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Zhao Y, Osano B, Were F, Kiarie H, Nicodemo C, Gathara D, English M. Characterising Kenyan hospitals' suitability for medical officer internship training: a secondary data analysis of a cross-sectional study. BMJ Open 2022; 12:e056426. [PMID: 35523483 PMCID: PMC9083393 DOI: 10.1136/bmjopen-2021-056426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/08/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To characterise the capacity of Kenya internship hospitals to understand whether they are suitable to provide internship training for medical doctors. DESIGN A secondary data analysis of a cross-sectional health facility assessment (Kenya Harmonized Health Facility Assessment (KHFA) 2018). SETTING AND POPULATION We analysed 61 out of all 74 Kenyan hospitals that provide internship training for medical doctors. OUTCOME MEASURES Comparing against the minimum requirement outlined in the national guidelines for medical officer interns, we filtered and identified 166 indicators from the KHFA survey questionnaire and grouped them into 12 domains. An overall capacity index was calculated as the mean of 12 domain-specific scores for each facility. RESULTS The average overall capacity index is 69% (95% CI 66% to 72%) for all internship training centres. Hospitals have moderate capacity (over 60%) for most of the general domains, although there is huge variation between hospitals and only 29 out of 61 hospitals have five or more specialists assigned, employed, seconded or part-time-as required by the national guideline. Quality and safety score was low across all hospitals with an average score of 40%. As for major specialties, all hospitals have good capacity for surgery and obstetrics-gynaecology, while mental health was poorest in comparison. Level 5 and 6 facilities (provincial and national hospitals) have higher capacity scores in all domains when compared with level 4 hospitals (equivalent to district hospitals). CONCLUSION Major gaps exist in staffing, equipment and service availability of Kenya internship hospitals. Level 4 hospitals (equivalent to district hospitals) are more likely to have a lower capacity index, leading to low quality of care, and should be reviewed and improved to provide appropriate and well-resourced training for interns and to use appropriate resources to avoid improvising.
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Affiliation(s)
- Yingxi Zhao
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Boniface Osano
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Kenya Paediatric Research Consortium (KEPRECON), Nairob, Kenya
| | - Fred Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Helen Kiarie
- Division of Monitoring & Evaluation, Ministry of Health, Nairobi, Kenya
| | - Catia Nicodemo
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Gathara
- Wellcome Trust Research Program, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
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Undergraduate Surgical Education: a Global Perspective. Indian J Surg 2021; 84:153-161. [PMID: 34177158 PMCID: PMC8219345 DOI: 10.1007/s12262-021-02975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Undergraduate surgical education is failing to prepare medical students to care for patients with surgical conditions, and has been significantly compromised by the COVID-19 pandemic. We performed a literature review and undertook semi-structured reflections on the current state of undergraduate surgical education across five countries: Egypt, Morocco, Somaliland, Kenya, and the UK. The main barriers to surgical education at medical school identified were (1) the lack of standardised surgical curricula with mandatory learning objectives and (2) the inadequacy of human resources for surgical education. COVID-19 has exacerbated these challenges by depleting the pool of surgical educators and reducing access to learning opportunities in clinical environments. To address the global need for a larger surgical workforce, specific attention must be paid to improving undergraduate surgical education. Solutions proposed include the development of a standard surgical curriculum with learning outcomes appropriate for local needs, the incentivisation of surgical educators, the incorporation of targeted online and simulation teaching, and the use of technology.
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O'Sullivan B, Chater B, Bingham A, Wynn-Jones J, Couper I, Hegazy NN, Kumar R, Lawson H, Martinez-Bianchi V, Randenikumara S, Rourke J, Strasser S, Worley P. A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries. Front Med (Lausanne) 2020; 7:594728. [PMID: 33330559 PMCID: PMC7729061 DOI: 10.3389/fmed.2020.594728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem. Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period. Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type. Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of "grow your own" strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.
