Medical Education Reform in Sub-Saharan Africa: The Case for Rehabilitation Integration in Cameroon

Medical Education Reform in Sub-Saharan Africa: The Case for Rehabilitation Integration in Cameroon | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Medical Education Reform in Sub-Saharan Africa: The Case for Rehabilitation Integration in Cameroon Ibrahim NPOCHINTO MOUMENI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7607486/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The World Health Organization's Rehabilitation 2030 initiative recognizes rehabilitation as an essential component of universal health coverage. However, medical education in Cameroon systematically excludes physical medicine and rehabilitation training, creating significant gaps in professional competency and healthcare delivery. Purpose This study examines the consequences of rehabilitation education absence in Cameroonian medical curricula and proposes an evidence-based integration model aligned with international standards and regional best practices. Methods We conducted a qualitative study (2023–2025) involving systematic discussions with academic leaders (n = 12) from major Cameroonian medical institutions including Universities of Yaoundé I, Douala, and Garoua. We analyzed the pioneering rehabilitation education experience at University of Dschang, which introduced experimental rehabilitation teaching in 2021 Results Academic leaders explicitly acknowledged rehabilitation as non-priority, stating "it doesn't exist in our national curriculum, why should we teach what isn't prescribed?" This educational deficit generates delayed rehabilitation referrals, inappropriate physician-therapist financial arrangements involving 30–50% revenue sharing, and over-reliance on diagnostic imaging rather than functional assessment. Conversely, Dschang's minimal 4-hour rehabilitation exposure generated unexpected student enthusiasm for Physical Medicine and Rehabilitation specialization, demonstrating integration feasibility and unmet educational demand. Conclusions Rehabilitation integration into medical education represents a critical health system strengthening opportunity for Cameroon. We propose a structured 100-hour curriculum distributed over three academic years with mandatory clinical rotations. This model addresses current professional marginalization while aligning with WHO recommendations and could serve as a template for other Sub-Saharan African countries facing similar educational gaps and professional recognition challenges. What was already known on this topic: Prior research has documented severe shortages of rehabilitation professionals across Sub-Saharan Africa and identified educational gaps as key barriers to workforce development. Several African countries, including South Africa, Ghana, Rwanda, and francophone nations like Côte d'Ivoire and Senegal, have successfully integrated rehabilitation training into medical curricula with measurable improvements in referral patterns and professional recognition. However, systematic analysis of the institutional mechanisms that perpetuate educational exclusion and their downstream effects on clinical practice patterns, particularly the documentation of commercial arrangements between physicians and rehabilitation professionals, remained limited in the literature. What this study adds: This study provides the first comprehensive analysis of rehabilitation education exclusion in Cameroon, documenting specific institutional resistance patterns and their consequences including quantified physician-therapist commission arrangements (30–50% revenue sharing) that compromise care quality. It presents novel evidence from the University of Dschang's pioneering experience, demonstrating that minimal educational exposure (4 hours) generates substantial student interest in rehabilitation specialization, contradicting assumptions about low demand. The study contributes a detailed, evidence-based 100-hour integration model aligned with WHO recommendations and regional best practices, offering a practical template for other African countries facing similar educational gaps and professional marginalization challenges. Medical education reform rehabilitation medicine physical therapy education curriculum development Sub-Saharan Africa health workforce training universal health coverage Figures Figure 1 Figure 2 Background The World Health Organization's "Rehabilitation 2030: A Call for Action" initiative established rehabilitation as a fundamental component of universal health coverage rather than an optional service [ 1 ]. This position was reinforced by the WHO Regional Strategy for Africa (2025–2035), which notes that over 63% of Africans lack access to necessary rehabilitation services [ 2 ]. Despite this global recognition, medical education in many Sub-Saharan African countries, particularly Cameroon, systematically excludes rehabilitation training from core curricula. On a global scale, the World Health Organization estimates that around 2.4 billion people currently need rehabilitation, based on Global Burden of Disease 2019 data [ 3 ]. The unmet need is rising fastest in low- and middle-income countries, underscoring the urgency of building capacity through medical education reforms. Cameroon faces a dual epidemiological burden combining persistent communicable diseases with rising non-communicable diseases—stroke, diabetes, cancer, and road traffic injuries. While the country has achieved significant progress in training physicians in classical disciplines (internal medicine, surgery, pediatrics, obstetrics), rehabilitation remains virtually absent from the national medical curriculum. This educational gap perpetuates profound misunderstanding of rehabilitation roles and translates into delayed prescriptions, fragmented care pathways, and non-clinical referral motivations that weaken the entire health system. Recent analyses of African rehabilitation challenges emphasize that "education is a key strategy for advancing rehabilitation service quality globally, but there is a shortage of physical medicine and rehabilitation education programs in the academic environment of most African countries" [ 4 ]. This educational deficit extends beyond technical competency gaps to fundamental questions of professional legitimacy and healthcare system integration. The impact of this deficiency transcends simple educational concerns to become a major public health issue. Cameroonian physicians, trained without significant exposure to physical medicine, physiotherapy, occupational therapy, or comprehensive rehabilitation, develop reductive rehabilitation conceptualizations, perceiving it solely as late-stage intervention for severely disabled patients. This impoverished representation feeds a vicious cycle of under-prescription, professional devaluation, and ethically questionable practices that compromise care quality and paramedical profession dignity. Methods Study Design and Setting We conducted a qualitative descriptive study combining institutional analysis and educational innovation assessment. The study was performed between-2023-2025 across multiple Cameroonian medical education institutions and focused on the University of Dschang's pioneering rehabilitation integration experience. Participants and Data Collection Institutional Assessment: We conducted informal but systematic discussions with academic leaders from major Cameroonian medical institutions: University of Yaoundé I (former CUSS), University of Douala, University of Garoua, and two accredited private medical institutes. Participants included senior faculty members, department heads, and high-level academic staff (n=12). Educational Innovation Analysis: We analyzed the University of Dschang Department of Physiotherapy and Physical Medicine experience, which introduced experimental rehabilitation lectures under the internal medicine module in 2021until now, following an initiative of the Faculty Dean. This analysis included informal student feedback gathered during discussions , academic performance assessment, and specialization interest trackin Comparative Analysis: We conducted systematic literature review and institutional website analysis of rehabilitation integration in African medical schools, focusing on South Africa, Ghana, Rwanda, Côte d'Ivoire, Morocco, and Senegal programs. Ethical Considerations This observational educational research study adhered to ethical principles outlined in the World Medical Association Declaration of Helsinki [5], adapted for qualitative social science methodology. The study design incorporated: Voluntary participation with complete information disclosure Systematic anonymization of participants' identities and institutional affiliations Confidential data storage with pseudonymization protocols Guaranteed withdrawal rights without requirement for justification This educational system analysis focused on institutional policies and academic practices without direct patient involvement, clinical interventions, or collection of personal health data. Following local research ethics guidelines for non-interventional educational studies, formal institutional review board approval was not required. All participants provided informed verbal consent for inclusion of their perspectives in academic analysis, with assurance of complete anonymity in any resulting publications. Thematic Analysis Framework: Data analysis followed systematic thematic coding of institutional responses around: (1) curriculum adherence patterns, (2) professional recognition attitudes, and (3) resistance justifications. Theme validation was ensured through independent review by senior faculty members not involved in data collection. Results Current State of Rehabilitation Education Our assessment revealed systematic exclusion of rehabilitation content from Cameroonian medical curricula. Academic leaders from all contacted institutions unanimously acknowledged rehabilitation as non-priority for medical education. When questioned about this absence, typical responses included: "Doctor Moumeni, it doesn't exist in our national medical personnel training curriculum—why should we do what isn't prescribed in the program?" Additional institutional perspectives reinforced resistance patterns: "We follow what the Ministry prescribes, nothing more" (Senior Faculty Member, Public University) and "Rehabilitation isn't part of our accreditation requirements" (Academic Administrator, Private Institution). These responses illustrate systematic adherence to centralized directives rather than educational innovation across institutional types. Table 1 provides a comprehensive comparison of rehabilitation training programs across Sub-Saharan Africa, highlighting Cameroon's critical educational deficit. The challenge of limited human resources for rehabilitation has been repeatedly highlighted as a major bottleneck in sub-Saharan Africa. Hanrahan et al. [6] documented the severe shortage of trained rehabilitation professionals across the region, showing that most countries have fewer than 10 physiotherapists per million inhabitants. This workforce gap reinforces the urgent need to incorporate rehabilitation principles into undergraduate medical education, ensuring that all physicians are trained to support and coordinate rehabilitation care even when specialists are scarce. This institutional attitude reflects profound misunderstanding of contemporary medical