Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education.

INTRODUCTION: The last two decades have seen a shift in former Soviet countries from highly specialized to more family medicine-focused systems. Medical education has slowly adjusted to these reforms, although the region is still at risk to have a chronic shortage of family doctors. This paper presents the evaluation of a new post-graduate family medicine program in Tajikistan, focused on competency-based training. The findings are relevant for policy makers, international organizations and practitioners participating in similar medical education reform programs. METHODS: We employed a quasi-experimental control group design and compared intervention residents, control group residents with traditional training, and 1st year residents with no training in two outcomes, clinical knowledge and competencies. We employed two objective measures, a written multiple-choice question test (MCQT) and an Objective Structured Clinical Examination (OSCE), respectively. We report reliability and validity of the measures along with ANOVA, planned contrasts and effect size estimates to examine differences across groups. RESULTS: We found statistically significant differences in both clinical knowledge and competencies between intervention and control groups. We also detected a large intervention effect size. Participants in the intervention outperformed control group participants in the two measures. Our analysis suggests that intervention and control group participants are comparable in terms of initial knowledge and competencies, strengthening the argument that the intervention caused the improvement in the program outcomes. DISCUSSION: Receiving tailored training and structured opportunities to practice knowledge and competencies in clinical settings have a positive effect on the education of family medicine doctors in Tajikistan. Our results support curriculum reform and investment in medical education in the form of longer and supervised on-the-job preparation designed to be more in line with international standards. We discuss suggestions for future studies and potential requirements to inform replicability in other countries. CONCLUSION: Family medicine is well recognized as central to health systems throughout the world, but high quality residency training lags behind in some countries. Our study showed that investing in family medicine residency programs and structured training is effective in increasing critical clinical competencies. We encourage promoting comprehensive post graduate family medicine doctor training so that the goals of a family medicine centered health system are attainable.

Evaluation of the microbial quality of Tajik sambusa and control of Clostridium perfringens germination and outgrowth by buffered sodium citrate and potassium lactate.

Clostridium perfringens spore destruction, aerobic plate counts (APCs), and counts of Enterobacteriaceae, coliforms, and Escherichia coli during baking of sambusa (a traditional Tajik food) were evaluated. Control of germination and outgrowth of C. perfringens spores in sambusa during cooling at room or refrigerated temperatures was evaluated using organic acid salts (buffered sodium citrate [Ional] and 1 and 2% potassium lactate, wt/wt). Sambusa were prepared with 40 g of either inoculated or noninoculated meat and baked for 45 min at 180 degrees C. For evaluation of destruction of C. perfringens spores during heating and germination and outgrowth of spores during cooling, ground beef was inoculated and mixed with a three-strain cocktail of C. perfringens spores. Aerobic bacteria, Enterobacteriaceae, coliforms, and E. coli were enumerated in noninoculated sambusa before and after baking and after cooling at room or refrigeration temperatures. After baking, APCs and Enterobacteriaceae and coliform counts were reduced by 4.32, 2.55, and 1.96 log CFU/g, respectively. E. coli counts were below detectable levels in ground beef and sambusa samples. Enterobacteriaceae, coliform, and E. coli counts were below detectable levels (< 0.04 log CFU/g) in sambusa after cooling by both methods. Total C. perfringens populations increased (4.67 log CFU/g) during cooling at room temperature, but minimal increases (0.31 log CFU/g) were observed during cooling under refrigeration. Incorporation of 2% (wt/wt) buffered sodium citrate controlled C. perfringens spore germination and outgrowth (0.25 log CFU/g), whereas incorporation of up to 2% (wt/wt) potassium lactate did not prevent C. perfringens spore germination and outgrowth. Incorporation of organic acid salts at appropriate concentrations can prevent germination and outgrowth of C. perfringens in improperly cooled sambusa.