By Dr. Said Sheikh Mohamed - Surgical Training Programmes Adviser at the Ministry of Health and Human Services; Somalia. Paediatric Surgeon at Royal Hospital and Benadir Hospital.
“A specialist title should certify demonstrated competence, supported by trained supervisors, structured education and reliable assessment of safe patient care.” Dr Said Sheikh Mohamed
The collapse of Somalia’s central government in 1991 dismantled much of the country’s medical education and specialist training infrastructure. Before then, Somali National University had provided a foundation for medical teaching, supported by functioning public hospitals, including Digfeer Hospital, and international academic cooperation.
In the years after the civil war, new medical schools helped rebuild undergraduate education and expand the health workforce. Somali doctors who pursued specialist training abroad also began returning with qualifications and experience. These are important gains.
Today, however, a growing number of private institutions are announcing postgraduate medical training programmes. Without national standards, their expansion could produce doctors who hold specialist titles without having developed the full competencies those titles should represent.
The question is straightforward: What standards of institution, faculty, curriculum, supervision and assessment are needed to train specialists safely and consistently?
1. An Organised Teaching Hospital#
A hospital becomes a postgraduate training institution when its clinical services, educational programme, faculty, facilities and governance are organised around a defined training programme. Assigning residents to a hospital does not, by itself, create that environment.
A trainee may see hundreds of patients without learning sound principles of diagnosis and management if clinical work is not guided by clear educational objectives.
2. Qualified Mentors#
Mentorship is at the heart of specialist training. Trainees learn by observing experienced doctors, discussing cases, participating in procedures, receiving feedback and making decisions under supervision. They should assume greater responsibility as their competence develops.
No postgraduate programme can be stronger than its faculty. An excellent clinician is not necessarily an effective educator, and years of clinical experience alone do not prepare someone to teach and assess specialist trainees.
Supervisors need appropriate specialist qualifications, clinical and teaching experience, assessment skills and a clear understanding of the curriculum. They must be able to give constructive feedback while upholding patient safety and professional standards. Training becomes less reliable when supervisors have not been prepared for this educational role.
3. Protected Teaching Time#
Postgraduate training cannot depend entirely on service delivery. Programmes need protected time for case discussions, journal clubs, morbidity and mortality meetings, radiology and pathology conferences, operative planning and formal teaching. Trainees also need opportunities to study research methods, ethics, evidence-based medicine and clinical decision-making, and to practise skills through simulation.
Clinical exposure is essential, but it is not a substitute for structured teaching.
4. A Clear Curriculum#
Every specialty needs a nationally recognised curriculum that sets out what trainees must know and be able to do. It should define clinical and procedural skills, emergency competencies, professional standards and research expectations. For surgical specialties, it should also specify operative skills and the level of supervision required at each stage.
A shared curriculum gives trainees, supervisors and assessors a clear basis for teaching and measuring progress.
5. Competence-Based Progression#
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A trainee should not advance simply because another year has passed, tuition has been paid or attendance has been recorded. Progression should depend on demonstrated competence and satisfactory performance.
Assessment should cover clinical knowledge and reasoning, procedural or operative ability, communication, documentation, emergency management and professionalism. Where relevant, it should also consider research and teaching. Examinations, workplace assessments and verified logbooks should contribute to the decision.
6. Patient Safety#
The purpose of specialist training is to prepare doctors to provide safe and effective care. Patient safety must therefore shape supervision, the responsibilities assigned to trainees and decisions about when they are ready to practise more independently.
7. A Verified Logbook#
A postgraduate logbook is more than administrative paperwork. It records a trainee’s exposure to relevant cases and procedures and helps supervisors identify gaps in experience.
Entries should be verified. The question is not merely whether a trainee has a logbook, but whether it provides credible evidence of the clinical experience and competence required by the programme.
8. Examinations That Test Practice#
A specialist examination should assess more than the ability to recall information from textbooks. Trainees must show that they can apply knowledge, make sound clinical decisions and perform relevant skills safely.
Poorly structured training risks awarding specialist qualifications to doctors who have completed the required years but have not met the expected specialist standard.
A National Framework#
Somalia needs a national framework for postgraduate medical education built around six priorities:
- National standards defining the requirements for specialist training.
- Institutional accreditation to assess hospitals before they train specialists.
- Faculty development to prepare and accredit supervisors.
- Standardised curricula so trainees receive comparable core education.
- Competence-based assessment using verified logbooks, workplace assessments, examinations and external review.
- Continuous quality improvement to identify weaknesses and strengthen programmes over time.
Postgraduate medical training is essential to strengthening Somalia’s healthcare system. Its growth must be matched by the expertise, facilities, supervision and assessment needed to prepare specialists who can care for patients safely.
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Dr. Said Sheikh Mohamed is a Surgical Training Programmes Adviser at the Ministry of Health and Human Services; Somalia. Paediatric Surgeon at Royal Hospital and Benadir Hospital.
The views expressed in this article are those of the author and do not necessarily reflect the editorial position of Dawan Africa.