practice evolution and deliberate ignorance of therapeutic and scientific developments from recent decades, particularly given that nursing care courses are taught in first and second years while rehabilitation remains excluded. Consequences of Educational Deficit The curricular gap generates multiple problematic consequences: Delayed Recognition and Referrals: Physicians approach rehabilitation as ancillary care reserved for post-stroke sequelae (often only post-hospitalization) or patent disability situations. This restrictive vision delays care that could prevent functional decline and improve outcomes across orthopedics, oncology, geriatrics, cardiothoracic surgery, respiratory medicine, and chronic pain management. Commercial Deviance: A concerning social phenomenon emerged: transformation of physiotherapy prescription into commercial transactions. Some prescribing physicians demand 30-50% revenue shares from physiotherapy sessions, creating kickback systems that fundamentally pervert therapeutic relationships. This practice contrasts sharply with other medical specialties where referrals follow established clinical pathways without financial arrangements. Professional Marginalization: Unlike dentistry or ophthalmology, which gain legitimacy through medical education integration, physiotherapy and rehabilitation professions remain "orphaned"—perceived as peripheral activities whose therapeutic value isn't fully integrated into Cameroonian medical culture. As one physician confided: "physiotherapy isn't an obligation or emergency—no real added value." International Comparisons Several African countries have successfully integrated rehabilitation into medical education, demonstrating reform feasibility and benefits: As detailed in Table 1, these successful implementations contrast sharply with Cameroon's minimal 4-hour exposure. South Africa: Medical training includes structured physical medicine and rehabilitation teaching from pre-clinical cycles, complemented by mandatory clinical rotations in specialized units. This approach enables students to discover physiotherapy, occupational therapy, and seven rehabilitation professions' roles in care continuity, subsequently fostering systematic and clinically relevant prescriptions. At the national policy level, South Africa has embedded structured rehabilitation modules in the undergraduate medical curriculum [7]. Early exposure to physical and rehabilitation medicine improves referral quality and aligns training with functional outcomes, showing feasibility and impact in an African context. Ghana: The International Rehabilitation Forum developed and implemented physician fellowship programs in rehabilitation medicine successfully since 2018. The Ghana College of Physicians and Surgeons partnered with IRF to approve a two-year "Sports, Exercise and Rehabilitation Medicine" fellowship program training family physicians in PMR and sports medicine [8,9]. Complementary evidence from Ghana indicates that structured rehabilitation content in medical training can improve patient access—particularly in rural districts—by changing referral behavior and service organization [8,9]. Rwanda: The Ministry of Health conducted ambitious medical curriculum revision in 2022 to integrate rehabilitation as mandatory transversal competency, aligned with "Rehabilitation 2030" program objectives. This curricular integration accompanies strong physiotherapy and occupational therapy expansion, now recognized as strategic disciplines for national public health needs. Rwanda currently has 360 registered physiotherapists, with 88 employed in public facilities (0.26 physiotherapists per 10,000 inhabitants) [10]. This policy reform is formally anchored at ministerial level and has begun to standardize earlier and more appropriate referrals to rehabilitation across public facilities [11]. Francophone Africa: Côte d'Ivoire has offered Physical Medicine and Rehabilitation university specialization for decades. Université Félix Houphouët-Boigny provides an eight-semester Specialized Studies Diploma covering comprehensive specialty domains from fundamental disability concepts to specialized rotations and thesis completion [6]. Similarly, Senegal has established physical medicine and functional rehabilitation services in hospitals with locally or internationally trained specialist physicians collaborating closely with multidisciplinary rehabilitation teams [12]. Morocco: A dedicated national strategy for Physical and Rehabilitation Medicine emphasizes workforce training, the creation of academic rehabilitation departments, and integration of rehabilitation content into medical curricula—showing that curriculum change is a policy choice that can be enacted in the region [13,14]. The Dschang Pioneer Experience The University of Dschang (ranked first university in Cameroon and CEMAC zone 2023-2024) [15] created Central Africa's first Physiotherapy and Physical Medicine Department in 2021 under visionary Rector and Medical Faculty Dean leadership. In 2021, this department initiated a limited educational experiment: introducing 4 hours of rehabilitation instruction for 5th-year medical students as an extra-curricular initiative, operating outside the official national medical curriculum framework. These 4 teaching hours covered rehabilitation foundations, rehabilitation professions overview, and clinical indications for rehabilitation services. While this represents minimal educational exposure compared to established medical subjects, the initiative constituted an unprecedented step in Cameroonian medical education landscape, demonstrating local capacity for educational innovation despite national curriculum constraints. The pedagogical response exceeded expectations. Students demonstrated remarkable engagement with this limited rehabilitation exposure, with several expressing newfound interest in Physical Medicine and Rehabilitation as a potential specialization pathway. They began perceiving PMR as a legitimate medical specialty positioned at the interface of neurology, orthopedics, pediatrics, geriatrics, traumatology, rheumatology, sports medicine, and pain medicine. Student feedback from participants proved particularly illuminating. Several contacted instructors seeking additional information about specialization opportunities abroad, including programs in France, Morocco, Tunisia, South Africa, Senegal [16], and Côte d'Ivoire. This spontaneous interest, generated by minimal educational exposure, suggests significant unmet demand for rehabilitation education within Cameroonian medical training. Cross-Institutional Validation: The enthusiasm observed at Dschang was corroborated by informal feedback from faculty members at other institutions who confirmed similar student interest when rehabilitation topics are briefly mentioned in related courses, suggesting broader potential for systematic curricular integration. Discussion Educational Reform as Health System Strengthening Our findings reveal that rehabilitation exclusion from medical education represents more than pedagogical oversight—it constitutes a systematic health system weakening that compromises care quality, professional development, and population health outcomes. The explicit acknowledgment by academic leaders that rehabilitation "isn't interesting" or "doesn't exist in our curriculum" reflects institutional resistance that perpetuates cycles of professional marginalization and care fragmentation. Institutional Theory Framework: Our findings align with organizational isomorphism theory (DiMaggio & Powell, 1983) [17], where institutions mimic established patterns rather than innovating. The repeated reference to "national curriculum compliance" demonstrates coercive isomorphism, where regulatory frameworks constrain educational evolution despite changing health needs. Consistent with broader LMIC evidence, strengthening rehabilitation requires addressing structural barriers—limited funding, low political visibility, and weak academic capacity. Integrating rehabilitation into medical curricula is among the most cost-effective levers to overcome these barriers and normalize timely referrals [18]. Deep Analysis of Institutional Resistance: The "National Curriculum" Paradigm The recurring institutional response—"it doesn't exist in our national curriculum, why should we teach what isn't prescribed?"—reveals profound systemic implications that extend beyond simple curricular gaps. This statement illuminates several critical dimensions of medical education governance in Sub-Saharan Africa. Implications for Institutional Autonomy: This response demonstrates excessive dependence on centralized directives, contrasting sharply with university autonomy patterns observed in developed medical education systems. While international medical schools routinely adapt curricula to emerging health needs and scientific developments, Cameroonian institutions appear constrained by rigid adherence to national frameworks. This centralized control mechanism may explain why medical education evolution lags behind epidemiological transitions and population health needs. International Comparisons of Curricular Innovation: Medical schools in countries with successful rehabilitation integration—South Africa, Ghana, Rwanda—demonstrate greater institutional flexibility in curriculum adaptation. These institutions interpret national guidelines as minimum standards rather than maximum boundaries, enabling responsive educational innovation. The contrast suggests that Cameroonian medical education operates within an institutional culture that prioritizes compliance over innovation, potentially stifling educational evolution and professional development. Mechanisms of Institutional Inertia: The "prescribed curriculum" response represents what educational theorists term "institutional inertia"—systematic resistance to change that becomes self-perpetuating. This mechanism operates through several pathways: administrative risk aversion (avoiding initiatives lacking explicit authorization), resource allocation patterns (funding follows established priorities), and professional socialization (faculty trained within existing paradigms reproduce those limitations). Understanding these mechanisms proves crucial for designing effective change strategies. Theoretical Frameworks for Educational Change: Literature on medical education transformation identifies several factors essential for successful curricular innovation: leadership vision, faculty development, resource availability, and external pressure for change. The Dschang experience suggests that local leadership vision can overcome institutional inertia, but scaling requires addressing systemic barriers that maintain status quo adherence to centralized directives. Analysis of Professional Marginalization: The Economics of Clinical Legitimacy The documented practice of physician-therapist commission arrangements (30-50% revenue sharing) provides a window into broader patterns of professional legitimacy construction within health systems. This phenomenon requires analysis through multiple theoretical lenses to understand its persistence and implications. Health Economics and Professional Power: The commission system reflects asymmetric power relationships where physicians control access to patient populations while rehabilitation professionals provide actual services. This arrangement parallels historical patterns in other health systems where