Teaching and Teacher Education for Health Professionals: Perspectives on Quality and Outlook of Health Professionals Education in Zambia

Purpos: To measure students’ perspectives on the teaching quality of the school of medicine at University of Zambia and concurrently measure health professionals educators perspectives on the need for teaching courses for health professionals educators (educational skills training). The results are discussed as indications for educational skills training for educators in health professionals’ education. Method: 250 medical students from the MB ChB programme were surveyed, in an evaluation exercise, to rate the teaching contribution of all the full-time and honorary lecturers (n=88). The students were requested to rate each lecturer out of 10 on eight scales: a) attendance, b) punctuality, c) clarity, d) interest in the subject, e) supportiveness to students, f) ability as a lecturer, g) appropriate use of audiovisual aids, and h) amount of workload done in the academic year. Additionally, a multi-site study surveyed 426 health professionals educators, defined as persons who considered themselves as continually participating in teaching students in a training institutions for health professions in the Country on the necessity for and their willingness to enroll into a teaching programme for health educators. Results: Two hundred students of the eligible 250 completed the evaluation giving a response rate of 80%. The scores for teaching quality ranged from 8/ 40 to 40/40. The mean score was 32.2. The results showed that about 27.2% (n=24) did not meet the merit standard which was set at 30/40 as the quality assurance benchmark by the School. This result suggests that a large proportion of teaching staff could benefit from teacher education. Four hundred and four questionnaires were completed and returned out of the 426 that had been distributed, yielding a response rate of 94.8 %. The Cronbach’s alpha for reliability test was 0.62 – 0.70 on the teaching skills sub-scale and 0.76 – 0.78 on the Educational skills sub-scale. The majority, over 85%, acknowledged they lacked expertise in educational skills and that they would enrol in a programme to improve their educational skills. There was overwhelming (>90%) agreement in topics to be covered. Limitations: Quality of teaching contributions only measured at school of medicine; Large proportion of educators’ survey were not full-time teaching staff. Implications: The belief that professional qualifications are sufficient for preparation for teaching health professionals is now being confronted. Formal systems of teacher education in the health professions have emerged worldwide and are now also available in Zambia

Student Evaluation of Teaching: A Case Study from School of Medicine (UNZA)

Purpose: This paper presents a case study of an academic department’s experience with evaluation. The purpose is to review the impact of student evaluation of teaching. The paper also introduces a new evaluation scoring method: the University of Zambia Staff Appraisal System (UNZASAS) method. Method: Anonymous 5-point Likert scale evaluation rating forms were administered to 134 third-year medical students in two consecutive years to measure students’ perceptions of teaching quality of four faculty members in an academic department at School of Medicine. The rating forms were scored using the UNZASAS method. Results: The response rate averaged 83%. The group average lecturer rating improved from 120 to 141.5. Individual performance of three lecturers improved while that of one declined. The UNZASAS method was effective in summarizing data to identify the areas of weakness and strength in the faculty members. The specificity and sensitivity of this method were fundamental to its success as a diagnostic tool for formative evaluation of teaching quality. Conclusions & Implications: The quality of teaching in the academic department improved after evaluation of teaching was introduced. The UNZASAS method proved to be an effective tool for scoring evaluation data and for providing faculty with useful and specific formative feedback. Health professionals training institutions can consider using the UNZASAS method for their evaluation of teaching contribution by educators

The Case Anatomical Knowledge Index (CAKI) as a Tool for Selecting Clinical Cases for Clinically Oriented Anatomy Teaching: Approach and Content

No Abstract Key Words: Anatomy, Case Anatomical Knowledge Index (CAKI), Clinical, Clinically Oriented Anatomy Teaching (COAT), Case, Disease, Prevalenc

An Investigation of How Clinicians use Anatomical Knowledge in Diagnostic Reasoning: A Grounded Theory Study of Clinicians in Zambia

