School of Medicine
http://ir.mu.ac.ke:8080/jspui/handle/123456789/29
2024-03-28T09:53:35ZAssessment of perceived competence in breaking bad news tasks among RESIDENT doctors at Moi Teaching and Referral Hospital
http://ir.mu.ac.ke:8080/jspui/handle/123456789/7048
Assessment of perceived competence in breaking bad news tasks among RESIDENT doctors at Moi Teaching and Referral Hospital
Chumba, David K.
Background: Breaking bad news refers to a medical procedure of passing unfavorable medical information to patients about their illnesses. Competence in this skill is required in medical practice and medical education curriculum was designed to equip doctors in this important issue. Globally, standardized specific guidelines in delivering bad news have been developed to assist doctors to fully disclose life threatening diagnosis, including cancer. It is against this backdrop of increasing burden of life-threatening diseases and the need for safe verbal procedures in Sub Saharan Africa that necessitated relooking at the training of breaking bad news skills among doctors.
Objectives: The objectives of this study were: to determine residents’ perception of their competence in performing Breaking Bad News tasks, to determine the relationship between residents’ perception of their competence and their sociodemographic characteristics, to determine the adequacy of the medical training curriculum content and methodologies utilized in training doctors in breaking bad news tasks and to determine residents perception of constraints they encounter at MTRH/MUSOM while performing breaking bad news tasks
Methods: A mixed methods approach used to collect data. Qualitative data on curriculum content methodologies and constraining factors; checklist and focus group discussions and in-depth interviews; quantitative data; perceived competence, additional training, level of training and gender in breaking bad news; surveys and causal-comparative research designs. Study population constituted postgraduate doctors from whom a sample of 80 out of 240 selected, purposeful sampling used to sample 7 residents doctors and 3 lecturers. Data was collected using questionnaires in-depth interviews and focus group discussion. Quantitative data was cleaned and entered and analyzed in SPSS version 10, descriptive statistics used to describe, and inferential statistics used in comparing data. Qualitative data was analyzed and presented thematically. A p-value of <_ 0.5 was set as significant for all tests.
Results: Competence in breaking bad news varied on three aspects: self-efficacy 134% ,however this was found to be overrated during the focus group discussion, empathy 74% of normed value, physicians beliefs scores 160% of the normed value, (N=80) 45% and 55% of the participants were female and male respectively 46% were in part 1 54% in part 2. Gender did not significantly influence competence self-efficacy t(78)=0.152 p= 0,876, empathy t(78)=0.015 p= 0.897 physician belief score t(78) =0.121 p=0.736 while level of training significantly influenced with part 2 residents being better in all aspects of competence; self-efficacy t(73)=0.427, p= 0.004., empathy t(73) 0.331 p =0.023, physician belief Score t(73) =0.213 p= 0.018. Curriculum structure (competence levels and helical approach) 12.5%, theoretical basis covered 42.5% task approach to training 20.2%, challenging situations addressed 36.3% and reflective approach 0% (N=80). Feeling uncomfortable, being stressed, workload and lack of formal training were identified as major constraints in breaking bad news.
Conclusions: Perceived competence varied according to the three aspects; self-efficacy was very good, less caring behaviour towards psychosocial aspects in life threatening disease care. Additional training and level of training significantly influences all aspects of competence in breaking bad news, Doctors’ curriculum content and methodologies breaking bad news is inadequate, Personal and workplace factors were the main constraints identified.
Recommendations: Curriculum need structuring to include competency levels, content and methodologies in breaking bad news. Breaking bad news training should be given during the clinical years. Training in breaking bad news at postgraduate level needed. Breaking bad news teaching and clinical teaching should be consistent and complementary to reduce the constraints associated with it.
