Effectiveness of the family medicine curriculum in the improvement of skills and knowledge of family medicine residents in Sudan 2024: a quantitative and qualitative survey

Abstract

Family medicine was established in Sudan in 2006 after the first family medicine master’s degree program was established. The objective of this study was to evaluate the effectiveness of the family medicine curriculum in the Sudan Medical Specialization Board (SMSB) and provide baseline and updated data on the strengths and weaknesses of the family medicine training program. A cross-sectional quantitative and qualitative descriptive survey was conducted from February to October 2024. Data was collected through a pretested, pre-coded online questionnaire. Semi-structured in-depth interviews were conducted with the family medicine specialists and trainers in the SMSB. All data were summarized numerically (mean, standard deviation, median) and graphically (frequency tables). The Chi square test was used to determine association among categorized variables. P value < 0.05 is considered statistically significant. Qualitative data was recorded, transcribed, coded, and analyzed using a content analysis approach. A total of 100 family medicine doctors participated in the study. Most of the participants (82%) were females. Regarding the job title (76%) of the participants were residents and the rest (24%) were specialists. More than half of the participants (66%) were from Khartoum state. Most of the participants (87%) reported satisfaction with the family medicine training curriculum in the SMSB and its effectiveness in improving knowledge and practices. Furthermore, (81%) of the participants reported that the lectures and workshops arranged for the residents were sufficient to improve their knowledge. Some of the residents interviewed (30%) complained of dissatisfaction with the research methodology course, and about half of them reported that the course was ineffective and did not improve their knowledge and skills in research. Furthermore, residents reported the family medicine research committee in the SMSB had unclear requirements which was reflected in a high rejection rate of the research proposals submitted by residents. The SMSB Family Medicine curriculum is a well-structured, training-focused program designed to enhance residents’ satisfaction, knowledge, and clinical competencies. Significant concerns arise regarding the need for standardized curriculum details, trainer availability, and research support, all of which are crucial for the ongoing development and effectiveness of the program.

Introduction

Family medicine is globally considered a new specialty, that was identified in 1969¹. In Sudan, family medicine was acknowledged in 2006 with a master’s degree^2,3. Since then, family medicine practice in Sudan has improved due to the improvement of educational programs. Five educational institutions in Khartoum and Gezira states currently offer postgraduate training programs for family medicine residents in Sudan^2,4. However, there is still some lack of awareness of the family physician’s role and a lack of knowledge that family physicians must uphold^2,5.

Lack of awareness of the family medicine specialty affects the continuity of care and the referral system at the primary care level, which may create a professional practical gap^2,6,7. The most significant barrier hindering family physicians from fully utilizing their skills and role in primary healthcare is the gap between diagnostic testing and referral processes⁸. Therefore, a strong training-based curriculum that contains continuous medical education (CME), and continuous professional development (CPD) programs, anticipated to improve the diagnostic knowledge and referral skills of family medicine doctors and improve their adherence and implementation of the clinical guidelines^9,10. High-quality CME and CPD programs have a positive impact on the practice and clinical experience of family medicine doctors¹¹.

The Curriculum defines the recommended training strategies for the residents’ training. Knowledge, attitudes, skills, and topic competencies for family medicine residents should be attained through a longitudinal well-established training program¹². The curriculum for family medicine residency can structure experience in several specified areas.

A well-written program and course learning outcomes and structured didactic lectures, workshops, journal clubs, and conferences are important in the family medicine curriculum. Similarly, a focus on evidence-based and outcome-oriented studies of common and chronic diseases is essential for family medicine physicians¹³. Furthermore, suitable referral patterns and providing cost-effective care are important parts of the family medicine curriculum^13,14,15.

There are few published studies about family medicine in Sudan in general. There is no recent study that evaluated the efficacy of the family medicine curriculum and satisfaction of the family medicine residents in the Sudan Medical Specialization Board (SMSB). This study aimed to evaluate the effectiveness of the family medicine curriculum in the SMSB to provide baseline and updated data on the strengths and weaknesses of the family medicine training program in the SMSB.

