Effectiveness and Key Success Factors for Implementation of Problem-Based Learning in Debre Tabor University: A Mixed Methods Study

BACKGROUND፡ Problem-based learning has been adopted as a core educational strategy for education of health professionals in more than a dozen of higher education institutions in Ethiopia. Debre Tabor University College of Health Sciences (DTUCHS) is one of the adopters. However, its effectiveness has not been researched yet. Thus, the objective of this study is to assess the quality of PBL implementation, its effectiveness in developing desired student learning outcomes and factors that facilitate or impede PBL implementation.METHODS: A cross-sectional study was conducted in DTUCHS from May to June 2018. We collected quantitative data from students and tutors using self-administered questionnaire. We complemented this with key informant interviews with academic leaders. We computed descriptive statistics from quantitative data while qualitative data were subjected to thematic analysis.RESULTS: A total of 308 students, 42 tutors and 8 academic leaders were included in the study. Students, tutors and academic leaders perceived that PBL was effective in developing knowledge, problem-solving skills, self-directed learning skills and collaboration competencies. The implementation process showed the existence of clear objectives, appropriate cases, and reasonable workload. Students rated tutors' performance positively, and tutors also rated student learning affirmatively. However, unlike tutors, students thought that the assessment of student performance in PBL was not appropriate. The factors that facilitated PBL implementation were students' and tutors' buy-in, clear curriculum design, adequate infrastructure, commitment to hire more faculty and develop their teaching skills continuously and strong coordination and monitoring.CONCLUSION: The findingsof our study support the introduction of PBL in a resource-constrained setting. Students, tutors and academic leaders perceived PBL to be effective in achieving desired student learning outcomes. Its implementation was considered consistent with the principles of PBL. Respondents identified the presence of enabling factors to implement PBL in Debre TaborUniversity (DTU)

Assessment of clinical competence of graduating medical students and associated factors in Ethiopia

BACKGROUND: Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors.METHODS AND MATERIALS: A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value &lt; 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores.RESULTS: Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture.CONCLUSIONS: Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates' licensing examinations is also a way forward.</p

Assessment of clinical competence of graduating medical students and associated factors in Ethiopia

BACKGROUND: Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors.METHODS AND MATERIALS: A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value &lt; 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores.RESULTS: Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture.CONCLUSIONS: Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates' licensing examinations is also a way forward.</p

Developing core competencies for the public health workforce in Ethiopia: The way forward

Background: Preparing the public health workforce for the 21st century is a formidable task as public health professionals are expected to address the myriad of political and economic development challenges in the context of limited resources. In spite of achieving most MDGs, the Ethiopian ‘health system’ continues to face complex and daunting tasks. Method: Available studies that outlined requirements for competent, motivated and empowered workforce in a rapidly evolving global order were reviewed and synthesized without following a formal review procedure. Result: Although it is not easy, in view of the available evidence, this synthesis provided the Way Forward to ascertain competencies of the public workforce in Ethiopia. Specific details on adopting and sharing competencies; promoting the development of a philosophy and definition of public health; promoting the development of a public health workforce taxonomy; promoting research to inform the design and implementation of reforms; curriculum development; learning materials development; strengthening continuing professional development (CPD); monitoring and evaluation; and setting up a follow-up mechanism for the long-term were defined. Conclusion: This synthesis has suggested clear guidance on how and who may have to track, adapt, share, and updates public health core competencies in Ethiopia. [Ethiop.J. Health Dev. 2020;34(Special issue 1):25-33

Practice analysis to validate Master of Public Health core competencies and identify education gaps in Ethiopia: a national cross-sectional study