2022-01-01T00:00:00ZA randomized clinical trial of a group cognitive‐behavioral therapy to reduce alcohol use among human immunodeficiency virus‐infected out‐patients in western Kenya
http://ir.mu.ac.ke:8080/jspui/handle/123456789/7011
A randomized clinical trial of a group cognitive‐behavioral therapy to reduce alcohol use among human immunodeficiency virus‐infected out‐patients in western Kenya
K. Papas, Rebecca; Gakinya, Benson; M. Mwaniki, Michael; Lee, Hana
Background and aims Culturally relevant and feasible interventions are needed to address limited professional resources in sub‐Saharan Africa for behaviorally treating the dual epidemics of HIV and alcohol use disorder. This study tested the efficacy of a cognitive‐behavioral therapy (CBT) intervention to reduce alcohol use among HIV‐infected outpatients in Eldoret, Kenya. Design Randomized clinical trial. Setting A large HIV outpatient clinic in Eldoret, Kenya, affiliated with the Academic Model Providing Access to Healthcare collaboration. Participants A total of 614 HIV‐infected outpatients (312 CBT; 302 HL; 48.5% male; mean age: 38.9 years; mean education 7.7 years) who reported a minimum of hazardous or binge drinking. Intervention and comparator A culturally adapted 6‐session gender‐stratified group CBT intervention compared with Healthy Lifestyles education (HL), each delivered by paraprofessionals over 6 weekly 90‐minute sessions with a 9‐month follow‐up. Measurements Primary outcome measures were percent drinking days (PDD) and mean drinks per drinking day (DDD) computed from retrospective daily number of drinks data obtained by use of the Timeline Followback from baseline through 9‐months post‐intervention. Exploratory analyses examined unprotected sex and number of partners. Findings Median attendance was 6 sessions across condition. Retention was 85% through the 9‐month follow‐up. PDD and DDD marginal means were significantly lower in CBT than HL at all three study phases. Maintenance period: PDD–CBT 3.64 (0.70), HL 5.72 (0.71), mean difference 2.08 (95% CI 0.13‐4.04); DDD–CBT 0.66 (0.10) HL 0.98 (0.10), mean difference 0.31 (95% CI 0.05‐0.58). Risky sex decreased over time in both conditions, with a temporary effect for CBT at the 1‐month follow‐up. Conclusions A cognitive‐behavioral therapy intervention was more efficacious than Healthy Lifestyles education in reducing alcohol use among HIV‐infected Kenyan outpatient drinkers.
2020-01-01T00:00:00ZMedical student’s admission criteria and their relationship to academic performance among medical students in Moi and Egerton Universities, Kenya
http://ir.mu.ac.ke:8080/jspui/handle/123456789/5882
Medical student’s admission criteria and their relationship to academic performance among medical students in Moi and Egerton Universities, Kenya
Omenge, Obwoge Ronald
Background: Admission into Kenyan public universities’ medical schools is either by Kenya Universities and Colleges Central Placement Service(KUCCPS) or on self-sponsorship programmes (SSP) basis. The KUCCPS selected students have strong O-level grades in all subjects, with specific cluster science subjects and cumulative points. The SSP students need to have minimum university entry requirements and cluster subjects for admission unto the medicine and surgery (MBCHB) programme. Objectives: The study aimed at analysing the relationship between Medical Students Admission Characteristics (sponsorship, sex, KCSE grade) and their performance in preclinical and clinical levels at Medical schools of Moi University (MU) and Egerton University (EU). The Study sought to; i) determine the relationship between medical students’ KCSE grades and their performance. ii)Analyzesponsorship basedthe performance of medical students. iii)Analyze the performance by gender in preclinical and clinical courses.
Methods: The study utilized ex post facto research design for Retrospective record review (3R) of 272 medical students of academic year 2007/08, 2008/09 and 2009/10 as cohort classes of Moi and Egerton Universities. The Target Population was Public Universities’ Medical students (MBChB) who had been examined at both preclinical and clinical levels. A Data sheet document was used to capture study data. The performance analysis used the t-test and coefficient correlation with the aid of the Statistical Package for Social Sciences (SPSS).