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Affiliation(s)
- Belinda O'Sullivan
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Bruce Chater
- Faculty of Medicine, Rural Clinical School, University of Queensland, Theodore, QLD, Australia
| | - Amie Bingham
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - John Wynn-Jones
- Keele Medical School, Keele University, Keele, United Kingdom
| | - Ian Couper
- Ukwanda Center for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Nagwa Nashat Hegazy
- Medical Education and Human Resources Center, Faculty of Medicine, Menoufia University, Shibin el Kom, Egypt
| | - Raman Kumar
- Family Medicine Practitioner, DOC24 Family Practice Clinic, Ghaziabad, India
| | - Henry Lawson
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | | | - James Rourke
- Center for Rural Health Studies, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sarah Strasser
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Banke-Thomas A, Maua J, Madaj B, Ameh C, van den Broek N. Perspectives of stakeholders on emergency obstetric care training in Kenya: a qualitative study. Int Health 2020; 12:11-18. [PMID: 30806665 PMCID: PMC6964219 DOI: 10.1093/inthealth/ihz007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
Background This study explores stakeholders’ perceptions of emergency obstetric care (EmOC) ‘skills-and-drills’-type training including the outcomes, strengths, weaknesses, opportunities and threats of the intervention in Kenya. Methods Stakeholders who either benefited from or contributed to EmOC training were purposively sampled. Semi-structured topic guides were used for key informant interviews and focus group discussions. Following verbatim transcriptions of recordings, the thematic approach was used for data analysis. Results Sixty-nine trained healthcare providers (HCPs), 114 women who received EmOC and their relatives, 30 master trainers and training organizers, and six EmOC facility/Ministry of Health staff were recruited. Following training, deemed valuable for its ‘hands-on’ approach and content by HCPs, women reported that they experienced improvements in the quality of care provided. HCPs reported that training led to improved knowledge, skills and attitudes, with improved care outcomes. However, they also reported an increased workload. Implementing stakeholders stressed the need to explore strategies that help to maximize and sustain training outcomes. Conclusions The value of EmOC training in improving the capacity of HCPs and outcomes for mothers and newborns is not just ascribed but felt by beneficiaries. However, unintended outcomes such as increased workload may occur and need to be systematically addressed to maximize training gains.
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Affiliation(s)
- Aduragbemi Banke-Thomas
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.,Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Judith Maua
- Liverpool School of Tropical Medicine, Nairobi, Kenya
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Charles Ameh
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Sidibé CS, Touré O, Broerse JEW, Dieleman M. Rural pipeline and willingness to work in rural areas: Mixed method study on students in midwifery and obstetric nursing in Mali. PLoS One 2019; 14:e0222266. [PMID: 31498819 PMCID: PMC6733462 DOI: 10.1371/journal.pone.0222266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/25/2019] [Indexed: 11/18/2022] Open
Abstract
The availability and retention of healthcare professionals in rural areas and remote areas is a challenge to the health sector worldwide. Attracting people who are most likely to be interested in rural practice can be conducive to the sustainable availability of health services in rural areas where health facilities are typically understaffed and existing professionals often underqualified. This article aims to contribute to the rural pipeline evidence, and reports on the findings of a study that investigated the career choices of midwifery and obstetric nurse students in Mali. The article enquires into the relationship between their intention to practice in rural areas and the different components of the rural pipeline. A mixed method study using a survey, semi-structured interviews, and document analysis was conducted from October to December 2017 on third-year midwifery and obstetric nurse students and school-managers. Descriptive statistics and bivariate analysis were performed for quantitative data, and content analysis was carried out for the qualitative data. Key findings suggest that students prefer urban locations for living and for work. The intention to work in rural areas seems to be influenced by the current living situation (currently living in a rural area) or having attended secondary school or professional training in rural areas.