Introduction: Competency-based education has the potential to transform education and health outcomes. The taskforce for strengthening public health education drafted core competencies for Master of Public Health (MPH) education in Ethiopia. This study aims to validate the draft MPH core competencies and identify education gaps. Methods: A national cross-sectional survey was conducted in 2015 with public health professionals who hold an MPH degree. The required sample size was calculated using a single population proportion formula. Study participants were selected from the different regions using a convenience sampling technique. They were asked to make judgments about the 127 draft competencies organized in 11 domains. For each competency statement, respondents answered four basic questions: 1) How important is the accurate and timely performance of the competency on population health outcomes? 2) How often do you perform the task? 3) How comfortable are you in performing the task? 4) When and where were you trained to perform the task? We collected data using a self-administered questionnaire. Data analysis involved calculating proportions for each competency, followed by generating an average percentage for each competency domain. Results: A total of 350 public health professionals from academia and practice participated in the study. Over 90% of respondents said that the draft public health core competencies were important for improving population health outcomes. More than one-third of the respondents indicated they performed the public health competencies rarely. A further 8.3% to 27.6% said they had never performed the public health competencies in their career. Although most respondents said they were competent, one-sixth to one quarter admitted a lack of capability in the domains of financial planning and management, cultural competence, policy and program, leadership and systems thinking, and education and training. Pre-service education was the most frequent setting for learning public health competencies. However, between one quarter and one third did not have any opportunity to learn some competencies, especially in the domains of cultural competence, financial planning and management, leadership and systems thinking, policy and program, communication skills, and education and training. Public health competency domains with high ‘not trained’ responses also drew high ‘not capable’ and high ‘never performed’ responses. Conclusions: The draft MPH core competencies are applicable to Ethiopia. The substantial education gaps found in our study warrant re-designing the MPH curriculum. [Ethiop. J. Health Dev. 2020; 34(Special issue 1):16-24] Keywords: Master of Public Health (MPH); essential competencies; postgraduate education; public health; competence gap

Gaps in public health training in Ethiopia: Insights from a qualitative study

Background: The challenges public health encounters in the 21st century in relation to social, economic, political and climatic dynamism are widely documented. Endeavors are under way at different levels to contain the challenges and ensure healthy living. However, the extent to which public health training is aligned with the demands of the century remains unclear. This study aims to explore efforts made by public health training institutions in Ethiopia to equip public health professionals with competencies that meet contemporary expectations, gaps and suggestions. Methods: Sixteen public health experts who hold advisory and decision-making positions in the public health sector, local and international development partners and public health training institutions of higher learning were purposively selected to participate in the study. A key informant interview technique was employed to collect data on what are perceived to be the gaps in public health graduates’ competencies, and suggested improvements. A topic guide was developed to elicit the competences of graduates, identify gaps in their competences, and extract suggestions on how to fill those gaps so as to contribute to the development of public health endeavours. Interviews were held at a time and place of convenience for the experts. Data collected were categorized under key themes: training, research, and future directions. Under each of these themes, knowledge and skills on leadership and management, community practice, design and conduct of problem-solving research were specified to compile and interpret the data. Efforts were made to faithfully represent the opinion of participants, and verbatim quotes of dominant opinions were collected without identifiers. Findings: There were four participants from training institutions, seven from public sector organizations, and five from development partners. The findings reveal the limitations of graduates to be able to take up public health functions. It was unanimously agreed that irrespective of the level of training, graduates need time to acquaint themselves with what is expected of them as a professional. It was found that public health graduates at master’s and PhD level failed to fit into the existing system fast enough to take on leadership responsibilities. Participants unanimously argued that public health training encounters major challenges in empowering students with the necessary knowledge and skills to meet contemporary public health challenges. The problem of a curriculum that does not change in line with changing public health needs, the lack of competence of teaching staff, lack of contemporary references, and lack of time and money to engage students in community practice, were identified as major drawbacks in training. The fact that the curricula of the different schools of public health were adapted from the same sources and has not been revised to fit the demands of the day was particularly emphasized by participants from universities. Students’ skill in planning and conducting problem-solving research, and skills to mobilize and engage the community to recognize and solve their own problems, were reported as limited, irrespective of the level of training and management. Conclusions: Public health training in Ethiopia is perceived to have major limitations, particularly where graduates, irrespective of their level of training, fail to contribute to public health functions. Curricula are not revised to meet current demands. This calls for concerted action by the education and health sectors and like-minded stakeholders to improve the curricula for the different levels of training in public health education. [Ethiop.J. Health Dev. 2020; 34(Special issue 1):4-10] Keywords: Public health training, public health competencies, community practice, problem-solving researc

Issues in the definition and philosophy of public health in relation to core competencies