Methods

Study design and population

A descriptive cross-sectional quantitative and qualitative study was conducted during the period from February to October 2024. SMSB was established in 1995 by Presidential Decree under the Sudan Medical Specialization Act. SMSB is the sole professional training body in the Republic of Sudan mandated to manage and deliver medical and health specialty programs in the country¹⁶. The driving foundation of SMSB is its specialty councils, which are responsible for the implementation of all activities concerning the training of medical doctors including the development and review of curricula. There are more than 61 specialty councils in the SMSB that offer master’s degrees (M.Sc.) and Medical Doctorate (MD)¹⁷.

The Family Medicine training program at the SMSB is a four-year, clinically based training program. The study population was composed of the third and fourth-year family medicine residents at SMSB and the family medicine specialists/consultants who have achieved the SMSB clinical MD, as they are more aware of the curriculum and the training program in SMSB. Family medicine trainers in the SMSB were also included in the in-depth interviews.

Data collection

The study adopted a mixed design approach (quantitative and qualitative). Quantitative data was collected with the use of a pre-coded and pre-tested structured questionnaire (Annex 1) that was designed by the first author for this study to collect the required information about the effectiveness of the family medicine curriculum. Pilot study was done, and the questionnaire was modified accordingly. The modifications were concentrated in reducing the length and reordering of the questionnaire.

The data was collected by the first author. The questionnaire was posted online using a Google form and was distributed in the WhatsApp groups of family medicine residents in the SMSB and the family medicine specialists. Data was collected online due to the war and the consequent displacement of the targeted family medicine doctors. Lack of internet in most of the cities in Sudan affected the data collection and number of the participants. A convenience sampling technique was used. A total of 100 family medicine doctors were surveyed during the four-months period of data collection.

For the qualitative part of this research: Twelve semi-structured in-depth online interviews were done with the family medicine residents, specialists/consultants, and trainers in the SMSB. The interviews aimed to extract in-depth information about the strengths and weaknesses of the family medicine curriculum in the SMSB. The interviews were audio-recorded and took about 15 min. Notes were taken during and after each interview to supplement the information. The recordings were transcribed verbatim, and the copies were anonymous. Qualitative data was collected and analyzed by the first author.

Statistical analysis

The statistical package for social sciences (SPSS 23) was used to summarize the data numerically (mean, standard deviation, median) and graphically (frequency tables). Chi square test was used to determine association among categorized variables. P value < 0.05 is considered statistically significant. Qualitative data were recorded, transcribed, coded, and then analyzed using a content analysis approach. Qualitative data were manually coded by the first author using an inductive thematic analysis approach. To minimize potential bias, the author followed a systematic coding process, maintained an audit trail, and continuously referred back to the original transcripts to ensure accuracy and consistency.

Ethical approval and consent to participate

Written ethical clearance and approval for conducting this research were obtained from the Alneelain University Institutional Review Board (IRB). Written informed consent was taken from all participants with assurance of confidentiality and all rights. All methods were carried out in accordance with relevant guidelines and regulations of the ethical committee and adhered to the Declaration of Helsinki. Participation was voluntary; any participant had the right to withdraw at any time. The collected information was used for research purposes only, with the consecration of all privacy issues. 

Results

Quantitative results

The sample consisted predominantly of female participants (82%) and a high proportion of residents (76%) compared to specialists or consultants. In terms of geographic distribution, 66% of the participants were from Khartoum state, followed by 20% from Gezira state and 14% from other regions. Regarding prior training in family medicine, 57% had not received any training before joining the SMSB program, while 43% had. Among those with prior training (n = 43), 67.4% had completed an M.Sc. in Family Medicine, and 32.6% held a diploma in the specialty, as shown in Table 1.

Table 1. Demographic characteristics of the participants,(n = 100).