medical dominance shapes interprofessional relationships. However, the explicit financial nature of these arrangements in Cameroon suggests more extreme marginalization than observed in systems with established rehabilitation education. Comparative Professional Recognition Patterns: The absence of similar commission arrangements with dentists, ophthalmologists, and other specialists illuminates the role of educational integration in professional legitimacy construction. These specialties achieved recognition through medical education inclusion, creating understanding of their roles, indications, and value among referring physicians. Rehabilitation professions, excluded from this educational legitimation process, remain vulnerable to exploitative relationship patterns. Cycles of Professional Legitimacy: Our analysis reveals self-reinforcing cycles where educational exclusion → professional marginalization → economic exploitation → reduced professional status → continued educational exclusion. Breaking these cycles requires strategic intervention at multiple points, with educational integration potentially providing the most leverage for sustainable change. Regulatory and Ethical Implications: The commission system raises significant questions about healthcare regulation and professional ethics. While informal financial arrangements exist in many health systems, the systematic nature and percentage ranges documented suggest regulatory gaps that compromise both care quality and professional development. Successful rehabilitation education integration might provide natural regulation through improved professional understanding and respect. Analysis of Student Response: Learning Theory and Professional Identity Formation The exceptional enthusiasm and studiousness demonstrated by current 6th-year students (who completed the 4-hour program plus clinical immersion at Dschang Regional Hospital during their 5th year) provides crucial insights into medical education effectiveness and professional identity formation mechanisms. Exposure-Impact Relationships in Medical Education: The disproportionate impact of minimal exposure (4 hours plus clinical immersion) on student career interests challenges conventional assumptions about educational dose-response relationships. Learning theory suggests that meaningful exposure to authentic professional contexts can trigger identity formation processes that influence career trajectories significantly. The clinical immersion component may have provided crucial authenticity that pure didactic teaching cannot achieve. Professional Discovery Mechanisms: The students' sustained interest progression from initial exposure through current 6th-year status illustrates professional discovery mechanisms identified in medical education literature. Exposure to previously unknown specialties can trigger identity resonance—alignment between personal interests, values, and perceived professional roles. The interdisciplinary nature of rehabilitation, spanning neurology, orthopedics, pediatrics, geriatrics, traumatology, rheumatology, sports medicine, and pain management, may particularly appeal to students seeking broad clinical scope. Predictive Factors for Specialty Interest: The sustained engagement observed in Dschang students suggests several predictive factors for rehabilitation specialty interest: exposure to diverse clinical applications, understanding of professional scope, recognition of career viability, and alignment with service motivations. These factors align with broader literature on medical specialty choice, suggesting that systematic curricular integration could generate substantial interest in rehabilitation careers. Implications for Curriculum Design: The Dschang experience demonstrates that effective rehabilitation education requires both conceptual understanding and authentic clinical exposure. The combination of didactic content with hospital-based immersion appears crucial for generating lasting impact. This suggests that successful national integration would require clinical rotation components, not merely classroom-based teaching, with implications for resource requirements and implementation strategies. Regional Context and Implementation Pathways The contrast between Dschang's innovation success and other institutions' resistance reveals critical implementation pathways for broader educational reform. Understanding these patterns proves essential for scaling successful approaches while addressing systematic barriers. Innovation Diffusion in Medical Education: The Dschang experience exemplifies what diffusion of innovation theory terms "early adoption"—implementation by institutions with leadership vision and capacity for change. However, scaling from early adoption to mainstream implementation requires addressing concerns and barriers of "early majority" institutions that require more evidence and support for change adoption. Resource and Capacity Considerations: The availability of qualified faculty (PhD-qualified physiotherapy specialists trained in European universities) at Dschang demonstrates that expertise exists within Cameroon but requires strategic mobilization. National scaling would need systematic faculty development, potentially through international partnerships, exchange programs, and targeted scholarship initiatives for rehabilitation education specialization [18,19]. Policy Integration Strategies: Successful national implementation likely requires coordinated action across multiple policy levels: national curriculum revision, institutional capacity building, faculty development programs, and clinical training site development. The WHO Regional Strategy 2025-2035 provides policy framework support, but implementation requires domestic policy coordination and resource commitment [1,2]. Proposed Integration Model: Evidence-Based Implementation Based on the Dschang experience analysis and international best practices review, we propose a structured three-year rehabilitation integration model totaling 100 theoretical hours plus clinical rotations, designed to address identified barriers while building on demonstrated success factors [18,19]. Year 4 - Foundation Module (25 hours): WHO frameworks introduction, biopsychosocial disability approach, physical medicine and physiotherapy scientific foundations, rehabilitation roles in major medical pathologies, and sensitization workshops including rehabilitation service visits. This foundational approach addresses the knowledge gap while building professional understanding. Year 5 - Applied Clinical Module (40 hours + 2 weeks rotation): Rehabilitation prescription principles and indications, profession-specific roles, transversal applications across medical specialties, practical workshops developing operational competencies, and mandatory clinical rotation in rehabilitation services. The clinical component addresses the authentic exposure requirement identified as crucial in the Dschang experience. Year 6 - Advanced Integration (35 hours + 2 weeks rotation): Physical Medicine and Rehabilitation as complete medical specialty, innovative approaches, public health integration, financing mechanisms, and socioeconomic impact analysis plus additional clinical rotation. This progression ensures comprehensive understanding while providing multiple clinical exposure opportunities. Implementation Considerations and Change Management Successful implementation requires coordinated change management addressing multiple stakeholder groups and systematic barriers identified through our analysis [18,19]. Institutional Level Strategies: Ministry of Higher Education directive requiring rehabilitation modules in accredited medical programs, faculty development programs supporting rehabilitation education capacity, and partnership agreements facilitating clinical training access. These strategies address the centralized directive dependence while building necessary capacity [18,19]. Professional Development Requirements: Integration of rehabilitation competencies in medical licensing examinations would create accountability for learning, continuing medical education requirements would address existing practitioners, and health insurance coverage expansion would support service sustainability. These mechanisms address the professional recognition cycle identified as crucial for sustainable change. System-Level Alignment: Coordination with WHO Regional Strategy 2025-2035 objectives, collaboration with successful African programs for knowledge transfer, research partnerships for implementation evaluation, and stakeholder engagement across government, professional, and civil society actors. This comprehensive approach addresses the systemic nature of required changes while building sustainable support for implementation. Limitations This study presents several methodological limitations. The restricted sample size and Cameroonian cultural specificity limit generalization to other African contexts. The principal investigator's cultural affiliation, while facilitating terrain access, may have influenced data interpretation. Additionally, the absence of longitudinal follow-up prevents assessment of observed therapeutic choice sustainability. The informal nature of institutional discussions, while providing authentic perspectives, limits systematic comparison across institutions. Furthermore, the Dschang experience analysis, though promising, represents early-stage implementation requiring longer-term evaluation for definitive conclusions. Conclusions This analysis demonstrates that rehabilitation integration into Cameroonian medical education represents a critical opportunity for health system strengthening and professional development. The systematic exclusion of rehabilitation content from medical curricula perpetuates cycles of professional marginalization, care fragmentation, and suboptimal health outcomes that compromise national health system effectiveness. The University of Dschang's pioneering experience provides compelling evidence that educational reform is both feasible and welcomed by students when properly implemented. The enthusiasm generated by minimal exposure (4 hours) suggests that comprehensive integration could transform professional attitudes and practice patterns significantly. Our proposed 100-hour integration model, aligned with WHO recommendations and regional best practices, offers a structured pathway for addressing current deficits while positioning Cameroon as a leader in African medical education innovation. The success of similar initiatives across Sub-Saharan Africa demonstrates that educational reform can catalyze broader health system improvements and professional recognition. Moving forward, successful implementation requires coordinated political will, institutional commitment, and professional leadership to overcome resistance and realize rehabilitation education's transformative potential. The cost of maintaining current exclusion—continued professional marginalization, suboptimal care, and health system inefficiencies—far exceeds implementation challenges. Cameroon has the opportunity to demonstrate African leadership in medical education reform while addressing critical workforce development needs. The evidence supports action; the question is whether institutions will demonstrate the vision and commitment necessary to realize this transformative opportunity. Declarations Author Contributions INM : Study