Tanzanian Training Centre for International Health, Ifakara, Tanzania.
St. Francis University College for Health and Allied Sciences, Ifakara, Tanzania.
BMC Med Educ. 2022 Sep 5;22(1):662. doi: 10.1186/s12909-022-03719-7.
In 2008, the government of Tanzania adopted a competency-based education and training (CBET) system to improve medical training. Yet there are still frequent observations of competency deficits among graduates, suggesting that the goal has not sufficiently been met. This study was designed to assess the underlying context of competency deficits in the health workforce in Tanzania and to provide recommendations for improvement.
A cross-sectional study using document analysis and focus groups was carried out in 13 training institutions that provided a diploma course in clinical medicine. The research team assessed availability and adequacy of instructors, physical resources and the process and systemic factors that impact curriculum implementation outcomes.
Six (46%) institutions had 75% or more of their teaching staff not trained in curriculum delivery and instructional methods. Seven (54%) institutions had lower instructor-students ratio than recommended (1:25). Overall, the full-time instructors in all institutions constituted only 44% of the teaching staff. Although all institutions had an adequate number of classrooms, the rooms were of small size with dilapidated walls, and had inadequate number of desks/ seats for students. Clinical skills laboratories existed in 11 (85%) institutions, but the majority were of small size, and were not fully equipped as per guidelines and were rarely used. Libraries were available in 12 (92%) institutions but five had seating capacities of 10% or less of the available students. Participants of focus group discussion in the majority of the institutions reported inadequate time allocated for practice and support from the clinical instructors at the practicum sites. Six (46%) institutions had no functioning governing/advisory boards and five (38%) lacked quality assurance policies and implementation plans.
Currently, health-training institutions in Tanzania are ill-equipped to produce competent clinicians because of major gaps in the structural, process and systemic components. These findings call for major investment to facilitate production of a competent health workforce.
2008 年，坦桑尼亚政府采用了基于能力的教育和培训（CBET）系统，以改善医学培训。然而，毕业生中仍然频繁观察到能力不足的情况，这表明该目标尚未充分实现。本研究旨在评估坦桑尼亚卫生人力中能力缺陷的潜在背景，并提供改进建议。
在提供临床医学文凭课程的 13 个培训机构中进行了横断面研究，使用文件分析和焦点小组。研究小组评估了教师的可用性和充足性、物理资源以及影响课程实施结果的过程和系统因素。
六（46%）个机构有 75%或更多的教学人员没有接受过课程教学和教学方法的培训。七（54%）个机构的教师-学生比例低于推荐的（1:25）。总体而言，所有机构的全职教师仅占教学人员的 44%。虽然所有机构都有足够数量的教室，但房间面积小，墙壁破旧，学生座位不足。11（85%）个机构设有临床技能实验室，但大多数实验室面积小，未按指南配备齐全，很少使用。12（92%）个机构都有图书馆，但有 5 个机构的座位容量仅为可用学生的 10%或更少。焦点小组讨论的参与者报告说，在实习地点，实践和临床教师的支持分配时间不足。六（46%）个机构没有运作的管理/咨询委员会，五个（38%）机构缺乏质量保证政策和实施计划。
目前，坦桑尼亚的卫生培训机构由于结构、过程和系统组成部分存在重大差距，因此无法培养出有能力的临床医生。这些发现呼吁进行重大投资，以促进有能力的卫生人力的培养。