Background: The role of biomedical sciences in diagnostic reasoning is contentious but diagnostic reasoning is a principal activity in clinical settings. Such ambiguity creates a tension for medical educators who use clinically oriented anatomy teaching.Purposes: The aim of this paper is to contribute to the debate in the literature via a novel grounded theory about use of anatomy in diagnostic reasoning.Methods: Systematic grounded theory procedures were used to collect data using forty-six weeks-long participant observations, self-administered questionnaires from 168 respondents (140 doctors and 28 medical students at UTH), and unstructured interviews with doctors working in hospitals.Results: Use of anatomy in diagnostic reasoning is a 5-stage cognitive process: patient information data gathering; ascribing the information gathered to anatomical descriptors; interpretation; anatomical representation of the clinical circumstances; and diagnosis.Conclusion: Use of anatomy in diagnostic reasoning is a 5-stage cognitive process: patient information data gathering; ascribing the information gathered to anatomical descriptors; interpretation; anatomical representation of the clinical circumstances; and diagnosis. The conceptual model presented provides a framework for future research and comparison with existing theories. Keywords: Anatomy, Diagnostic Reasoning, Grounded Theory, Clinically Oriented Anatomy Teachin

A Review of Outcome of Postgraduate Medical Training in Zambia

The University of Zambia School of Medicine was opened in 1966. Since inception, over 1200 undergraduate students have graduated with Bachelor of Medicine and Bachelor of Surgery. The postgraduate Master of Medicine (M.Med)programme was started in 19822 with the intention of providing district specialists in the rural and semi urban communities of Zambia. Additional hope was to stem the brain drain to other countries. This is a study to describe the deployment of graduates of the M.Med training programs at the University of Zambia School Of Medicine in relation to the objectives defined by the University of Zambia senate in 1981. It was found that the School of Medicine has produced 118 Master of Medicine graduates in 5 clinical programs over a period of 22 years. The average graduation rate is 5 students per annum. The largest specialist group has been in General surgery with 34 (29% ) of all graduates. The ratio of men to women was 3 to 1. The ratio of Zambian to Non Zambian ratio was 10:1. Of all students who have graduated over this period 13 (11%) have gone abroad and 7(6%) have died., Eighty-eight (75%) of the graduates are working along the line of rail in the 5 most urbanized towns in the country. Twenty-five ( 21%) are doing non clinical jobs which involve health programs administration and 12 (10%) are working in private practice. We concluded that external migration is not a major problem and, overall, the creation of a local postgraduate training program has reduced brain drain. The key challenge is internal brain drain

'Kids sold, desperate moms need cash': Media representations of Zimbabwean women migrants

The article draws on 575 randomly selected articles from the South African Media database to explore the representation of Zimbabwean women migrants. Using critical discourse analysis (CDA), the article shows that some of the dominant construction types depict a picture of caricatured, stereotypical and stigmatised Zimbabwean migrant women without voice and individuality. In turn, the diversity of their actualities is not captured in the process of constructing the twin images of Zimbabwean women as victims and as purveyors of decadent and other negative social ills in society. We conclude that Zimbabwean women migrants appear in the SA media primarily in three negative images: suppliers of sexual services, as un-motherly, and as victims. We also conclude that there is need for media to capture the voices of migrant women recounting their everyday lived experiences in different political and socio-economic contexts in order to account for the migrant women's voices of resilience, defiance and victimhood and of agency, against the normalising and marginalising influences of political institutions and national border controls. This would also help capture the transformative nature of migration to the women, the 'home' in Zimbabwe and the 'home' in South Africa.IS

Comparison of treatment outcomes of new smear-positive pulmonary tuberculosis patients by HIV and antiretroviral status in a TB/HIV clinic, Malawi

