Anthony Amalba

Medical students' achievement on the Bachelor of Medicine, Bachelor of Surgery/Chirurgery Final Part I and II licensing examination: a comparison of students in problem-based learning, community-based education and service, and conventional curricula in Ghana.

Purpose: Problem-based learning is an established method of teaching and learning in medical education. However, its impact on students’ achievement on examinations is varied and inconsistent. We compared the levels of achievement on the Bachelor of Medicine, Bachelor of Surgery/Chirurgery (MB ChB) Part I and II licensing examination of students in problem-based learning, community-based education and service (PBL/COBES), and conventional curricula. Methods: In 2014, we analyzed the MB ChB Final Part I and II licensing examination results of students in three classes (2004, 2005, and 2006) of the School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana. Ninety-three students in the 2004 and 2005 cohorts followed a conventional curriculum, and 82 students in the 2006 cohort followed a PBL/COBES curriculum. Using appropriate statistical tools, the analysis compared individual discipline scores and the proportions of students who received distinction/credit/pass grades among the classes. Results: The PBL students had significantly higher mean and median scores than the conventional students in Obstetrics and Gynecology, Internal Medicine, Community Health and Family Medicine, Surgery, and Psychiatry, but not in Child Health and Pediatrics. Also, a significantly (P=0.0010) higher percentage, 95.1% (n=78), of the PBL students passed all the disciplines, compared to 79.6% (n=74) of the conventional students. Conclusion: The PBL students significantly performed better in all the disciplines except child health and pediatrics, where the conventional students scored higher. These findings demonstrate that the benefits of the PBL/COBES curriculum are tangible and should be fostered.

Awareness, use and associated factors of emergency contraceptive pills among women of reproductive age (15-49 years) in Tamale, Ghana

BackgroundEmergency contraceptive pills (ECPs) are one of the means by which women can use after intercourse to prevent pregnancy. ECPs can be used to reduce the prevalence of unwanted pregnancies and unsafe abortions. This study investigated awareness and use of ECPs among reproductive age (15-49 years) women in Tamale, Ghana. Factors associated with the use of ECPs were also investigated.MethodsThis cross sectional study was conducted among 200 women of reproductive age (15-49 years) in Tamale, Ghana. Data on socio-demographic variables, awareness and usage of ECPs were assessed by means of a previously validated questionnaire. Univariate and multivariate logistic regression analyses were performed to identify factors associated with the use of ECPs.ResultsAwareness level of ECPs were found to be 69.0% (n = 138); 42.8% (n = 59) got the awareness from a health worker, 31.8% (n = 44) from the radio/TV and 25.4% (n = 35) from family members/friends. Eighty-five percent (n = 117) knew the correct time-frame for an effective use of ECP to prevent pregnancy. Forty percent (39.9%, n = 55) of the participants who had awareness have ever used ECPs. Factors that were found to be associated with the use of ECPs were; participants who said ECPs were affordable (AOR = 6.1, 95% CI = 2.51 – 10.40, p = 0.001), available (AOR 2.1, 95% CI = 0.61 – 6.01, p = 0.001), cultural (AOR = 3.5, 95% CI = 1.01 – 10.15, p = 0.011) and religious unacceptable (AOR = 4.0, 95% CI = 1.02 – 10.0, p = 0.005).ConclusionA relatively high level of awareness and usage of ECPs was found. Factors that were associated with the use of ECPs were availability and affordability. Cultural and religious unacceptability did not hinder the use of ECPs. Health authorities should continue to make ECPs available to women of reproductive age.

Assessing the reliability and validity of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in Ghanaian medical students.

