Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital

<p>Abstract</p> <p>Background</p> <p>Mulago National Referral Hospital (MNRH), Uganda’s primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH.</p> <p>Methods</p> <p>Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis.</p> <p>Results</p> <p>Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.</p> <p>Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills.</p> <p>Conclusions</p> <p>Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.</p

Prevalence and psychopathological characteristics of depression in consecutive otorhinolaryngologic inpatients

<p>Abstract</p> <p>Background</p> <p>High prevalence of depression has been reported in otorhinolaryngologic patients (ORL). However, studies using a semi-structured interview to determine the prevalence of depression in ORL are lacking. Therefore the present study sought to determine the depression prevalence in ORL applying a semi-structured diagnostic interview and to further characterize the pathopsychological and demographic characteristics of depression in these patients.</p> <p>Methods</p> <p>One-hundred inpatients of the otorhinolaryngologic department of a German university hospital participated voluntarily (age M = 38.8 years, SD = 13.9; 38.0% female). Depression was assessed using a clinical interview in which the International Diagnostic Checklist for depression (IDCL) was applied. Patients completed the Brief Symptom Inventory (BSI) which constitutes three composite scores and nine symptom scales and the Beck Depression Inventory (BDI). Multivariate analyses of variance, correlations and effect sizes were conducted.</p> <p>Results</p> <p>A prevalence of depression of 21.0% was determined, 38.0% of the depressed patients were female. Depressed patients showed higher scores on the BSI-scales "interpersonal sensitivity", "depression", "anxiety", "phobic anxiety" and "psychoticism" with medium effect sizes.</p> <p>Conclusions</p> <p>High prevalence of depression was found which is in accordance with results of prior studies. Depressed patients showed higher psychological distress as compared to non-depressed patients. The results call for carrying on in engaging in depression research and routine depression screening in ORL.</p

A theoretical framework to describe communication processes during medical disability assessment interviews

BACKGROUND: Research in different fields of medicine suggests that communication is important in physician-patient encounters and influences satisfaction with these encounters. It is argued that this also applies to the non-curative tasks that physicians perform, such as sickness certification and medical disability assessments. However, there is no conceptualised theoretical framework that can be used to describe intentions with regard to communication behaviour, communication behaviour itself, and satisfaction with communication behaviour in a medical disability assessment context. OBJECTIVE: The objective of this paper is to describe the conceptualization of a model for the communication behaviour of physicians performing medical disability assessments in a social insurance context and of their claimants, in face-to-face encounters during medical disability assessment interviews and the preparation thereof. CONCEPTUALIzATION: The behavioural model, based on the Theory of Planned Behaviour (TPB), is conceptualised for the communication behaviour of social insurance physicians and claimants separately, but also combined during the assessment interview. Other important concepts in the model are the evaluation of communication behaviour (satisfaction), intentions, attitudes, skills, and barriers for communication. CONCLUSION: The conceptualization of the TPB-based behavioural model will help to provide insight into the communication behaviour of social insurance physicians and claimants during disability assessment interviews. After empirical testing of the relationships in the model, it can be used in other studies to obtain more insight into communication behaviour in non-curative medicine, and it could help social insurance physicians to adapt their communication behaviour to their task when performing disability assessment

Nuevo profesionalismo, educación médica y sistemas de salud New professionalism, medical education and healthcare systems

El propósito de este artículo es discutir de qué modo el denominado "nuevo profesionalismo" puede ayudar a que la educación de los médicos se haga teniendo en cuenta los efectos de la globalización tanto sobre la situación de salud como sobre las necesidades de profesionales sanitarios, con particular énfasis en los países de la Unión Europea los cuales están inmersos en un profundo proceso de reforma de sus enseñanzas universitarias. Para ello, en primer lugar se presentan los conceptos básicos del "nuevo profesionalismo" y de las estrategias fundamentales de la educación médica actual que trata de formar médicos capaces de afrontar los retos éticos, científicos y profesionales que se plantean a comienzos del presente siglo. A continuación, se insiste en la interdependencia de las reformas del pregrado, del posgrado y de la formación continuada. Se plantean luego los retos y dificultades que han de afrontarse a la hora de cambiar las distintas etapas de la educación médica. Y se concluye que, pese a lo reciente de las reformas de la educación médica, a su gran complejidad, y a la todavía escasa disponibilidad de evaluaciones contrastadas sobre sus resultados, existen fuertes sinergias entre los principios y valores del "nuevo profesionalismo" y los objetivos de las reformas.<br>The scope of this paper is to discuss how so-called "new professionalism" can help in how the education of physicians is conducted, by taking into account the effects of globalization both on the situation of health and on the needs of health professionals with particular emphasis on European Union countries, which are engaged in a profound process of reform in university education. To achieve this, first we present the basic concepts of "new professionalism" and the key strategies of current medical education, which is to train physicians capable of dealing with ethical, scientific and professional challenges that are arising at the beginning of this century. The interdependence of reforms in the undergraduate, graduate and ongoing training areas is then emphasized. The challenges and difficulties to be faced when switching to different stages of medical education are then outlined. It was concluded that, notwithstanding recent reforms in medical education, their great complexity and the still limited availability of contrasting assessments of their results, there are strong synergies between the principles and values of the "new professionalism" and the objectives of the reforms