clinical/practical teaching methods	3.18	0.78
Curriculum and evaluation methods	3.02	0.83
Instructional teaching methods	2.96	0.85
Overall Research Skills	2.95	0.84
Data Collection Skills	2.84	0.88
Study & Protocol Design Skills	2.80	0.88
Data Analysis Skills	2.72	0.91
Research software	2.70	0.96
Research supervision & mentorship	2.72	0.91
Study Dissemination Skills	2.62	0.96
Funding	2.41	0.96

Faculty development preferences

When asked to indicate how well their faculty development needs are currently being met on a 4-point Likert scale, participants on average indicated 2.40. However, on the same scale, they indicated an average of 3.72 when asked how important faculty development is to their professional development. Specifically, perceived barriers to faculty development included time (75.65%) and challenges related to prioritizing work activities (53.91%). A lack of interest in teaching and research was only noted by 17.39% of participants as a barrier to faculty development programs.

When asked why participants would be interested in engaging in faculty development sessions, improving their teaching/scholarship (87.83%) and personal interest (76.52%) were the most cited. Some participants also indicated that faculty development has the potential to improve clinical care and patient outcomes (Table 5).

Table 5.

Reasons to participate in faculty development

	n	%
Improve my teaching/scholarship	202	87.83%
Personal interest	176	76.52%
Networking/building connections	148	64.35%
Institutional requirement	99	43.04%
Desire for promotion	93	40.43%

Demographic associations

The Kruskal-Wallis-H test was performed to determine any significance between demographic variables and responses (Table 6).

Table 6.

Associations of demographic characteristics with perceived faculty development needs and skills (Kruskal-Wallis H Test)

Variable	Chi-Square	df	p-Value
Faculty Development Needs Being Met
Role	18.25	3	< 0.001
Highest Education	17.70	5	0.003
Faculty Rank	8.45	4	0.076
Overall Teaching Skills
Role	20.26	3	< 0.001
Highest Education	5.45	5	0.363
Faculty Rank	9.99	4	0.040
Importance of Faculty Development
Role	19.39	3	< 0.001
Highest Education	22.03	5	< 0.001
Faculty Rank	10.84	4	0.028

The importance of faculty development was significant between role, highest education, and faculty rank. Medical doctors, hospital administrators, participants with terminal degrees (e.g., fellowship, doctorate, or PhD), and Assistant Professors/Senior lecturers indicated faculty development to be the most important. Meanwhile, nurses, those holding advanced diplomas (A1), and staff with no faculty rank indicated the lowest importance of faculty development.

There was also a statistically significant association between faculty development needs being met and role, and highest education level. Those whose development needs are least being met included medical doctors, and those holding a terminal degree (e.g., fellowship diploma, doctorate, or PhD). Interestingly, participants with an advanced diploma (A1) ranked the importance of faculty development the lowest but also were the highest indicating that their professional development needs are being met.

Overall perceived teaching skills were found to be statistically significant against role and faculty rank, but not against education level. Those perceiving their teaching skills the highest included midwives (3.77) and Assistant Professors/Senior Lecturers (3.77). Meanwhile, the perceived lowest teaching skills were from hospital administrators (3.15) and those with no faculty rank (3.39). The overall perceived research skills had no statistical significance against these respective demographics.

Discussion

Strengthening faculty development in clinical academic settings has the potential to improve the overall academic environment across health sciences universities and their teaching sites. The findings of this study suggest that AHSU should consider ways to recognize, develop, and support both their clinical and non-clinical staff engaged in academic activities and that AHSU faces several key challenges. Overcoming these challenges can be done through institutional support systems, improved academic recognition frameworks, and the promotion of innovative teaching and learning methods. However, universities should also consider contextual factors when designing these programs so that they meet the institutional and workforce needs [8].

Institutional support systems

Institutional support systems have the potential to strengthen or hinder the academic development and output of faculty. Our study found that while participants indicated an interest in faculty development and scholarly activities, they indicated lacking dedicated institutional time to engage in these, especially in research. With 46.52% and 24.78% of participants spending their free time out of work hours engaging in research and teaching respectively, this highlights the need for institutional policy support in prioritizing work time towards this. Time was also the most frequently cited barrier to faculty development programs (75.65%). This challenge is further illuminated by demographic associations, where medical doctors and hospital administrators, along with those holding terminal degrees, consistently indicated a higher perceived importance of faculty development and yet also reported that their development needs were least being met.

Ultimately, faculty development should be designed so that faculty can engage with the wider university and health system, making them more productive members of the institution [9]. Furthermore, ownership is the driver of change in developing a culture of academic quality, meaning that universities should take ownership over their policies and systems that either promote or hinder faculty development [10]. When universities design systems to promote academic activity and development, this can benefit the entire institutional system and health sector.