conceptualization, theoretical framework development, complete manuscript drafting, curricular proposal development, figure and table creation, critical literature analysis, intellectual content revision, and final version approval for submission. Acknowledgments We eAuthor Contributions INM: Study conceptualization, theoretical framework development, complete manuscript drafting, curricular proposal development, figure and table creation, critical literature analysis, intellectual content revision, and final version approval for submission. Acknowledgments We express profound gratitude to Rector Roger Tsafack Nanfosso, University of Dschang Rector, President of the Conference of Francophone African and Middle Eastern University Rectors, and President of the Conference of Cameroonian University Institution Heads, for visionary leadership enabling Central Africa's first Physiotherapy and Physical Medicine Department creation. His strategic vision and institutional support opened pathways for this historic academic innovation. Our thanks extend to Professor Siméon Pierre Choukem, Dean of the Faculty of Medicine and Pharmaceutical Sciences at the University of Dschang, for his accompaniment in introducing the first rehabilitation modules in Cameroonian medical curricula. His commitment to pedagogical excellence and confidence in this pioneering initiative proved instrumental in achieving this first step toward integrated medical training. We thank all study participants for their confidence and contribution to advancing knowledge in African medical education. Clinical trial number: not applicable. Ethical Approval This observational non-interventional study respects ethical principles of qualitative social science research and does not require institutional review board approval. All participants provided informed consent after complete information about study objectives and methods. Funding This study received no external funding. Competing Interests The author declares no competing interests related to this study. Data Availability Anonymized data are available upon reasonable request to the corresponding author. xpress profound gratitude to Rector Roger Tsafack Nanfosso , University of Dschang Rector, President of the Conference of Francophone African and Middle Eastern University Rectors, and President of the Conference of Cameroonian University Institution Heads, for visionary leadership enabling Central Africa's first Physiotherapy and Physical Medicine Department creation. His strategic vision and institutional support opened pathways for this historic academic innovation. Our thanks extend to Professor Siméon Pierre Choukem , Dean of the Faculty of Medicine and Pharmaceutical Sciences at the University of Dschang, for his accompaniment in introducing the first rehabilitation modules in Cameroonian medical curricula. His commitment to pedagogical excellence and confidence in this pioneering initiative proved instrumental in achieving this first step toward integrated medical training. We thank all study participants for their confidence and contribution to advancing knowledge in African medical education. Clinical trial number: not applicable. Ethical Approval This observational non-interventional study respects ethical principles of qualitative social science research and does not require institutional review board approval. All participants provided informed consent after complete information about study objectives and methods. Funding This study received no external funding. Competing Interests The author declares no competing interests related to this study. Data Availability Anonymized data are available upon reasonable request to the corresponding author. Corresponding Author: Dr. Ibrahim NPOCHINTO MOUMENI Department of Physiotherapy and Physical Medicine Faculty of Medicine and Pharmaceutical Sciences University of Dschang, West Region, Cameroon Email: [email protected] References World Health Organization. Rehabilitation 2030: a call for action. 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Available from: https://www.hogip.sn/index.php/specialites/autres-specialites-hogip/medecine-physique-et-readaptation-fonctionnelle DiMaggio PJ, Powell WW. The iron cage revisited: institutional isomorphism and collective rationality in organizational fields. Am Sociol Rev. 1983;48(2):147-160. doi:10.2307/2095101. Dambi JM, Jelsma J, Mlambo T. Strengthening rehabilitation in health systems of low- and middle-income countries: challenges and opportunities. Disabil Rehabil . 2020;42(3):311–321. doi:10.1080/09638288.2018.1498543 Gutenbrunner C, Nugraha B. Strengthening health-related rehabilitation services at national levels. J Rehabil Med. 2021;53(4):jrm00159. doi:10.2340/16501977-2825. Table Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. 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11:32:18","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84992,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7607486/v1/a02624a9b43b6d49c0aaac0b.html"},{"id":92256216,"identity":"26968a16-bdb5-44b9-a7ec-72e7c10beb88","added_by":"auto","created_at":"2025-09-26 11:32:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":278796,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCycle of Professional Marginalization in Rehabilitation Medicine.\u003c/strong\u003e This conceptual model illustrates the self-reinforcing mechanisms that perpetuate rehabilitation medicine exclusion from Cameroonian medical education. The cycle demonstrates how curricular exclusion leads to professional ignorance among physicians, resulting in delayed referrals and commercial deviance (30-50% commission arrangements). Professional devaluation reinforces institutional resistance to educational reform, creating a continuous cycle that compromises patient outcomes through fragmented care, suboptimal rehabilitation services, and health system inefficiencies. Each component feeds into the next, maintaining the marginalization of rehabilitation professions within the healthcare system.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7607486/v1/b6a463c1d21d3f7397108e29.png"},{"id":92256211,"identity":"5902c2ff-8091-4d85-be00-bdea035987e1","added_by":"auto","created_at":"2025-09-26 11:32:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":561819,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProposed Three-Year Rehabilitation Integration Model for Cameroonian Medical Education.\u003c/strong\u003e The figure contrasts the current situation (4 hours at University of Dschang only) with the proposed comprehensive curriculum spanning Years 4-6 of medical training. The structured progression includes: Year 4 Foundation Module (25 hours + workshops), Year 5 Applied Clinical Module (40 hours + 2 weeks rotation), and Year 6 Advanced Integration (35 hours + 2 weeks rotation), totaling 100 theoretical hours and 4 weeks of clinical exposure. This evidence-based model aligns with WHO Rehabilitation 2030 objectives and regional African best practices, addressing current educational deficits while preparing graduates for evidence-based rehabilitation prescription and interprofessional collaboration.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7607486/v1/cf26524f5fe8023d66fd6614.png"},{"id":100593935,"identity":"084878a4-0f68-478d-a5c3-62151fd20dbf","added_by":"auto","created_at":"2026-01-19 13:29:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2192827,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7607486/v1/869a1367-168a-42fa-b5ea-25af2f76132a.pdf"},{"id":92256204,"identity":"ea43ff32-a887-44d0-8a27-31d29f8b07f1","added_by":"auto","created_at":"2025-09-26 11:32:18","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":422053,"visible":true,"origin":"","legend":"","description":"","filename":"Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-7607486/v1/8e2571842e5bab7ccbf66d5e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Medical Education Reform in Sub-Saharan Africa: The Case for Rehabilitation Integration in Cameroon","fulltext":[{"header":"Background","content":"\u003cp\u003eThe World Health Organization's \"Rehabilitation 2030: A Call for Action\" initiative established rehabilitation as a fundamental component of universal health coverage rather than an optional service [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This position was reinforced by the WHO Regional Strategy for Africa (2025\u0026ndash;2035), which notes that over 63% of Africans lack access to necessary rehabilitation services [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite this global recognition, medical education in many Sub-Saharan African countries, particularly Cameroon, systematically excludes rehabilitation training from core curricula.\u003c/p\u003e\u003cp\u003eOn a global scale, the World Health Organization estimates that around 2.4\u0026nbsp;billion people currently need rehabilitation, based on Global Burden of Disease 2019 data [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The unmet need is rising fastest in low- and middle-income countries, underscoring the urgency of building capacity through medical education reforms.\u003c/p\u003e\u003cp\u003eCameroon faces a dual epidemiological burden combining persistent communicable diseases with rising non-communicable diseases\u0026mdash;stroke, diabetes, cancer, and road traffic injuries. While the country has achieved significant progress in training physicians in classical disciplines (internal medicine, surgery, pediatrics, obstetrics), rehabilitation remains virtually absent from the national medical curriculum. This educational gap perpetuates profound misunderstanding of rehabilitation roles and translates into delayed prescriptions, fragmented care pathways, and non-clinical referral motivations that weaken the entire health system.\u003c/p\u003e\u003cp\u003eRecent analyses of African rehabilitation challenges emphasize that \"education is a key strategy for advancing rehabilitation service quality globally, but there is a shortage of physical medicine and rehabilitation education programs in the academic environment of most African countries\" [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This educational deficit extends beyond technical competency gaps to fundamental questions of professional legitimacy and healthcare system integration.\u003c/p\u003e\u003cp\u003eThe impact of this deficiency transcends simple educational concerns to become a major public health issue. Cameroonian physicians, trained without significant exposure to physical medicine, physiotherapy, occupational therapy, or comprehensive rehabilitation, develop reductive rehabilitation conceptualizations, perceiving it solely as late-stage intervention for severely disabled patients. This impoverished representation feeds a vicious cycle of under-prescription, professional devaluation, and ethically questionable practices that compromise care quality and paramedical profession dignity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a qualitative descriptive study combining institutional analysis and educational innovation assessment. The study was performed between-2023-2025 across multiple Cameroonian medical education institutions and focused on the University of Dschang\u0026apos;s pioneering rehabilitation integration experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Assessment:\u003c/strong\u003e We conducted informal but systematic discussions with academic leaders from major Cameroonian medical institutions: University of Yaound\u0026eacute; I (former CUSS), University of Douala, University of Garoua, and two accredited private medical institutes. Participants included senior faculty members, department heads, and high-level academic staff (n=12).