Undergraduate students' contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda

BACKGROUND

It has been realised that there is need to have medical training closer to communities where the majority of the population lives in order to orient the trainees' attitudes towards future practice in such communities. Although community based education (CBE) has increasingly been integrated into health professions curricula since the 1990s, the contribution students make to service delivery during CBE remains largely undocumented. In this study, we examined undergraduate health professions students' contribution to primary health care during their CBE placements.

METHODS

This was a qualitative study involving the Medical Education for Equitable Services to All Ugandans consortium (MESAU). Overall, we conducted 36 Focus Group Discussions (FGDs): one each with youth, men and women at each of 12 CBE sites. Additionally, we interviewed 64 community key-informants. All data were audio-recorded, transcribed and analysed using qualitative data analysis software Atlas.ti Ver7.

RESULTS

Two themes emerged: students' contribution at health facility level and students' contribution at community level. Under theme one, we established that students were not only learning; they also contributed to delivery of health services at the facilities. Their contribution was highly appreciated especially by community members. Students were described as caring and compassionate, available on time and anytime, and as participating in patient care. They were willing to share their knowledge and skills, and stimulated discussion on work ethics. Under the second theme, students were reported to have participated in water, sanitation, and hygiene education in the community. Students contributed to maintenance of safe water sources, educated communities on drinking safe water and on good sanitation practices (hand washing and proper waste disposal). Hygiene promotion was done at household level (food hygiene, hand washing, cleanliness) and to the public. Public health education was extended to institutions. School pupils were sensitised on various health-related issues including sexuality and sexual health.

CONCLUSION

Health professions students at the MESAU institutions contribute meaningfully to primary health care delivery. We recommend CBE to all health training programs in sub-Saharan Africa.

Health-profession students' teaching and learning expectations in Ugandan medical schools: pre- and postcommunity placement comparison

PURPOSE

The benefits of community-based medical education for both students and teachers are becoming increasingly clear. However, there is paucity of information about the importance of incorporating students' thoughts in the community-based education curriculum and the impact it has on their intentions to work in rural communities. The purpose of this study was to assess the teaching and learning expectations before and after placement of health-profession students going for community placement for the first time and make suggestions for improvement of the community-based programs.

METHODS

The study was a cross-sectional survey with both structured and unstructured questions. Participants were recruited from four medical schools in Uganda targeting 100% participation of health-profession students going for community placement in 2014. In total, 454 and 305 participants responded to self-administered questionnaires before and after community placement, respectively; and they were from different programs and years of study.

RESULTS

Students' learning expectations before placement, in ranking were: community engagement, interpersonal skills, community diagnosis, clinical skills, lifestyle practices, and patient management. After placement, the order of ranking was: interpersonal skills, community engagement, community diagnosis, lifestyle practices, clinical skills, and patient management. Most of the students had prior rural exposure and expected to do community engagement. However, after community placement they indicated having developed interpersonal skills. The various health-profession students were able to harmoniously work together to achieve a common purpose, which they find difficult to do in a classroom environment.

CONCLUSION

Having student teams comprised of different health programs and years of study going for community placement together promoted peer-to-peer mentorship and enhanced team building during community placement.

Standardizing assessment practices of undergraduate medical competencies across medical schools: challenges, opportunities and lessons learned from a consortium of medical schools in Uganda

Introduction

Health professions education is gradually moving away from the more traditional approaches to new innovative ways of training aimed at producing professionals with the necessary competencies to address the community health needs. In response to these emerging trends, Medical Education for Equitable Services to All Ugandans (MESAU), a consortium of Ugandan medical schools developed key competencies desirable of graduates and successfully implemented Competency Based Education (CBE) for undergraduate medical students.

Objectives

To examine the current situation and establish whether assessment methods of the competencies are standardized across MESAU schools as well as establish the challenges, opportunities and lessons learned from the MESAU consortium.

Methods

It was a cross-sectional descriptive study involving faculty of the medical schools in Uganda. Data was collected using focus group discussions and document reviews. Findings were presented in form of themes.

Results

Although the MESAU schools have implemented the developed competencies within their curricular, the assessment methods are still not standardized with each institution having its own assessment procedures. Lack of knowledge and skills regarding assessment of the competencies was evident amongst the faculty. The fear for change amongst lecturers was also noted as a major challenge. However, the institutional collaboration created while developing competencies was identified as key strength.

Conclusion

Findings demonstrated that despite having common competencies, there is no standardized assessment blue print applicable to all MESAU schools. Continued collaboration and faculty development in assessment is strongly recommended.

Phylogenetic analysis and positive-selection site detecting of vascular endothelial growth factor family in vertebrates

Vascular endothelial growth factor (VEGF), known to play an important role in vascular homeostasis, vascular integrity and angiogenesis, is little known about the evolutionary relationship of its five members especially the role of gene duplication and natural selection in the evolution of the VEGF family. In this study, seventy-five full-length cDNA sequences from 33 vertebrate species were extracted from the NCBI's GenBank, UniProt protein database and the Ensembl database. By phylogenetic analyses, we investigated the origin, conservation, and evolution of the VEGFs. Five VEGF family members in vertebrates might be formed by gene duplication. The inferred evolutionary transitions that separate members which belong to different gene clusters correlated with changes in functional properties. Selection analysis and protein structure analysis were combined to explain the relationship of the site-specific evolution in the vertebrate VEGF family. Eleven positive selection sites, one transmembrane region and the active sites were detected in this process.