BackgroundMedical education can play important role in cultivating the willingness among the medical students to work in underprivileged areas after their graduation. Experiential learning through early exposure to primary health care centers could help students better understand the opportunities and challenges of such settings. However, the information on the real experiences and reflections of medical students on the rural primary health care settings from low-income countries like Nepal are still limited. The aim of this study is to demonstrate the learning process of the medical students through their reflective writings based on Kolb’s theory of experiential learning.MethodsThe students wrote their experiences, observations and reflections on the experiential learning from the primary health care centers on individual logbook as part of their community posting assignments. We analyzed the data of 50 logbooks through content analysis using Kolb’s experiential learning cycle as a theoretical framework.ResultsThe students’ reflections are structured around the four main learning stages of Kolb’s experiential learning theory. Each learning stage consisted of different categories. The first stage consisted of concrete experiences on rural health and learning by doing. The second stage included their reflective observations on primary versus tertiary care, application of theoretical knowledge and role of supervisors. In the third stage, the students developed and refined their concepts on self-development, understanding reality, compassion and sense of responsibility. The final stage, active experimentation, included their immediate future plans, suggestions to improve curriculum, plans after becoming a doctor and suggestions to improve policies.ConclusionThis study provided important insights on different stages of experiential learning of medical students on primary health care in low resource rural settings. Reflective writing of experiential learning could be an important step to address the gaps in medical education for resource constraint settings like that of Nepal and other low-income countries.

Equity in health outcomes for rural and remote populations in low-and middle-income countries (LMICs) is limited by a range of socioeconomic , cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a Johnston et al. Rural Health Workforce for LMICs significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multinational study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.

Introduction:Nepal is beginning to develop palliative care services across the country. Most people live in rural areas, where the Mid-Level Health Workers (MHWs) are the major service providers. Their views on providing palliative care are most important in determining how the service is organized and developed.Aim:This study aims to ascertain the perceptions of MHWs about palliative care in their local community, to inform service development.Methods:A qualitative descriptive design, using focus group discussions, was used to collect data from a rural district of Makwanpur, 1 of the 75 districts of Nepal. Twenty-eight MHWs participated in four focus group discussions. The data were analyzed using content analysis.Result:Four themes emerged from the discussion: (i) suffering of patients and families inflicted by life-threatening illness, (ii) helplessness and frustration felt when caring for such patients, (iii) sociocultural issues at the end of life, and (iv) improving care for patients with palliative care needs.Conclusion:MHWs practicing in rural areas reported the suffering of patients inflicted with life-limiting illness and their family due to poverty, poor access, lack of resources, social discrimination, and lack of knowledge and skills of the health workers. While there are clear frustrations with the limited resources, there is a willingness to learn among the health workers and provide care in the community.

No abstract

Introduction: The newly established Patan Academy of Health Sciences (PAHS) has incorporated measurement of non-cognitive skills and behaviours into the summative assessment in the setting of problem based learning (PBL). This study aims to validate a PBL process assessment tool for PAHS. Methods: A list of 72 items of student behaviours observable in PBL tutorials was compiled from literature review. They were categorized under ten broad dimensions consistent with predefined PAHS Graduate Attributes. A series of PBL project committee meetings and expert inputs refined the list of 72 items to 47 and categorized them under eight dimensions. These 47 items, each with a 4-point rating scale, formed the Tutor Assessment of Student Tool (TAS-Tool). Twenty-four trained faculty members used the TAS-Tool to evaluate the performance of 41 senior high school students in PBL tutorials. Results: The internal-consistency of the TAS-Tool was very high (Cronbach's α = 0.954). Removal of two inconsistent items further increased it to 0.975. Principal components analysis with varimax rotation applied to the remaining 45 items gave seven components and explained 69.47% of the variation between the components. These seven components (% variation) were: Immersed in the Tutorial Process (20.16%); Professional (12.71%); Communicator and Team Leader (11.25%); Critical Thinker (8.77%); Reflector (6.22%); Creative (5.95%), and Sensitive (4.41%). Conclusion: TAS-Tool was found to be a reliable and valid instrument and applicable in formative PBL process assessment at PAHS starting with the pioneer cohort of medical students. Further validation of TAS-Tool through longitudinal study with PAHS students is required for summative purpose.