Variables	Frequency	Percent (%)
Gender
Female	82	82.0
Male	18	18.0
Job title
Resident	76	76.0
Specialist	24	24.0
Residence
Khartoum state	66	66.0
Gezira state	20	20.0
Other state	14	14.0
Did you receive family medicine training program before joining the training in the SMSB
Yes	43	43.0
No	57	57.0
If yes, which type of training? (n = 43)
Diploma in family medicine	14	32.6
M.Sc. family medicine	29	67.4

Most of the participants (87%) reported satisfaction with the SMSB family medicine training curriculum, and they believed it to be effective in improving knowledge and practice. In addition, (81%) of the participants reported that the lectures and workshops arranged for the residents were sufficient to improve their knowledge, Table 2.

The satisfaction rate with the arranged courses and workshops and the clinical-based training program in SMSB was high, amounting to (86%) and (81%), respectively. Most of the participants (93%) reported that the introduction of online learning was useful to the residents. Regarding the research methodology course, (70%) of the respondents reported that the course was sufficient in improving their knowledge, and the rest (30%) believed the research methodology course was not adequate as shown in Table 2.

Table 2. Respondents’ opinion regarding the effectiveness of the family medicine curriculum, (n = 100).

Question	Yes	No
Satisfaction with the family medicine training curriculum in the SMSB	87 (87%)	13 (13%)
The family medicine training curriculum in the SMSB is effective in improving knowledge and practice	87 (87%)	13 (13%)
Lectures and workshops that were arranged for the residents were sufficient in improving their knowledge	81 (81%)	19 (19%)
Satisfaction with the arranged courses and workshops in the SMSB	86 (86%)	14 (14%)
Satisfaction with the clinical-based training program in SMSB	81 (81%)	19 (19%)
Introduction of the online learning was useful to the residents	93 (93%)	7 (7%)
The research methodology course in SMSB was sufficient in improving the knowledge	70 (70%)	30 (30%)

Half of the respondents (15/30, 50%) who reported inadequacy of the research methodology course in the SMSB reported that the course was not effective in improving their knowledge and skills. (14/30, 46.7%) of them reported the course duration was short, and only (1/30, 3.3%) reported that the course materials were challenging to comprehend.

Satisfaction with the family medicine curriculum revealed significant association when tested in cross tabulation with residence (p value = < 0.001), respondents’ opinion regarding the effectiveness of the family medicine curriculum (p value = < 0.001), respondents’ opinion regarding the effectiveness of the research methodology course (p value = < 0.001) and the satisfaction with the clinical-based training program in SMSB (p value = < 0.001), as displayed in Table 3.

Table 3. Cross tabulation between satisfaction with the family medicine curriculum and respondents job title, residence and opinion regarding the effectiveness of the family medicine curriculum, (n = 100).

Variables	Satisfaction with the family medicine curriculum		P value
	No	Yes
Job title
Resident	10	66	0.620
Specialist	3	21
Residence
Khartoum state	5	61	<0.001
Gezira state	1	19
Other state	7	7
Did you received family medicine training program before joining the training in the SMSB?
No	7	50	0.517
Yes	6	37
Do you think the family medicine training curriculum in the SMSB is effective in improving your knowledge and practice?
No	13	0	<0.001
Yes	0	87
Do you think the research methodology course in SMSB is quite enough in improving the knowledge?
No	12	18	<0.001
Yes	1	69
Are you satisfied with the clinical-based training program in SMSB?
No	12	7	<0.001
Yes	1	80

In the binary logistic regression model (Nagelkerke R² = 0.805), lecture-based training emerged as a strong and statistically significant predictor of the outcome (OR = 235.5, 95% CI: 14.1–3921.1, p < 0.001), while clinical-based training (when included) also showed a significant positive association (OR = 30.4, p = 0.013), whereas demographic variables such as gender, job title, residence, and prior family medicine training were not significantly associated with the outcome (p > 0.05), Table 4.

Table 4. Binary logistic regression of predictors affecting satisfaction with the family medicine curriculum in SMSB, (N = 100).

