@article {1396877,
	title = {Clinical performance among recent graduates in nine low- and middle-income countries},
	journal = {Trop Med Int Health},
	volume = {24},
	year = {2019},
	month = {2019 05},
	pages = {620-635},
	abstract = {OBJECTIVES: Recent studies have identified large and systematic deficits in clinical care in low-income countries that are likely to limit health gains. This has focused attention on effectiveness of pre-service education. One approach to assessing this is observation of clinical performance among recent graduates providing care. However, no studies have assessed performance in a standard manner across countries. We analysed clinical performance among recently graduated providers in nine low- or middle-income countries. METHODS: Service Provision Assessments from Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda were used. We constructed a Good Medical Practice Index that assesses completion of essential clinical actions using direct observations of care (range 0-1), calculated index scores by country and clinical cadre, and assessed the role of facility and clinical characteristics using regression analysis. RESULTS: Our sample consisted of 2223 clinicians with at least one observation of care. The Good Medical Practice score for the sample was 0.50 (SD = 0.20). Nurses and midwives had the highest score at 0.57 (SD = 0.20), followed by associate clinicians at 0.43 (SD = 0.18), and physicians at 0.42 (SD = 0.16). The average national performance varied from 0.63 (SD = 0.18) in Uganda to 0.39 (SD = 0.17) in Nepal, persisting after adjustment for facility and clinician characteristics. CONCLUSIONS: These results show substantial gaps in clinical performance among recently graduated clinicians, raising concerns about models of clinical education. Competency-based education should be considered to improve quality of care in LMICs. Observations of care offer important insight into the quality of clinical education.},
	keywords = {Adult, Africa, Child, Child, Preschool, Clinical Competence, Delivery of Health Care, Developing Countries, Education, Medical, Female, Haiti, Health Care Surveys, Humans, Income, Infant, Infant, Newborn, Male, Maternal-Child Health Services, Midwifery, Nepal, Nurses, Physicians, Pregnancy, Quality of Health Care},
	issn = {1365-3156},
	doi = {10.1111/tmi.13224},
	author = {Lewis, Todd P and Sanam Roder-DeWan and Address Malata and Youssoupha Ndiaye and Margaret E Kruk}
}
