Clinical performance among recent graduates in nine low- and middle-income countries
© 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd..
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.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2019 |
---|---|
Erschienen: |
2019 |
Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
---|---|
Enthalten in: |
Tropical medicine & international health : TM & IH - 24(2019), 5 vom: 15. Mai, Seite 620-635 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Lewis, Todd P [VerfasserIn] |
---|
Links: |
---|
Themen: |
Clinical performance |
---|
Anmerkungen: |
Date Completed 16.01.2020 Date Revised 16.01.2020 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1111/tmi.13224 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM294454098 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM294454098 | ||
003 | DE-627 | ||
005 | 20231225081519.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231225s2019 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1111/tmi.13224 |2 doi | |
028 | 5 | 2 | |a pubmed24n0981.xml |
035 | |a (DE-627)NLM294454098 | ||
035 | |a (NLM)30821062 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Lewis, Todd P |e verfasserin |4 aut | |
245 | 1 | 0 | |a Clinical performance among recent graduates in nine low- and middle-income countries |
264 | 1 | |c 2019 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 16.01.2020 | ||
500 | |a Date Revised 16.01.2020 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a © 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. | ||
520 | |a 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 | ||
520 | |a 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 | ||
520 | |a 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 | ||
520 | |a 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 | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a clinical performance | |
650 | 4 | |a low- and middle-income countries | |
650 | 4 | |a pays à revenu faible ou intermédiaire | |
650 | 4 | |a performance clinique | |
650 | 4 | |a quality of care | |
650 | 4 | |a qualité des soins | |
700 | 1 | |a Roder-DeWan, Sanam |e verfasserin |4 aut | |
700 | 1 | |a Malata, Address |e verfasserin |4 aut | |
700 | 1 | |a Ndiaye, Youssoupha |e verfasserin |4 aut | |
700 | 1 | |a Kruk, Margaret E |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Tropical medicine & international health : TM & IH |d 1997 |g 24(2019), 5 vom: 15. Mai, Seite 620-635 |w (DE-627)NLM086387235 |x 1365-3156 |7 nnns |
773 | 1 | 8 | |g volume:24 |g year:2019 |g number:5 |g day:15 |g month:05 |g pages:620-635 |
856 | 4 | 0 | |u http://dx.doi.org/10.1111/tmi.13224 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 24 |j 2019 |e 5 |b 15 |c 05 |h 620-635 |