Perceptions of Undergraduate Students towards Utilization of Clinical Simulation in Teaching and Learning in Rural Universities in Uganda: A Mixed method study.

Background: Simulation is a new pedagogical method in Africa that underscores the need to operationalize it and generate context-specific scholarship regarding clinical simulation in Africa. Despite the superior learning outcomes of using simulation in medical education, its use in developing countries is often limited, compounded by limited scholarship on simulation especially relevant to an African context. The research aimed to explore perceptions surrounding the use of simulation among undergraduate students. Methods: A mixed method convergent parallel design was used in which both the quantitative and qualitative approaches were employed currently to explore the perception of the undergraduate students towards the use of clinical simulation in teaching and learning. The quantitative approach assessed the perception of the students on a five-point Likert from strongly disagree to strongly agree scale while the qualitative approach employed a focused group discussion to explore the perception of the students in regards to clinical simulation. Quantitative data was analyzed using Stata Version 17. Qualitative results were analyzed through thematic analysis by Brauna and Clark. Results: 298 participants were recruited into the study. The mean age of the participants was 27 years with a standard deviation of 5.81 years. The majority 152(51.01%) of the participants were males. Most 111(37.25%) of the participants were pursuing Bachelor of Medicine and Bachelor of Surgery. The grand mean of the perception scores of the students towards the use of simulation in clinical teaching was 3.875269 ±0.5281626. The participants strongly agreed that it is incredibly helpful to have someone who works in the field debrief with them after completing a scenario and their overall perception towards this was high (Mean =4.65241±0.6617337). Conclusion: This exploratory study revealed that medical, nursing, and midwifery students from the rural Universities of Busitema and Lira demonstrated a positive perception of the use of clinical simulation in teaching and learning. The results conclude that simulations help students better understand concepts in clinical settings, provide them with valuable learning experiences, and help them stimulate critical thinking abilities. Further, the participants perceive simulation to be realistic, and knowledge gained could be transferred to the clinical areas.

"We are actually being involved in management of the patient": A qualitative exploration of experiences of students and faculty regarding the use of clinical simulation in Busitema University and Lira University.

Introduction: Experiences regarding the use of simulation in low-resource settings like Uganda where it has not taken root have not been explored. The purpose of the study was to explore the experiences of students, clinical staff, and faculty regarding the use of clinical simulation in teaching undergraduate students. Materials and methods: The study was conducted at Busitema and Lira Universities in Uganda. We conducted 20 in-depth interviews with the faculty staff and 10 focused group discussions with undergraduate Nursing, Midwifery, Medical and Anesthesia students. The study obtained ethical clearance from the Busitema University Research and Ethics Committee (BUFHS-2023-78) and Uganda National Council of Science and Technology (HS3027ES). Thematic analysis was used to analyze the data. Results: Four themes emerged from the data. Simulation was seen to be about improvising and (return) demonstration. Concerns of realism were expressed including notions that simulation was not real, that simulation felt real and the extreme end that simulation tends to present the ideal setting. Perceived benefits of simulation include room for mistakes and immediate feedback, enhanced confidence and self-efficacy, enhanced acquisition of soft and clinical skills, prepares students for clinical placement, convenient and accessible. Concerns were expressed related to whether skills in clinical simulation would translate to clinical competence in the clinical setting. Conclusion: Students perceived simulation to be beneficial. However, concerns about realism and transferability of skills to clinical settings were noted. Clarifying preconceived notions against the use of clinical simulation will enhance its utilization in educational settings where simulation is not readily embraced.

Practices and drivers of self-medication with antibiotics among undergraduate medical students in Eastern Uganda: A cross-sectional study.

Self-medication with antibiotics remains one of the major drivers of antimicrobial resistance. Practices of self-medication among nursing and medical students have not been explored in our setting. This study sought to determine the prevalence and factors associated with self-medication with antibiotics among undergraduate university students pursuing health-related courses in Eastern Uganda. A descriptive cross-sectional study design was used. The study was done among undergraduate students who were doing undergraduate programs in Nursing, Anesthesia, and medicine at Busitema University. A self-administered questionnaire was used to collect data from 326 participants. Descriptive statistics were used in data analysis. The prevalence of self-medication with antibiotics was 93.8% (n = 300) of which 80% were either currently using self-medication or had self-medicated in the past six months. The common reasons for self-medication were the perception that it was a minor illness (55%), previous use of antibiotic (52%), a perception that they were health workers (50%), and the notion that they knew the right antibiotic for their condition (44%). Metronidazole (64%) and amoxicillin (65%) were the most commonly used antibiotics. Self-medication was most common for conditions such as peptic ulcer, diarrhea, and wound infections. Inappropriate drug use was common among participants on self-medication which occurred in the form of multiple use of antibiotics (64.4%, n = 194) and a tendency to switch to other antibiotics (58.5%) mostly because the former antibiotic was perceived not to be an effective treatment. The prevalence of self-medication with antibiotics was high among medical students. Prior use of the antibiotic and having a minor illness were the most common drivers of self-medication. Public health strategies should address the high misuse of antibiotics among medical students to negate the likely consequence of antimicrobial resistance.

