title: Student and faculty perceptions on the rapid scale-up of medical students in Ethiopia.
abstract: BACKGROUND
  Ethiopia is a country of over 94 million people that has a severe physician shortage with approximately only 2.5 physicians per 100,000 persons. Recently, the Ethiopian government implemented a "flood and retain" initiative to rapidly increase the quantity of physicians in Ethiopia. Consequently, medical student enrollment at Addis Ababa University (AAU) School of Medicine increased from 100 to approximately 300-400 students per class. This study evaluated the impact of the rapid scale-up in the number of medical students on the quality of medical education at AAU and the impact of the U.S. government-funded Medical Education Partnership Initiative (MEPI) grant awarded to AAU to provide resources to strengthen the quality of medical education at AAU.
  
  
  METHODS
  Qualitative, semi-structured, in-depth interviews were conducted with 22 key informants including faculty members, administrators and medical students at AAU. The audio recordings were transcribed verbatim and interview data were analyzed with thematic analysis.
  
  
  RESULTS
  Four key themes emerged from the data. Overall, participants perceived a decrease in the quality of medical education at AAU due to challenges created by the rapid scale-up in the number of medical students. Positive learning environments were described as difficult to achieve due to overcrowding in classrooms and the limited numbers of textbooks. Overall, participants stated that infrastructure improvement is needed to provide adequate medical student training. The medical education initiatives implemented and funded by MEPI have provided significant resources to support the medical student curriculum but additional resources are required to accommodate a large student body.
  
  
  CONCLUSIONS
  The unprecedented rapid scale-up of medical students has impacted multiple facets of medical education at AAU. It is important to consider the perspectives of students and faculty in order to focus future medical education policies, MEPI programming and the allocation of resources.
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Rm 510, Atlanta, GA, 30322, USA.
authors.forename: Brittney S
authors.initials: BS
authors.lastname: Mengistu
authors.affiliation: Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Vins
authors.affiliation: Emory University School of Medicine, 1599 Clifton Rd, 6th fl, Atlanta, GA, 30322, USA.
authors.forename: Caitrin M
authors.initials: CM
authors.lastname: Kelly
authors.affiliation: Emory University School of Law and Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
authors.forename: Daphne R
authors.initials: DR
authors.lastname: McGee
authors.affiliation: Department of Medicine, Emory University School of Medicine, 1599 Clifton Rd, 6th fl, Atlanta, GA, 30322, USA.
authors.forename: Jennifer O
authors.initials: JO
authors.lastname: Spicer
authors.affiliation: College of Health Sciences, Addis Ababa University, Black Lion Hospital Campus, Second Floor, Office No 35, PO Box 5729, Addis Ababa, Ethiopia.
authors.forename: Miliard
authors.initials: M
authors.lastname: Derbew
authors.affiliation: School of Medicine, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.
authors.forename: Abebe
authors.initials: A
authors.lastname: Bekele
authors.affiliation: School of Public Health, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.
authors.forename: Damen Haile
authors.initials: DH
authors.lastname: Mariam
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health and, Department of Medicine, Emory University School of Medicine, 1518 Clifton Rd #7011, Claudia Nance Rollins Bldg, Atlanta, GA, 30322, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine and Departments of Epidemiology and Global Health Rollins School of Public Health, Emory University, 1599 Clifton Rd, 6th fl, Atlanta, GA, 30322, USA.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Rm 510, Atlanta, GA, 30322, USA. dcomeau@emory.edu.
authors.forename: Dawn L
authors.identifier: http://orcid.org/0000-0003-2877-9151
authors.initials: DL
authors.lastname: Comeau
mesh_terms: D000328:Adult; D003479:Curriculum; D005002:Ethiopia; D005180:Faculty, Medical / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010820:Physicians / Q000600:supply & distribution; D036301:Qualitative Research; D012577:Schools, Medical; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data*
keywords: Africa; Evaluation; Medical education