The main difficulty of our study was the fact that just 67.2% of the teachers filled out the questionnaire. This rate is lower than that found an Algerian, where the response rate was 100% [5]. This difference could be explained by the fact that most of the questionnaires were sent to the teachers by email. It is well known that the response rate of online surveys without financial motivations is generally between 6% and 15% lower than traditional methods (face-to-face interview) [6,7]. In addition, it is not excluded that teachers had being reserved to judge this new LMD. The majority (64.5%) of medical school’s teachers had not received training on LMD reform since its introduction. This could limit its understanding in implementation process. The absence of training before the introduction of the LMD reform in African universities was pointed out by HUGON [8]. In Algeria [5] several university partners (teachers, students, and administrative staff) complained that the LMD reform was hasty, specifically the problem of teacher’s training. However, 56.6% of Lomé’s teachers had being trained in new ICTs. In Mali, Fomba et al. in 2011 found that only 22% of teachers had sufficient skills in computer use [9]. Methods used for teaching were handout (89.5%) and power-points (82.9%). Only 60.5% of teachers gave printed version of their courses to students. In a previous study including all the faculties of University of Lomé, the medical school was the rare faculty where new technologies were most used for teaching [4]. Our results are similar to that found by Bachir in university of Maroua [10]. To adapt, the LMD reform must use new technology. In medical school as in other faculties of University Lomé, the courses are not online [4].
According to the teachers, one of the strong points of the LMD reform in medical school was the better evaluation’s system. The evaluation in the LMD reform requires three examinations: one test in the middle of the semester, one in the end of the semester and one for the resit (the one who failed the previous evaluations). The fact that all students of the university are putting together during the evaluation can limit cheating. Most of teachers (28.6%) recognized also that the LMD reform upgrade the university of Lomé to be on international standards. This can facilitate the recognition of diplomas from University of Lomé in foreign universities [11-13]. The organization of education in the teaching units has been the core of the LMD reform in several African universities [9, 10, 14, 15]. The ICTs have revolutionized many aspects of educational system, including teaching and learning and become essential in higher education [16-18]. But they are a big challenge for most developing countries due to socio-economic and technological conditions [19].
The absence of intermediate diplomas (29.3%) and pathways between different courses of medical and paramedical training was the main weakness of LMD reform since its introduction. Indeed, in accordance with the principles of the LMD system, the first purpose of the introduction of this reform in the medical schools in Togo was to combine the bachelor’s degree of all courses of health studies. The decision of admission in Master degree of any course should be made according to the average marks or scholarly achievements: the best students in research master for medical school and others in professional master for paramedical training according to merit. When this principle was first applied, all the students who validated the bachelor’s degree had refused to continue their studies in paramedical schools. This forced to reintroduce the numerus clausus in the first year to avoid the high number of medical students.
Finally, there is no intermediate diploma and pathways of students up to today as hoped. LMD reform has been successful in France with more than 6 common studies in bachelor's degree and orientation according to the level of students [20].
The other aspects for improving LMD reform were: increase human and material resources, the availability of online courses, organization of more practical lessons and workshops, mentoring student’s presentation and homework. This situation is similar to those found in other African universities [9, 14] .
Despite these difficulties, the LMD system is not a choice for our universities, but a necessity to upgrade the training [21].
Limitation
The main limitation of our study is related to the unwillingness of some teachers to give their opinion on the LMD reform.