Lessons learnt from comprehensive evaluation of community-based education in Uganda: a proposal for an ideal model community-based education for health professional training institutions

Abstract

BackgroundCommunity-based education (CBE) can provide contextual learning that addresses manpower scarcity by enabling trainees acquire requisite experiences, competence, confidence and values. In Uganda, many health professional training institutions conduct some form of community-based education (CBE). However, there is scanty information on the nature of the training: whether a curriculum exists (objectives, intended outcomes, content, implementation strategy), administration and constraints faced. The objective was to make a comprehensive assessment of CBE as implemented by Ugandan health professional training institutions to document the nature of CBE conducted and propose an ideal model with minimum requirements for health professional training institutions in Uganda.MethodsWe employed several methods: documentary review of curricula of 22 institutions, so as to assess the nature, purpose, outcomes, and methods of instruction and assessment; site visits to these institutions and their CBE sites, to assess the learning environment (infrastructure and resources); in-depth interviews with key people involved in running CBE at the institutions and community, to evaluate CBE implementation, challenges experienced and perceived solutions.ResultsCBE was perceived differently ranging from a subject, a course, a program or a project. Despite having similar curricula, institutions differ in the administration, implementation and assessment of CBE. Objectives of CBE, the curricula content and implementation strategies differ in similar institutions. On collaborative and social learning, most trainees do not reside in the community, though they work on group projects and write group reports. Lectures and skills demonstrations were the main instruction methods. Assessment involved mainly continuous assessment, oral or written reports and summative examination.ConclusionThis assessment identified deficiencies in the design and implementation of CBE at several health professional training institutions, with major flaws identified in curriculum content, supervision of trainees, inappropriate assessment, trainee welfare, and underutilization of opportunities for contextual and collaborative learning. Since CBE showed potential to benefit the trainees, community and institutions, we propose a model that delivers a minimum package of CBE and overcomes the wide variation in the concept, conduct and implementation of CBE.

Eksplorasi Permasalahan Dalam Implementasi Community-Based Education Di Fakultas Kedokteran

“…Pada penelitian ini didapatkan bahwa meskipun tujuan pembelajaran sudah tercantum dalam buku pedoman di Institusi B, namun tujuan pembelajaran tersebut dirasakan oleh pembimbing masih kurang jelas terutama pada masa-masa awal pelaksanaan program CBE walaupun persiapan untuk pembimbing sudah dilaksanakan sebelum program dimulai. Permasalahan seperti tersebut juga pernah ditemukan oleh oleh Kaye et al, (2011) saat melakukan eva-luasi program CBE di Uganda bahwa in-struktur masih belum memahami kurikulum, terutama mengenai kompetensi yang diharapkan termasuk bagaimana kurikulum diimplementasikan.…”

Community-based pedagogy of nursing in developing countries: An integrative review

“…For instance, in Uganda these programs were adapted to enhance students' learning in the community with the aim of enhancing interest of students working in rural areas of Uganda. [12,[48][49][50] Students indicated the possibility of taking their career into the community after graduation. However, being willing to work in rural communities and to achieve this goal are two different things in Uganda, wherein the infrastructure and funding for rural community work continue to be developed.…”

“…The theme revealed positive outcomes based on several factors, including collaborative partnership, impact to student learning, [12,36,[45][46][47][48][49][50] community academic partnership, [51,52] cultural competence, [6,41,42] faculty-student relationship [20] and access to funding and developing a relationship between the university and community. [6,8,36,53] Linda et al [8] used an interpretive existentialistphenomenological approach to describe a community-based education program.…”

Community-based nursing education in South Africa: A grounded-middle range theory

“…Research shows that using communities for experiential learning has a number of positive outcomes, including facilitating the development of professional competencies in line with the demands of the health care system [12] a better understanding of the social determinants of health and their impact on the health of the population [4] increased understanding of social justice issues and their influence on health [13] interprofessional and multi-disciplinary approaches to addressing health issues; and development of leadership behaviours in students. [12,15] More importantly, students' exposure to learning in diverse community-based settings prepares them for life after graduation and stimulates in them a special interest and motivation to work with communities, including remote, rural and under-resourced health care settings because these settings resemble those in which they underwent educational preparation.…”

“…With the call for the re-engineering of PHC for universal health coverage, [1] a number of countries have health policies which are PHC oriented. It is imperative for nursing education programs to be responsive to the national health policies [12,13] as they have to prepare graduates who are able to function at all levels of the health care system. [14] Part of preparing responsive nursing students includes the use of appropriate and diverse practical placement settings for experiential learning.…”