The main difficulty of our study was related to the filling of the questionnaires by the teachers. Indeed, the response rate was 67.2%. This rate is low compared to a similar Algerian study in the French department with 100% return [5]. This low response rate may be due to the data collection method used for our questionnaire (mail); knowing that the response rate of online surveys without financial incentives is generally between 6% and 15% lower than those of other so-called traditional methods [6,7]. In addition, it is not excluded a distrust on the part of teachers to decide on the reform LMD.
The majority (64.5%) of the health science faculty’s teachers had received no training on LMD reform. This could limit the understanding of the LMD by the teachers responsible for applying it. The lack of teacher training prior to the introduction of the LMD reform in African universities was raised by HUGON and collaborators [8]. In Algeria [5] several university partners (teachers, students, and administrative staff) claimed that the LMD reform was hasty and specifically raised the problem of lack of training.
In our study 56.6% of teachers had received computer and communication technology (CCT) training. Our results are higher than those of Fomba and collaborators in 2011 in Mali, who found that 22% of teachers had sufficient mastery of computer tools for dispensing the course [9]. Regarding the method of delivery of courses, the observation of our results shows that the explanation of the mimeographs (89.5%) or power-points (82.9%) were the methods most used by teachers of the faculty. Only 60.5% of teachers provided students with a digital version of their courses. In a previous study of several faculties at the University of Lomé, the health science faculty’s teachers sent out the few teachers who used digital media to run classes [4]. Our results are also close to those of Bachir and collaborators in Algeria [10] or the course using a digital medium, the reading and the commentary of the texts or the mimeographs emerged as teaching methods. Because CCT education is one of the objectives of the LMD reform, although nearly half of the FSS teachers have not received CCT training, we have seen commendable efforts by their teachers to adapt to the requirements of the LMD.
No courses provided at the health science faculty of Lomé were put online, tutorials and practical works were organized in respectively 59.2% and 38.2% of cases. In a previous study in Lomé, no teacher from the different faculties of the University of Lomé put the courses online [4]. Although we did not interview teachers about the reasons for not organizing their tutorials and practical works, the lack of material resources (labs) and / or human resources (teachers) can explain this. The weakness of material resources in the implementation of the LMD was also reported in Algeria [5].
One of the strong points of the LMD reform at the Health Science Faculty was, according to the teachers, the best system of evaluation with limitation of fraud (27, 6%). The evaluation in the LMD reform requires two examinations organized by the institution at the end of each semester. This same type of evaluation was found by Bachir in Algeria [10]. The organization of education by teaching units and capitalization would also be a strong point of the LMD according to 26.3% of teachers. The organization of education in the teaching units has been the basis of the LMD reform in several African universities [9–11].
The lack of both human and material resources was the first weak point raised by teachers (27.6%) in the LMD reform. This is a general finding in several African universities [4, 9, 12].
The lack of an intermediate diploma and orientation was mentioned by 34.2% of teachers as an unresolved problem by the LMD reform. Indeed, in accordance with the principles of the LMD system, the idea of introducing this reform in the universities of Togo in general and the medical school in particular was among other things to combine the license of all branches of health sciences. The different streams were to be individualized only from the Master: research master for medical students and professional for students of paramedical schools according to a numerus clausus. Its attempt to apply met with the ambition of all the students having validated the license of continued in the medical sector whereas in principle some had to be oriented in the paramedical schools. This situation is responsible for the plethoric number of students and has forced to reintroduce the numerus clausus in first year. Finally, there is still no intermediate diploma and transhumance students as desired by the LMD system. This shows the lack of preparation of African universities for this reform; leading 22.4% of teachers to say that the LMD would not be suitable for the Heath Science Faculty.
The LMD reform would also be responsible for the absenteeism of students in the course (according to 17.1% of teachers) and internships (14.5% of teachers). The hospital internship is an integral part of medical training, a large number of students could be responsible for a drop in the quality of student training mentioned by 5.3% of teachers. Despite these difficulties, the integration of the LMD system no longer becomes a choice, but a necessity [13].
Limitation
the main limitation of our study is related to the reluctance of some teachers to give their opinion on the LMD reform to the FSS of Lomé.