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]
Roder-DeWan, Sanam [VerfasserIn]
Malata, Address [VerfasserIn]
Ndiaye, Youssoupha [VerfasserIn]
Kruk, Margaret E [VerfasserIn]

Links:

Volltext

Themen:

Clinical performance
Journal Article
Low- and middle-income countries
Pays à revenu faible ou intermédiaire
Performance clinique
Qualité des soins
Quality of care

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