Introduction There are various definitions of ‘public health’, as it operates under different and sometimes conflicting skill sets, finance models, professional paradigms, legal authorities, and political environments. Official documents in Ethiopia do not attempt to give a formal definition of the term. A collective deliberation and position on these issues are therefore required. Method A rapid review of documents was undertaken to define ‘public health’, in order to help guide the preparation of core competencies for public health training in Ethiopia. Philosophical, theoretical, and programmatic materials were also reviewed. Findings and conclusions: The review reveals that various definitions of ‘public health’ persist and the situation is even worse in the neglected and even more controversial field of the philosophy of public health, whose complexity almost implies addressing the philosophy of everything. This is compounded by the quasi-absence of units/departments of public health philosophy and public health journals. The impact of this in the development of more impactful human resources for public health should not be underestimated. Even though public health will always be judged by what happens in practice, the better-developed schools of public health in Ethiopia are called upon to develop mechanisms to articulate a philosophy of public health for the country. [Ethiop. J. Health Dev. 2020;34(Special issue 1):34-38

Assessment of clinical competence of graduating medical students and associated factors in Ethiopia

BACKGROUND: Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors.METHODS AND MATERIALS: A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value &lt; 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores.RESULTS: Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture.CONCLUSIONS: Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates' licensing examinations is also a way forward.</p

Development and use of a scale to assess gender differences in appraisal of mistreatment during childbirth among Ethiopian midwifery students

Mistreatment during childbirth occurs across the globe and endangers the well-being of pregnant women and their newborns. A gender-sensitive approach to mistreatment during childbirth seems relevant in Ethiopia, given previous research among Ethiopian midwives and patients suggesting that male midwives provide more respectful maternity care, which is possibly mediated by self-esteem and stress. This study aimed a) to develop a tool that assesses mistreatment appraisal from a provider's perspective and b) to assess gender differences in mistreatment appraisal among Ethiopian final-year midwifery students and to analyze possible mediating roles of self-esteem and stress. First, we developed a research tool (i.e. a quantitative scale) to assess mistreatment appraisal from a provider's perspective, on the basis of scientific literature and the review of seven experts regarding its relevance and comprehensiveness. Second, we utilized this scale, the so-called Mistreatment Appraisal Scale, among 390 Ethiopian final-year midwifery students to assess their mistreatment appraisal, self-esteem (using the Rosenberg Self-Esteem Scale), stress (using the Perceived Stress Scale) and various background characteristics. The scale's internal consistency was acceptable (α = .75), corrected item-total correlations were acceptable (.24 - .56) and inter-item correlations were mostly acceptable (.07 - .63). Univariable (B = 3.084, 95% CI [-.005, 6.173]) and multivariable (B = 1.867, 95% CI [-1.472, 5.205]) regression analyses did not show significant gender differences regarding mistreatment appraisal. Mediation analyses showed that self-esteem (a1b1 = -.030, p = .677) and stress (a2b2 = -.443, p = .186) did not mediate the effect of gender on mistreatment appraisal. The scale to assess mistreatment appraisal appears to be feasible and reliable. No significant association between gender and mistreatment appraisal was observed and self-esteem and stress were not found to be mediators. Future research is needed to evaluate the scale's criterion validity and to assess determinants and consequences of mistreatment during childbirth from various perspectives

Risk Factors for Positive Appraisal of Mistreatment during Childbirth among Ethiopian Midwifery Students

The maternal mortality ratio and neonatal mortality rate remain high in Ethiopia, where few births are attended by qualified healthcare sta. This is partly due to care providers’ mistreatment of women during childbirth, which creates a culture of anxiety that decreases the use of healthcare services. This study employed a cross-sectional design to identify risk factors for positive appraisal of mistreatment during childbirth. We asked 391 Ethiopian final year midwifery students to complete a paper-and-pen questionnaire assessing background characteristics, prior observation of mistreatment during education, self-esteem, stress, and mistreatment appraisal. A multivariable linear regression analysis indicated age (p = 0.005), stress (p = 0.019), and previous observation of mistreatment during education (p 0.001) to be significantly associated with mistreatment appraisal. Younger students, stressed students, and students that had observed more mistreatment during their education reported more positive mistreatment appraisal. No significant association was observed for origin (p = 0.373) and self-esteem (p = 0.445). Findings can be utilized to develop educational interventions that counteract mistreatment during childbirth in the Ethiopian context