"No PBL is better than online PBL": Qualitative exploration regarding the perceived impact of online problem-based learning on nursing and medical students' learning during COVID-19 lockdown.

The COVID-19 pandemic and its restrictions increased the adoption of online learning even in low-income countries. The adoption of online teaching methods may have affected teaching and learning, particularly in settings where it was used for the first time. This study was conducted to explore the perceptions of medical and nursing students regarding the impact of online delivery of problem-based learning (PBL) on students learning and academic performance during COVID-19 imposed restrictions. Methods and materials: This was a qualitative study among fourth and fifth-year nursing and medical undergraduate students at Busitema University Faculty of Health Sciences. Four focused group discussions were conducted and the interviews focused on students' perceptions, experiences, and attitudes toward the PBL process conducted online and its likely impact on their learning. Braun and Clarke's thematic analysis was used for qualitative data analysis. Results: Four themes were identified that represented perceptions of online PBL on learning: transition to online learning; perceived benefits of online learning; limited learning and poor performance; and lost soft and practical skills. During the initial stages of introduction to online PBL learning, students transitioning to online had to adapt and familiarize themselves with online learning following the introduction of online learning. Students perceived that learning was less online compared to face-to-face sessions because of reduced learner engagement, concentration, motivation, peer-to-peer learning, and limited opportunities for practical sessions. Online learning was thought to increase students' workload in the form of a number of assessments which was thought to reduce learning. Online tutorials were perceived to reduce the acquisition of soft skills like confidence, communication, leadership, and practical or clinical skills. While learning was thought to be less during online teaching, it was noted to allow continued learning during the lockdown, to be flexible, enhance self-drive and opportunity for work, solve infrastructure problems, and protect them from COVID-19 infection. Conclusion: Generally, online learning enabled continuity and flexibility of learning. However, online PBL learning was perceived to be less engaging compared to traditional classroom-based PBL. Online PBL was seen to deter students from acquiring critical generic and clinical skills inherently found in traditional PBL. Innovative pedagogical measures should be adopted to avoid reduced learning noted in the online teaching methods to ensure the successful adoption of online teaching and learning in the post-COVID-19 era.

Are antibiotic prescription practices in Eastern Uganda concordant with the national standard treatment guidelines? A cross-sectional retrospective study.

OBJECTIVES: This study aimed to evaluate the antibiotic prescription patterns of health workers in Eastern Uganda and more specifically whether they are in accordance with the Ugandan standard treatment guidelines and other indicators of appropriate antimicrobial prescription. METHODS: Patient data were obtained from the health management information system of the outpatient department registers of Soroti and Mbale Regional Referral Hospitals from 2016-2018. RESULTS: The prevalence of non-adherence to treatment guidelines when prescribing antibiotics was 82.6% (95% CI 81.4-83.7%). Guidelines were more likely to be adhered to when prescribing antibiotics for individuals aged 13-19 years compared with their counterparts aged 0-12 years [adjusted odds ratio (aOR) = 0.55, 95% CI 0.40-0.74]. When prescribing antibiotics for males, health workers were twice as likely not to adhere to guidelines compared with when prescribing for females (aOR = 2.09, 95% CI 1.61-2.72). When prescribing cephalosporins and nitroimidazoles, health workers were likely not to adhere to guidelines compared with when prescribing penicillin (cephalosporins, aOR = 1.92, 95% CI 1.28-2.86; nitroimidazoles, aOR = 1.70, 95% CI 1.09-2.65). Health workers were most likely not to follow guidelines when prescribing antibiotics in combination (two antibiotics, aOR = 1.27, 95% CI 1.03-1.56). CONCLUSION: Non-adherence to treatment guidelines for an indicated diagnosis and inappropriate antibiotic prescription are significantly prevalent in Eastern Uganda. Health workers were more likely not to follow guidelines when prescribing for males, children up to 12 years of age and when prescribing cephalosporins, nitroimidazoles or double antibiotic combinations.