Academic recognition frameworks

In addition to institutional support systems, academic recognition frameworks also have the potential to strengthen faculty development. Our study found that 71.30% of participants don’t hold a faculty rank, highlighting a gap in academic recognition systems across clinical teaching sites, where faculty often engage in teaching health professionals from multiple universities, including AHSU. This is also due to the newness of AHSU as a university, with not all faculty having formal ranks yet or being formally engaged in teaching various academic programs depending on the availability of academic programs at those sites.

Having academic appointment systems to recognize and appraise faculty for their activities not only incentivizes increased scholarly activity, but can also strengthen a culture of academic identity and incentivize creativity and innovation [11]. Appraisal systems can foster a culture of innovation and growth through the metrics they appraise and how high-performing faculty are recognized. Furthermore, with participants citing research as their weakest overall skills area, recognition frameworks can also shift research from being something that is done in parallel to clinical activities to being something that is integrated into teaching and clinical engagement [12]. Our findings demonstrate a notable correlation between holding a formal faculty rank and higher self-reported teaching skills, emphasizing the potential for academic recognition to foster professional growth. Establishing clear recognition pathways could be instrumental in enhancing their engagement with faculty development and overall teaching proficiency. Recognition provides the opportunity to drive the institution’s mission forward through what it chooses to foster and recognize.

Promoting innovation

The findings of this study suggest that while participants have skills in fundamental teaching and research activities, there is a need to promote innovation and to strengthen skills in new, innovative techniques. For example, the weakest skills areas highlighted by participants were primarily innovative teaching and learning strategies, including artificial intelligence and technology and curriculum design. Additionally, while discussions were the most frequently used teaching method, more innovative methods and evidence-based approaches grounded in effective adult learning principles, including flipped classrooms and simulation-based teaching, were cited the least. Despite the lack of significant demographic associations with perceived research skills, the overall lower confidence in this area compared to teaching skills highlights a need for targeted support to foster innovation. Promoting research-focused faculty development initiatives, particularly in areas like securing funding and dissemination, could be crucial for enhancing the academic environment and encouraging innovative practices.

One way that the promotion of innovation can be achieved is through a team-based approach, whereby development programs are geared more towards team benefits and achievements, rather than individuals [10]. This approach can have a greater impact on the implementation of innovative approaches in team settings and hold greater accountability for their implementation. The skills cited by participants, including educational technology, flipped classrooms, and curriculum design, are best strengthened when put into practice, and a team-based, practical development approach can promote a culture of accountability and implementation in these areas, beyond individualized, theory-based faculty development programs.

Strengths and limitations

This study has several strengths, including its cross-sectional, survey-based design, which allowed for the collection of a broad range of perceptions from a diverse group of participants across multiple clinical teaching sites. The anonymous questionnaire ensured candid responses, and the adaptation of questions from a validated tool (Research Capacity and Culture Survey) for research skills lends credibility to those specific findings. However, the study also has limitations. Being a self-report survey, the data on perceived skills and preferences may be subject to social desirability bias. The study’s focus on AHSU’s specific context means that the findings may not be generalizable to other medical schools or healthcare settings without further research. Additionally, while the Kruskal-Wallis test identified associations, the cross-sectional nature of the study prevents establishing causality between the demographic variables and the observed perceptions.

Conclusion

Faculty development initiatives have the potential not only the improve academic output of faculty members, but also to strengthen the overall clinical environment and academic culture. This study aimed to generate baseline data on the job activities and perceived teaching and research skills of faculty at AHSU’s primary teaching sites. While participants largely indicated a strong interest in faculty development initiatives both for personal and professional reasons, specific skills and institutional support gaps were highlighted to further promote their development. The findings of this study suggest that institutional support systems, academic recognition frameworks, and promoting innovation are three ways that universities can strengthen faculty development initiatives. In doing so, faculty develop programs have the potential to strengthen the overall academic culture and contribute to preparing a more equipped health workforce to meet the rising demands of the health sector.

Abbreviations

AHSU

Africa Health Sciences University

KFHR

King Faisal Hospital Rwanda

SD

Standard deviation

WHO

World Health Organization

Authors’ contributions

KN conceptualized the study. KN and BU administered the project and collected the data. KN analyzed the data. KN, GN, and RG wrote the original draft. All authors reviewed and approved the final manuscript.

Funding

This project did not receive any funding.

Data availability

The dataset and materials are available upon reasonable request to the corresponding author.

Declarations

Ethics approval and consent to participate

Ethics approval was obtained from the King Faisal Hospital Rwanda Institutional Review Board (Ref. #KFH/2024/237/IRB) and endorsed by the Rwanda National Ethics Committee. This study adhered to the Declaration of Helsinki. Participants provided informed consent to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.