The perceived role of community based medical education among Kenyan-trained doctors’ choice of rural practice and specialty

Abstract

Background: The recruitment and retention of healthcare professionals, especially doctors, in rural and remote areas remains a major challenge and a contributor to inequity that favors urban populations worldwide. Sub-Saharan Africa (SSA) suffers major challenges related to doctors not working in rural areas where over 60% of the population lives. Community based medical education (CBME) during undergraduate medical training plays a positive role in attracting medical doctors to rural practice. The CBME influence on medical doctors’ choice of specialty and rural practice has been documented in a few countries but not in Kenya. Objective: To determine the perceived role of CBME in the choice of rural practice and specialty by Kenyan-trained doctors. Methods: An analytical cross-sectional study design was used to simultaneously study both the exposure and outcome of CBME in medical training. All consenting medical graduates of the years 2000, 2001 and 2002 from Moi University School of Medicine (MUSOM) and University of Nairobi School of Medicine (UNSOM) were interviewed. These cohorts were selected as those that had gone through more innovative training and also had significant career stability. Data collection forms were emailed to the study participants using email addresses obtained from the Medical Practitioners and Dentists Board secretariat. The data collected included medical school attended, rating of the CBME during medical training. Also collected were data on the rating of the perceived role of CBME on choice of rural practice and specialty. Data received were stored in MS Excel database. Bivariate analysis was used for simple descriptive data. Fisher’s exact formula was used in the analysis of the categorical data as the sample size and expected values were small. Chi-square was used to determine association. Multivariate analysis was used for confounders. Results were presented in tables. Results: The Study was conducted between February and September 2018. The eligible number in each cohort was 96, 83 and 90 for UNSOM and 49, 40 and 41 for MUSOM in the years 2000, 2001 and 2002 respectively. The average response rates were 35.8% and 38.0 % for UNSOM and MUSOM participants. Both groups rated CBME high (80% UNSOM vs. 93% MUSOM). Factors found to be associated with a positive perception for rural posting included, the medical school, rural upbringing, parents’ level of education and early rural posting. MUSOM graduates rated the perceived role of CBME in the choice of rural practice and specialty higher than UNSOM ones [73.5 (95% CI: 60.6, 86.3)] vs. [45.9 (95%CI: 35.9, 56.0)] for rural practice and [65.3 (95% CI: 51.5, 79.1)] vs. [34.7 (95%CI: 25.1, 44.3)] for specialty. After multivariate analysis for confounding it was observed that the medical school the participant graduated from was statistically significant associated with a positive perception on the role of CBME in the choice of rural practice [OR 7.315; (95%CI: 2.497,21.428) p-value 0.000] Conclusions: Graduates of a community based education and service (COBES) program were seven times more likely to perceive CBME as having played a role in their choice of rural practice and specialty than those of community oriented program. Recommendations: Harmonization of CBME in favor of COBES will improve attraction of doctors to rural practice and specialties that comply with rural practice in Kenya