Clinical skills of general practitioners in Nairobi, Kenya: a cross-sectional study

Abstract

BackgroundQuality service delivery in primary care requires motivated and competent health professionals. In the Kenyan private sector, general practitioners (GP), with no post-graduate training in family medicine, offer primary care. There is a paucity of evidence on the ability of primary care providers to deliver comprehensive care and no such evidence is available for GPs practising in the private sector in Kenya.AimTo evaluate GPs’ training and experience in the skills required for comprehensive primary care.Design and settingA cross-sectional descriptive survey in 13 primary care clinics in the private sector of Nairobi, KenyaMethodA questionnaire, originally designed for a national survey of primary care doctors in South Africa, was adapted. The study collected self-reported data on performance of clinical skills by 25 GPs. Data were analysed in the Statistical Package for Social Sciences.ResultsGPs were mostly under 40 years, with less than 10 years of experience and an equal gender distribution. GPs reported moderate performance with adult health, communication and consultation, and clinical administration; and weak performance with emergencies, child health, surgery, ear-nose-and-throat, eyes, women’s health and orthopaedics. The GPs lacked training in specific skills such as proctoscopy, contraceptive devices, skin procedures, intra-articular injections, red reflex test and use of a genogram.ConclusionGeneral practitioners lacked training and performed poorly in some of the essential skills required in primary care. Continuing professional development, training in Family Medicine and deployment of family physicians to the clinics could improve the comprehensiveness of care.

Understanding of ‘generalist medical practice’ in South African medical schools

“…In high-income countries, generalist medical practice (also referred to as ‘generalism’) at UG medical training is discussed mainly with the view to prepare students to follow a postgraduate career in general practice (GP), 15 , 48 different from the low- and middle-income countries (including South Africa) 49 where postgraduate specialisation in general medical practice is not necessarily a prerequisite for general practice. 50 , 51 Literature indicates that students perceived ‘generalism’ to be of lower prestige in the medical profession. 52 , 53 , 54 These perceptions were already present at the very start of medical school and seemed to be reinforced during UG training.…”