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Open Access Research article

Lessons learnt from comprehensive evaluation of community-based education in Uganda: a proposal for an ideal model community-based education for health professional training institutions

Dan K Kaye1*, Wilson W Muhwezi2, Ann N Kasozi3, Steven Kijjambu3, Scovia N Mbalinda4, Isaac Okullo5, Rose C Nabirye4, Hussein Oria6, Lynn Atuyambe7, Sarah Groves8, Gilbert Burnham9 and Andrew Mwanika5

Author Affiliations

1 Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

2 Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

3 Office of the Dean, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

4 Department of Nursing, School of Health Sciences, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

5 Department of Dentistry, School of Health Sciences, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

6 Department of Pharmacy, School of Health Sciences, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

7 Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda

8 Department of Nursing, Johns Hopkins School of Nursing, Baltimore, Maryland, USA

9 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

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BMC Medical Education 2011, 11:7  doi:10.1186/1472-6920-11-7

Published: 1 March 2011

Abstract

Background

Community-based education (CBE) can provide contextual learning that addresses manpower scarcity by enabling trainees acquire requisite experiences, competence, confidence and values. In Uganda, many health professional training institutions conduct some form of community-based education (CBE). However, there is scanty information on the nature of the training: whether a curriculum exists (objectives, intended outcomes, content, implementation strategy), administration and constraints faced. The objective was to make a comprehensive assessment of CBE as implemented by Ugandan health professional training institutions to document the nature of CBE conducted and propose an ideal model with minimum requirements for health professional training institutions in Uganda.

Methods

We employed several methods: documentary review of curricula of 22 institutions, so as to assess the nature, purpose, outcomes, and methods of instruction and assessment; site visits to these institutions and their CBE sites, to assess the learning environment (infrastructure and resources); in-depth interviews with key people involved in running CBE at the institutions and community, to evaluate CBE implementation, challenges experienced and perceived solutions.

Results

CBE was perceived differently ranging from a subject, a course, a program or a project. Despite having similar curricula, institutions differ in the administration, implementation and assessment of CBE. Objectives of CBE, the curricula content and implementation strategies differ in similar institutions. On collaborative and social learning, most trainees do not reside in the community, though they work on group projects and write group reports. Lectures and skills demonstrations were the main instruction methods. Assessment involved mainly continuous assessment, oral or written reports and summative examination.

Conclusion

This assessment identified deficiencies in the design and implementation of CBE at several health professional training institutions, with major flaws identified in curriculum content, supervision of trainees, inappropriate assessment, trainee welfare, and underutilization of opportunities for contextual and collaborative learning. Since CBE showed potential to benefit the trainees, community and institutions, we propose a model that delivers a minimum package of CBE and overcomes the wide variation in the concept, conduct and implementation of CBE.