Problem based learning: tutors’ views 5 years after implementation at a sub-Saharan University

Background: Curriculum evaluation is key to continuous assurance of quality of education.Objectives: To assess the teachers’ perceptions on how well student teaching and learning activities were conducted at an institution that had practiced PBL for five years.Methods: A cross sectional descriptive study. 150 teachers from 23 departments at the College of Health Sciences participated in the study. A 25 item self-administered questionnaire was used to collect data. Activities evaluated included; students assessment, self-directed learning, feedback and clinical exposure. Data were entered in epi data and analysed using SPSS. Ethical approval was obtained.Results: The participants’ average teaching experience was eight years. The PBL/COBES approach mostly achieved the aim of producing self-directed and lifelong learners. Half of the teaching staff actively provided regular feedback about the learning and teaching activities they were involved in. Early clinical exposure was widely accepted as a highly rewarding appropriate teaching and learning strategy. COBES activities were well organized although involvement of College staff was low.Conclusion: PBL/COBES program was successfully executed and had high acceptance among Faculty. The biggest challenge was getting all staff to provide regular feedback. Self institutional curriculum review can be done cheaply and quickly to provide feedback for continual curriculum improvement.Key words: Problem Based Learning, Evaluation, Curriculum, Universit

Student and tutor perception of a new problem based learning curriculum at Faculty of Medicine, Makerere University

Background: The Makerere University Faculty of Medicine started the implementation of the Problem Based Learning/Community Based Education and Service curriculum for incoming students in the academic year 2003/2004. It undertook an intense preparatory period of 2 years before implementation, which included sensitizing, and training tutors to take their new role. Objectives: To evaluate student and tutor perception of the New PBL Curriculum at the Faculty of Medicine and to evaluate tutors perception of how well the students were doing.Methods: The study was at the end of the first semester, after seventeen weeks of the new curricula implementation. A 19-item questionnaire was self-administered by the students. An open discussion led by one of the investigators followed that questionnaire filling session. A 5-point likert scale was used to rate the different aspects. A different questionnaire was administered to the 35 academic staff that had tutored the twenty tutorial groups of eight to ten students each. The data collected from the two questionnaires was analyzed using SSPS software. The Faculty Research Committee approved the study.Results: Out of 180 students, 135 students filled in the questionnaire. In addition 25 tutors out of 35 filled in their questionnaire. The tutors’ facilitation of the tutorials was rated highly by the students. Students’ rated their (students’) participation in the tutorial process as excellent. The students rated access to learning resources as inadequate and they were anxious as to whether they were learning enough. On the other hand the tutors were satisfied with the depth and scope of the discussions by the students. The majority of the tutors thought it was the right move to introduce PBL. They were however concerned about sustainability of the novel educational reform (PBL).Conclusion: The students perceived the new method as acceptable. They expressed anxiety and uncertainly as to whether they were learning enough. And whereas the students were not sure they were learning enough, the tutors were satisfied with the depth of knowledge exhibited by the students. To sustain the reform tutors’ concerns and fears ought to be addressed

Is a PhD a necessary requirement for lecturers in a`Medical School? Report of a survey

Background: Makerere University introduced a new policy1 on the minimum qualification for appointment to a lecturer teaching position and eligibility for subsequent promotions. The highlight of the policy is a requirement for a PhD or equivalent as the minimum qualification necessary for appointment to a lecturer position and above.As a result of this policy fewer and fewer members have shown interest or indeed joined the Faculty of Medicine teaching staff roll.Objectives: This study set out to investigate the perception of the faculty and the impact of the policy on staffing.Methods: Literature review, oral and a questionnaire interviews were used to gather data. Participants included current members of teaching staff (of biomedical sciences and clinical disciplines) postgraduate students and visiting overseas academic staff and adjunct staff employed by the Ministry of Health at teaching hospitals.Data collected was analyzed and summarized in tabular form.Results: A PhD or equivalent is required as a minimum qualification to join academic positions at lecturer level and above at Faculty of Medicine and subsequent promotion to higher positions. There was a significant lag in promotions and recruitment in the Faculty of Medicine compared to counterparts employed by the Uganda Ministry of Health at the teaching hospitals. Participants expressed strong views that a PhD or equivalent should not be a minimum requirement nor should it be a prerequisite for promotions though it should be encouraged. Policy documents from other universities did not require a PhD or equivalent qualifications as a minimum requirement for appointment to the academic ranks of those institutions.Conclusion: Whereas it is desirable for the academic staff to acquire a PhD, it should not be a mandatory requirement. The policy was not in the best interest of the Faculty of Medicine and may not be for other medical schools to impose that requirement for appointment or promotion.University policy makers should consider schools of medicine as an exception to the policy requiring a PhD or equivalent as minimum requirement for teaching at a Medical School

