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 < 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.

Assessment of core teaching competency of health professional educators in Ethiopia: an institution-based cross-sectional study.

OBJECTIVES: Understanding the competency of educators is key to informing faculty development, recruitment and performance monitoring. This study aimed to assess the core teaching competency of nursing, midwifery and biomedical educators, and associated factors in Ethiopia. DESIGN: An institution-based cross-sectional study was conducted in January 2020 using structured tools adapted from the WHO's nurse and midwifery educator competency frameworks. SETTING: Two health science colleges and nine student practice sites in Ethiopia. PARTICIPANTS: All classroom instructors and clinical preceptors of nursing, midwifery and biomedical technician training programmes, and all the graduating class students. MEASURES: Overall teaching competency scores, teaching domain competency scores, competency gaps and performance gaps of educators were outcome measures. Past training on teaching skills courses, teaching experiences and sociodemographic characteristics of educators are associated factors. RESULTS: Most educators were not trained in teaching methods (82%). The teaching competency scores of classroom instructors and clinical preceptors were 61.1% and 52.5%, respectively. Competency gaps were found in using active learning methods, performance assessment, feedback and digital learning. Professional background of classroom instructors had a significant and strong association with their competency score (p=0.004; V=0.507). Age and teaching experience of clinical preceptors had significant associations with their competency score (p=0.023 and p=0.007, respectively) and had strong associations (V=0.280 and 0.323, respectively). Sex of students and their perceptions of how well the educators give education resources had a significant and strong association (p<0.001; V = 0.429). CONCLUSIONS: Nursing, midwifery and biomedical educators lacked the competency to undertake important teaching roles, which could contribute to the low quality of education. More attention should be given to strengthening faculty development.

Physicians' satisfaction with clinical laboratory services at public hospitals in Ethiopia: A national survey.

INTRODUCTION: Physician is a central figure in the client list of clinical laboratory. Monitoring physicians' satisfaction with laboratory service is an important indicator of the quality management system and required by international laboratory standards. However, there is no national data on physician satisfaction with laboratory services in Ethiopia. Therefore, the aim of this national survey was to assess satisfaction level of physicians with laboratory services at public hospitals in Ethiopia. METHODS: Institutional based cross-sectional study design was employed from November 1-30/2017. A total of 327 physicians were randomly selected from 60 public hospitals from all regions of Ethiopia. Data was collected using pre-tested self-administered questionnaire and analyzed with SPSS version 23 software. Logistic regression model was fitted to identify predictors of physician satisfaction with laboratory services. A p-value of less than 0.05 was taken as statistically significant. RESULTS: Overall, 55% of physicians were satisfied with the clinical laboratory services. More than half of the physicians were satisfied with the existing laboratory request form (69%), legibility and completeness of laboratory report (61%), notification of new test (78%) and test interruption (70%). On the other hand, many physicians were dissatisfied with the absence of laboratory hand book (87.5%), the existing test menu (68%), lab-physician interface (62%), availability of referral and/or back up service (62%), notification of Turn Around Time (TAT) (54%), timely notification of panic result (55%), long TAT (33.1%), provision of urgent service (67%), and timely advisory service (57%). Most of the physicians perceived that consistent quality of service was not delivered at all working shifts (71%). At 5% level of significance, we did not find enough evidence to conclude that sex, age, marital status, education level, and experience were statistically associated with physician satisfaction (p-values > 0.05). CONCLUSION: This national survey revealed nearly half of the physicians were unsatisfied with laboratory service at public hospitals in Ethiopia, which mainly related to lack of adequate test menu, laboratory hand book, on time notification of panic result, provision of urgent service, timely advisory service, delivery of quality services in all working shifts and weak lab-physician interface. Therefore, hospital management should address the gaps and improve the needs of physicians for better patient health care. In addition, laboratories should evaluate and monitor physician satisfaction level at regular interval.

Patients' satisfaction with clinical Laboratory Services in Public Hospitals in Ethiopia.

BACKGROUND: Knowing customers' level of satisfaction is relevant to improve and provide quality health care services. In the clinical laboratory, monitoring customers' satisfaction is an important indicator of the quality management system and required by international laboratory standards. However, in Ethiopia, there has not been baseline data about the satisfaction level of patients' with laboratory services at the national level. The aim of this national level survey was to assess patients' satisfaction level with laboratory services at public hospitals in Ethiopia. METHODS: A national survey was conducted using an institutional based cross-sectional study design was employed from 01 to 30 November 2017. A total of 2399 patients were selected randomly from 60 public hospitals. Data was collected using structured questionnaire, entered in Epi Info and analyzed with SPSS software. Multiple logistic regression model was fitted to identify predictors of patients' satisfaction with laboratory services. A p-value of less than 0.05 was taken as statistically significant. RESULT: Overall, 78.6% of the patients were satisfied with the clinical laboratory services. Patients were dissatisfied with cleanness of latrine (47%), long waiting time (30%), clear and understandable advisory service during specimen collection (26%), adequacy of waiting area (25%), easy accessibility of laboratory (19%) and latrine location (20%), availability of requested service (18%), unfair payment of service (17%) and missing of result (12%). The educational status (P = 0.032), and distance (P = 0.000) were significantly associated with client overall satisfaction level. CONCLUSION: Most laboratory patients' were satisfied with the service provided by public hospital laboratories in public hospitals in Ethiopia. However, patients' were dissatisfied with the accessibility of sites, adequacy of waiting area, cleanness of latrine, long TAT, communication, missing of results, availability of requested service and cost of service. Therefore, responsible bodies in each level should act on the identified gaps and improve the need of patients in each hospital laboratory. In addition, all hospital laboratories should conduct a satisfaction survey and meet the needs of laboratory patients.

Exploring health workforce regulation practices and gaps in Ethiopia: a national cross-sectional study.

BACKGROUND: Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system. In 2010, Ethiopia established a national authority aiming to ensure competence and ethics of health professionals. Subsequently, subnational regulators were established and regulatory frameworks were developed. Although there were anecdotal reports of implementation gaps, there was lack of empirical evidence to corroborate the reports. We conducted a national study to explore health professional regulation practices and gaps focusing on registration, licensing, ethics, scope of practice, and continuing professional development. METHODS: We conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers. We used two stage stratified cluster sampling to select health professionals. The quantitative data were subjected to descriptive and multivariable logistic regression analysis. We conducted thematic analysis of the qualitative data. RESULTS: We interviewed 554 health professionals in the quantitative survey. And 31 key informants participated in the qualitative part. Nearly one third of the respondents (32.5%) were not registered. Many of them (72.8%) did not renew their licenses. About one fifth of them (19.7%) did nothing against ethical breaches encountered during their clinical practices. Significant of them ever practiced beyond their scope limits (22.0%); and didn't engage in CPD in the past 1 year (40.8%). Majority of them (97.8%) never identified their own CPD needs. Health regulators and managers stressed that regulatory bodies had shortage of skilled staff, budget and infrastructure to enforce regulation. Regulatory frameworks were not fully implemented. CONCLUSIONS: Health professionals were not regulated well due to limited capacity of regulators. This might have affected quality of patient care. To ensure effective implementation of health professional regulation, legislations should be translated into actions. Draft guidelines, directives and tools should be finalized and endorsed. Capacity of the regulators and health facilities needs to be built. Reinstituting health professionals' council and regulation enforcement strategies require attention. Future studies are recommended for assessing effects and costs of weak regulation.

Practice analysis of junior doctors in Ethiopia: implications for strengthening medical education, practice and regulation.

