Investment case for two-year post university speciality training in family medicine in Tajikistan: how much is needed for continuing and scaling up the improved education of family doctors?

Abstract

Background A new two-year Post University Specialty Training (PUST) programme in family medicine was introduced to improve the quality of postgraduate speciality medical education in Tajikistan. Postgraduate education of family doctors (FDs) needs to be urgently scaled up, as 38% of FD positions in Tajikistan remained unfilled in 2018. Moreover, the international financial support for the PUST programme is ending. This investment case assesses the minimum funding needed for the continuation and scale-up of PUST and establishes the rationale for the investment in the light of a recent evaluation. Methods The costs of the programme were calculated for 2018 and a scale-up forecast made for the period 2019–2023. The impact of the scale-up on the shortage of FDs was assessed. An evaluation using a Multiple Choice Questionnaire and Objective Structured Clinical Examination (OSCE) assessed and compared theoretical knowledge, clinical skills and competencies of PUST trained and conventionally trained FDs. Results The annual costs of the programme were US$ 228,000 in 2018. The total investment needed for scaling up PUST from 31 new FDs in 2018 to 100 FD graduates each year by 2023 was US$ 802,000.However, when the retirement of FDs and population growth are considered, the scale-up will result only in maintaining the current level of FDs working and not solve the country’s FD shortage. The PUST FDs demonstrated significantly better clinical skills than the conventionally trained interns, scoring 60 and 45% of OSCE points, respectively. Theoretical knowledge showed a similar trend; PUST FDs answered 44% and interns 38% of the questions correctly. Conclusions The two-year PUST programme has clearly demonstrated it produces better skilled family doctors than the conventional one-year internship, albeit some enduring quality concerns do still prevail. The discontinuation of international support for PUST would be a major setback and risks potentially losing the benefits of the programme for family medicine and also other specialities. To guarantee the supply of adequately trained FDs and address the FD shortage, the PUST should be continued and scaled up. Therefore, it is essential that international support is extended and a gradual transition to sustainable national financing gets underway.

Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education

“…However, there was an undercurrent of resistance to expanding the length of all specialty trainings due to concerns about cost implications. Our findings, and coherent with recent publications [ 8 , 10 ], underscore the importance for more and strong evidence to show the benefits of longer, and higher quality training, brings savings to the health system in the long run. To replicate the effects of a reformed residency program (e.g.…”

“…The demonstrated cost-effectiveness [ 10 ] and overall outcomes suggest moving from conventional residency programs, such as the Internatura, towards more structured programs in line with international standards, such as the PUST program in Tajikistan. The success of the changes demonstrated in our study highlights the demand for proper modification of the medical education curriculum, clear description of roles and responsibilities, the training of staff, and the allocation of educational resources including on-site facilities for clinical practice, as well as buy-in by all relevant stakeholders.…”

“…In 2013, the MEP, in close collaboration with a variety of stakeholders (for details see [ 10 ]) developed a new residency program for FM doctors more in line with international standards and as an alternative to the Internatura program [ 8 ]. The Post-Graduate Specialty Training (PUST) in Family Medicine in Tajikistan aims to improve the clinical knowledge and competencies of FM doctors, including their leadership and communication skills, eventually leading to an increase in quality of care, contributing to a stronger health system, and better health of the Tajik population.…”

“…Only very few peer-reviewed publications from Tajikistan are available, describing the medical education reform overall [ 3 , 8 ]; the progress of the medical education reform activities as part of the MEP [ 8 ]; and the learning environment of PUST participants [ 21 ]. While two papers describe the nursing education reform and its effects in more detail [ 22 , 23 ], only one peer-reviewed publication by Kempers et al [ 10 ] is available so far, focusing specifically on the reform of the program for the specialization in FM. The economic investment case of the PUST program emphasizes its value to address the shortage of FM doctors expected in the future [ 10 ], including a brief presentation of the PUST evaluation results.…”

“…While two papers describe the nursing education reform and its effects in more detail [ 22 , 23 ], only one peer-reviewed publication by Kempers et al [ 10 ] is available so far, focusing specifically on the reform of the program for the specialization in FM. The economic investment case of the PUST program emphasizes its value to address the shortage of FM doctors expected in the future [ 10 ], including a brief presentation of the PUST evaluation results. So far, no detailed results of this evaluation were published, comparing the two different FM specialty programs in Tajikistan.…”