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducational Innovation Analysis:\u003c/strong\u003e We analyzed the University of Dschang Department of Physiotherapy and Physical Medicine experience, which introduced experimental rehabilitation lectures under the internal medicine module in 2021until now, following an initiative of the Faculty Dean. This analysis included \u003cstrong\u003einformal student feedback gathered during discussions\u003c/strong\u003e, academic performance assessment, and specialization interest trackin\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparative Analysis:\u003c/strong\u003e We conducted systematic literature review and institutional website analysis of rehabilitation integration in African medical schools, focusing on South Africa, Ghana, Rwanda, C\u0026ocirc;te d\u0026apos;Ivoire, Morocco, and Senegal programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis observational educational research study adhered to ethical principles outlined in the World Medical Association Declaration of Helsinki [5], adapted for qualitative social science methodology. The study design incorporated:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eVoluntary participation with complete information disclosure\u003c/li\u003e\n \u003cli\u003eSystematic anonymization of participants\u0026apos; identities and institutional affiliations\u003c/li\u003e\n \u003cli\u003eConfidential data storage with pseudonymization protocols\u003c/li\u003e\n \u003cli\u003eGuaranteed withdrawal rights without requirement for justification\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis educational system analysis focused on institutional policies and academic practices without direct patient involvement, clinical interventions, or collection of personal health data. Following local research ethics guidelines for non-interventional educational studies, formal institutional review board approval was not required. All participants provided informed verbal consent for inclusion of their perspectives in academic analysis, with assurance of complete anonymity in any resulting publications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThematic Analysis Framework:\u003c/strong\u003e Data analysis followed systematic thematic coding of institutional responses around: (1) curriculum adherence patterns, (2) professional recognition attitudes, and (3) resistance justifications. Theme validation was ensured through independent review by senior faculty members not involved in data collection.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCurrent State of Rehabilitation Education\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur assessment revealed systematic exclusion of rehabilitation content from Cameroonian medical curricula. Academic leaders from all contacted institutions unanimously acknowledged rehabilitation as non-priority for medical education. When questioned about this absence, typical responses included: \u0026quot;Doctor Moumeni, it doesn\u0026apos;t exist in our national medical personnel training curriculum\u0026mdash;why should we do what isn\u0026apos;t prescribed in the program?\u0026quot;\u003c/p\u003e\n\u003cp\u003eAdditional institutional perspectives reinforced resistance patterns: \u0026quot;We follow what the Ministry prescribes, nothing more\u0026quot; (Senior Faculty Member, Public University) and \u0026quot;Rehabilitation isn\u0026apos;t part of our accreditation requirements\u0026quot; (Academic Administrator, Private Institution). These responses illustrate systematic adherence to centralized directives rather than educational innovation across institutional types.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 1 provides a comprehensive comparison of rehabilitation training programs across Sub-Saharan Africa, highlighting Cameroon\u0026apos;s critical educational deficit.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe challenge of limited human resources for rehabilitation has been repeatedly highlighted as a major bottleneck in sub-Saharan Africa. Hanrahan et al. [6] documented the severe shortage of trained rehabilitation professionals across the region, showing that most countries have fewer than 10 physiotherapists per million inhabitants. This workforce gap reinforces the urgent need to incorporate rehabilitation principles into undergraduate medical education, ensuring that all physicians are trained to support and coordinate rehabilitation care even when specialists are scarce.\u003c/p\u003e\n\u003cp\u003eThis institutional attitude reflects profound misunderstanding of contemporary medical practice evolution and deliberate ignorance of therapeutic and scientific developments from recent decades, particularly given that nursing care courses are taught in first and second years while rehabilitation remains excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsequences of Educational Deficit\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe curricular gap generates multiple problematic consequences:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDelayed Recognition and Referrals:\u003c/strong\u003e Physicians approach rehabilitation as ancillary care reserved for post-stroke sequelae (often only post-hospitalization) or patent disability situations. This restrictive vision delays care that could prevent functional decline and improve outcomes across orthopedics, oncology, geriatrics, cardiothoracic surgery, respiratory medicine, and chronic pain management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommercial Deviance:\u003c/strong\u003e A concerning social phenomenon emerged: transformation of physiotherapy prescription into commercial transactions. Some prescribing physicians demand 30-50% revenue shares from physiotherapy sessions, creating kickback systems that fundamentally pervert therapeutic relationships. This practice contrasts sharply with other medical specialties where referrals follow established clinical pathways without financial arrangements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Marginalization:\u003c/strong\u003e Unlike dentistry or ophthalmology, which gain legitimacy through medical education integration, physiotherapy and rehabilitation professions remain \u0026quot;orphaned\u0026quot;\u0026mdash;perceived as peripheral activities whose therapeutic value isn\u0026apos;t fully integrated into Cameroonian medical culture. As one physician confided: \u0026quot;physiotherapy isn\u0026apos;t an obligation or emergency\u0026mdash;no real added value.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInternational Comparisons\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral African countries have successfully integrated rehabilitation into medical education, demonstrating reform feasibility and benefits:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAs detailed in Table 1, these successful implementations contrast sharply with Cameroon\u0026apos;s minimal 4-hour exposure.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSouth Africa:\u003c/strong\u003e Medical training includes structured physical medicine and rehabilitation teaching from pre-clinical cycles, complemented by mandatory clinical rotations in specialized units. This approach enables students to discover physiotherapy, occupational therapy, and seven rehabilitation professions\u0026apos; roles in care continuity, subsequently fostering systematic and clinically relevant prescriptions.\u003c/p\u003e\n\u003cp\u003eAt the national policy level, South Africa has embedded structured rehabilitation modules in the undergraduate medical curriculum [7]. Early exposure to physical and rehabilitation medicine improves referral quality and aligns training with functional outcomes, showing feasibility and impact in an African context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGhana:\u003c/strong\u003e The International Rehabilitation Forum developed and implemented physician fellowship programs in rehabilitation medicine successfully since 2018. The Ghana College of Physicians and Surgeons partnered with IRF to approve a two-year \u0026quot;Sports, Exercise and Rehabilitation Medicine\u0026quot; fellowship program training family physicians in PMR and sports medicine [8,9].\u003c/p\u003e\n\u003cp\u003eComplementary evidence from Ghana indicates that structured rehabilitation content in medical training can improve patient access\u0026mdash;particularly in rural districts\u0026mdash;by changing referral behavior and service organization [8,9].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRwanda:\u003c/strong\u003e The Ministry of Health conducted ambitious medical curriculum revision in 2022 to integrate rehabilitation as mandatory transversal competency, aligned with \u0026quot;Rehabilitation 2030\u0026quot; program objectives. This curricular integration accompanies strong physiotherapy and occupational therapy expansion, now recognized as strategic disciplines for national public health needs. Rwanda currently has 360 registered physiotherapists, with 88 employed in public facilities (0.26 physiotherapists per 10,000 inhabitants) [10].\u003c/p\u003e\n\u003cp\u003eThis policy reform is formally anchored at ministerial level and has begun to standardize earlier and more appropriate referrals to rehabilitation across public facilities [11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFrancophone Africa:\u003c/strong\u003e C\u0026ocirc;te d\u0026apos;Ivoire has offered Physical Medicine and Rehabilitation university specialization for decades. Universit\u0026eacute; F\u0026eacute;lix Houphou\u0026euml;t-Boigny provides an eight-semester Specialized Studies Diploma covering comprehensive specialty domains from fundamental disability concepts to specialized rotations and thesis completion [6]. Similarly, Senegal has established physical medicine and functional rehabilitation services in hospitals with locally or internationally trained specialist physicians collaborating closely with multidisciplinary rehabilitation teams [12].\u003c/p\u003e\n\u003cp\u003eMorocco: A dedicated national strategy for Physical and Rehabilitation Medicine emphasizes workforce training, the creation of academic rehabilitation departments, and integration of rehabilitation content into medical curricula\u0026mdash;showing that curriculum change is a policy choice that can be enacted in the region [13,14].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Dschang Pioneer Experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Dschang (ranked first university in Cameroon and CEMAC zone 2023-2024) [15] created Central Africa\u0026apos;s first Physiotherapy and Physical Medicine Department in 2021 under visionary Rector and Medical Faculty Dean leadership. In 2021, this department initiated a limited educational experiment: introducing 4 hours of rehabilitation instruction for 5th-year medical students as an extra-curricular initiative, operating outside the official national medical curriculum framework.