Strategies from the 2000–01 Ebola outbreak in Uganda

AbstractBackgroundAn outbreak of Ebola virus disease was reported from Gulu district, Uganda, on Oct 8, 2000. Over a period of 3 months, the outbreak spread to two other parts of the country, namely Mbarara and Masindi districts. Response measures included surveillance, community mobilisation, and case and logistics management. Three coordination committees were formed: the National Task Force (NTF), the District Task Force (DTF), and the Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow-up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism, and international relations. This study documents this experience and draws lessons that are of interest to the rest of the world.MethodsThe international response was coordinated by the WHO under the umbrella organisation of the Global Outbreak and Alert Response Network. A WHO and Centers for Disease Control and Prevention case definition for Ebola was adapted and used to capture four categories of cases: alert cases, suspected cases, probable cases, and confirmed cases. Guidelines for identification and management of cases were developed and disseminated to people responsible for surveillance, case management, contact tracing, and information, education, and communication.FindingsFor the duration of the epidemic that lasted to Jan 16, 2001, 425 cases with 224 deaths were reported throughout Uganda. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12·6 cases per 10 000 inhabitants when the contacts of all cases were considered, and was 4·5 cases per 10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2·5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared free of Ebola on Feb 27, 2001, 42 days after the last case was reported. The Government's role in coordination of both local and international support was of huge importance. The NTF and the corresponding district committees worked closely in the harmonised implementation of the mutually agreed programme. Community mobilisation using community-based health workers, cultural and religious leaders, and Members of Parliament was effective in transmitting information to the public.InterpretationPast experience in epidemic management shows that, in the absence of free availability of information to the public, rumours that are unhelpful to epidemic control efforts prevail and spread quickly. During this outbreak in Uganda, rumour was managed by frank and open discussion of the epidemic, daily updates, fact sheets, and press releases. Information was regularly disseminated to communities through mass media and press conferences. Community mobilisation and transmission of information to the public was critical in controlling the epidemic. All levels of the community spontaneously demonstrated solidarity and response to public health interventions—even in areas of relative insecurity, where the number of rebel abductions dropped considerably during the outbreak.FundingNone

High Efficacy of Two Artemisinin-Based Combinations (Artesunate + Amodiaquine and Artemether + Lumefantrine) in Caala, Central Angola.

In April 2004, 137 children 6-59 months of age with uncomplicated Plasmodium falciparum (Pf) malaria (Caala, Central Angola) were randomized to receive either artemether-lumefantrine (Coartem) or artesunate + amodiaquine (ASAQ). After 28 days of follow-up, there were 2/61 (3.2%) recurrent parasitemias in the Coartem group and 4/64 (6.2%) in the ASAQ group (P = 0.72), all classified as re-infections after PCR genotyping (cure rate = 100% [95%CI: 94-100] in both groups). Only one patient (ASAQ group) had gametocytes on day 28 versus five (Coartem) and three (ASAQ) at baseline. Compared with baseline, anemia was significantly improved after 28 days of follow-up in both groups (Coartem: from 54.1% to 13.4%; ASAQ: from 53.1% to 15.9%). Our findings are in favor of a high efficacy of both combinations in Caala. Now that Coartem has been chosen as the new first-line anti-malarial, the challenge is to insure that this drug is available and adequately used

Adherence to a Six-Dose Regimen of Artemether-Lumefantrine for Treatment of Uncomplicated Plasmodium Falciparum Malaria in Uganda.