							95% C.I. for EXP(B)
	B	S.E.	Wald	df	Sig.	Exp(B)	Lower	Upper
Gender	−0.524	1.638	0.102	1	0.749	0.592	0.024	14.672
Job	−0.203	1.671	0.015	1	0.904	0.817	0.031	21.594
Residence	1.087	0.867	1.574	1	0.210	2.966	0.543	16.212
Lectures	3.584	1.384	6.702	1	0.010	36.016	2.388	543.104
Clinical based training	3.416	1.374	6.178	1	0.013	30.443	2.059	450.101
Constant	−12.743	5.103	6.236	1	0.013	0.000

Qualitative results

The in-depth interviews results highlighted the respondents’ perceptions of positive and negative aspects of the family medicine curriculum at the SMSB.

Positive perception of training quality

About (75%, 9/12) of the doctors surveyed in the qualitative survey reported a well-prepared family medicine training program. Family medicine training focuses on clinical-based training, including CME and CPD programs. Residents feel that the duration of the clinical rotation, especially the final nine months, is sufficient for improving clinical knowledge.

Comprehensive curriculum

The curriculum covers all disciplines and is patient centered. Regular updates to the curriculum help maintain its relevance and effectiveness compared to other specialties.

Curriculum details and structure need improvement

Some specialists called for a more detailed curriculum to standardize training across different training centers in Sudan. There is a requirement for clearly defined topics for tutorials and case discussions, alongside activating weekly reports summarizing completed activities.

Lack of family medicine trainers

The centralization of family medicine trainers in Khartoum and Gezira states poses a significant challenge. Many newly graduated specialists seek better opportunities abroad, further exacerbating the shortage of trainers in Sudan.

Suggested improvements

Recommendations for organizing “Training of Trainers” (TOT) workshops to improve the skills of the trainers.

Research challenges

Residents expressed difficulties with unclear requirements from the research committee, resulting in a high rejection rate of proposals without justification. Suggestions from residents include a review or reform of the research committee’s processes to improve clarity and support their work.

Summary

The interviews reveal a largely positive view of the family medicine curriculum’s design and execution at SMSB, highlighting its comprehensive and clinically focused nature. However, significant concerns arise regarding the need for standardized curriculum details, trainer availability, and research support, all of which are crucial for the ongoing development and effectiveness of the program.

Discussion

The study’s purpose was to evaluate the effectiveness of the family medicine curriculum in SMSB. Qualitative and quantitative surveys were used to collect the data for the study. Our findings from both the qualitative and quantitative surveys were consistent with the adequacy of the family medicine training program at the SMSB.

The satisfaction rate of residents for the family medicine curriculum in the SMSB was high, concerning the training with a well-arranged four-year clinical rotation, courses, and workshops. These results are consistent with Pensa et al. findings¹⁸.

The qualitative survey revealed that the SMSB four-year family medicine training program is effective in improving skills and knowledge. Peck et al. concluded in their study that the family skill curriculum used in their school improved the residents’ knowledge and attitudes¹⁹.

The CME and CPD programs in the family medicine specialty in SMSB improve the knowledge and experience of the residents. In 2015, similar results were reported by May et al.¹¹.

Findings showed that clinical rotation in SMSB is patient-centered training and covers all disciplines in family medicine. This results in improving the residents’ knowledge, attitude, and patient respect. Our findings are consistent with Schiefer et al. who aimed to assess the skills and empathy of the family medicine curriculum²⁰.

Some interviewed residents indicated dissatisfaction with the research methodology course in SMSB. The course was not effective in improving the knowledge and skills of half of them. Furthermore, residents reported that the family medicine research committee at the SMSB had unclear requirements which were reflected in a high rejection rate of the research proposals submitted by residents.

