Comparative Study of Professional Competences of Graduates of Innovative and Conventional Medical Schools in Kenya: A Case of Graduates of School of Medicine-Moi University and the School of Medicine- University of Nairobi

Abstract

Since the first half of the 20th " Century, the training of medical doctors has undergone major educational reforms. Many factors have contributed to the driving forces that have changedthe development and implementation of curricula for training doctors. However, some medical schools, both in developed and in developing countries have continued to use the conventional approaches whiles others have shifted to innovative approaches. The World Federation (WFME/WHO,of Medical Education and the World HealthOrganisation 2003) have advocated for reforms in the planning, development and implementation of curricula in medical education for the overall purpose of improving performance of medical doctors as they play their current and future roles in the world. In Kenya, the School of Medicine at the College of Health Sciences-University of Nairobi has implemented a conventional curriculum over the years while the School of Medicine at Moi University has implemented an innovative curriculum since its inception. The purpose of the study was to compare the competences of the graduates of Moi University and University of Nairobi using the seven global minimum requirements of competences of medical doctors as advocated by various international organisations involved in medical education such as the International Institute of Medical Education (lIME) and WFME. The seven global competences are i) knowledge of scientific foundation of medicine ii) application of clinical skills iii) Population health and health systems iv) Communication skills v) Critical thinking and research vi) Management of information systems and vi) Professional ethics, attitudes, behaviour and values (Schwarz,M.R., Wojtczak, A., 2002). The statement of the problem of the study focuses on the declining trend in the health situation in Kenya despite the investment made in the health sector especially training of health professionals, particularly doctors. The National Health Sector Strategic Plan II (2005-2010) indicates that there is need to reverse this trend and one of the strategies is in training of human resources. Medical doctors in Kenya and the world at large play a major role in improving health of populations. However, it is not clear how graduates of the two Schools of Medicine compare concerning the seven minimum globalcompetences. Therefore, the competences of graduates objectives of this from conventional seven global professional competences their supervisors (ii) determine study were and innovative as perceived any significant descriptive questionnaire, and focus discussion group guide in collecting in each competence comments incorporated design, which The desired random doctors. Intern doctors in four (4) provincial in the study. In total, six (75%) provinces sample of 47 supervisors were given distributed to the graduates and supervisors 54 (64.3%) questionnaires from graduates were returned from graduates received from graduates (100%) questionnaires of the and the supervisors. was pilot-tested had and and objectivity. using Gay's (I992) for non-response, sample lack of 84 intern and eleven (I I) district hospitals were used selected of 140, which included Medical Doctors and questionnaires to fill. the self-administered were returned. of medicine, from supervisors and size was therefore of school of medicine, of school themselves in Kenya were covered. A purposively from a population in charges, sample on the data. The questionnaire estimate of 20%. An increase of 10% to the sample accounted return of the questionnaires. schools the used a self-administered to improve its content validity, reliability sampled determine on the competences area. The questionnaire A population of 280 intern doctors was randomly Nursing Officer medical by the graduates The study was of a comparative specific indicators (i) by the graduates differences graduates of the two medical schools as perceived to working Research questionnaire. assistants A total of Out of these, 26 questionnaires Moi University, University while 28 were of Nairobi. in four (4) provincial A total of 47 and eleven (II) district hospitals were returned. Data on competences of graduates from the two schools was analysed and inferential statistics. The chi-square test with Yates correction significant differences between ratings of competences the two medical schools using categories confounding factors on the seven global professional Female supervisors were the majority further analysis of the results to gender and supervisors and Good while controlling of for competences. (60%) compared pertaining was used to determine from graduates of Excellent using descriptive to female graduates distribution, (41 %). On there was significant difference (1=6.48, Idf, P>0.05 [0.010]) between the proportion