Situational analysis of teaching and learning of medicine and nursing students at Makerere University College of Health Sciences

Continuing professional development training needs for primary care doctors in central Uganda

BACKGROUND

Continuing professional development (CPD) activities relevant to medical doctors and their patients should be informed by current assessed training needs. The CPD provision is expected to improve the quality of professional practice and ethics. However, the Uganda Medical and Dental Practitioners' Council still receives about 40 reports of malpractice every month.

AIM

The study aimed to describe the CPD training needs of doctors working in public primary care facilities in central Uganda.

SETTING

The district health system of central Uganda comprised 10 General Hospitals (GH) and 37 Health Center IVs (HC IVs) with a staffing norm of six and two doctors, respectively.

METHODS

This was a cross-sectional survey of 100 doctors working in public primary care facilities using the World Health Organization (WHO) Hennessy-Hicks questionnaire. Descriptive statistics of the importance, current performance, and training need of each skilled activity were calculated. Content analysis was applied to data from the open-ended questions.

RESULTS

The response rate was 91%, majority were males, 80 (87.9%) from 7 GHs and 24 HC IVs with an average age of 37.9 years. The domain with the highest CPD training need for the doctors was research and audit, with a mean score (standard deviation [s.d.]) of 1.94 (±1.69), followed by administration 1.58 (±1.61) and clinical tasks 1.28 (±1.29). The clinical tasks domain had the most suggested CPD topics.

CONCLUSION

Research and audit and clinical tasks were identified as important domains for CPD training for doctors in this setting.Contribution: The results give insight into CPD training needs of primary care doctors and guide various CPD providers.

Self-paced online learning to improve knowledge competencies for hypertension among medical students in Uganda: A pre-post study

The growing burden of hypertension (HT) is projected to reach 1.56 billion globally by 2025 and is an increasing public health concern, even for low- and middle-income countries (LMIC) like Uganda, where the prevalence of HT is 31.5%. The objective of this study was to test the effectiveness of a freely available HT online course on knowledge competencies for medical students in Uganda. The online course was developed by a multidisciplinary team at Johns Hopkins University to address HT control in resource-constrained healthcare settings. Students in the 3rd, 4th, and 5th years of medical school were randomly selected to participate in the online course. Pre and post knowledge tests were administered using an online survey system. Of the 201 invited students, 121 (60.2%) completed the study. Significant improvements in mean knowledge scores were evident following the online course completion for Module 1, Fundamentals of HT (21.9±2.5 to 23.7±2.5, p<0.001), and Module 2, Basics of HT Management (14.9±3.3 to 18.5±4.3, p<0.001). No statistically significant differences were evident by gender or school year. Students who took a shorter duration to complete the course had significantly higher mean score improvement between pre- and post-test (mean score improvement 7.0 if <4 weeks, 3.6 if 4-8 weeks, and 3.7 if >8 weeks, p<0.003). Students recognized information on blood pressure measurement (32.2%) and HT management (22.3%) as the most important concept addressed in the course. A self-paced online course, complementing medical school training, improved knowledge on HT burden and management in Uganda.

The situational analysis of teaching-learning in clinical education in Iran: a postmodern grounded theory study

BACKGROUND

Clinical teaching-learning is a context-bound phenomenon. One of the problems related to field of medical education research is the lack of sufficient attention to context-appropriate methodologies. The purpose of this qualitative inquiry is to explain and represent teaching-learning in the clinical education of general medicine in Iran using the three types of maps situational, social worlds/arenas, positional, in combination with discourse analysis.

METHODS

In this study, the authors used the situational analysis approach as a postmodern version of grounded theory. The data collection was undertaken in three stages. In the first stage, a mini literature review was conducted to highlight a possible gap in applying situational analysis in medical education research and the development of this methodology. In the second stage, the latest and most up-to-date documents of the Ministry of Health and Medical Education (MOHME) of Iran, the general medicine curriculum, and related documents were analyzed. Finally, the remote semi-structured interviews (web-based and telephone) were undertaken in the third stage. Participants in this stage included expert clinical teachers, medical education specialists, and students. In this study, the notes and transcripts were analyzed for the emergence and categorization of sub-themes and themes, represented in three maps.

RESULTS

Thirty-one participants were involved in the web-based interviews, while seven participants took part in the telephone interview. Based on this research, the teaching-learning situation in clinical education on general medicine in Iran was represented in three maps; situational, social worlds/arenas, and positional. In addition, the results showed, clinical education of general medicine in Iran in six positions (curriculum; culture, behavior and attitude; management and leadership; environment, space and time; financial; and technology) has serious problems and challenges. Finally, based on the horizontal axis of the positional map, recommendations were provided to develop and support effective clinical teaching.

