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.
Highlights
Community-based education (CBE) can provide contextual learning that addresses manpower scarcity by enabling trainees acquire requisite experiences, competence, confidence and values
Our aim was to answer the following questions: What is the nature of CBE conducted? Does CBE promote learning? What challenges do institutions face in implementing CBE and what are potential solutions? The objective of the comprehensive assessment of CBE conducted in health professional training institutions in Uganda was two-fold: 1) To analyze the nature of CBE conducted by different institutions as well as challenges involved; 2) To analyze effectiveness of CBE in promoting learning and acquisition of competences for cadres at different levels
As an outcome of this comprehensive assessment, we identified a critical need to propose an ideal CBE curriculum whose content and implementation would provide a minimum package of CBE
Summary
Community-based education (CBE) can provide contextual learning that addresses manpower scarcity by enabling trainees acquire requisite experiences, competence, confidence and values. In the context of health professional education, CBE refers to instruction whereby trainees learn and acquire professional competencies in community settings Such settings include general practices, communities, community health centres or rural hospitals [2] with the focus being learning about health services in the community, methods of health promotion, as well as social and economic aspects of illness [2]. Provision of support for community site tutors and faculty improves the quality of medical students’ learning experiences during rural rotations [6] Such exposure to the communities through community placements during CBE shapes trainees’ values and perceptions of rural practice, eventually promoting ethics, professionalism and health professionals uptake of rural practice [2,7,8]
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