The perception of Family Medicine by Medical Student and Clinical Teaching Staff: Tajikistan

Author(s) Dilrabo Kadirova1, Jura Inomzoda2, Sabine Kiefer3, Erik van Twillert 4, Kaspar Wyss 5
Affiliation(s) 1Chair of Family Medicine Nb. 1, Tajik State Medical University, Dushanbe, Tajikistan, 2Chair of Family Medicine Nb. 2, Tajik State Medical University, Dushanbe, Tajikistan, 33Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland, 4Medical Education Project, Swiss Tropical and Public Health Institute, Dushanbe, Tajikistan, 53Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
Country - ies of focus Tajikistan
Relevant to the conference tracks Health Workforce
Summary The Tajik government is committed to promoting a family medicine model for Tajikistan. However, recent trends show that family medicine remains an unpopular choice among medical students. The study explores, in a cross-sectional survey, the perception of students as well as teaching staff on family medicine. Results show that several steps can be taken by the university to improve the perception of family medicine among students and staff (e.g. orientation events, early exposure to family medicine training). However, extrinsic incentives are perceived as the most promising drivers for changing students’ perception of family medicine.
Background The Tajik government is, in its National Strategy 2010–2020, committed to a family medicine model by which affordable primary health care should be introduced throughout the country. To successfully implement the strategy, reforming medical education to increase the number of family doctors is therefore a priority. The Swiss Agency for Development and Cooperation is assisting these efforts through the Medical Education Project (MEP) being implemented by the Swiss Tropical and Public Health Institute.Though the changes are on-going, it is being observed that many students and health workers find family medicine still unattractive. The number of interns registering for family medicine has, similar to other Central Asian Countries, decreased strongly over the last years.It is assumed that several factors during undergraduate studies influence the choice of specialisation. Among these factors are the mediated perception of family medicine through medical teaching staff as well as the students own perception. To increase the number of family doctors, it is essential to understand the perception of family medicine at different stages of a students’ lifecycle at university and the possible positive or negative influences of these through teaching staffs’ own perception of family medicine.
Objectives The objective of the study was to generate insight into the prevailing perceptions of family medicine among medical undergraduate students and teaching staff. Possible determinants including the influence of socio-demographic aspects and clinical teaching. The changes to students' perception over the course of study were also investigated.
Methodology In 2013 a cross sectional survey among 1st, 4th and 6th year students as well as all clinical teaching staff at the Tajik State Medical University (TSMU) was carried out by the chairs of family medicine. Perception of respondents towards family medicine was assessed through a set of items relating to family medicine. Respondents were asked to rate them on a 5-point Likert scale.
In total more than 2’500 students and more than 350 staff of TSMU were included in the study. The ratings were analysed through factor analysis to identify underlying dimensions in the perception items. Each factor was combined in a composite score to compare opinions of different groups using statistical tests for independent samples and outcome variables to investigate the influence of socio-demographics.
Results Students were mostly interested in working in specialities other than family medicine, most prominently surgery and obstetrics and gynaecology. In their speciality choice, students rated the possibility to work in Dushanbe and/or abroad, as well as prestige and salary very highly. Teaching staff reinforced these aspects as main drivers for students’ choices but also added that career opportunities/professional possibilities would play an important role. Overall students and staff of all three cohorts agreed that working as a family doctor is currently not very attractive in Tajikistan.
There was also large agreement that most students, as well as teaching staff, do not actually know what family medicine is really about. Moreover, students were convinced that society and other medical professionals have a low opinion and perception of family medicine.
Nevertheless, students showed themselves to be open to family medicine. Students and teaching staff both agreed that everyone should receive training in family medicine, no matter what specialty they choose later. Students supported the idea that family medicine should have the same prestige as any other speciality. This was seen differently by some teaching staff. However, students and teaching staff did not agree that family doctors should receive higher salaries than narrow specialists or that the access to specialists should be controlled by family doctors.
The majority of students did not recall any comments by teaching staff about family medicine. Of those who had heard about family medicine, many reported that the statements were neutral or positive.
More in-depth results are currently being analysed and will be presented at the Geneva Health Forum 2014.
Conclusion The study provides insight into Tajik medical undergraduate students’ perception of family medicine and indicates that targeted interventions are necessary to increase the interest and commitment of students to become family doctors.
Several steps can be taken in conjunction with the university, the chairs of family medicine and through the medical education curriculum to improve students and staff perception of family medicine.
Given the low level of knowledge of family medicine, it is concerning that students and staff have a rather bad perception of family medicine. The majority of teaching staff and students were unfamiliar with family medicine. Once students enter university orientation and information events are essential. Contents of family medicine lectures, as well as career pathways, should be presented to the students. Similarly, information and promotion activities for the teaching staff would lead to a better perception of family medicine. Adapting the curriculum to provide an earlier and intensified exposure to family medicine training is required. Attractiveness and participation in practical trainings in family medicine should also be incentivised.A higher appreciation of family doctors, through extrinsic incentives, would positively change student perceptions. The most important aspects for students choosing a speciality were those which currently cannot be offered by family medicine positions in Tajikistan, specifically the placement in the Dushanbe or the higher prestige of a speciality. These aspects need reforms and continuous efforts from the Tajik Ministry of Health to better the conditions for family doctors and provide incentives for students to take up family medicine. Incentives for students need to be well-designed and structured to ensure that they truly raise students’ interest in family medicine. Beside higher salaries for the family doctors compared to other narrow specialities, this could include mandatory internships in family medicine.Based on the Tajik national health sector strategy, a strong political commitment from the government outlining the possible career pathways and opportunities for family doctors would clearly enhance the perception, value and popularity of family medicine.

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