CONCLUSIONS

The clinical learning environment is a complex and multi-layered social environment in which should be considered these numerous social layers, arenas, social worlds, and discourses while developing curricula and teaching.

Which psychosocial interventions improve sex worker well-being? A systematic review of evidence from resource-rich countries

OBJECTIVE

To establish the state of the evidence base around psychosocial interventions that support well-being in sex workers in order to inform policy and practice within a resource-rich geographical context.

METHODS

Published and unpublished studies were identified through electronic databases (PsychINFO, CINHAL Plus, MEDLINE, EMBASE, The Cochrane Library and Open Grey), hand searching and contacting relevant organisations and experts in the field. Studies were included if they were conducted in high-income settings with sex workers or people engaging in exchange or transactional sex, and evaluated the effect of a psychosocial intervention with validated psychological or well-being measures or through qualitative evaluation.

RESULTS

A total of 19 202 studies were identified of which 10 studies met the eligibility criteria. The heterogeneity found dictated a narrative synthesis across studies. Overall, there was very little evidence of good quality to make clear evidence-based recommendations. Despite methodological limitations, the evidence as it stands suggests that peer health initiatives improve well-being in female street-based sex workers. Use of ecological momentary assessment (EMA), a diary-based method of collecting real-life behavioural data through the use of twice-daily questionnaires via a smartphone, increased self-esteem and behaviour change intentions.

CONCLUSIONS

Work with sex workers should be based on an evidence-based approach. Limitations to the existing evidence and the constraints of this work with vulnerable groups are recognised and discussed.

Exploring the need for a responsive school curriculum to cope with the Covid-19 pandemic in Pakistan

The article investigates the response of the Pakistani curriculum to the Covid-19 outbreak. It also looks into the development of a curriculum that addresses the specificities of students' situations, while reminding them of global connectedness. The article is based on semi-structured interviews with 10 curriculum experts, 20 principals, and 35 teachers, as well as content analysis of the 2018 National Curriculum Framework of Pakistan. Its findings reveal participants' disappointment with the top-down, predetermined nature of the curriculum, which makes it inadequate for situations such as the Covid-19 pandemic. The curriculum was perceived as being highly rigid, with little room for alternative modalities. Participants believed the curriculum could not support children's learning in normal times, much less during a pandemic. Therefore, this article suggests a complete revamping of the curriculum and strengthening of teachers' capabilities. It also suggests curricular material be updated to make it context specific, responsive to the needs of learners, and supportive of independent learning.

Case-based learning combined with science, technology, engineering and math (STEM) education concept to improve clinical thinking of undergraduate nursing students: A randomized experiment

Aims

The present study was conducted to apply and examine case-based learning (CBL) and Science, Technology, Engineering, and Math (STEM) education concept in the training of nursing student's clinical thinking.

Design

A randomized experimental design with non-equivalent group pretest-posttest.

Methods

Participants were requested to participant in either of the two programmes: traditional education programme as a control group or CBL combined with STEM education concept (the STEM group). Questionnaires of critical thinking, self-directed learning, self-efficacy were administered before and after the experiment.

Results

Differences between the STEM group and control group were observed in critical thinking, self-directed learning, self-efficacy and career choice over one semester. Accordingly, CBL combined with STEM education concept enhanced the nursing student's clinical thinking.

Influence of community-based education on undergraduate health professions students' decision to work in underserved areas in Uganda

Background

Uganda is beset by a shortage of health workers and the few available are mal-distributed. Providing rural exposure through community-based education could positively influence students’ perspectives towards work in rural areas. We aimed to assess the impact of Community-Based Education and Research (COBERS) on health professions students’ attitudes towards working in rural areas. This was a before-and-after study among 525 students of 4 medical universities in Uganda. Data was collected using self-administered paper-based questionnaires. Logistic regression and Poisson regression respectively were used to assess intention and intended number of years of work in rural areas.

