The experience of Armenian family medicine residents with participatory learning methods in rural health centres

Introduction: The Family Medicine residency program in Armenia relies on traditional teacher- centred and didactic learning methods. The program is largely classroom based. Learning through contact with patients is limited. The Children of Armenia Fund has been active in medical education since 2010. It has provided educational support for family doctors and nurses in medical centres and hosted family medicine residents. In July 2016, family physician partners of COAF worked alongside the COAF educational supervisor to provide residents more active methods of learning combined with practical teaching in clinics, a combination which was called participatory learning. Method: A two-day seminar for the family medicine residents was designed to include structured patient contact and active classroom learning methods. The program had three components: structured clinical teaching in family medicine clinics, group case presentations, and problem based learning. Participants’ experience was evaluated through a focus group discussion led by an independent researcher. Results: Five main themes emerged from the focus group: a feeling of responsibility; the opportunity to practice and receive feedback; the merger of theory and practice; the benefits of small group and problem-based learning; and evidence-based medicine. The findings concord with existing research on the benefits of active learning and resident-patient contact: increase in motivation and engagement of residents during their training. The unexpected finding was the ease and enthusiasm with which residents adapted and valued the novel approach. Discussion: Active learning methods have been shown to improve performance in assessments. Although unaccustomed to participatory learning methods, this group of family medicine residents in Armenia were immediately appreciative of the approach. This has implications for family medicine training in Armenia. More student-centred, active learning methods and practical teaching with patients is likely to be acceptable to residents

Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study

Abstract Background The COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia. Methods We employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges. Results The number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public’s fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic. Conclusions The COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies