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Clinical performance among recent graduates in nine low‐ and middle‐income countries

OBJECTIVES: Recent studies have identified large and systematic deficits in clinical care in low‐income countries that are likely to limit health gains. This has focused attention on effectiveness of pre‐service education. One approach to assessing this is observation of clinical performance among r...

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Autores principales: Lewis, Todd P., Roder‐DeWan, Sanam, Malata, Address, Ndiaye, Youssoupha, Kruk, Margaret E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850366/
https://www.ncbi.nlm.nih.gov/pubmed/30821062
http://dx.doi.org/10.1111/tmi.13224
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author Lewis, Todd P.
Roder‐DeWan, Sanam
Malata, Address
Ndiaye, Youssoupha
Kruk, Margaret E.
author_facet Lewis, Todd P.
Roder‐DeWan, Sanam
Malata, Address
Ndiaye, Youssoupha
Kruk, Margaret E.
author_sort Lewis, Todd P.
collection PubMed
description OBJECTIVES: Recent studies have identified large and systematic deficits in clinical care in low‐income countries that are likely to limit health gains. This has focused attention on effectiveness of pre‐service education. One approach to assessing this is observation of clinical performance among recent graduates providing care. However, no studies have assessed performance in a standard manner across countries. We analysed clinical performance among recently graduated providers in nine low‐ or middle‐income countries. METHODS: Service Provision Assessments from Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda were used. We constructed a Good Medical Practice Index that assesses completion of essential clinical actions using direct observations of care (range 0–1), calculated index scores by country and clinical cadre, and assessed the role of facility and clinical characteristics using regression analysis. RESULTS: Our sample consisted of 2223 clinicians with at least one observation of care. The Good Medical Practice score for the sample was 0.50 (SD = 0.20). Nurses and midwives had the highest score at 0.57 (SD = 0.20), followed by associate clinicians at 0.43 (SD = 0.18), and physicians at 0.42 (SD = 0.16). The average national performance varied from 0.63 (SD = 0.18) in Uganda to 0.39 (SD = 0.17) in Nepal, persisting after adjustment for facility and clinician characteristics. CONCLUSIONS: These results show substantial gaps in clinical performance among recently graduated clinicians, raising concerns about models of clinical education. Competency‐based education should be considered to improve quality of care in LMICs. Observations of care offer important insight into the quality of clinical education.
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spelling pubmed-68503662019-11-21 Clinical performance among recent graduates in nine low‐ and middle‐income countries Lewis, Todd P. Roder‐DeWan, Sanam Malata, Address Ndiaye, Youssoupha Kruk, Margaret E. Trop Med Int Health Original Research Papers OBJECTIVES: Recent studies have identified large and systematic deficits in clinical care in low‐income countries that are likely to limit health gains. This has focused attention on effectiveness of pre‐service education. One approach to assessing this is observation of clinical performance among recent graduates providing care. However, no studies have assessed performance in a standard manner across countries. We analysed clinical performance among recently graduated providers in nine low‐ or middle‐income countries. METHODS: Service Provision Assessments from Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda were used. We constructed a Good Medical Practice Index that assesses completion of essential clinical actions using direct observations of care (range 0–1), calculated index scores by country and clinical cadre, and assessed the role of facility and clinical characteristics using regression analysis. RESULTS: Our sample consisted of 2223 clinicians with at least one observation of care. The Good Medical Practice score for the sample was 0.50 (SD = 0.20). Nurses and midwives had the highest score at 0.57 (SD = 0.20), followed by associate clinicians at 0.43 (SD = 0.18), and physicians at 0.42 (SD = 0.16). The average national performance varied from 0.63 (SD = 0.18) in Uganda to 0.39 (SD = 0.17) in Nepal, persisting after adjustment for facility and clinician characteristics. CONCLUSIONS: These results show substantial gaps in clinical performance among recently graduated clinicians, raising concerns about models of clinical education. Competency‐based education should be considered to improve quality of care in LMICs. Observations of care offer important insight into the quality of clinical education. John Wiley and Sons Inc. 2019-03-24 2019-05 /pmc/articles/PMC6850366/ /pubmed/30821062 http://dx.doi.org/10.1111/tmi.13224 Text en © 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research Papers
Lewis, Todd P.
Roder‐DeWan, Sanam
Malata, Address
Ndiaye, Youssoupha
Kruk, Margaret E.
Clinical performance among recent graduates in nine low‐ and middle‐income countries
title Clinical performance among recent graduates in nine low‐ and middle‐income countries
title_full Clinical performance among recent graduates in nine low‐ and middle‐income countries
title_fullStr Clinical performance among recent graduates in nine low‐ and middle‐income countries
title_full_unstemmed Clinical performance among recent graduates in nine low‐ and middle‐income countries
title_short Clinical performance among recent graduates in nine low‐ and middle‐income countries
title_sort clinical performance among recent graduates in nine low‐ and middle‐income countries
topic Original Research Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850366/
https://www.ncbi.nlm.nih.gov/pubmed/30821062
http://dx.doi.org/10.1111/tmi.13224
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