Background: Smear-positive pulmonary TB is the most infectious form of TB. Previous studies on the effect of HIV and antiretroviral therapy on TB treatment outcomes among these highly infectious patients demonstrated conflicting results, reducing understanding of important issues. Methods: All adult smear-positive pulmonary TB patients diagnosed between 2008 and 2010 in Malawi's largest public, integrated TB/HIV clinic were included in the study to assess treatment outcomes by HIV and antiretroviral therapy status using logistic regression. Results: Of 2,361 new smear-positive pulmonary TB patients, 86% had successful treatment outcome (were cured or completed treatment), 5% died, 6% were lost to follow-up, 1% failed treatment, and 2% transferred-out. Overall HIV prevalence was 56%. After adjusting for gender, age and TB registration year, treatment success was higher among HIV-negative than HIV-positive patients (adjusted odds ratio 1.49; 95% CI: 1.14-1.94). Of 1,275 HIV-infected pulmonary TB patients, 492 (38%) received antiretroviral therapy during the study. Pulmonary TB patients on antiretroviral therapy were more likely to have successful treatment outcomes than those not on ART (adjusted odds ratio: 1.83; 95% CI: 1.29-2.60). Conclusion: HIV co-infection was associated with poor TB treatment outcomes. Despite high HIV prevalence and the integrated TB/HIV setting, only a minority of patients started antiretroviral therapy. Intensified patient education and provider training on the benefits of antiretroviral therapy could increase antiretroviral therapy uptake and improve TB treatment success among these most infectious patients. © 2013 Tweya et al

Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings

BACKGROUND AND AIMS: There a shortage of robust information about profiles of gastrointestinal disease in sub-Saharan Africa. The endoscopy unit of the University Teaching Hospital in Lusaka has been running without interruption since 1977 and this 38-year record is largely intact. We report an analysis of endoscopic findings over this period. METHODS: Written endoscopy records from 29th September 1977 to 16th December 2014 were recovered, computerised, coded by two experienced endoscopists and analysed. Temporal trends were analysed using tables, graphs, and unconditional logistic regression, with age, sex of patient, decade, and endoscopist as independent variables to adjust for inter-observer variation. RESULTS: Sixteen thousand nine hundred fifty-three records were identified and analysed. Diagnosis of gastric ulcer rose by 22 %, and that of duodenal ulcer fell by 14 % per decade. Endoscopically diagnosed oesophageal cancer increased by 32 % per decade, but gastric cancer rose only in patients under 60 years of age (21 % per decade). Oesophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group. Two HIV-related diagnoses, oesophageal candidiasis and Kaposi’s sarcoma, rose from almost zero to very high levels in the 1990s but fell substantially after 2005 when anti-retroviral therapy became widely available. CONCLUSIONS: This useful dataset suggests that there are important trends in some endoscopic findings over four decades. These trends are not explained by inter-observer variation. Reasons for the divergent trends in incidence of peptic ulceration and apparent trends in diagnosis of upper gastrointestinal cancers merit further exploration

Determinants of high residual post-PCV13 pneumococcal vaccine-type carriage in Blantyre, Malawi:a modelling study

Background In November 2011, Malawi introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into the routine infant schedule. Four to 7 years after introduction (2015–2018), rolling prospective nasopharyngeal carriage surveys were performed in the city of Blantyre. Carriage of Streptococcus pneumoniae vaccine serotypes (VT) remained higher than reported in high-income countries, and impact was asymmetric across age groups. Methods A dynamic transmission model was fit to survey data using a Bayesian Markov-chain Monte Carlo approach, to obtain insights into the determinants of post-PCV13 age-specific VT carriage. Results Accumulation of naturally acquired immunity with age and age-specific transmission potential were both key to reproducing the observed data. VT carriage reduction peaked sequentially over time, earlier in younger and later in older age groups. Estimated vaccine efficacy (protection against carriage) was 66.87% (95% CI 50.49–82.26%), similar to previous estimates. Ten-year projected vaccine impact (VT carriage reduction) among 0–9 years old was lower than observed in other settings, at 76.23% (CI 95% 68.02–81.96%), with sensitivity analyses demonstrating this to be mainly driven by a high local force of infection. Conclusions There are both vaccine-related and host-related determinants of post-PCV13 pneumococcal VT transmission in Blantyre with vaccine impact determined by an age-specific, local force of infection. These findings are likely to be generalisable to other Sub-Saharan African countries in which PCV impact on carriage (and therefore herd protection) has been lower than desired, and have implications for the interpretation of post-PCV carriage studies and future vaccination programs.</p