Assessing predictors of students' academic performance in Ethiopian new medical schools: a concurrent mixed-method study

Assessment of clinical competence of graduating medical students and associated factors in Ethiopia

BACKGROUND

Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors.

METHODS AND MATERIALS

A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value < 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores.

RESULTS

Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture.

CONCLUSIONS

Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates' licensing examinations is also a way forward.

Are Ethiopian schools of medicine producing competent medical graduates for providing quality health care in the era of COVID-19 pandemic?

BACKGROUND

Competent health workforce, including medical doctors, is the heart of health systems. Cognizant of this, Ethiopia is implementing licensure exam as a strategy to produce competent health workforce, including medical doctors and beyond, for the provision of high quality health care, among others. However, there is a dearth of evidence on medical graduates' competence in Ethiopia in the era of Covid-19 pandemic. Hence, this study aimed to assess the competence of medical graduates-based on licensure exam results in Ethiopia.

METHODS

A multi -center institution-based cross-sectional study was conducted among 1051 medical graduates (selected through cluster sampling method) from May - July 2022 in Medical Schools found in Amhara region, Northwest Ethiopia. Data were collected from secondary sources at the Ministry of Health and Medical Schools using a structured checklist. Data analysis was performed using SPSS Version 23 software. A binary logistic regression analysis was performed to identify factors associated with graduates' competence.

RESULTS

Nine hundred sixty-one (91.4%) medical graduates were competent. The study revealed that those graduates with older age (AOR: 0.63; 95% CI: 0.52, 0.76), being female graduates (AOR: 0.39; 95% CI: 0.22, 0.69), graduated in 2021 (AOR: 0.31; 95%; CI: 0.17, 0.60) and attending education in junior medical schools (AOR: 0.06; 95% CI : 0.01, 0.40) have lower competence as compared with that of their counterparts. Whereas, graduates with no repeating internship attachment (AOR: 2.41; 95% CI: 1.40, 4.17) and graduates with repeating academic year (AOR: 2.01; 95% CI: 1.14, 3.56) have better competence than that of their counterparts.

CONCLUSION

The proportion of competent medical graduates was relatively low as per the national strategic plan which aspires that all medical graduates to be competent. Medical graduate's competence was affected by age, gender, curriculum being implemented, and having academic as well as internship repeats. As result, policymakers should scale up competency based education in Medical Schools.