Measuring baseline levels of adherence and identifying risk factors for non-adherence are important steps before the introduction of new antimalarials. In Mbarara in southwestern Uganda, we assessed adherence to artemether-lumefantrine (Coartem) in its latest World Health Organization blister formulation. Patients with uncomplicated Plasmodium falciparum malaria were prescribed artemether-lumefantrine and received an explanation of how to take the following five doses at home. A tablet count was made and a questionnaire was completed during a home visit. Among 210 analyzable patients, 21 (10.0%) were definitely or probably non-adherent, whereas 189 (90.0%) were probably adherent. Age group was not associated with adherence. Lack of formal education was the only factor associated with non-adherence after controlling for confounders (odds ratio = 3.1, 95% confidence interval [CI] = 1.1-9.7). Mean lumefantrine blood levels were lower among non-adherent (n = 16) (2.76 microg/mL, 95% CI = 1.06-4.45) than among adherent (n = 171) (3.19 microg/mL, 95% CI = 2.84-3.54) patients, but this difference was not statistically significant. The high adherence to artemether-lumefantrine found in our study suggest that this drug is likely to be very effective in Mbarara provided that patients receive clear dosage explanations

The sonographic pattern of diseases presenting with scrotal pain at Mulago hospital, Kampala, Uganda

Background: Scrotal pain is a common presentation in the male patient. There is a wide overlap of symptoms and signs making differentiation at clinical diagnosis difficult. Ultrasound has been documented to improve the accuracy of diagnosis of scrotal diseases. This study was aimed at determining the sonographically detectable diseases in patients with scrotal pain, describe their sonographic appearances and to relate the diseases to the sociodemographic and clinical characteristics of the patients presenting at Mulago hospital.Patients and Methods: This was a Cross sectional descriptive study done at Mulago Hospital, between May 2003 and March 2004. Consecutive patients with scrotal pain referred for ultrasound evaluation and consented were scanned using an ATL HDI 1500 machine model 2000 with a 5-12 MHz linear probe.Results: Of the seventy-three patients, 19 had acute epididymitis, 19 chronic nonspecific epididymitis, 12 testicular torsion, and 7 tuberculous epididymo-orchitis diagnosed at ultrasound. The entire epididymis was more often involved and there was no significant difference in pattern of involvement in acute and tuberculous epididymitis except that the frequency of calcifications was significantly higher in tuberculous  epididymo-orchitis lesions than in those of either acute epididymitis  (p=0.0017) or chronic epididymitis (p=0.0017).Testicular torsion was more  common in adolescents and young adults. Acute epididymitis was seen in all age-groups and was associated with anomalies of the genitourinary tract at the extremes of age and sexual activity in young adults. Clinical assessment had low accuracy in diagnosis of cause of scrotal pain.Conclusion: Scrotal ultrasound gave added information in the diagnosis of patients with scrotal pain. This expedites proper patient management and reduces morbidity. Infections and testicular torsion are the commonest cause of scrotal pain at Mulago hospital. Tuberculous epididymo-orchitis is still a problem at Mulago Hospital

Learning Radiology in an Integrated Problem-Based Learning (PBL) Curriculum

Background: The Faculty of Medicine (FoM) has been training health professions in Uganda since 1924. Five years ago, it decided to change the undergraduate curriculum from traditional to Problem Based Learning (PBL) and adopted the SPICES model. Radiology was integrated into the different courses throughout the 5 year program. The objective was to improve the implementation of the integration of Radiology in the integrated PBL curriculum.Methods: This was a cross sectional descriptive study of radiologists and medical students using interviews and semi-structured questionnaires respectively.Results: Radiologists’ and students’ perceptions and opinions on Radiology training were gathered. A Radiology training rationale was developed. Learning outcomes for Radiology were defined and learning formats were chosen. Learning materials were identified and strategies to improve the implementation were formulated.Conclusions: This work has culminated into changes in Radiology integration in the curriculum and training at the FOM

Anaemia and blood transfusion in African children presenting to hospital with severe febrile illness