of male and female respondents in the study. The findings on distribution of male and female graduates showed that the majority of the respondents were male graduates (61%) from the conventional medical school as compared to 58% from innovative medical school However, there was no significant difference (i =0.00, Idf, P>0.05 [0.959]) in gender distribution of graduates from the two medical schools. The findings showed that graduates from the conventional school rated themselves 82% and 18% on excellent and good categories respectively in the knowledge of scientific foundation of medicine while the graduates from innovative school ratings were 89% and 11% on the same categories. On further analysis of the results, there was no significant difference (1=1.45, l df, P>0.05 supervisors on graduates [0.228]) between the graduates. from conventional The ratings of school (56%, 34%) and those from innovativeschool (53%, 47%) on this competence showed no significant difference [i =2.99, 1df,P>0.05 {0.084}] either. The majority of graduates of the two schools considered themselves highly competent in clinical skills (76%, 24% IMS; and 79%, 21% eMS). However, there was no significant difference [r =0.11, l df, P>0.05 {0.735}] between the ratings of proportion of graduates from the two schools. The findings on supervisors ratings (70%, 30%IMS; and 70%, 30% eMS) of graduates showed no significant difference [i =0.2, l df, P>0.05 {0.877}] as well. On population health and health systems competence, the graduates' rating from innovative and conventional school was 69%, 31% and 85%, 15% respectively. On the same competence the supervisors rating of graduates was 40%, 60% and 42%, 58% from innovative and conventional schools respectively. On further analysis of the results, there was significant difference (i =6.35, l df, P>0.05 [0.012]) in the ratings of graduates on this competence. However, there was no significant [1=0.02, Idf, P>0.05 difference {O.0886}]in the ratings of supervisors. As regards communication skills competence, 100% and themselves conventional school 0% on excellent rated 53% and 51%, 49% respectively. (1=14.13, significant difference competence with no significant supervisors ratings. 88% and themselves conventional graduates' The study school ratings showed from innovative categories school rated those from category. The while 15% on the same and conventional Further analysis schools of the results showed were 47%, that there was Idf, P>0.05 [0.000]) in the ratings of graduates [1=0.08, difference showed a significant However, was no significant [1=0.10, that graduates thinking 1 df, P>0.05 from {0.671}] in the innovative competence on this while school rated graduates from 50% and 50% on the same competence. themselves concerning this competence. difference good from innovative 12% on critical rated and 85% and themselves supervisors' ratings of graduates graduates [,1=10.73, difference on further analysis The Idf, P>0.05 {0.001}] ]of supervisors' results there Idf, P>0.05 {0.754}] in the competence . .2 The results showed a significant [.2 =41.50, 1 df, P<0.05 {O.OOO}] in the difference graduates' ratings (100%, 0% IMS; 64%, 36% CMS) on the management system's competence although the supervisors 49% CMS) showed no significant ratings of graduates [1=0.51, difference of information (58%, 42% IMS;51 %, Idf, P>0.05 {0.477}] on the same competence. Concerning ] competence on professional graduates ratings from innovative respectively) showed supervisors ratings attitudes, and conventional no significant on graduates ethics, of innovative =0.03, Idf, P>0.05 [0.86]). the 1 df, P>0.05 [0.42]). The and conventional competence (78%, 22% and 78%, 22% respectively) and values, schools (77%, 23% and 71%, 29% (1=0.65, difference behaviour schools showed no significant on the same difference (1In conclusion, graduates from the two medical schools do not differ at all as perceived by their supervisors on the seven global competences. However, there seems to be significant differences in the way graduates perceive themselves as regards the four competences as shown in the study. These differences may be due to limitation of self- assessment method, which does not always provide for objective information, as was the case in graduates' ratings. However, since this limitation applied equally to respondents of the two universities, the differences between the graduates from the two schools of medicinecan be indicative of the effects resulting from the different curricula used. This study focused on the seven global competences of medical doctors and was conducted using self-administered questionnaire to generate information from graduates and supervisors. A further study, which uses multiple methods of data collection, should be conducted to compare graduates' competences from innovative and conventional schools of medicine in order to establish the meaningful gains obtained by re-orienting medical education to new educational strategies and approaches.