improving clinical education - how can we increase clinical competencies in rural areas? (1) H26

one of the main missions of medical school is to produce a healthcare professional that is competent enough to practice in the context of where it is located, in the social background where the medical school exists in the world.

assessing the educational needs of a country to improve clinical education

when a country decides that graduates from a medical school possess the sufficient competencies to practice independently, it needs to gather sufficient amount of reliable data, from which inferences can be made and corrective actions can be taken.

it can be said that the educational needs of a country depends on the situations in which the country needs its medical graduate to function in.

The competency requirement for independent practice in a developing tropical country (knowledge about various tropical infectious diseases, nutritional deficiencies, and good idea about community preventive medicine to prevent common oral fecal route infectious diseases etc)) and independent practice in an urbanized city clinic (knowledge about mental health, non-communicable disease, and health screening for the over-nourished etc) is vastly different.

Thus, during the course of the medical education, the content of the curriculum and the content of the formative and summative assessment should match the needs of the local community. 

to give an example, it would be pointless to have a patient with Scurvy in the exit examination in an urban developed country. 

likewise, a medical student in a developing country should be assessed in their skills and competence to diagnose and manage common illnesses in that local area. 

therefore, one way to assess the educational needs of a country is to have a good understanding of the country's healthcare needs and deficiencies. 

another way to improve clinical education is to assess the graduates to find out just what specific areas are deficient in competencies. Is it the communication skills? understanding of community medicine? is it the lack in knowledge that is required to diagnose and manage the patient? or lack of clinical culture understanding?

to investigate into these deficiencies, a simple questionnaire-based research can be done, for example asking the graduates where they lack in competencies, and/or asking their colleagues where the graduates lack in skills and competencies. 

once the data of graduates' deficiencies are found, the rest is up to the school to set outcome goals to fill in the deficiencies while they're in the medical school. 

possible intervention activities to improve clinical education

about content - 

The examination should be based on demographic data of the country, and the common things that the graduates would face once they exit medical school, should be asked more frequently.
the assessment criteria should be clearly set, as outcomes for which all learning should make as foundations for the mapping and construct of curriculum. 

"assessment drives learning" - once the assessments criteria have been set, the curriculum could be re-set and students themselves would have the motivation to face the new assessment criteria, which is more suited for practice in that particular country.

about context-

some contextual things that can change to make medical graduates more grounded and ready for practice are; 

to increase clinical exposure, and

assessments based on competencies. 

students should be assessed on the "Does" and "Shows how" level of skills and competencies (of the Miller's 4 levels of knowledge, skills and competencies) while they're exposed to the actual situation of practice in the local context (high authenticity) 

interventions-

some intervention activities that can be done to improve clinical education is to have frequent mini-CEX in the clinical context, followed by an immediate feedback session to investigate and correct any deficiencies in competence and skills of the medical students.

another intervention is the introduction of Portfolio system where each students would simulate what they would do when faced with each patient they encounter while observing in the clinical context, and record them in the form of Portfolio, discussing these clinical scenario with their mentors.