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Affiliation(s)
- Cheick Sidya Sidibé
- Institut National de Formation en Sciences de la Santé, Bamako, Mali
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
- * E-mail:
| | - Ousmane Touré
- Institut National de Formation en Sciences de la Santé, Bamako, Mali
| | - Jacqueline E. W. Broerse
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Marjolein Dieleman
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
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Talib Z. Postgraduate Medical Education in Sub-Saharan Africa: A Scoping Review Spanning 26 Years and Lessons Learned. J Grad Med Educ 2019; 11:34-46. [PMID: 31428258 PMCID: PMC6697307 DOI: 10.4300/jgme-d-19-00170] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Investments in training physician specialists through postgraduate medical education (PGME) are critical for Sub-Saharan Africa, given the increasing burden of non-communicable diseases. OBJECTIVES The objectives of this scoping review were to (1) understand the breadth of publications on PGME from Sub-Saharan Africa, and (2) conduct a thematic analysis of lessons learned by specific training programs. METHODS We conducted a literature search of 7 databases for PGME literature published between January 1991 and December 2016. Two reviewers independently reviewed titles and abstracts for inclusion. Full-text articles were then reviewed, and bibliometric data were extracted to create a profile of PGME-related publications. Two authors coded the manuscripts to identify articles written about specific PGME programs. These were analyzed for lessons learned. RESULTS We identified 813 publications that reported on postgraduate medical education in Sub-Saharan Africa. Most articles were published between 2005 and 2016. Nations leading in publication were South Africa and Nigeria, followed by Ethiopia, Uganda, Kenya, Ghana, and Malawi. The largest number of articles related to general surgery training, followed by family medicine, emergency medicine, and anesthesiology. Thematic analysis revealed advantages of training programs for health facilities, challenges related to teaching, resourcing, and standardizing of training, and lessons learned related to international partnerships, faculty engagement, and research support for trainees. CONCLUSIONS PGME in Sub-Saharan Africa has evolved over the past 26 years. Future growth will require strategic support to scale programs, support new specialties, trainees, and teachers, and leverage best practice models to sustain PGME programs.
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Amalba A, Abantanga FA, Scherpbier AJJA, van Mook WNKA. Working among the rural communities in Ghana - why doctors choose to engage in rural practice. BMC MEDICAL EDUCATION 2018; 18:133. [PMID: 29884172 PMCID: PMC5994092 DOI: 10.1186/s12909-018-1234-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND An unequal distribution of health personnel, leading to unfavourable differences in health status between urban and rural populations, is a serious cause for concern globally. Part of the solution to this problem lies in attracting medical doctors to rural, remote communities, which presents a real challenge. The present study therefore explored the factors that influence medical doctors' decision to practise in rural Ghana. METHODS We conducted a cross-sectional descriptive study based on questionnaires. Participants were doctors working in health facilities in the districts and rural areas of the Northern Region, Ghana. The qualitative data analysis consisted of an iterative process of open, axial and selective coding. RESULTS We administered the questionnaires to 40 doctors, 27 of whom completed and returned the form, signalling a response rate of 67.5%. The majority of the doctors were male (88.9%) and had been trained at the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS) (63%). Although they had chosen to work in the remote areas, they identified a number of factors that could prevent future doctors from accepting rural postings, such as: a lack of social amenities, financial and material resources; limited career progression opportunities; and too little emphasis on rural practice in medical school curricula. Moreover, respondents flagged specific stakeholders who, in their opinion, had a major role to play in the attraction of doctors and in convincing them to work in remote areas. CONCLUSIONS The medical doctors we surveyed had gravitated to the rural areas themselves for the opportunity to acquire clinical skills and gain experience and professional independence. Nevertheless, they felt that in order to attract such cadre of health professionals to rural areas and retain them there, specific challenges needed addressing. For instance, they called for an enforceable, national policy on rural postings, demanding strong political commitment and leadership. Another recommendation flowing from the study findings is to extend the introduction of Community-Based Education and Service (COBES) or similar curriculum components to other medical schools in order to prepare students for rural practice, increasing the likelihood of them accepting rural postings.
