Informing the medical education reform in Tajikistan: evidence on the learning environment at two nursing colleges

Nursing Students’ Perception of the Educational Environment in a Public University in Ahvaz, Iran: A Study Based on DREEM Questionnaire

Background: Students’ perception of educational environment is an important factor in evaluating the quality of education as it provides invaluable resources to identify the strengths and weaknesses of educational environment. However, there is a paucity of information regarding the educational environment from the perceptions of nursing students in Iran.Purpose: This study aimed to investigate nursing students’ perception of the educational environment and compare the male and female students’ perceptions of the educational environment in a public university in Ahvaz, Iran.Methods: A cross-sectional study was conducted among 130 nursing students in a public university in Ahvaz, Iran, using the Dundee Ready Educational Environment Measure (DREEM) questionnaire. Convenient sampling was used to recruit the samples. Descriptive statistics and independent t-test were used for data analysis.Results: The overall mean (SD) DREEM score in this study was 105.01(22.00), indicating a more positive educational environment than negative. The highest mean (SD) DREEM score was related to Students’ Perceptions of Learning domain 24.03(6.01), while the lowest one was related to Students’ Social Self-Perceptions domain 14.01(4.00). The female students showed significantly better mean score in the domains of Students’ Academic Self-Perception and Students’ Social Self-Perception than males (p<0.05).Conclusion: The students’ perception of their educational environment is a positive and optimistic one. Therefore, it is suggested that students’ perceptions of the educational environment be measured regularly, for instance, at the end of each academic year, to create a healthy and effective environment for learning in the educational environment.

The Educational Environment Is Warming Up: Response to Changes in a Component of a Medical Curriculum

INTRODUCTION

The Dundee Ready Educational Environment Measure (DREEM) is a valid instrument to evaluate the educational environment of institutions. This quantitative study aimed to discover if applying interactive educational approaches to a component of a traditionally taught medical curriculum improved the educational environment, as measured by the DREEM.

METHODS

The bilingual Arabic-English DREEM questionnaire was distributed twice to all third-year medical students (273 students) at the Hashemite University in Jordan. The first data collection occurred at the completion of a traditionally taught component of the Neurology module and the second data collection at the end of an interactively taught component of the same module. A paired t-test was used to compare the results.

RESULTS

The total DREEM score for the innovative interactive course was 120.04/200 (from 183 questionnaires) and for the traditionally taught course was 114.69/200 (from 198 questionnaires). Of the five DREEM sub-scales, the interactive course scored statistically significantly higher than the traditionally taught course for "perceptions of learning" and "perceptions of atmosphere" (p-value 0.013 and 0.011, respectively). The interactively taught course was particularly valued by students for being participative, student-centered, and developing their professional competence. The lowest scoring item for both courses was "there is a good support system for students who get stressed."

DISCUSSION

This study demonstrated that students value interactive learning environments and that there is benefit in introducing these components to a traditionally taught medical curriculum, when it may not be feasible to bring innovation to the entire medical curriculum due to resource constraints.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01359-y.

Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education

INTRODUCTION

The last two decades have seen a shift in former Soviet countries from highly specialized to more family medicine-focused systems. Medical education has slowly adjusted to these reforms, although the region is still at risk to have a chronic shortage of family doctors. This paper presents the evaluation of a new post-graduate family medicine program in Tajikistan, focused on competency-based training. The findings are relevant for policy makers, international organizations and practitioners participating in similar medical education reform programs.

METHODS

We employed a quasi-experimental control group design and compared intervention residents, control group residents with traditional training, and 1st year residents with no training in two outcomes, clinical knowledge and competencies. We employed two objective measures, a written multiple-choice question test (MCQT) and an Objective Structured Clinical Examination (OSCE), respectively. We report reliability and validity of the measures along with ANOVA, planned contrasts and effect size estimates to examine differences across groups.