\u003c/p\u003e\n\u003cp\u003eThese 4 teaching hours covered rehabilitation foundations, rehabilitation professions overview, and clinical indications for rehabilitation services. While this represents minimal educational exposure compared to established medical subjects, the initiative constituted an unprecedented step in Cameroonian medical education landscape, demonstrating local capacity for educational innovation despite national curriculum constraints.\u003c/p\u003e\n\u003cp\u003eThe pedagogical response exceeded expectations. Students demonstrated remarkable engagement with this limited rehabilitation exposure, with several expressing newfound interest in Physical Medicine and Rehabilitation as a potential specialization pathway. They began perceiving PMR as a legitimate medical specialty positioned at the interface of neurology, orthopedics, pediatrics, geriatrics, traumatology, rheumatology, sports medicine, and pain medicine.\u003c/p\u003e\n\u003cp\u003eStudent feedback from participants proved particularly illuminating. Several contacted instructors seeking additional information about specialization opportunities abroad, including programs in France, Morocco, Tunisia, South Africa, Senegal [16], and C\u0026ocirc;te d\u0026apos;Ivoire. This spontaneous interest, generated by minimal educational exposure, suggests significant unmet demand for rehabilitation education within Cameroonian medical training.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCross-Institutional Validation:\u003c/strong\u003e The enthusiasm observed at Dschang was corroborated by informal feedback from faculty members at other institutions who confirmed similar student interest when rehabilitation topics are briefly mentioned in related courses, suggesting broader potential for systematic curricular integration.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eEducational Reform as Health System Strengthening\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings reveal that rehabilitation exclusion from medical education represents more than pedagogical oversight\u0026mdash;it constitutes a systematic health system weakening that compromises care quality, professional development, and population health outcomes. The explicit acknowledgment by academic leaders that rehabilitation \u0026quot;isn\u0026apos;t interesting\u0026quot; or \u0026quot;doesn\u0026apos;t exist in our curriculum\u0026quot; reflects institutional resistance that perpetuates cycles of professional marginalization and care fragmentation.\u003c/p\u003e\n\u003cp\u003eInstitutional Theory Framework: Our findings align with organizational isomorphism theory (DiMaggio \u0026amp; Powell, 1983) [17], where institutions mimic established patterns rather than innovating. The repeated reference to \u0026quot;national curriculum compliance\u0026quot; demonstrates coercive isomorphism, where regulatory frameworks constrain educational evolution despite changing health needs.\u003c/p\u003e\n\u003cp\u003eConsistent with broader LMIC evidence, strengthening rehabilitation requires addressing structural barriers\u0026mdash;limited funding, low political visibility, and weak academic capacity. Integrating rehabilitation into medical curricula is among the most cost-effective levers to overcome these barriers and normalize timely referrals [18].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeep Analysis of Institutional Resistance: The \u0026quot;National Curriculum\u0026quot; Paradigm\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe recurring institutional response\u0026mdash;\u0026quot;it doesn\u0026apos;t exist in our national curriculum, why should we teach what isn\u0026apos;t prescribed?\u0026quot;\u0026mdash;reveals profound systemic implications that extend beyond simple curricular gaps. This statement illuminates several critical dimensions of medical education governance in Sub-Saharan Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Institutional Autonomy:\u003c/strong\u003e This response demonstrates excessive dependence on centralized directives, contrasting sharply with university autonomy patterns observed in developed medical education systems. While international medical schools routinely adapt curricula to emerging health needs and scientific developments, Cameroonian institutions appear constrained by rigid adherence to national frameworks. This centralized control mechanism may explain why medical education evolution lags behind epidemiological transitions and population health needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInternational Comparisons of Curricular Innovation:\u003c/strong\u003e Medical schools in countries with successful rehabilitation integration\u0026mdash;South Africa, Ghana, Rwanda\u0026mdash;demonstrate greater institutional flexibility in curriculum adaptation. These institutions interpret national guidelines as minimum standards rather than maximum boundaries, enabling responsive educational innovation. The contrast suggests that Cameroonian medical education operates within an institutional culture that prioritizes compliance over innovation, potentially stifling educational evolution and professional development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMechanisms of Institutional Inertia:\u003c/strong\u003e The \u0026quot;prescribed curriculum\u0026quot; response represents what educational theorists term \u0026quot;institutional inertia\u0026quot;\u0026mdash;systematic resistance to change that becomes self-perpetuating. This mechanism operates through several pathways: administrative risk aversion (avoiding initiatives lacking explicit authorization), resource allocation patterns (funding follows established priorities), and professional socialization (faculty trained within existing paradigms reproduce those limitations). Understanding these mechanisms proves crucial for designing effective change strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheoretical Frameworks for Educational Change:\u003c/strong\u003e Literature on medical education transformation identifies several factors essential for successful curricular innovation: leadership vision, faculty development, resource availability, and external pressure for change. The Dschang experience suggests that local leadership vision can overcome institutional inertia, but scaling requires addressing systemic barriers that maintain status quo adherence to centralized directives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Professional Marginalization: The Economics of Clinical Legitimacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe documented practice of physician-therapist commission arrangements (30-50% revenue sharing) provides a window into broader patterns of professional legitimacy construction within health systems. This phenomenon requires analysis through multiple theoretical lenses to understand its persistence and implications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth Economics and Professional Power:\u003c/strong\u003e The commission system reflects asymmetric power relationships where physicians control access to patient populations while rehabilitation professionals provide actual services. This arrangement parallels historical patterns in other health systems where medical dominance shapes interprofessional relationships. However, the explicit financial nature of these arrangements in Cameroon suggests more extreme marginalization than observed in systems with established rehabilitation education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparative Professional Recognition Patterns:\u003c/strong\u003e The absence of similar commission arrangements with dentists, ophthalmologists, and other specialists illuminates the role of educational integration in professional legitimacy construction. These specialties achieved recognition through medical education inclusion, creating understanding of their roles, indications, and value among referring physicians. Rehabilitation professions, excluded from this educational legitimation process, remain vulnerable to exploitative relationship patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCycles of Professional Legitimacy:\u003c/strong\u003e Our analysis reveals self-reinforcing cycles where educational exclusion \u0026rarr; professional marginalization \u0026rarr; economic exploitation \u0026rarr; reduced professional status \u0026rarr; continued educational exclusion. Breaking these cycles requires strategic intervention at multiple points, with educational integration potentially providing the most leverage for sustainable change.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegulatory and Ethical Implications:\u003c/strong\u003e The commission system raises significant questions about healthcare regulation and professional ethics. While informal financial arrangements exist in many health systems, the systematic nature and percentage ranges documented suggest regulatory gaps that compromise both care quality and professional development. Successful rehabilitation education integration might provide natural regulation through improved professional understanding and respect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Student Response: Learning Theory and Professional Identity Formation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe exceptional enthusiasm and studiousness demonstrated by current 6th-year students (who completed the 4-hour program plus clinical immersion at Dschang Regional Hospital during their 5th year) provides crucial insights into medical education effectiveness and professional identity formation mechanisms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExposure-Impact Relationships in Medical Education:\u003c/strong\u003e The disproportionate impact of minimal exposure (4 hours plus clinical immersion) on student career interests challenges conventional assumptions about educational dose-response relationships. Learning theory suggests that meaningful exposure to authentic professional contexts can trigger identity formation processes that influence career trajectories significantly. The clinical immersion component may have provided crucial authenticity that pure didactic teaching cannot achieve.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Discovery Mechanisms:\u003c/strong\u003e The students\u0026apos; sustained interest progression from initial exposure through current 6th-year status illustrates professional discovery mechanisms identified in medical education literature. Exposure to previously unknown specialties can trigger identity resonance\u0026mdash;alignment between personal interests, values, and perceived professional roles. The interdisciplinary nature of rehabilitation, spanning neurology, orthopedics, pediatrics, geriatrics, traumatology, rheumatology, sports medicine, and pain management, may particularly appeal to students seeking broad clinical scope.