Undergraduate students’ contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda

Abstract

BackgroundIt has been realised that there is need to have medical training closer to communities where the majority of the population lives in order to orient the trainees’ attitudes towards future practice in such communities. Although community based education (CBE) has increasingly been integrated into health professions curricula since the 1990s, the contribution students make to service delivery during CBE remains largely undocumented. In this study, we examined undergraduate health professions students’ contribution to primary health care during their CBE placements.MethodsThis was a qualitative study involving the Medical Education for Equitable Services to All Ugandans consortium (MESAU). Overall, we conducted 36 Focus Group Discussions (FGDs): one each with youth, men and women at each of 12 CBE sites. Additionally, we interviewed 64 community key-informants. All data were audio-recorded, transcribed and analysed using qualitative data analysis software Atlas.ti Ver7.ResultsTwo themes emerged: students’ contribution at health facility level and students’ contribution at community level. Under theme one, we established that students were not only learning; they also contributed to delivery of health services at the facilities. Their contribution was highly appreciated especially by community members. Students were described as caring and compassionate, available on time and anytime, and as participating in patient care. They were willing to share their knowledge and skills, and stimulated discussion on work ethics. Under the second theme, students were reported to have participated in water, sanitation, and hygiene education in the community. Students contributed to maintenance of safe water sources, educated communities on drinking safe water and on good sanitation practices (hand washing and proper waste disposal). Hygiene promotion was done at household level (food hygiene, hand washing, cleanliness) and to the public. Public health education was extended to institutions. School pupils were sensitised on various health-related issues including sexuality and sexual health.ConclusionHealth professions students at the MESAU institutions contribute meaningfully to primary health care delivery. We recommend CBE to all health training programs in sub-Saharan Africa.

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

“…Our findings support prior studies that suggest that medical students can change clinical supervisors’ practice by increasing inquiry and accountability, both of which are particularly relevant as health care increasingly relies on compliance with guidelines, checklists, and keeping up with evidence-based practice. 22,29 These findings are especially relevant in low-resource settings where students can provide cost-effective improvements to quality of care.…”

“…22 This report focuses on a qualitative analysis of key informant interviews and provides a descriptive summary of survey findings, which illustrate study site characteristics and student activities. Our study team included faculty from George Washington University (GWU), which served as the coordinating center for MEPI; regional experts in CBE; and representatives from each MEPI-funded medical school, who were appointed by the relevant principal investigator.…”

“…From previous literature and site visits to the MEPI-participating schools, and from TWG members’ experiences in each country, we developed a common framework that linked academic activity to potential impact on health facilities (Figure 1). 3,4,13–22 Developing this framework allowed our study team, with members from 10 different countries, to identify common elements of education activities and common areas of intersection between medical students and health facilities such as staff interactions, quality of care, patient experiences, and facility outreach. In this study we used this common framework to extend the understanding of how undergraduate medical students can make contributions to the health facilities where they train.…”

The effect of undergraduate students on district health services delivery in the Western Cape Province, South Africa

“…[2,3] The quality of care, attitudes of staff, and long-term recruitment of practitioners have all been shown to improve health services as a result of a health facility becoming a teaching site in a developed country. [4] However, apart from one Ugandan study regarding community-based education, [5] not much data exist with regard to the effect of students at district level in low-and middle-income countries, where the service pressures are more intense as a result of severely limited resources to deal with an overwhelming burden of disease.…”

Narrativas e Memórias de Docentes Médicos sobre o Ensino Baseado na Comunidade no Sertão Nordestino

“…Se, por um lado, o EBC apresenta uma série de vantagens e potencialidades para a educação e a prática em saúde [3][4][5] , por outro, sua implementação suscita um conjunto de desafios que envolvem a universidade, o sistema de saúde, os estudantes, os profissionais da rede de saúde e os docentes 6,7 . promovido pelas políticas indutoras da reorientação da formação em saúde no SUS e para o SUS 8,9 , corroboradas nas novas Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina (DCN) 10 , tais desafios ainda podem ser sentidos.…”