ISQUA16-1513WHAT ARE JUNIOR MEDICAL DOCTORS IN ETHIOPIA ACTUALLY DOING: USING EVIDENCE GENERATED FROM TASK ANALYSIS STUDY TO STRENGTHEN MEDICAL PRACTICE, EDUCATION AND REGULATION

Abstract

Objectives: Doctors play critical roles in improving health services quality and realizing the roles requires improving quality of medical education and practice. We conducted a task analysis study to describe practice of junior medical doctors in Ethiopia and generate evidences for strengthening their education, practice and regulation. Methods: A cross-sectional study was conducted in February 2015 with nationally representative sample of recently graduated medical doctors (6 months to 4 years of experience) working in public hospitals. We used structured interview to determine how often they performed expected tasks, how competent they felt in completing them and the perceived importance of the tasks for patient and/or population health outcomes. We calculated percentages and averages to describe practice characteristics. Tasks with a combination of relatively low competence, low frequency and high criticality scores were identified as indicative of priority gaps in education and practice. We determined emphasis and distribution of medical licensing exam by combining means of frequency and criticality scores and averaging it with expert rating. Results: A total of 191 general practitioners sampled from 66 public hospitals in the nine regional states and two city administrations participated in the study. Majority of them were males (73.8%) and had 2 years or less of work experience (66%). Almost all respondents (98.5%) recognized the importance of the medical tasks for patient and population health outcomes. Majority of respondents (51.6-58. 5%) said they provided medical, pediatric, and dermatology care frequently. In contrast, majority of (55.6-77.2%) reported infrequent performance of tasks related to psychiatry, ophthalmology, dentistry, obstetrics/gynecology, and population health and health systems. Further, vast majority of doctors (74.7-99.2%) said they were competent in all domains of clinical care. However, a significant percentage (9.3-25.3%) reported capacity gaps in dental, ophthalmic, obstetrics/gynecology, surgical, generic clinical skills, emergency, psychiatry and population health and health systems functions. Gaps in education seem to be highest for long-term and permanent family planning methods, clinical and laboratory diagnostic procedures, surgical and obstetrics/gynecology therapeutic procedures, management of eye problems, population health and health systems, and, research competencies. Furthermore, our results suggested that the exam distribution for licensing exam should be 20.8% internal medicine, 15.9% surgery, 17.3% pediatrics, 15.6% obstetrics and gynecology, 3.8% psychiatry, 4.2% dermatology, 3.7% ophthalmology, 3.6% ear, nose and throat, 3% dentistry and oral health and 12.3% public health. Conclusion: Although general practitioners recognize importance of their duties and responsibilities, their actual practice is not sufficiently comprehensive with limited participation in mental, eye, dental and reproductive health care and public health activities. Top pre-service education gaps and priority needs for in-service training were found to be long-term and permanent family planning methods, procedural skills, eye care, and population health and health systems. The first medical licensing exam blueprint was developed based on results of the task analysis.