RESULTS

We found statistically significant differences in both clinical knowledge and competencies between intervention and control groups. We also detected a large intervention effect size. Participants in the intervention outperformed control group participants in the two measures. Our analysis suggests that intervention and control group participants are comparable in terms of initial knowledge and competencies, strengthening the argument that the intervention caused the improvement in the program outcomes.

DISCUSSION

Receiving tailored training and structured opportunities to practice knowledge and competencies in clinical settings have a positive effect on the education of family medicine doctors in Tajikistan. Our results support curriculum reform and investment in medical education in the form of longer and supervised on-the-job preparation designed to be more in line with international standards. We discuss suggestions for future studies and potential requirements to inform replicability in other countries.

CONCLUSION

Family medicine is well recognized as central to health systems throughout the world, but high quality residency training lags behind in some countries. Our study showed that investing in family medicine residency programs and structured training is effective in increasing critical clinical competencies. We encourage promoting comprehensive post graduate family medicine doctor training so that the goals of a family medicine centered health system are attainable.

Medical education state reform in Tajikistan: Between tradition and modernity

After its post-independence economic and social transformation, the healthcare system of Tajikistan has been shifting from a centrally planned, hospital, and specialist-focused model to a primary oriented care delivery system. Since 2010 the government of the Republic of Tajikistan has been implementing the National Health Strategy aimed at improving the population's health. Significantly reformed medical education is a major prerequisite for changing and defining a new landscape of Tajik medicine that could provide the local population with high-quality health care services. The ongoing medical education state reform involves the restructuring of undergraduate, postgraduate education, and continuing professional development programs in compliance with the recommendations of the World Medical Education Federation. This article gives a brief overview of the history and heritage of Persian-Tajik medicine and helps to retrace its evolution throughout the centuries until modern times. The authors describe the current state of the Tajik medical education system as well as the complexities and controversies, milestones, and the primary outcomes of the medical education reform implemented as part of the National Health Strategy.

Assessing the effects of the nursing education reform on the educational environment in Tajikistan: a repeated cross-sectional analysis

Background

A well-functioning education system for family nurses is a priority of the primary health care reform in Tajikistan. In 2015/2016, a baseline study was carried out to measure the educational environment at two nursing colleges, in Kulob and Dushanbe. Building on the study's recommendations, the educational reform has addressed several key issues to improve the educational environment among nursing students with a focus on strengthening competency-based learning and clinical skills. A follow-up study was carried out in late 2018 to comparatively analyse progress in the educational environment against the baseline and assess potential impacts of tailored interventions.

Method

A repeated cross-sectional survey involving 1239 students was applied to measure changes in the educational environment between 2015/2016 (baseline) and 2018 (endline) using the Dundee Ready Education Environment Measure (DREEM). We compared mean scores over time using Welch's two sample t-test and the Wilcoxon-Mann-Whitney test. Single items have additionally been analysed using critical threshold (flags) for mean scores, and the percentage of answers falling above or below predefined values. A multivariate non-parametric regression was applied to control for confounding factors. Internal consistency was examined using Cronbach's α.

Results

Cronbach's α for overall scores ranged between 0.87 and 0.89. Between 2015/2016 and 2018 the perceived educational environment improved with an increase of the mean total DREEM score from 131.8 to 146.9 in Dushanbe and from 134.9 to 151.2 in Kulob. Mean comparisons and multivariate regression revealed a significant increase of all sub-scores between 2015/2016 and 2018 with students' social self-perception exhibiting the smallest progress. Despite the general improvements observed, analysis at the level of single items revealed persistent weaknesses including a lack of competency-based learning and stress.

Conclusions

The education environment has improved in several important ways between 2015/2016 and 2018 which points to a likely positive contribution of the nursing education reform. This progress notwithstanding, there is still notable room for further improvement. Targeted efforts aimed at a better organization of practical trainings, improved didactical competences of teachers, and support structures for lonely and stressed students still seem to be lacking for the achievement of a good nursing education system in Tajikistan.