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictive Factors for Specialty Interest:\u003c/strong\u003e The sustained engagement observed in Dschang students suggests several predictive factors for rehabilitation specialty interest: exposure to diverse clinical applications, understanding of professional scope, recognition of career viability, and alignment with service motivations. These factors align with broader literature on medical specialty choice, suggesting that systematic curricular integration could generate substantial interest in rehabilitation careers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Curriculum Design:\u003c/strong\u003e The Dschang experience demonstrates that effective rehabilitation education requires both conceptual understanding and authentic clinical exposure. The combination of didactic content with hospital-based immersion appears crucial for generating lasting impact. This suggests that successful national integration would require clinical rotation components, not merely classroom-based teaching, with implications for resource requirements and implementation strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegional Context and Implementation Pathways\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe contrast between Dschang\u0026apos;s innovation success and other institutions\u0026apos; resistance reveals critical implementation pathways for broader educational reform. Understanding these patterns proves essential for scaling successful approaches while addressing systematic barriers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInnovation Diffusion in Medical Education:\u003c/strong\u003e The Dschang experience exemplifies what diffusion of innovation theory terms \u0026quot;early adoption\u0026quot;\u0026mdash;implementation by institutions with leadership vision and capacity for change. However, scaling from early adoption to mainstream implementation requires addressing concerns and barriers of \u0026quot;early majority\u0026quot; institutions that require more evidence and support for change adoption.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResource and Capacity Considerations:\u003c/strong\u003e The availability of qualified faculty (PhD-qualified physiotherapy specialists trained in European universities) at Dschang demonstrates that expertise exists within Cameroon but requires strategic mobilization. National scaling would need systematic faculty development, potentially through international partnerships, exchange programs, and targeted scholarship initiatives for rehabilitation education specialization [18,19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy Integration Strategies:\u003c/strong\u003e Successful national implementation likely requires coordinated action across multiple policy levels: national curriculum revision, institutional capacity building, faculty development programs, and clinical training site development. The WHO Regional Strategy 2025-2035 provides policy framework support, but implementation requires domestic policy coordination and resource commitment [1,2].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProposed Integration Model: Evidence-Based Implementation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the Dschang experience analysis and international best practices review, we propose a structured three-year rehabilitation integration model totaling 100 theoretical hours plus clinical rotations, designed to address identified barriers while building on demonstrated success factors [18,19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYear 4 - Foundation Module (25 hours):\u003c/strong\u003e WHO frameworks introduction, biopsychosocial disability approach, physical medicine and physiotherapy scientific foundations, rehabilitation roles in major medical pathologies, and sensitization workshops including rehabilitation service visits. This foundational approach addresses the knowledge gap while building professional understanding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYear 5 - Applied Clinical Module (40 hours + 2 weeks rotation):\u003c/strong\u003e Rehabilitation prescription principles and indications, profession-specific roles, transversal applications across medical specialties, practical workshops developing operational competencies, and mandatory clinical rotation in rehabilitation services. The clinical component addresses the authentic exposure requirement identified as crucial in the Dschang experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYear 6 - Advanced Integration (35 hours + 2 weeks rotation):\u003c/strong\u003e Physical Medicine and Rehabilitation as complete medical specialty, innovative approaches, public health integration, financing mechanisms, and socioeconomic impact analysis plus additional clinical rotation. This progression ensures comprehensive understanding while providing multiple clinical exposure opportunities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplementation Considerations and Change Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSuccessful implementation requires coordinated change management addressing multiple stakeholder groups and systematic barriers identified through our analysis [18,19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Level Strategies:\u003c/strong\u003e Ministry of Higher Education directive requiring rehabilitation modules in accredited medical programs, faculty development programs supporting rehabilitation education capacity, and partnership agreements facilitating clinical training access. These strategies address the centralized directive dependence while building necessary capacity [18,19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Development Requirements:\u003c/strong\u003e Integration of rehabilitation competencies in medical licensing examinations would create accountability for learning, continuing medical education requirements would address existing practitioners, and health insurance coverage expansion would support service sustainability. These mechanisms address the professional recognition cycle identified as crucial for sustainable change.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSystem-Level Alignment:\u003c/strong\u003e Coordination with WHO Regional Strategy 2025-2035 objectives, collaboration with successful African programs for knowledge transfer, research partnerships for implementation evaluation, and stakeholder engagement across government, professional, and civil society actors. This comprehensive approach addresses the systemic nature of required changes while building sustainable support for implementation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study presents several methodological limitations. The restricted sample size and Cameroonian cultural specificity limit generalization to other African contexts. The principal investigator\u0026apos;s cultural affiliation, while facilitating terrain access, may have influenced data interpretation. Additionally, the absence of longitudinal follow-up prevents assessment of observed therapeutic choice sustainability.\u003c/p\u003e\n\u003cp\u003eThe informal nature of institutional discussions, while providing authentic perspectives, limits systematic comparison across institutions. Furthermore, the Dschang experience analysis, though promising, represents early-stage implementation requiring longer-term evaluation for definitive conclusions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis analysis demonstrates that rehabilitation integration into Cameroonian medical education represents a critical opportunity for health system strengthening and professional development. The systematic exclusion of rehabilitation content from medical curricula perpetuates cycles of professional marginalization, care fragmentation, and suboptimal health outcomes that compromise national health system effectiveness.\u003c/p\u003e\u003cp\u003eThe University of Dschang's pioneering experience provides compelling evidence that educational reform is both feasible and welcomed by students when properly implemented. The enthusiasm generated by minimal exposure (4 hours) suggests that comprehensive integration could transform professional attitudes and practice patterns significantly.\u003c/p\u003e\u003cp\u003eOur proposed 100-hour integration model, aligned with WHO recommendations and regional best practices, offers a structured pathway for addressing current deficits while positioning Cameroon as a leader in African medical education innovation. The success of similar initiatives across Sub-Saharan Africa demonstrates that educational reform can catalyze broader health system improvements and professional recognition.\u003c/p\u003e\u003cp\u003eMoving forward, successful implementation requires coordinated political will, institutional commitment, and professional leadership to overcome resistance and realize rehabilitation education's transformative potential. The cost of maintaining current exclusion\u0026mdash;continued professional marginalization, suboptimal care, and health system inefficiencies\u0026mdash;far exceeds implementation challenges.\u003c/p\u003e\u003cp\u003eCameroon has the opportunity to demonstrate African leadership in medical education reform while addressing critical workforce development needs. The evidence supports action; the question is whether institutions will demonstrate the vision and commitment necessary to realize this transformative opportunity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eINM\u003c/strong\u003e: Study conceptualization, theoretical framework development, complete manuscript drafting, curricular proposal development, figure and table creation, critical literature analysis, intellectual content revision, and final version approval for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe eAuthor Contributions\nINM: Study conceptualization, theoretical framework development, complete manuscript drafting, curricular proposal development, figure and table creation, critical literature analysis, intellectual content revision, and final version approval for submission.\nAcknowledgments\nWe express profound gratitude to Rector Roger Tsafack Nanfosso, University of Dschang Rector, President of the Conference of Francophone African and Middle Eastern University Rectors, and President of the Conference of Cameroonian University Institution Heads, for visionary leadership enabling Central Africa's first Physiotherapy and Physical Medicine Department creation. His strategic vision and institutional support opened pathways for this historic academic innovation.\nOur thanks extend to Professor Siméon Pierre Choukem, Dean of the Faculty of Medicine and Pharmaceutical Sciences at the University of Dschang, for his accompaniment in introducing the first rehabilitation modules in Cameroonian medical curricula. His commitment to pedagogical excellence and confidence in this pioneering initiative proved instrumental in achieving this first step toward integrated medical training.\nWe thank all study participants for their confidence and contribution to advancing knowledge in African medical education.\nClinical trial number: not applicable.\nEthical Approval\nThis observational non-interventional study respects ethical principles of qualitative social science research and does not require institutional review board approval. All participants provided informed consent after complete information about study objectives and methods.\nFunding\nThis study received no external funding.\nCompeting Interests\nThe author declares no competing interests related to this study.\nData Availability\nAnonymized data are available upon reasonable request to the corresponding author.\nxpress profound gratitude to \u003cstrong\u003eRector Roger Tsafack Nanfosso\u003c/strong\u003e, University of Dschang Rector, President of the Conference of Francophone African and Middle Eastern University Rectors, and President of the Conference of Cameroonian University Institution Heads, for visionary leadership enabling Central Africa\u0026apos;s first Physiotherapy and Physical Medicine Department creation. His strategic vision and institutional support opened pathways for this historic academic innovation.