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Affiliation(s)
- Anthony Amalba
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences (SMHS), University for Development Studies (UDS), P. O. Box, 1883 Tamale, Ghana
| | - Francis A. Abantanga
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences (SMHS), University for Development Studies (UDS), P. O. Box, 1883 Tamale, Ghana
| | - Albert J. J. A. Scherpbier
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - W. N. K. A. van Mook
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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8
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De Villiers M, Conradie H, Van Schalkwyk S. Teaching Medical Students in a New Rural Longitudinal Clerkship: Opportunities and Constraints. Ann Glob Health 2018; 84:58-65. [PMID: 30873776 PMCID: PMC6748171 DOI: 10.29024/aogh.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Medical schools in Africa are responding to the call to increase numbers of medical graduates by up-scaling decentralized clinical training. One approach to decentralized clinical training is the longitudinal integrated clerkship (LIC), where students benefit from continuity of setting and supervision. The ability of family physician supervisors to take responsibility for the clinical training of medical students over a longer period than the usual, in addition to managing their extensive role on the district health platform, is central to the success of such training. Objective: This study investigated the teaching experiences of family physicians as clinical supervisors in a newly introduced LIC model in a rural sub-district in the Western Cape, South Africa. Method: Nine semi-structured interviews were conducted with six family physicians as part of the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) five-year longitudinal study. Code lists were developed inductively using Atlas.ti v7, they were compared, integrated, and categories were identified. Emerging common themes were developed. Findings: Three overarching themes emerged from the data, each containing subthemes. The rural platform was seen to be an enabling learning space for the LIC students. The family physicians’ experienced their new teaching role in the LIC as empowering, but also challenging. Lack of time for teaching and the unstructured nature of the work emerged as constraints. Despite being uncertain about the new LIC model, the family physicians felt that it was easier to manage than anticipated. Conclusion: The centrality of the rural context framed the teaching experiences of the family physicians in the new LIC, forming the pivot around which constraints and opportunities for teaching arose. The African family physician is well positioned to make an important contribution to the upscaling of decentralized medical training, but would need to be supported by academic institutions and health service managers in their teaching role.
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Affiliation(s)
| | - Hoffie Conradie
- Faculty of Medicine and Health Sciences, Stellenbosch University, ZA
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Tarimo CN, Kapanda GE, Muiruri C, Kulanga AT, Lisasi E, Mteta KA, Kessi E, Mogella D, Venance M, Rogers T, Mimano L, Bartlett J. Building Clinical Clerkships Capacity in a Resource-limited Setting: The Case of the Kilimanjaro Christian Medical University College in Tanzania. Ann Glob Health 2018; 84:129-138. [PMID: 30873784 PMCID: PMC6748287 DOI: 10.29024/aogh.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The shortage of medical doctors in sub-Saharan Africa (SSA) has resulted in increased enrolment in medical schools, which has not been matched with increased faculty size or physical infrastructure. This process has led to overcrowding and possibly reduced quality of training. To reduce overcrowding at its teaching hospital, the Kilimanjaro Christian Medical University College introduced eight-week peripheral clerkship rotations in 2012. We explore students' perceptions and attitudes towards peripheral hospital placements. METHOD The clerkship rotations were conducted in eight hospitals operating in the northern Tanzania, after evaluating each hospitals' capabilities and establishing the optimum number of students per hospital. Paper-based surveys were conducted after student rotations from 2014 to 2016. RESULTS Overall student satisfaction was moderate (strength of consensus measure (sCns), 77%). The three cohorts exhibited improving trends over three years with respect to satisfaction with clinical skills and attitude towards placements. student-preceptor interaction was rated highly (sCns 81-84%). The first cohort students expressed concerns about limited laboratory support, and poor access to Internet and learning resources. Specific interventions were undertaken to address these concerns. CONCLUSIONS Student experiences in peripheral rotations were positive with adequate satisfaction levels. Opportunities exist for medical schools in SSA to enhance clinical training and relieve overcrowding through peripheral clerkship rotations.