Results

Before COBERS, 228/518 (44.0%) students indicated that they intended to work in rural areas as compared to 245/506 (48.4%) after the COBERS placement. Before the COBERS placement, the factors that were associated with students considering to work in a rural area were: extra allowance (OR = 0.2; 95% CI 0.1–0.6), and availability of social amenities (OR = 0.2; 95% CI 0.1–0.7). After their COBERS placement, the factors were: access to long distance courses (OR = 2.0; 95% CI 1.0–3.7) and being posted to a facility in a rural area (OR = 15.0; 95% CI 6.5–35.5). Before the COBERS placement the factors that influenced how long students thought they would be willing to work in a rural environment were: reliable electricity (IRR = 0.6; 95% CI 0.3–1.0) and Internet (IRR = 1.5; 95% CI 1.0–2.3), high salary (IRR = 0.4; 95% CI 0.3–0.7), and having skills to practice in rural settings (IRR = 2.0; 95% CI 1.3–3.1). Reliable electricity (IRR = 0.5; 95% CI 0.3–0.8) and long distance courses (IRR = 2.1; 95% CI 1.4–3.1) were significant motivators after having undergone the COBERS placement.

Conclusions

The majority of health professions students do not intend to work in rural areas after they graduate. Improving the welfare of health professionals working in rural areas could attract more health professionals to rural areas thus addressing the maldistribution of health workers in Uganda.

A situation analysis of inter-professional education and practice for ethics and professionalism training at Makerere University College of Health Sciences

Background

Students at Makerere University College of Health Sciences (MakCHS) are introduced to ethics and professionalism using the inter-professional education (IPE) model. Ethics and professionalism should be running themes throughout succeeding years of study during which students are expected to develop qualities and skills for future inter-professional practice (IPP). We performed a situation analysis of IPE and IPP among students and teaching health professionals at MakCHS to guide development of a relevant training curriculum of ethics and professionalism.

Methods

A cross sectional study with quantitative and qualitative methods which included questionnaires, focus group discussions and key informant interviews.

Results

We interviewed 236 undergraduate students (148, 63 % male) and 32 teaching health professionals (25, 78 % male). Two hundred fifteen (91 %) students indicated they had joint learning activities with students of other professions and 166 (70 %) stated there was benefit in having an IPE model training curriculum. Most students (140, 59 %) strongly agreed that learning with other students will make them more effective members of the health team. Whereas the respondents reported inter professionalism as being well articulated in their course curricula, more than half said IPE is only implemented in the pre-clinical years of study. They noted that IPE and IPP concepts were not well programmed, health professionals engaged in teaching had poor attitudes towards IPE and IPP, there were limited numbers of skilled health care workers to implement IPP and there was poor communication between students and teaching health professionals. Majority of teaching health professionals noted challenges in implementation of IPE such as poor coordination and large student population and major factors influencing ethics and professionalism in healthcare such as limited government support, low pay for the health care workers, disrespect and lack of appreciation of the health workers by the public.

Conclusions

Our findings demonstrate that IPE, IPP, ethics and professionalism are not emphasized in the clinical years of study at MakCHS. We recommend increased sensitization on the concepts of IPE and IPP plus enhanced mentorship for both students and teaching health professionals. Innovative strategies of implementation of IPE and IPP for training in ethics and professionalism must be introduced.

Comforting strategies and perceived barriers to pediatric pain management during IV line insertion procedure in Uganda's national referral hospital: A descriptive study

BACKGROUND

Venipuncture and intravenous (IV) cannula insertions are the two common sources of pain in hospitalized children and health care today. The WHO asserts that, pain relief is a basic fundamental right and requires a multidisciplinary approach. Nonpharmacological comforting strategies when implemented are important to relive pain related distress in children during peripheral IV line insertion. However, evidence to date that suggests implementation of such strategies and their barriers in Uganda remains very limited. This study aimed at establishing the current practices in regard to the use of comforting strategies and the perceived barriers faced by health care providers to implement pediatric pain management during IV line insertion procedure in Uganda's national referral hospital, Mulago.

METHOD

A cross sectional and descriptive study was conducted between December 1, 2012 and February 28, 2013 involving doctors, nurses and interns in six pediatric wards of Mulago Hospital in Uganda. A pre-tested self- administered and semi- structured questionnaire was used to collect the data. Data was entered into SPSS and descriptive statistics run on all the variables.

RESULTS

Of the 120 questionnaires distributed, 105 (RR = 87.5%) were returned and completed. The evidence based comforting strategies used for pain management during IV line insertion by the majority of health care professionals were; skin to skin (51%) and appropriate upright positioning of the child on mother's lap (69%). The least used comforting strategies were; allowing the child to suck his thumb or hand (70%), use of distraction (69%) and directing the child to suck one of his fingers into his mouth (90%). The identified barriers to implementing comforting strategies were; lack of time (42%), having emergency situations (18%), and not knowing the right method to use (11%). Of 105, 100 (95%) reported that there is need for continuous professional development on comforting strategies.

