Please use this identifier to cite or link to this item: http://bura.brunel.ac.uk/handle/2438/30511
Title: ‘We were treated like we are nobody’: a mixed-methods study of medical doctors’ internship experiences in Kenya and Uganda
Authors: Zhao, Y
Mbuthia, D
Gathara, D
Nzinga, J
Tweheyo, R
English, M
Ankomisyani, DS
Kemunto, L
King’ori, W
Munyoki, G
Munywoki, J
Nicodemo, C
Okello, TR
Rutebemberwa, E
Simba, J
Wagaiyu, E
Were, F
Issue Date: 8-Nov-2023
Publisher: BMJ Publishing Group
Citation: Zhao, Y. et al. (2023) '‘We were treated like we are nobody’: a mixed-methods study of medical doctors’ internship experiences in Kenya and Uganda', BMJ Global Health, 8 (11), e013398, pp. 1 - 12. doi: 10.1136/bmjgh-2023-013398.
Abstract: Objective: Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors’ internship experiences in Kenya and Uganda. Methods: Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data. Findings: Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being ‘treated like we are nobody’. Conclusion: We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors’ well-being and provide standardised supervision, support systems and conducive learning environments.
Description: What is already known on this topic: Ensuring appropriate and well-supported medical internship training is important for health workforce production and health systems’ quality of care, however, there is a scarcity of studies focusing on medical officer interns in low-ncome and middle-income countries where resources are most restrained thus education and working conditions are worst. What this study adds: Most interns are satisfied with their job but many reported working unreasonable hours as long as 72 hours due to staff shortage. Interns reported challenging scenarios where they had poor supervision and insufficient support due to consultants not being available, and sometimes interns were the only staff managing the wards or had to perform certain procedures unsupervised. Some consultants also expressed concerns with interns’ preparedness coming into the internship as well as competence postinternship. How this study might affect research, practice or policy: We highlighted the need to improve the resource availability and capacity of internship hospitals, ensure interns’ preparedness before internship, prioritise the well-being of individual doctors and ensure standardised supervision, support systems and conducive learning environments are in place. This study adds to the global literature on internship experiences of medical doctors and could also help others design evidence-based policies and interventions to address specific challenges during medical internships.
Collaborators: Kenya & Uganda Medical Internship Experience Study Group: Dos Santos Ankomisyani, Mike English, David Gathara, Lyndah Kemunto, Wangechi King’ori, Daniel Mbuthia, Gilbert Munyoki, Joshua Munywoki, Catia Nicodemo, Jacinta Nzinga, Tom Richard Okello, Elizeus Rutebemberwa, Justus Simba, Raymond Tweheyo, Evelyn Wagaiyu, Fred Were, Yingxi Zhao.
Data availability: statement Data are available on reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
Supplementary files are available online at: https://gh.bmj.com/content/8/11/e013398#supplementary-materials .
URI: https://bura.brunel.ac.uk/handle/2438/30511
DOI: https://doi.org/10.1136/bmjgh-2023-013398
Other Identifiers: ORCiD: Yingxi Zhao https://orcid.org/0000-0002-4937-4703
ORCiD: Mike English https://orcid.org/0000-0002-7427-0826
ORCiD: Catia Nicodemo https://orcid.org/0000-0001-5490-9576
e013398
Appears in Collections:Brunel Business School Research Papers

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