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Affiliation(s)
| | | | - Charles Muiruri
- Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Durham, North Carolina, US
| | - Ahaz T Kulanga
- Kilimanjaro Christian Medical University College, Moshi, TZ
| | - Esther Lisasi
- Kilimanjaro Christian Medical University College, Moshi, TZ.,University of Cape Town, ZA
| | - Kien A Mteta
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Moshi, TZ
| | - Egbert Kessi
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | | | - Maro Venance
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | - Temu Rogers
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | - Lucy Mimano
- Kilimanjaro Christian Medical University College, Moshi, TZ
| | - John Bartlett
- Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Durham, North Carolina, US.,Medicine, Global Health, and Nursing, Duke University, US
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Kapanda GE, Muiruri C, Kulanga AT, Tarimo CN, Lisasi E, Mimano L, Mteta K, Bartlett JA. Enhancing future acceptance of rural placement in Tanzania through peripheral hospital rotations for medical students. BMC MEDICAL EDUCATION 2016; 16:51. [PMID: 26861915 PMCID: PMC4746898 DOI: 10.1186/s12909-016-0582-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 02/04/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Mal-distribution of health care workers is a global health challenge that exacerbates health disparities, especially in resource-limited settings. Interventions to mitigate the problem have targeted qualified personnel with little focus on medical students. However, studies have demonstrated that rural rotations positively influence students to practice in rural settings upon graduation. To evaluate the influence of peripheral rotations in a resource-limited setting, the Kilimanjaro Christian Medical University College introduced a 12-week clerkship rotation in peripheral hospitals for third-year medical (MD3) students in 2012. We administered an end-of-rotation survey to assess student perceptions, and attitudes toward rural practice after graduation. METHODS Questionnaires were voluntarily and anonymously administered to MD3 students in April 2014. The questions assessed perceptions of the experience, and attitudes towards rural practice upon graduation. The perceptions were assessed using strength of consensus measures (sCns). The effect of the experience on likelihood for rural practice was assessed using Crude Odds Ratio (COR), and predictors using Adjusted Odds Ratio (AOR) with 95 % Confidence Intervals (CI) tested at a 5 % level of significance. Variation was assessed using Hosmer and Lemeshow test Chi-square. RESULTS 111 out of 148 MD3 students participated; 62 % were male; 62 % <25 years old; and 72 % matriculated directly from secondary school. Overall, 81 % of MD3 students were satisfied with rural rotations (sCns = 83 %). The likelihood of accepting rural practice deployment after graduation was predicted by satisfaction with the peripheral hospital rotation program (AOR, 4.32; 95 % CI, 1.44-12.96; p, 0.009) and being male (AOR, 2.73; 95 % CI, 1.09-6.84; p, 0.032). Students admitted in medical school after health-related practice trended toward a higher likelihood of accepting rural practice after graduation compared to those enrolled directly from secondary school, although the difference was not significant (AOR, 4.99; 95 % CI, 0.88-28.41; p, 0.070). The Hosmer and Lemeshow test p-value was 0.686, indicating a good fit of the model. No significant differences in satisfaction between these two groups were observed, and also no significant differences between students born in rural areas compared to those born in urban areas existed. CONCLUSION Results indicate that satisfaction with rural rotations is associated with increased likelihood of rural practice after graduation. We conclude that opportunities may exist to reduce mal-distribution of healthcare workers through interventions that target medical students.
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Affiliation(s)
| | | | - Ahaz T Kulanga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | | | - Esther Lisasi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Lucy Mimano
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - John A Bartlett
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
- Duke Global Health Institute, Durham, NC, USA.
- Duke University School of Medicine, Durham, NC, USA.
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Muthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC MEDICAL EDUCATION 2015; 15:178. [PMID: 26489421 PMCID: PMC4618348 DOI: 10.1186/s12909-015-0463-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/12/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. METHODS Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. RESULTS Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. CONCLUSION Perception of medical graduates' unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practice.
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Affiliation(s)
| | - Tashmin Khamis
- The Aga Khan University, P.O. Box 30270, GPO 00100, Nairobi, Kenya.
| | - Mushtaq Ahmed
- The Aga Khan University, P.O. Box 38129, Ufukoni Road, Dar es Salaam, Tanzania.