BACKGROUND: Severe anaemia in children is a leading cause of hospital admission and a major cause of mortality in sub-Saharan Africa, yet there are limited published data on blood transfusion in this vulnerable group. METHODS: We present data from a large controlled trial of fluid resuscitation (Fluid Expansion As Supportive Therapy (FEAST) trial) on the prevalence, clinical features, and transfusion management of anaemia in children presenting to hospitals in three East African countries with serious febrile illness (predominantly malaria and/or sepsis) and impaired peripheral perfusion. RESULTS: Of 3,170 children in the FEAST trial, 3,082 (97%) had baseline haemoglobin (Hb) measurement, 2,346/3,082 (76%) were anaemic (Hb <10 g/dL), and 33% severely anaemic (Hb <5 g/dL). Prevalence of severe anaemia varied from 12% in Kenya to 41% in eastern Uganda. 1,387/3,082 (45%) children were transfused (81% within 8 hours). Adherence to WHO transfusion guidelines was poor. Among severely anaemic children who were not transfused, 52% (54/103) died within 8 hours, and 90% of these deaths occurred within 2.5 hours of randomisation. By 24 hours, 128/1,002 (13%) severely anaemic children had died, compared to 36/501 (7%) and 71/843 (8%) of those with moderate and mild anaemia, respectively. Among children without severe hypotension who were randomised to receive fluid boluses of 0.9% saline or albumin, mortality was increased (10.6% and 10.5%, respectively) compared to controls (7.2%), regardless of admission Hb level. Repeat transfusion varied from ≤2% in Kenya/Tanzania to 6 to 13% at the four Ugandan centres. Adverse reactions to blood were rare (0.4%). CONCLUSIONS: Severe anaemia complicates one third of childhood admissions with serious febrile illness to hospitals in East Africa, and is associated with increased mortality. A high proportion of deaths occurred within 2.5 hours of admission, emphasizing the need for rapid recognition and prompt blood transfusion. Adherence to current WHO transfusion guidelines was poor. The high rates of re-transfusion suggest that 20 mL/kg whole blood or 10 mL/kg packed cells may undertreat a significant proportion of anaemic children. Future evaluation of the impact of a larger volume of transfused blood and optimum transfusion management of children with Hb of <6 g/dL is warranted. Please see related article: http://dx.doi.org/10.1186/s12916-014-0248-5. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-014-0246-7) contains supplementary material, which is available to authorized users

Supervised versus unsupervised antimalarial treatment with six-dose artemether-lumefantrine: pharmacokinetic and dosage-related findings from a clinical trial in Uganda.

BACKGROUND: A six-dose antimalarial regimen of artemether-lumefantrine (A/L) may soon become one of the most widely used drug combination in Africa, despite possible constraints with adherence and poor absorption due to inadequate nutrition, and a lack of pharmacokinetic and effectiveness data. METHODS: Within a trial of supervised versus unsupervised A/L treatment in a stable Ugandan Plasmodium falciparum transmission setting, plasma lumefantrine concentrations were measured in a subset of patients on day 3 (C [lum]day3) and day 7 (C [lum]day7) post-inclusion. Predictors of lumefantrine concentrations were analysed to show how both C [lum]day7 and the weight-adjusted lumefantrine dose affect 28-day recrudescence and re-infection risks. The implications of these novel findings are discussed in terms of the emergence of lumefantrine-resistant strains in Africa. RESULTS: C [lum]day3 and C [lum]day7 distributions among 241 supervised and 238 unsupervised patients were positively skewed. Unsupervised treatment and decreasing weight-adjusted lumefantrine dose were negatively associated with C [lum]day3. Unsupervised treatment and decreasing age showed strong negative associations with C [lum]day7. Both models were poorly predictive (R-squared < 0.25). There were no recrudescences in either arm, but decreasing lumefantrine dose per Kg resulted in up to 13-fold higher adjusted risks of re-infection. Re-infections occurred only among patients with C [lum]day7 below 400 ng/mL (p < 0.001). CONCLUSION: Maintaining the present six-dose regimen and ensuring high adherence and intake are essential to maximize the public health benefits of this valuable drug combination