Practice analysis of junior doctors in Ethiopia:implications for strengthening medical education,practice and regulation

Background:A high performing physician workforce is critical to attain nationally set health sector goals.Ethiopia has expanded training of medical doctors.However,little is known about junior doctors’performance.Understanding medical practice is essential to inform medical education and practice,establish licensure examination and guide workforce management decisions.We conducted a practice analysis study to identify gaps in Ethiopian medical education and practice,and to determine composition of subjects in national licensing examination.Methods:We conducted a cross-sectional study with national representative sample of junior doctors.After calculating a sample size of 198,we used a two-stage stratified cluster sampling method to select study participants.We collected data using a structured questionnaire comprising 222 tasks.Study participants reported in interviews on frequency of,competence at,and importance of doing each task for improved health outcome.We developed proportions,averages,graphs and tables.Using the results of practice analysis and experts’ratings,relative weights of subjects in the national licensing examination for medical undergraduates were determined.Results:A total of 191 junior doctors participated.Most were males(74.6%)and had less than 2 years of experience(69.8%).Junior doctors frequently performed tasks of internal medicine and pediatrics.Their participation in obstetrics and gynecology,ophthalmology,psychiatry and dentistry services was infrequent.Junior doctors had competency gaps to conduct clinical procedures,research and health programming tasks.Practice analysis results and expert ratings generated comparable recommendations for composition of a national licensing examination,with more than threequarters of the items focusing on internal medicine,pediatrics,surgery,obstetrics and gynecology,and public health.Conclusion:Junior doctors in Ethiopia rarely managed psychiatry,ophthalmology and dental patients.They had competence gaps in clinical procedures,research and health programming skills.The findings have implications for establishing licensing examination,and reviewing curriculum,continuing professional development,placement and rotation policy,and distribution of responsibilities.

Reasons to pursue a career in medicine:a qualitative study in Sierra Leone

Background:Many low-income and crises-affected countries like Sierra Leone struggle with the recruitment and retention of their health professionals,particularly nurses and doctors.There are multiple factors that influence the‘recruitment to retention’pipeline.The first stage of an exploration into the issues influencing the availability of qualified health care workers may focus on the aspects which influence their entry into relevant educational programmes.This paper explores the reasons given by junior doctors in Sierra Leone for wanting to become a doctor.It also describes entry procedures into undergraduate medical education.Methods:In-depth interviews were conducted with purposively sampled junior doctors(n=15)from the only medical school in Sierra Leone in October 2013.Digital diaries and two follow-up interviews were used to explore their evolving career experiences and aspirations until November 2016.In addition,semi-structured interviews with key informants(n=20),including senior teaching staff at the medical school(n=7),were conducted.Thematic analysis was used to explore linkages and themes across cases.Results:Six themes were identified.The most commonly mentioned reasons for wanting to become a doctor were a desire to help(theme 4)and the influence of family and friends,via role modelling(theme 2)and verbal encouragement(theme 3).Other motives were an interest from a young age(theme 1),being attracted by the job prospects(theme 5),and having an intellectual and science capacity(theme 6).Junior doctors gave at least two and up to six reasons for applying to enter the medical profession.Doctors were allowed entry to the medical school largely based on their previous academic performance.Conclusions:This study showed that multiple reasons underlie the decision to apply for entrance to medical school and the decision to enter medicine is complex.These findings may inform the review of future admission procedures by the medical school in Sierra Leone and similar settings,which is a crucial step in addressing the human resource needs for healthcare that currently exist.