Purpose: We investigated the validity and reliability of the Revised Two Factor Study Process Questionnaire (R-SPQ2F) in preclinical students in Ghana. Methods: The R-SPQ2F was administered to 189 preclinical students of the University for Development Studies, School of Medicine and Health Sciences. Both descriptive and inferential statistics with Cronbach’s alpha test and factor analysis were done. Results: The mean age of the students was 22.69± 0.18years, 60.8% (n=115) were males and 42.3% (n=80) were in their second year of medical training. The students had higher mean deep approach scores (31.23±7.19) than that of surface approach scores (22.62±6.48). Findings of the R-SPQ2F gave credence to a solution of two-factors indicating deep and surface approaches accounting for 49.80% and 33.57%, respectively, of the variance. The scales of deep approach (Cronbach’s alpha, 0.80) and surface approach (Cronbach’s alpha, 0.76) and their subscales demonstrated an internal consistency that was good. The factorial validity was comparable to other studies. Conclusion: Our study confirms the construct validity and internal consistency of the R-SPQ2F for measuring approaches to learning in Ghanaian preclinical students. Deep approach was the most dominant learning approach among the students. The questionnaire can be used to measure students’ approaches to learning in Ghana and in other African countries.

Community-based education: The influence of role modeling on career choice and practice location

Abstract Introduction: Research findings in medical education support the importance of positive role models in enhancing learning and influencing the career path of medical students and graduates. The authors explored the characteristics of positive and negative role models during Community-Based Education and Service (COBES), as well as their effect on trainees’ career paths. Method: A cross-sectional survey was conducted by means of a questionnaire among medical students to explore the characteristics of positive and negative role models during COBES. Associations between gender, choice of specialty, and practice location were assessed using the chi-square test. All qualitative data analysis was performed using the principles of primary, secondary, and tertiary coding. Result: The majority of the students indicated that role modeling during COBES will affect their choice of specialty and practice location with a significant gender difference in terms of practice location (p < 0.005). Qualitative data supported the finding that positive role modeling during COBES may influence graduates willingness to work in rural area. Conclusion: The desire and willingness to work in a rural community combined with good communication and excellent interpersonal skills as well as good leadership skills are attributes of good role modeling that could influence medical students’ career choice during COBES.

Psychometric properties of the dundee ready educational environment measure in a sample of Ghanaian Medical Students

Background: The Dundee Ready Educational Environment Measure (DREEM) has been widely accepted and recognized for the assessment of the educational environment in a variety of health professions education programs. Concerns regarding the psychometric properties of the DREEM have been raised. This study evaluated the psychometric properties of the DREEM in a sample of Ghanaian medical students following a problem-based learning curriculum. Methods: A sample of 234 second to fourth year medical students of the University for Development Studies, School of Medicine and Health Sciences were invited to complete the DREEM questionnaire. Psychometric measures employed included Cronbachs alpha analysis, confirmatory factor analysis and principal component analysis with varimax rotation. Results: The internal consistency for the overall DREEM was 0.92. Apart from two subscales that had Cronbachs alpha values < 0.70, the remainder had values ranging from 0.73 – 0.78. Confirmatory factor analysis did not support the original five factor structure of the DREEM. Large significant correlation coefficients were found between the five factors raising concerns about the independency of the individual subscales. Exploratory factor analysis suggested various factor solutions ranging from 4 to 14 factors. The four factor structure was interpretable and was maintained. All of the four factors achieved eigenvalues > 1, and in total they accounted for 37.6% of the variance. Alpha values for the subscales of the new four factor structure ranged from 0.618 – 0.915. Discussion: The overall internal consistency of the DREEM was found to be excellent. The internal consistency of the individual subscales was variable, as two subscales had alpha values < 0.70 and the remainder exceeding 0.70. The original five factor structure of the DREEM was not supported. Exploratory factor analysis suggested a four factor solution as a possible alternative to the five factor structure of the DREEM.

Reducing the breast cancer menace: the role of the male partner in Ghana.

