ArticleTropical medicine & international health : TM & IH2019
Clinical performance among recent graduates in nine low- and middle-income countries.
Article in Tropical medicine & international health : TM & IH, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed.
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- Comparison of the clinical competency of nurses trained in competency-based and object-based approaches in the Democratic Republic of the Congo: A cross-sectional study.Global health & medicine · 2023Article
- Health service quality in 2929 facilities in six low-income and middle-income countries: a positive deviance analysis.The Lancet. Global health · 2023Article
- Best and worst performing health facilities: A positive deviance analysis of perceived drivers of primary care performance in Nepal.Social science & medicine (1982) · 2022Article
- Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana.Global health, science and practice · 2022Review
- Developing Research Education Groups in African Cancer Centers: The Experience in Tanzania.Journal of cancer education : the official journal of the American Association for Cancer Education · 2021Article
- Decentralization and Regionalization: Redesigning Health Systems for High Quality Maternity Care Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries".International journal of health policy and management · 2021Article
- Learning from changes concurrent with implementing a complex and dynamic intervention to improve urban maternal and perinatal health in Dar es Salaam, Tanzania, 2011-2019.BMJ global health · 2021Article
- Change in clinical knowledge of diabetes among primary healthcare providers in Indonesia: repeated cross-sectional survey of 5105 primary healthcare facilities.BMJ open diabetes research & care · 2020Article
- Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap.BMJ global health · 2020Review
- Health system quality in the time of COVID-19.The Lancet. Global health · 2020Article
- Digital health capacity and pediatric care quality in LMICs: A large-scale analysis of 5311 health facilities.Digital healthArticle
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Authors and funding
5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectivesRecent studies have identified large and systematic deficits in clinical care in low-income countries that are likely to limit health gains. This has focused attention on effectiveness of pre-service education. One approach to assessing this is observation of clinical performance among recent graduates providing care. However, no studies have assessed performance in a standard manner across countries. We analysed clinical performance among recently graduated providers in nine low- or middle-income countries.
methodsService Provision Assessments from Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda were used. We constructed a Good Medical Practice Index that assesses completion of essential clinical actions using direct observations of care (range 0-1), calculated index scores by country and clinical cadre, and assessed the role of facility and clinical characteristics using regression analysis.
resultsOur sample consisted of 2223 clinicians with at least one observation of care. The Good Medical Practice score for the sample was 0.50 (SD = 0.20). Nurses and midwives had the highest score at 0.57 (SD = 0.20), followed by associate clinicians at 0.43 (SD = 0.18), and physicians at 0.42 (SD = 0.16). The average national performance varied from 0.63 (SD = 0.18) in Uganda to 0.39 (SD = 0.17) in Nepal, persisting after adjustment for facility and clinician characteristics.
conclusionsThese results show substantial gaps in clinical performance among recently graduated clinicians, raising concerns about models of clinical education. Competency-based education should be considered to improve quality of care in LMICs. Observations of care offer important insight into the quality of clinical education.
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