Results: The results indicated that students’ KCSE grades did not influence performance at preclinical courses at MU (p=0.090) and EU (p=0.088), nor performance at clinical courses at MU (p=0.154) and EU (p=0.474) medical schools. Student’s sponsorship did not influence their performance in preclinical courses at MU (p =0.120) though it did influence at EU (p=0.004), in clinical courses it significantly influenced students’ performance at both schools of MU (p=0.005) and EU (p =0.005) medical schools. Gender did not influence students’ performance in preclinical courses at MU (p=0.949) and EU (p=0.629), but significantly influenced clinical courses performance at MU (p=0.001), However, it and didn’t influence performance at clinical courses atEU (p=0.819). . Conclusion: The study concludedthat: i) KCSE aggregate grade was not a predictorat performance in preclinical courses and clinical courses at MU and EU medical schools respectively. ii) Sponsorship did not predict performance in clinical courses at MU though it did at EU and clinical courses at both MU and EU medical schools. iii) Gender did not predict students’ performance in preclinical courses at MU, EU and clinical courses at EU, though it predicts clinical courses performance at MU medical school.
Recommendation: The study recommended Medical schools to consider an open entry Examination system for applicants who meet minimum cluster requirements regardless of the KCSE aggregate grade. Sponsorship of students in Medical schools should be considered on equal basis. Farther study on a larger population should be used to carry out a study on the gender influence in the performance in Pre-clinical and clinical courses.
Key words:academic performance, admission characteristics, clinical performance, medical student, preclinical performance
2017-01-01T00:00:00ZCompetency perception of medical educators in innovative medical curriculum planning and development at Moi University, College of Health sciences
http://ir.mu.ac.ke:8080/jspui/handle/123456789/5751
Competency perception of medical educators in innovative medical curriculum planning and development at Moi University, College of Health sciences
Chepkeitany, Harun Chemjor
The background to this study concerns innovations in medical education curricula and
changing health care needs that require constant changes in medical school curricula.
Innovative medical curricula provide an opportunity to study perceived competence of
educators in innovative medical curriculum planning and development. Competency
of educators could be related to innovative medical curriculum planning and
development as a making process. The objective of the study was to investigate and
determine the competency perception of medical educators in innovative medical
curriculum planning and development. The study was a cross-sectional, quantitative
and descriptive survey design, conducted at Moi University, College of Health
Sciences. The SPICES model on innovative medical curriculum, (Harden, 1984) was
the theoretical framework that guided the innovative study. Harden’s ten questions to
ask when planning an innovative medical curriculum (Harden, 1986) was the
conceptual framework that guided the research process.
The methodology involved all educators in the College of Health Sciences and a pretested questionnaire was used to collect data from participants. Quantitative data were
collected and analysis was done via SPSS Version 16 for windows. Presentation of
data was done using frequency tables. In addressing the research question,
respondents were asked to state “What effect does educator’s perceived lack of
competence in curriculum planning and development have on an innovative medical
curriculum making process”. The study Measured competency perception of
educators on innovative medical curriculum planning and development as a process.
In the Results, a total of 139 educators participated with 92 (66%) returned, 11 (12%)
incomplete and 81 (58%) valid were analysed. Major findings indicate that, while a
higher proportion (60.0%) of educators depicts some competence on innovative
medical curriculum planning and development, significant proportion (40.0%) exhibit
incompetence in developing and implementing PBL, developing curriculum resources
and assessment instruments. Significant proportions (30%) were not well equipped in
identifying and aligning essential competency domains, management of informatics,
critical thinking and research.
It was concluded that there is a significant relationship between lack of educator’s
competence in curriculum development and innovative medical curriculum planning
and development making process. 87.6% of medical educators strongly perceived that
lack of educator’s competence on curriculum development has effect on innovative
medical curriculum making process
Recommendations are that, regular trainings, seminars and conferences on innovative
medical curricula issues are recommended for educators. Prospective studies be done
to determine relationships between incompetence in innovative medical curriculum
planning and development and teaching and learning.
2015-01-01T00:00:00Z