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Background: Medical education in Sub-Saharan Africa is in need of reform to promote the number and quality of physicians trained. Curriculum change and innovation in this region, however, face a challenging context that may affect curriculum outcomes. Research on outcomes of curriculum innovation in Sub-Saharan Africa is scarce. We investigated curriculum outcomes in a Sub-Saharan African context by comparing students' perceived preparedness for practice within three curricula in Mozambique: a conventional curriculum and two innovative curricula. Both innovative curricula used problem-based learning and community-based education. Methods: We conducted a comparative mixed methods study. We adapted a validated questionnaire on perceived professional competencies and administered it to 5th year students of the three curricula (n = 140). We conducted semi-structured interviews with 5th year students from these curricula (n = 12). Additional contextual information was collected. Statistical and thematic analyses were conducted. Results: Perceived preparedness for practice of students from the conventional curriculum was significantly lower than for students from one innovative curriculum, but significantly higher than for students from the other innovative curriculum. Major human and material resource issues and disorganization impeded the latter's sense of preparedness. Both innovative curricula, however, stimulated a more holistic approach among students toward patients, as well an inquiring and independent attitude, which is valuable preparation for Sub-Saharan African healthcare. Discussion: In Sub-Saharan Africa, risks and benefits of curriculum innovation are high. Positive outcomes add value to local healthcare in terms of doctors' meaningful preparedness for practice, but instead outcomes can be negative due to the implementation challenges sometimes found in Sub-Saharan African contexts. Before embarking on innovative curriculum reform, medical schools need to assess their capability and motivation for innovation. [ABSTRACT FROM AUTHOR]

Collaborative approaches such as Problem Based Learning (PBL) may provide the opportunity to bring together diverse students but their efficacy in practice and the complications that arise due to the mixed ethnicity needs further investigation. This study explores the key advantages and problems of heterogeneous PBL groups from the students' and teachers' opinions. Focus groups were conducted with a stratified sample of second year medical students and their PBL teachers. We found that students working in heterogeneous groupings interact with students with whom they don't normally interact with, learn a lot more from each other because of their differences in language and academic preparedness and become better prepared for their future professions in multicultural societies. On the other hand we found students segregating in the tutorials along racial lines and that status factors disempowered students and subsequently their productivity. Among the challenges was also that academic and language diversity hindered student learning. In light of these the recommendations were that teachers need special diversity training to deal with heterogeneous groups and the tensions that arise. Attention should be given to create 'the right mix' for group learning in diverse student populations. The findings demonstrate that collaborative heterogeneous learning has two sides that need to be balanced. On the positive end we have the 'ideology' behind mixing diverse students and on the negative the 'practice' behind mixing students. More research is needed to explore these variations and their efficacy in more detail.