Family medicine in Sudan is one of the specialties preferred by female doctors²¹. Most of our study participants were females. Furthermore, more than half of the participants were from Khartoum state. These results were consistent with Abdelgadir et al. study on feminization in family medicine in Sudan. Also, they reported that most family medicine doctors from Khartoum and Gezira states due to the presence of training programs and job offers in these states²¹.

The qualitative survey identified some problems facing family residents in Sudan. The training programs are mainly concentrated in Khartoum and Gezira states, and residents of other states complained that the arrangements and organization of training lectures and workshops in their states are different from those in Khartoum and Gezira states. These differences in the curriculum may be due to the lack of family medicine trainers in the other states in Sudan. Moreover, the availability of enough primary health care (PHC) centers and family medicine doctors in Khartoum and Gezira states could explain these differences.

The same issue was discussed by Abdelgadir et al. as they reported the economic situation and the government plan play an important role in the localization of the jobs and training programs in Khartoum and Gezira states²¹. The inequalities in the distribution of the workforce are thought to be one of the major threats challenging the Sudanese health sector²². Rural and remote areas lack enough qualified health workers which affects the delivery of health care services and health education^21,23.

Conclusion

The family medicine curriculum in SMSB is a comprehensive training curriculum that effectively increases knowledge and clinical skills among residents. The CME and CPD programs improve the skills and experience of family doctors. Residents in the SMSB are satisfied during their four years of clinical rotation. The organized lectures and workshops are sufficient to improve residents’ knowledge. The research methodology course is challenging for some residents. Family medicine training programs were mainly localized in Khartoum and Gezira states in Sudan. This resulted in the improvement of primary care and centralization of family medicine jobs in these states, which shows clear discrepancies between these states and the other states of the country.

Recommendations

Based on the results of this study, the following recommendations are offered as possible means to improve family medicine curriculum and training in Sudan.

The SMSB in collaboration with the Ministry of Health (MOH) needs to expand the coverage and improve PHC facilities to include the rest of the states of Sudan. The MOH must encourage family medicine doctors to work in Sudan PHC centers and SMSB training programs by facilitating the recruitment and arranging job offers to cover all states of Sudan.

The family medicine curriculum must be regularly reviewed, evaluated, and updated to improve the family medicine training in Sudan.

The SMSB Family Medicine Council must re-evaluate the research methodology course to improve residents’ skills and knowledge.

The family medicine research committee in the SMSB needs to reauthorize clear guidance to the family medicine residents to solve the problem of the high rejection rate of the research proposals.

Further studies on family medicine training and practice in Sudan must be done to improve the settings of family medicine and encouragement of auditing.

Study limitations

The study adopted mixed qualitative and quantitative approaches for better results. However, some obstacles were faced in collecting data for the qualitative survey due to the war in Sudan and the consequent displacement and lack of internet. Relatively small sample size and might limit the validity of the results.

Acknowledgements

Thanks to Dr. Salah Abdelgadir Abdelmagid and Ms. Samia Mohamed Eltayb for their support and guidance. Special thanks to the family medicine colleagues and residents for their acceptance to participate in the study.

Author contributions

Hiba Salah Abdelgadir: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software, original draft; Writing. Hind Salah Abdelgadir: Data curation; Resources; Software; Formal analysis, original draft; Writing - review & editing. Nasreldin M. Ahmed: Supervision, original draft; review & editing. Adel A. Nasser: Original draft; review & editing. Abed Saif Ahmed Alghawli: Original draft; review & editing, Funding acquisition. Amani A. K. Elsayed: Original draft; review & editing. All authors approved the final version of the manuscript before submission.

Funding

This study was supported via funding from Deanship of Scientific Research, Prince Sattam bin Abdulaziz University [project number: PSAU/2025/R/1446].

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Competing interests

The authors declare no competing interests.

Abbreviations

CME

Continuous medical education

CPD

Continuous professional development

IRB

Institutional review board

MD

Medical Doctorate, depending on the country and academic system

M.Sc.

Master’s degree

PHC

Primary health care

SMSB

Sudan medical specialization board

TOT

Training of trainers

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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