Rationale and Objectives
The objectives of this article are: To explore the impact of the Radiological Society of North America–sponsored “Teach the Teachers” training course and other capacity building interventions (CBIs) on Uganda’s ultrasound (US) training capacity; compare performance of students undertaking a modular diploma ultrasound course to the non-modular; and compare performance among various health cadres undertaking US training.
Materials and Methods
The impact of the “Teach the Teachers” training course and other capacity building interventions were evaluated through analysis of the planning, implementation, sustainability, and output of the training center. Comparison of students’ performance in the modular and non-modular diploma courses was by a retrospective cohort methodology using odds ratios. Comparison of performance was by analyzing their mean test scores using a paired Student t -test.
Results
To date, 306 students from nine African countries have successfully completed the US diploma training. Fifty (16%) are non-Ugandans. The non-modular cohort has performed better than the modular (OR = 3.2) in the final written examination. The mean test scores for the final written examinations were: 73.4%, 71.9%, 61.2%, and 57% for the doctors, radiographers, assistant physicians, and nurses/midwives, respectively.
Conclusion
The Radiological Society of North America–sponsored “Teach the Teacher’s course in US” together with other capacity building interventions have led to an established center of excellence for US training in Uganda.
In 2001, Uganda with a population of 28 million had only 25 radiologists and 60 non-physician sonographers. There were about 150 ultrasound (US) machines countrywide, most operated by untrained or undertrained personnel. Similar shortages of trained US users occurred through Africa . Special US techniques such as small parts, musculoskeletal, Doppler, and interventional US were not routinely applied. There were poor health indices for diseases in which US plays a significant diagnostic role such as maternal mortality .
This poor state of human resource still persists in Africa, and is perceived by the World Health Organization as the largest hindrance to achieving the health-related Millennium Development Goals . In addition, there is insufficient US training capacity, facilities and resources. Individuals from Africa who wish to undertake formal courses in US have had to travel to Europe or America, which proves too expensive and deters many from training. Some of those who train abroad do not return to Africa, where earnings are lower.
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Objectives
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Methods
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Setting Up the Training Center and Affiliations
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Courses Offered
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Entry Requirements
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Teaching and Assessment
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The Modular and Non-modular Cohorts for Teaching for the Post-basic Diploma in US
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Resources and Funding
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The Teaching Faculty and Institute Organogram
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Results
Number of Students who have Graduated with the US Diploma since Inception, 2002 July to January 2009
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Comparison of the Non-modular and Modular Cohorts
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Table 1
Comparison of the Mean Scores for the Non-modular and Modular Cohorts for the Final Examinations
Test Number of Questions Cohort Number in Cohort Mean% Score † Standard Deviation_t__P_ Value Physics 21 Non-modular 188 62.85 17.353 6.605 .000 Modular 103 48.99 16.675 Abdomen 35 Non-modular 188 67.11 16.108 1.043 .298 Modular 103 65.17 14.532 Obstetrics 20 Non-modular 188 71.01 14.709 1.145 .253 Modular 103 69.08 13.224 Gynecology 18 Non-modular 188 65.84 16.986 2.372 .019 Modular 103 60.50 19.060 Other ∗ 6 Non-modular 188 54.62 21.318 4.407 .000 Modular 103 42.59 22.759 JUREI 100 Non-modular 210 65.22 15.108 2.794 .006 Modular 102 60.73 12.370 Tropical 100 Non-modular 198 66.32 13.755 1.134 .190 Modular 103 64.69 7.798 Practical 2 Non-modular 174 64.59 14.680 −2.024 .044 Modular 101 67.84 11.632
JUREI, total mark for the all the subjects, namely physics, abdominal, obstetrics, gynecology, and “other” that make up the final written examination set by Jefferson Ultrasound Research and Education Institute.
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Comparison of Performance among the Cadres
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Table 2
Mean Score by Cadre for Combined Group of Non-modular and Modular
Cadre Number in Cadre JUREI Mean Score for Combined Cohorts SD Tropical Disease Mean Score for Combined Cohorts SD Practical Mean Score for Combined Cohorts SD Doctor 25 73.4 6.71 76.3 9.24 71.5 12.88 Radiographer 101 71.8 10.85 68.9 12.03 68.5 13.76 Clinical officer 70 61.2 13.25 63.4 9.74 64.0 13.01 Nurse/midwife 111 57.1 14.36 63.3 11.03 64.6 12.13
JUREI, Jefferson Ultrasound Research and Education Institute.
For all the three final examinations, JUREI, tropical diseases and practical, the doctors performed best, followed by the radiographers, assistant physicians, and the nurses/midwives.
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Table 3
Performance by Cadre in the Final Written Examination by JUREI, with a 70% Cutoff Mark
Profession Medical Officer Radiographer Assistant Physicians Nurses and Midwives Others ∗ Total JUREI -70% Positive outcome Count 16 64 23 29 132 % within Profession 64.0% 63.4% 32.9% 26.1% 42.3% Negative outcome Count 9 37 47 82 5 180 % within Profession 36.0% 36.6% 67.1% 73.6% 100.0% 57.7%
JUREI, Jefferson Ultrasound Research and Education Institute.
The difference in the performance of the cadres was statistically significant, with a Pearson chi-square of 41.30 and a P value of .000.
Further analysis showed that at the 50% cutoff mark, the significant difference in performance was still maintained, but with a Pearson chi-square of 37.21 and a P value.
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Table 4
Performance by Cadre in the Final Written Tropical Diseases Ultrasound Examination with a Cutoff Mark of 70%
Profession Medical Officer Radiologist Assistant
Physicians Nurses and Midwives Other ∗ Total Tropical diseases -70% Positive outcome Count 19 41 18 27 105 % within Profession 79.2% 41.0% 27.3 25.5% 34.9% Negative outcome Count 5 59 48 79 5 196 % within Profession 20.8% 59.0% 72.7% 74.5% 100.0% 65.1%
The difference in the performance of the cadres was statistically significant, with a Pearson chi-square of 30.86 and a P value of .000.
Further analysis showed that at the 50% cutoff mark, there was no significant difference in performance among the cadres.
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Discussion
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Conclusion
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