CPIRD: A successful Thai programme to produce clinically competent medical graduates

Assessment of dropout rates in the preclinical years and contributing factors: a study on one Thai medical school

BACKGROUND

The highest dropout rate for medical students is during the preclinical years of education. Several studies have reported possible contributing factors, however, studies regarding the dropout rate from medical education among Thai medical students and its associated factors are still lacking. This study aimed to identify the prevalence of dropout from medical education within the preclinical period and its associated factors among Thai medical students.

METHODS

We collected data from preclinical medical students who entered one medical school in Bangkok, Thailand, between 2017-2019. Demographic data, admission program, pre-admission mental health status assessed by the Thai Mental Health Indicator 66, mental health records from the faculty-based counseling services, and academic achievement were extracted. Data were reported in a descriptive fashion. We analyzed the association between dropout and these factors by robust Poisson regression.

RESULTS

In total, 914 students were recruited. Dropout was only 1.5%, which was lower than the previous studies. Regression analysis showed a significant association between dropout and mental health problems [Prevalence ratio (PR) 58.20, 95%CI 13.72- 246.95] but not admission program [PR 0.32, 95%CI 0.09 - 1.16] or failing examinations [PR 0.59, 95%CI 0.18 - 1.90]. However, other contributing factors such as financial status, family problems, medical illness, and students' motivation, were not evaluated in this study.

CONCLUSIONS

Mental health problems during medical education were associated with dropout after adjusting for other confounding variables. Further longitudinal studies are needed to identify the impacts of academic failure on dropout in higher clinical years.

Early outcomes of a rural-oriented physician education programme against rural physician shortages in Guangxi province: a prospective cohort study

OBJECTIVES

This study aimed to investigate early outcomes of one of the first medical undergraduate education programmes with a goal of mitigating severe rural physician shortages in China, which was developed by Guangxi Medical University (GXMU) and was called the Rural-oriented Free Tuition Medical Education (RTME)-GXMU programme.

DESIGN

A prospective cohort study comprising a baseline investigation and follow-up research was conducted to dynamically observe the evolution of the RTME-GXMU programme that began since 2010.

PARTICIPANTS

380 RTME-GXMU graduates and 383 non-RTME-GXMU graduates from GXMU who completed trainings between 2015 and 2018 were recruited in the baseline investigation. Among them, 285 RTME-GXMU and 283 non-RTME-GXMU graduates responded to the follow-up research.

MAIN OUTCOME MEASURES

Graduate practice location, registered specialty, passing rate of the National Medical Licensing Examination (NMLE), specialty of residency programme and contract compliance for the RTME-GXMU graduates.

RESULTS

By the end of 2018, 100% of the 2015 RTME-GXMU graduates enrolled in this study practised in rural township health centres and registered themselves as general practitioners (GPs). All the RTME-GXMU graduates had completed or were attending residency programmes of general practice (GP). The above data stood in stark contrast to that of the non-RTME-GXMU graduates among whom as few as 1.06% worked in rural areas, 2.13% registered as GPs and less than 3% chose GP residency programmes. No significant differences were detected on passing rates of the NMLE between the two groups. Only one RTME-GXMU graduate broke the contract and dropped off the programme.

CONCLUSIONS

The RTME-GXMU programme has achieved encouraging early outcomes. Reduced entry score and proper usage of urban primary care institutions are two key approaches contributing to these positive early results.

A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries

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.

Global variability in orthopedic surgery training

Medical and orthopedic training varies throughout the world. The pathways to achieve competency in orthopedic surgery in other countries differ greatly from those in the United States. This review summarizes international educational requirements and training pathways involved in the educational development of orthopedic surgeons. Understanding the differences in training around the world offers comparative opportunities which may lead to the improvement in education, training, and competency of individuals providing orthopedic care.

Perception of educational environment among medical students in Thailand

OBJECTIVES

To examine the perception of educational environment among clinical year students in Thailand using Dundee ready education environment measure (DREEM) and identify factors associated with the DREEM scores.

METHODS

A total of 2,467 fourth- to sixth-year students from 34 teaching hospitals nationwide responded to a Thai version of DREEM questionnaire. Data on each student's sex, year of study, size of teaching hospitals and GPAX were collected. Mean total DREEM scores and subscales were calculated and then compared across groups using t-test and one-way ANOVA.

RESULTS

The overall student perception on educational environment was 'more positive than negative,' with the mean total DREEM score of 131.1 (SD=17.4). Similar findings were observed in all subscales. Mean total DREEM scores were lower in medium-size than small- and large-size teaching hospitals 129.9 (SD = 18.1), 131.9 (SD = 17.5) and 131.6 (SD=16.4) respectively (F _(2,2422)=3.21, p=0.04). Sex and years of study was associated with certain DREEM subscales.

CONCLUSIONS

Clinical year medical students in Thailand were satisfied with their academic learning environment, with varying perceptions across different size of teaching hospitals. Repeat assessment of educational environment of medical schools over time is needed for monitoring changes after specific educational interventions being applied.

CPIRD: A successful Thai programme to produce clinically competent medical graduates

The programme titled “Collaborative Project to Increase Production of Rural Doctors” (CPIRD) is a rural medical education project launched in 1994 in Thailand. This study aimed to compare the academic performances in medical study over five years and the pass rates in national medical license examinations (MLE) between students enrolled in CPIRD and two other tracks.

Grade point average (GPA) over five years and results of MLEs for four cohorts of students enrolled from 2003 to 2006 in Prince of Songkla University were collected from the registration department. A longitudinal analysis was used to compare the GPA over time for medical students enrolled in CPIRD and those from the national and direct regional tracks through generalized estimating equation (GEE) models. The MLE pass rates were compared using chi-square and fisher's exact tests as appropriate.

Female students dominated the CPIRD group. GPAs in the first three years in the CPIRD group were significantly lower than those of the other two groups, this disparity narrowed in the fourth and fifth years. For step one of the MLE (basic sciences), cohorts 2003 and 2006 of the CPIRD group had a significantly lower pass rate than the other two groups but there was no significant difference in cohort 2004 and cohort 2005. The CPIRD step two and three MLE pass rates were not significantly different from the national track in all cohorts and lower than the direct track only for step two in cohort 2003 and step three in cohort 2006. The step three pass rate of the CPIRD group in cohort 2004 was significantly higher than the other two tracks.

Despite weaker competency in basic science, the CPIRD was successful in forming clinical competency.