Dejene Daniel, Ayalew Firew, Yigzaw Tegbar, Mengistu Samuel, Aderaw Zewdie, Moges Nurilign Abebe, Stekelenburg Jelle, Versluis Marco
Medical Center, Groningen University Department of Health Sciences, Groningen, The Netherlands
Health Workforce Improvement Program, Jhpiego Ethiopia, Addis Ababa, Ethiopia.
BMJ Open. 2025 Apr 29;15(4):e090682. doi: 10.1136/bmjopen-2024-090682.
In response to a critical shortage of skilled workforce, Ethiopia has scaled up its health professional education (HPE) by increasing the number of training institutions and student enrolment capacity. However, strong evidence that shows how the HPE scale-up affected clinical placements is lacking. This study investigated the challenges and effects of the rapid HPE scale-up in clinical placements, and the adjustments made in response to the challenges.
A qualitative study using focus group discussions and constructivist grounded theory was conducted in July-August 2022.
The teaching hospitals of six medical schools in Ethiopia.
53 purposefully selected participants (25 clinician-teachers and 28 intern students).
Adequacy of skilled clinicians, student preparedness and learning environment were input measures. Quality of supervision, assessment, feedback and practice exposure are process measures. Clinical competence was an outcome measure.
We identified six themes: (1) class size and student motivation, (2) availability of skilled and motivated clinician-teachers, (3) learning environment and practice management, (4) clinical supervision and assessment, (5) extent of exposure, and (6) clinical competence. The HPE upscaling caused student overcrowding, resource shortages and unconducive learning environments. Concerns were reported on clinical supervision, assessment, feedback, role modelling and programme management. Clinician-teachers and students had low levels of motivation. Competitions for practice diminished learning collaboration. In response to the challenges, adjustments were made to strengthen clinical rotations, engage teaching methods and hire more clinician-teachers.
The rapid HPE scale-up affected clinical placements, reducing student authentic practice and skill development. There is a need to optimise student enrolment, train clinicians as teachers and improve clinical learning resources. Interprofessional education can optimise student practice. Placement coordination facilitates supervision. Student practice should be expanded to primary healthcare settings.
为应对技术熟练劳动力的严重短缺，埃塞俄比亚通过增加培训机构数量和学生招生能力来扩大其卫生专业教育（HPE）。然而，缺乏有力证据表明HPE扩大规模对临床实习产生了怎样的影响。本研究调查了临床实习中HPE快速扩大规模所带来的挑战和影响，以及为应对这些挑战所做的调整。
2022年7月至8月进行了一项采用焦点小组讨论和建构主义扎根理论的定性研究。
埃塞俄比亚六所医学院的教学医院。
53名经过有目的选择的参与者（25名临床教师和28名实习学生）。
技术熟练的临床医生的充足程度、学生的准备情况和学习环境是输入指标。监督质量、评估、反馈和实践机会是过程指标。临床能力是结果指标。
我们确定了六个主题：（1）班级规模与学生积极性，（2）技术熟练且积极性高的临床教师的可用性，（3）学习环境与实践管理，（4）临床监督与评估，（5）接触程度，（6）临床能力。HPE的扩大导致学生过度拥挤、资源短缺和不利于学习的环境。在临床监督、评估、反馈、榜样作用和项目管理方面存在担忧。临床教师和学生的积极性水平较低。实践竞争减少了学习合作。为应对这些挑战，进行了调整以加强临床轮转、采用教学方法并聘请更多临床教师。
HPE的快速扩大规模影响了临床实习，减少了学生的真实实践和技能发展。需要优化学生招生、培训临床医生担任教师并改善临床学习资源。跨专业教育可以优化学生实践。实习协调有助于监督。应将学生实践扩展到初级卫生保健机构。