CONCLUSIONS

Findings demonstrated that fewer health care providers used some evidence based comforting strategies of pain relief during pediatric peripheral IV line insertion. Distraction and other evidence based strategies for pain and distress relieve are less often used by the majority of the health care providers. Incorporating pediatric pain management content in all health professionals training curricula could improve the current practices for better health outcomes.

The Scope of Mental Illness and Status of Psychiatric Care in Uganda

Mental illness in Uganda affects over one-third of the population. Less than half of these individuals seek intervention because of the lack of mental health services, including providers of care, such as nurses; psychotropic medicines; psychosocial interventions; and psychotherapies. Stigma associated with mental illness also is a significant barrier to care. The purpose of this article is to describe the scope of mental illness and the status of psychiatric care in Uganda as well as to provide implications for mental health nursing.

Competency-based medical education in two Sub-Saharan African medical schools

BACKGROUND

Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME).

INSTITUTIONAL REVIEWS

This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes are highlighted. Both schools used similar processes in developing their CBME curricula, with early and significant stakeholder involvement. Competencies were determined taking into consideration each country's health and education systems. Final competency domains were similar between the two schools. Both schools established medical education departments to support their new curricula. New teaching methodologies and assessment methods were needed to support CBME, requiring investments in faculty training. Both schools received external funding to support CBME development and implementation.

CONCLUSION

CBME has emerged as an important change in medical education in Sub-Saharan Africa with schools adopting it as an approach to transformative medical education. Makerere University and the University of Ibadan have successfully adopted CBME and show that CBME can be implemented even for the low-resourced countries in Africa, supported by external investments to address the human resources gap.

Accreditation in a sub Saharan medical school: a case study at Makerere University

INTRODUCTION

Of more than the 2,323 recognized and operating medical schools in 177 countries (world wide) not all are subjected to external evaluation and accreditation procedures. Quality Assurance in medical education is part of a medical school's ethical responsibility and social accountability. Pushing this agenda in the midst of resource limitation, numerous competing interests and an already overwhelmed workforce were some of the challenges faced but it is a critical element of our medical profession's social contract. This analysis paper highlights the process of standard defining for Medical Education in a typically low resourced sub Saharan medial school environment.

METHODS

The World Federation for Medical Education template was used as an operating point to define standards. A wide range of stakeholders participated and meaningfully contributed in several consensus meetings. Effective participatory techniques were used for the information gathering process and analysis.

RESULTS

Standards with a clear intent to enhance education were set through consensus. A cyclic process of continually measuring, judging and improving all standards was agreed and defined. Examples of the domains tackled are stated.

CONCLUSION

Our efforts are good for our patients, our communities and for the future of health care in Uganda and the East African region.

Patient satisfaction with services in outpatient clinics at Mulago hospital, Uganda

OBJECTIVE

To identify factors associated with general satisfaction among clients attending outpatient clinics in a referral hospital in Uganda.

DESIGN

Cross-sectional exit survey of patients and care-givers in selected outpatient clinics.

SETTING

Seven outpatients' clinics at Mulago National Referral and Teaching Hospital.

MAIN OUTCOME MEASURES

Mean score of clients' general satisfaction with health-care services.

RESULTS

Overall the clients' general satisfaction was suboptimal. Average satisfaction was higher among clients with a primary or secondary education compared with none, those attending HIV treatment and research clinic compared with general outpatient clients, and returning relative to new clients. Conversely, satisfaction was lower among clients incurring costs of at least $1.5 during the visit, and those reporting longer waiting time (>2 h). Client's perceived technical competence of provider, accessibility, convenience and availability of services especially prescribed drugs were the strongest predictor of general satisfaction.

CONCLUSIONS

This study highlights the important findings about outpatient services at Mulago hospital. The sub-optimal satisfaction scores for outpatient care strongly suggest that more could be done to assure that services provided are more patient centered. Significant factors including category of clinic visited, waiting time, costs incurred, accessibility of services and perceived providers' technical competence at this hospital should be explored by the Makerere University College of Health Sciences and Mulago hospital for potential improvements in quality of the health service delivered.

Makerere University College of Health Sciences' role in addressing challenges in health service provision at Mulago National Referral Hospital

BACKGROUND

Mulago National Referral Hospital (MNRH), Uganda's primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH.

METHODS

Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis.

RESULTS

Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills.

CONCLUSIONS

Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.