BACKGROUND Breast cancer continues to be the most common type of cancer afflicting many women worldwide. Presently, educational campaigns and research target only women as if men have no role in the management of this disease. The study examined the willingness of male partners to assist in early female breast cancer detection as well as their awareness and knowledge levels. MATERIALS AND METHODS Using a semi-structured questionnaire, data was collected from 500 public servants within the Tamale Metropolis and analyzed in SPSS. RESULTS The level of awareness of breast cancer was very high (98.8%) but there was a low level of knowledge of breast cancer among the male population. Marital status and religion had no effect on attitude, but increasing educational status significantly increased knowledge and positive attitude towards breast cancer examination (χ2=4.255, p=0.0391). The majority (92.0%) agreed that men can assist in early breast cancer detection and 96.2% were willing to be provided with breast examination skills. CONCLUSIONS Although level of awareness on female breast cancers among the men was high, they generally lack knowledge of the disease. Majority of male partners want to assist in early breast cancer detection if provided with the necessary skills.

Working among the rural communities in Ghana - why doctors choose to engage in rural practice

BackgroundAn unequal distribution of health personnel, leading to unfavourable differences in health status between urban and rural populations, is a serious cause for concern globally. Part of the solution to this problem lies in attracting medical doctors to rural, remote communities, which presents a real challenge. The present study therefore explored the factors that influence medical doctors’ decision to practise in rural Ghana.MethodsWe conducted a cross-sectional descriptive study based on questionnaires. Participants were doctors working in health facilities in the districts and rural areas of the Northern Region, Ghana. The qualitative data analysis consisted of an iterative process of open, axial and selective coding.ResultsWe administered the questionnaires to 40 doctors, 27 of whom completed and returned the form, signalling a response rate of 67.5%. The majority of the doctors were male (88.9%) and had been trained at the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS) (63%). Although they had chosen to work in the remote areas, they identified a number of factors that could prevent future doctors from accepting rural postings, such as: a lack of social amenities, financial and material resources; limited career progression opportunities; and too little emphasis on rural practice in medical school curricula. Moreover, respondents flagged specific stakeholders who, in their opinion, had a major role to play in the attraction of doctors and in convincing them to work in remote areas.ConclusionsThe medical doctors we surveyed had gravitated to the rural areas themselves for the opportunity to acquire clinical skills and gain experience and professional independence. Nevertheless, they felt that in order to attract such cadre of health professionals to rural areas and retain them there, specific challenges needed addressing. For instance, they called for an enforceable, national policy on rural postings, demanding strong political commitment and leadership. Another recommendation flowing from the study findings is to extend the introduction of Community-Based Education and Service (COBES) or similar curriculum components to other medical schools in order to prepare students for rural practice, increasing the likelihood of them accepting rural postings.

Nurses’ knowledge and attitudes regarding malnutrition in children and its management in Ghana

Background Malnutrition contributes significantly to child morbidity and mortality. Nurses require appropriate knowledge, skills and attitudes to prevent and treat malnutrition in children using appropriate guidelines or protocols. Objectives The aim of this article was to assess nurses’ knowledge, attitudes towards malnutrition and its management using the World Health Organization (WHO) or United Nations International Children’s Fund guidelines for the treatment of severely malnourished children and to evaluate factors associated with their knowledge and attitudes. Methods Participants included 104 nurses working in the outpatient and paediatric units or departments of four hospitals in Tamale metropolis. An 88-item questionnaire was used to measure nurses’ socio-demographic characteristics as well as their knowledge and attitudes towards malnutrition in children and its management using the WHO guidelines for the inpatient treatment of severely malnourished children. Results Nurses’ knowledge in malnutrition and its management was slightly above average (54.0%), but their attitudes were highly positive. Factors that were associated with nurses’ knowledge were number of nutrition courses undertaken in nursing school, number of years working as a nurse, receipt of a refresher course on nutrition after school and receipt of training on the guidelines. Nurses’ attitudes were associated with report of having awareness on the guidelines, number of years a nurse has been involved in the treatment of a severely malnourished child. Conclusion Nurses’ knowledge levels in the inpatient treatment of severely malnourished children were not desirable. However, their attitudes were generally positive. Receipt of previous training, awareness of the WHO guidelines, practice experience and number of years as a nurse significantly affected knowledge and attitude scores in the positive direction.