Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.
University of Basel, Basel, Switzerland.
BMC Med Educ. 2021 May 28;21(1):306. doi: 10.1186/s12909-021-02749-x.
The last two decades have seen a shift in former Soviet countries from highly specialized to more family medicine-focused systems. Medical education has slowly adjusted to these reforms, although the region is still at risk to have a chronic shortage of family doctors. This paper presents the evaluation of a new post-graduate family medicine program in Tajikistan, focused on competency-based training. The findings are relevant for policy makers, international organizations and practitioners participating in similar medical education reform programs.
We employed a quasi-experimental control group design and compared intervention residents, control group residents with traditional training, and 1st year residents with no training in two outcomes, clinical knowledge and competencies. We employed two objective measures, a written multiple-choice question test (MCQT) and an Objective Structured Clinical Examination (OSCE), respectively. We report reliability and validity of the measures along with ANOVA, planned contrasts and effect size estimates to examine differences across groups.
We found statistically significant differences in both clinical knowledge and competencies between intervention and control groups. We also detected a large intervention effect size. Participants in the intervention outperformed control group participants in the two measures. Our analysis suggests that intervention and control group participants are comparable in terms of initial knowledge and competencies, strengthening the argument that the intervention caused the improvement in the program outcomes.
Receiving tailored training and structured opportunities to practice knowledge and competencies in clinical settings have a positive effect on the education of family medicine doctors in Tajikistan. Our results support curriculum reform and investment in medical education in the form of longer and supervised on-the-job preparation designed to be more in line with international standards. We discuss suggestions for future studies and potential requirements to inform replicability in other countries.
Family medicine is well recognized as central to health systems throughout the world, but high quality residency training lags behind in some countries. Our study showed that investing in family medicine residency programs and structured training is effective in increasing critical clinical competencies. We encourage promoting comprehensive post graduate family medicine doctor training so that the goals of a family medicine centered health system are attainable.
在过去的二十年中，前苏联国家的医疗体系已经从高度专业化转变为更加注重家庭医学。医学教育已经慢慢适应了这些改革，尽管该地区仍然面临着家庭医生长期短缺的风险。本文介绍了塔吉克斯坦新的研究生家庭医学项目的评估，该项目侧重于以能力为基础的培训。这些发现对参与类似医学教育改革项目的政策制定者、国际组织和从业者具有重要意义。
我们采用了准实验对照设计，比较了干预组居民、接受传统培训的对照组居民和没有培训的第一年居民在两个结果上的差异，即临床知识和能力。我们分别采用了两种客观的衡量标准，即书面多项选择题测试（MCQT）和客观结构化临床考试（OSCE）。我们报告了这些衡量标准的可靠性和有效性，以及方差分析、计划对比和效应量估计，以检验组间差异。
我们发现干预组和对照组在临床知识和能力方面都存在统计学上的显著差异。我们还检测到了一个很大的干预效果大小。干预组的参与者在两个衡量标准上都优于对照组的参与者。我们的分析表明，干预组和对照组的参与者在初始知识和能力方面是可比的，这加强了干预导致方案结果改善的论点。
在临床环境中接受量身定制的培训和结构化的机会来实践知识和能力对塔吉克斯坦家庭医学医生的教育有积极的影响。我们的结果支持课程改革和以更长时间和有监督的在职准备形式对医学教育的投资，以使其更符合国际标准。我们讨论了未来研究的建议和潜在要求，以告知在其他国家的可复制性。
家庭医学在世界范围内被广泛认为是卫生系统的核心，但一些国家的高质量住院医师培训却落后。我们的研究表明，投资家庭医学住院医师培训计划和结构化培训是提高关键临床能力的有效方法。我们鼓励推广全面的研究生家庭医学医生培训，以实现以家庭医学为中心的卫生系统的目标。