BACKGROUND: A high performing physician workforce is critical to attain nationally set health sector goals. Ethiopia has expanded training of medical doctors. However, little is known about junior doctors' performance. Understanding medical practice is essential to inform medical education and practice, establish licensure examination and guide workforce management decisions. We conducted a practice analysis study to identify gaps in Ethiopian medical education and practice, and to determine composition of subjects in national licensing examination. METHODS: We conducted a cross-sectional study with national representative sample of junior doctors. After calculating a sample size of 198, we used a two-stage stratified cluster sampling method to select study participants. We collected data using a structured questionnaire comprising 222 tasks. Study participants reported in interviews on frequency of, competence at, and importance of doing each task for improved health outcome. We developed proportions, averages, graphs and tables. Using the results of practice analysis and experts' ratings, relative weights of subjects in the national licensing examination for medical undergraduates were determined. RESULTS: A total of 191 junior doctors participated. Most were males (74.6%) and had less than 2 years of experience (69.8%). Junior doctors frequently performed tasks of internal medicine and pediatrics. Their participation in obstetrics and gynecology, ophthalmology, psychiatry and dentistry services was infrequent. Junior doctors had competency gaps to conduct clinical procedures, research and health programming tasks. Practice analysis results and expert ratings generated comparable recommendations for composition of a national licensing examination, with more than three-quarters of the items focusing on internal medicine, pediatrics, surgery, obstetrics and gynecology, and public health. CONCLUSION: Junior doctors in Ethiopia rarely managed psychiatry, ophthalmology and dental patients. They had competence gaps in clinical procedures, research and health programming skills. The findings have implications for establishing licensing examination, and reviewing curriculum, continuing professional development, placement and rotation policy, and distribution of responsibilities.

Misdiagnosis of pulmonary tuberculosis and associated factors in peripheral laboratories: a retrospective study, Addis Ababa, Ethiopia.

OBJECTIVE: Sputum smear microscopy reading errors are likely to result in failure to detect persons with infectious TB. This study was intended to review misdiagnosis of pulmonary TB and associated factors in peripheral laboratories. RESULTS: During the study period 1033 (10.5%) sputum smear positive and 8783 (89.5%) smear negative slides were reported by peripheral laboratories. The slides were re-read by the central referral laboratories (CRLs) as the reference standard reading. Of 1033 positive slides reported by peripheral laboratories, 25 (2.4%) were false positive. Out of 8783 smear negative slides reported by peripheral laboratories, 35 (0.4%) were false negative. The sensitivity, specificity, positive predictive value and negative predictive value of peripheral laboratories were 96.64, 99.72, 97.58, and 99.61% respectively. The peripheral laboratories and CRLs have an observed agreement (Po) of 0.9939. Of 135 peripheral laboratories, 93 (68.9%) read negative and positive slides correctly, 49 (36.3%) did not have lens cleaning tissue papers, 11 (8.1%) lacked frosted slides, and 14 (10.4%) had shortage of reagents. As conclusions, the peripheral laboratories and CRLs had high agreement for sputum smear microscopy reading. However, a few TB cases were misdiagnosed despite having the disease; these individuals might continue to spread the infection in the community.

How well does pre-service education prepare midwives for practice: competence assessment of midwifery students at the point of graduation in Ethiopia.

BACKGROUND: Midwifery support and care led by midwives is the most appropriate strategy to improve maternal and newborn health. The Government of Ethiopia has recently improved the availability of midwives by scaling up pre-service education. However, the extent to which graduating students acquire core competencies for safe and effective practice is not known. The purpose of this study was to evaluate the quality of midwifery education by assessing the competence of graduating midwifery students. METHODS: We conducted a cross-sectional study to assess the competence of students who completed basic midwifery education in Ethiopia in 2013. We interviewed students to obtain their perceptions of the sufficiency and quality of teachers and educational resources and processes. We assessed achievement of essential midwifery competencies through direct observation, using a 10-station Objective Structured Clinical Examination (OSCE). We calculated average percentage scores of performance for each station and an average summary score for all stations. Chi-square test, independent sample t test, and linear regression analysis were used to assess the statistical significance of differences and associations. RESULTS: We assessed 484 graduating students from 25 public training institutions. Majority of students rated the learning environment unfavorably on 8 out of 10 questions. Only 32 % of students managed 20 or more births during training, and just 6 % managed 40 or more births. Students' overall average competence score was 51.8 %; scores ranged from 32.2 % for manual vacuum aspiration to 69.4 % for active management of the third stage of labor. Male gender, reporting sufficient clinical experience, and managing greater numbers of births during training were significant predictors of higher competence scores. CONCLUSIONS: The quality of pre-service midwifery education needs to be improved, including strengthening of the learning environment and quality assurance systems. In-service training and mentoring to fill competence gaps of new graduates is also essential.