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Muthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC MEDICAL EDUCATION 2015; 15:178. [PMID: 26489421 DOI: 10.5539/hes.v3n1p115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/12/2015] [Indexed: 05/22/2023]
Abstract
BACKGROUND Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. METHODS Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. RESULTS Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. CONCLUSION Perception of medical graduates' unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practice.
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Affiliation(s)
| | - Tashmin Khamis
- The Aga Khan University, P.O. Box 30270, GPO 00100, Nairobi, Kenya.
| | - Mushtaq Ahmed
- The Aga Khan University, P.O. Box 38129, Ufukoni Road, Dar es Salaam, Tanzania.
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Monroe-Wise A, Kibore M, Kiarie J, Nduati R, Mburu J, Drake FT, Bremner W, Holmes K, Farquhar C. The Clinical Education Partnership Initiative: an innovative approach to global health education. BMC MEDICAL EDUCATION 2014; 14:1043. [PMID: 25547408 PMCID: PMC4335420 DOI: 10.1186/s12909-014-0246-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 11/06/2014] [Indexed: 05/30/2023]
Abstract
BACKGROUND Despite evidence that international clinical electives can be educationally and professionally beneficial to both visiting and in-country trainees, these opportunities remain challenging for American residents to participate in abroad. Additionally, even when logistically possible, they are often poorly structured. The Universities of Washington (UW) and Nairobi (UoN) have enjoyed a long-standing research collaboration, which recently expanded into the UoN Medical Education Partnership Initiative (MEPI). Based on MEPI in Kenya, the Clinical Education Partnership Initiative (CEPI) is a new educational exchange program between UoN and UW. CEPI allows UW residents to partner with Kenyan trainees in clinical care and teaching activities at Naivasha District Hospital (NDH), one of UoN's MEPI training sites in Kenya. METHODS UW and UoN faculty collaborated to create a curriculum and structure for the program. A Chief Resident from the UW Department of Medicine coordinated the program at NDH. From August 2012 through April 2014, 32 UW participants from 5 medical specialties spent between 4 and 12 weeks working in NDH. In addition to clinical duties, all took part in formal and informal educational activities. Before and after their rotations, UW residents completed surveys evaluating clinical competencies and cross-cultural educational and research skills. Kenyan trainees also completed surveys after working with UW residents for three months. RESULTS UW trainees reported a significant increase in exposure to various tropical and other diseases, an increased sense of self-reliance, particularly in a resource-limited setting, and an improved understanding of how social and cultural factors can affect health. Kenyan trainees reported both an increase in clinical skills and confidence, and an appreciation for learning a different approach to patient care and professionalism. CONCLUSIONS After participating in CEPI, both Kenyan and US trainees noted improvement in their clinical knowledge and skills and a broader understanding of what it means to be clinicians. Through structured partnerships between institutions, educational exchange that benefits both parties is possible.
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Affiliation(s)
- Aliza Monroe-Wise
- Department of Medicine, University of Washington, Seattle, USA.
- Department of Global Health, University of Washington, Seattle, USA.
| | - Minnie Kibore
- Department of Global Health, University of Washington, Seattle, USA.
| | - James Kiarie
- Department of Global Health, University of Washington, Seattle, USA.
- Department of Epidemiology, University of Washington, Seattle, USA.
- Department of Ob-Gyn, University of Nairobi, Nairobi, Kenya.
| | - Ruth Nduati
- Department of Epidemiology, University of Washington, Seattle, USA.
- Department of Pediatrics, University of Nairobi, Nairobi, Kenya.
| | | | | | - William Bremner
- Department of Medicine, University of Washington, Seattle, USA.
| | - King Holmes
- Department of Global Health, University of Washington, Seattle, USA.
| | - Carey Farquhar
- Department of Medicine, University of Washington, Seattle, USA.
- Department of Global Health, University of Washington, Seattle, USA.
- Department of Epidemiology, University of Washington, Seattle, USA.
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