\u003c/p\u003e\n\u003cp\u003eOur thanks extend to \u003cstrong\u003eProfessor Sim\u0026eacute;on Pierre Choukem\u003c/strong\u003e, Dean of the Faculty of Medicine and Pharmaceutical Sciences at the University of Dschang, for his accompaniment in introducing the first rehabilitation modules in Cameroonian medical curricula. His commitment to pedagogical excellence and confidence in this pioneering initiative proved instrumental in achieving this first step toward integrated medical training.\u003c/p\u003e\n\u003cp\u003eWe thank all study participants for their confidence and contribution to advancing knowledge in African medical education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis observational non-interventional study respects ethical principles of qualitative social science research and does not require institutional review board approval. All participants provided informed consent after complete information about study objectives and methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no competing interests related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnonymized data are available upon reasonable request to the corresponding author.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCorresponding Author:\u003c/strong\u003e Dr. Ibrahim NPOCHINTO MOUMENI\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Department of Physiotherapy and Physical Medicine\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Faculty of Medicine and Pharmaceutical Sciences\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;University of Dschang, West Region, Cameroon\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Email: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eWorld Health Organization. Rehabilitation 2030: a call for action. Geneva: World Health Organization; 2017.\u003c/li\u003e\n\u003cli\u003eWHO Regional Committee for Africa. Regional strategy to strengthen rehabilitation in health systems 2025\u0026ndash;2035. Lusaka: WHO AFRO; 2025.\u003c/li\u003e\n\u003cli\u003eCieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019. \u003cem\u003eLancet\u003c/em\u003e. 2021;396(10267):2006\u0026ndash;2017. doi:10.1016/S0140-6736(20)32340-0.\u003c/li\u003e\n\u003cli\u003eDouryang M, Pillay L, Mkumbuzi NS, Foti C. The World Health Organization\u0026apos;s Rehabilitation 2030 vision: an African perspective. Front Rehabil Sci. 2024;5:1442626. doi: 10.3389/fresc.2024.1442626. \u003c/li\u003e\n\u003cli\u003eAmerican Anthropological Association. \u003cem\u003ePrinciples of Professional Responsibility\u003c/em\u003e [Internet]. 2012 [cited 2025 Sep 15]. Available from: https://www.americananthro.org/ethics\u003c/li\u003e\n\u003cli\u003eHanrahan CF, Naidoo P, Akinola O, Munthali RJ, Loveday M. Building workforce capacity for rehabilitation in sub-Saharan Africa. \u003cem\u003eAfr J Disabil\u003c/em\u003e. 2022;11:1073. doi:10.4102/ajod.v11i0.1073.\u003c/li\u003e\n\u003cli\u003eSouth African Department of Health. \u003cem\u003eUndergraduate medical curriculum: integration of rehabilitation modules\u003c/em\u003e[Internet]. Pretoria: Department of Health; 2020 [cit\u0026eacute; 2025 sept 15]. Disponible sur: https://www.health.gov.za/\u003c/li\u003e\n\u003cli\u003eTannor AY, Nelson MES, Steere H, Quao BO, Haig AJ. Building PRM in sub-Saharan Africa. Front Rehabilit Sci. 2022;3:910841. doi: 10.3389/fresc.2022.910841.\u003c/li\u003e\n\u003cli\u003eInternational Rehabilitation Forum (IRF). Fellowship programs in Rehabilitation Medicine: Ghana project report. Accra: IRF \u0026amp; Ghana College of Physicians and Surgeons; 2018.\u003c/li\u003e\n\u003cli\u003eCakumba M, Donohue M, Nhunzvi C, Mutambudzi M. Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study. Afr J Disabil. 2022;11:a918. doi: 10.4102/ajod.v11i0.918.\u003c/li\u003e\n\u003cli\u003eRwanda Ministry of Health. \u003cem\u003eRevised medical education curriculum including rehabilitation sciences\u003c/em\u003e [Internet]. Kigali: Ministry of Health; 2022 [cit\u0026eacute; 2025 sept 15]. Disponible sur: https://www.moh.gov.rw/\u003c/li\u003e\n\u003cli\u003eUniversit\u0026eacute; F\u0026eacute;lix Houphou\u0026euml;t-Boigny. Specialized Studies Diploma-Physical Medicine. Abidjan: UFHB; 2024. Available from: https://w.univ-fhb.edu.ci/parcours-formation/diplome-detude-specialisee-medecine-physique-medecine-et-specialite/\u003c/li\u003e\n\u003cli\u003eHajjioui A. Abderrazak Hajjioui: shining a light on rehabilitation. \u003cem\u003eGlobal Health Journal (PMC interview)\u003c/em\u003e. 2022 Nov 1. PMCID: PMC9589386.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eEl Hassani A, Tahiri M, Ouanas A, Bahouh M, Ouhabi H, et al.\u003c/strong\u003e\u003cbr\u003e \u003cem\u003eKnowledge towards Physical Medicine and Rehabilitation among Training Doctors and Medical Students at the Mohammed VI University Hospital of Marrakech.\u003c/em\u003e\u003cbr\u003e \u003cstrong\u003eOpen Journal of Therapy and Rehabilitation. 2024;12(2):143\u0026ndash;156.\u003c/strong\u003e\u003cbr\u003edoi : 10.4236/ojtr.2024.122010\u003c/li\u003e\n\u003cli\u003eActu Cameroun. University of Dschang ranked first in CEMAC zone and second in CEEAC zone. August 6, 2024. Available from: https://actucameroun.com/2024/08/06/luniversite-de-dschang-classee-premiere-en-zone-cemac-et-deuxieme-en-zone-ceeac\u003c/li\u003e\n\u003cli\u003eHOGIP Medical Center. Physical medicine and functional rehabilitation. Dakar: HOGIP; 2024. Available from: https://www.hogip.sn/index.php/specialites/autres-specialites-hogip/medecine-physique-et-readaptation-fonctionnelle\u003c/li\u003e\n\u003cli\u003eDiMaggio PJ, Powell WW. The iron cage revisited: institutional isomorphism and collective rationality in organizational fields. Am Sociol Rev. 1983;48(2):147-160. doi:10.2307/2095101.\u003c/li\u003e\n\u003cli\u003eDambi JM, Jelsma J, Mlambo T. Strengthening rehabilitation in health systems of low- and middle-income countries: challenges and opportunities. \u003cem\u003eDisabil Rehabil\u003c/em\u003e. 2020;42(3):311\u0026ndash;321. doi:10.1080/09638288.2018.1498543\u003c/li\u003e\n\u003cli\u003eGutenbrunner C, Nugraha B. Strengthening health-related rehabilitation services at national levels. J Rehabil Med. 2021;53(4):jrm00159. doi:10.2340/16501977-2825.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medical education reform, rehabilitation medicine, physical therapy education, curriculum development, Sub-Saharan Africa, health workforce training, universal health coverage","lastPublishedDoi":"10.21203/rs.3.rs-7607486/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7607486/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe World Health Organization's Rehabilitation 2030 initiative recognizes rehabilitation as an essential component of universal health coverage. However, medical education in Cameroon systematically excludes physical medicine and rehabilitation training, creating significant gaps in professional competency and healthcare delivery.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis study examines the consequences of rehabilitation education absence in Cameroonian medical curricula and proposes an evidence-based integration model aligned with international standards and regional best practices.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a qualitative study (2023\u0026ndash;2025) involving systematic discussions with academic leaders (n\u0026thinsp;=\u0026thinsp;12) from major Cameroonian medical institutions including Universities of Yaound\u0026eacute; I, Douala, and Garoua. We analyzed the pioneering rehabilitation education experience at University of Dschang, which introduced experimental rehabilitation teaching in 2021\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAcademic leaders explicitly acknowledged rehabilitation as non-priority, stating \"it doesn't exist in our national curriculum, why should we teach what isn't prescribed?\" This educational deficit generates delayed rehabilitation referrals, inappropriate physician-therapist financial arrangements involving 30\u0026ndash;50% revenue sharing, and over-reliance on diagnostic imaging rather than functional assessment. Conversely, Dschang's minimal 4-hour rehabilitation exposure generated unexpected student enthusiasm for Physical Medicine and Rehabilitation specialization, demonstrating integration feasibility and unmet educational demand.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eRehabilitation integration into medical education represents a critical health system strengthening opportunity for Cameroon. We propose a structured 100-hour curriculum distributed over three academic years with mandatory clinical rotations. This model addresses current professional marginalization while aligning with WHO recommendations and could serve as a template for other Sub-Saharan African countries facing similar educational gaps and professional recognition challenges.\u003c/p\u003e\u003ch2\u003eWhat was already known on this topic:\u003c/h2\u003e\u003cp\u003ePrior research has documented severe shortages of rehabilitation professionals across Sub-Saharan Africa and identified educational gaps as key barriers to workforce development. Several African countries, including South Africa, Ghana, Rwanda, and francophone nations like C\u0026ocirc;te d'Ivoire and Senegal, have successfully integrated rehabilitation training into medical curricula with measurable improvements in referral patterns and professional recognition. However, systematic analysis of the institutional mechanisms that perpetuate educational exclusion and their downstream effects on clinical practice patterns, particularly the documentation of commercial arrangements between physicians and rehabilitation professionals, remained limited in the literature.\u003c/p\u003e\u003ch2\u003eWhat this study adds:\u003c/h2\u003e\u003cp\u003eThis study provides the first comprehensive analysis of rehabilitation education exclusion in Cameroon, documenting specific institutional resistance patterns and their consequences including quantified physician-therapist commission arrangements (30\u0026ndash;50% revenue sharing) that compromise care quality. It presents novel evidence from the University of Dschang's pioneering experience, demonstrating that minimal educational exposure (4 hours) generates substantial student interest in rehabilitation specialization, contradicting assumptions about low demand. The study contributes a detailed, evidence-based 100-hour integration model aligned with WHO recommendations and regional best practices, offering a practical template for other African countries facing similar educational gaps and professional marginalization challenges.\u003c/p\u003e","manuscriptTitle":"Medical Education Reform in Sub-Saharan Africa: The Case for Rehabilitation Integration in Cameroon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-26 11:32:11","doi":"10.21203/rs.3.rs-7607486/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"30e9d26e-39fe-458d-9e38-7b62652d6bff","owner":[],"postedDate":"September 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T06:39:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-26 11:32:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7607486","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7607486","identity":"rs-7607486","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}