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Student characteristics associated with good performance in medical school
HEALTHCARE POLICY ‘‘STUDENT CHARACTERISTICS ASSOCIATED WITH GOOD PERFORMANCE IN MEDICAL SCHOOL.’’ Cynthia P. Cordero, M. R. Festin, and B. F. Agbayani. CEU, University of the Philippines, Manila, Philippines. Objective: The University of the Philippines College of Medicine (UPCM) offers high quality medical education at low cost. Admission policies have to consider that this privilege is distributed equitably. This study determined student characteristics on admission that are associated with good performance at the UPCM. Design: Retrospective cohort study. Setting: University of the Philippines College of Medicine. Participants: 1265 students admitted from 1980 to 1989 at the UPCM with a pre-medical degree (PREMED). Main Outcome Measure(s): Good performance was measured by not having a failing grade in all the subjects taken, having graduated and general weighted average (GWAG) in UPCM (1.00–5.00 with 1.00 as excellent). Results: The following admission characteristics were studied: (1) age; (2) sex; (3) student category: academic vs. special students (i.e. ethnic minority/regionalization); (4) university where PREMED education was taken; and (5) PREMED GWAG. Multiple logistic regression analysis showed that the higher the PREMED GWAG, the higher is the likelihood of not having a failing grade. PREMED GWAG and having taken PREMED at UP were the two factors found associated with having graduated. UP graduates are 4 times (OR 5 3.7; 95% CI: 1.4–10.0) more likely to graduate in medicine than non-UP graduates. A student with a GWAG of 2.25 is 31% less likely to graduate than a student with a GWAG of 1.25. There was a trend that special students were less likely to graduate than those who entered by academic merits, but this was not statistically significant (OR 5 0.53; 95% CI: 0.23–1.23). Multiple linear regression showed that having taken PREMED at UP & higher PREMED GWAG were associated with higher UPCM GWAG. Conclusion: PREMED GWAG and having taken PREMED at UP were the important factors associated with good performance in medical school. Special students tend to perform less well than their classmates, but this difference was not statistically significant.
‘‘PHILIPPINE GUIDELINES ON THE DETECTION AND MANAGEMENT OF DYSLIPIDEMIA—A CONCEPTUAL FRAMEWORK FOR GUIDELINE DEVELOPMENT IN DEVELOPING COUNTRIES.’’ Antonio L. Dans. CEU, University of the Philippines, Manila, Philippines. Objective: The objectives of the study were: (1) to develop local practice guidelines on the detection and management of dyslipidemia; (2) to assess the validity and reliability of these guidelines. Design: A 4-step guideline development technique. Setting: Metro Manila. Participants: 39 delegates representing 13 medical, civic, governmental and non-governmental organizations. Methods: Guidelines were developed in a 4-phase process designed to address the perceived threats to validity, reliability, acceptability and feasibility. The final guides were considered valid, if panelist acceptance and satisfaction were high as measured in a self-administered questionnaire. The guidelines were considered reliable, if panelist participation was sustained through the various phases (i.e. numerators were preserved). Results: 12 statements were ratified, addressing 3 major questions on the management of dyslipidemia: (1) who should be screened; (2) how should screening be done; and (3) how should treatment be undertaken. Guideline validity was demonstrated by high rates of participant acceptance and satisfaction over the final guidelines. Reliability was demonstrated by sustained panelist participation in the 6-month process. Conclusion: Local practice guidelines for dyslipidemia were developed, using methods which maximized validity and reliability in a developing country setting. In addition, this method helped assure acceptability and sustainability of the guideline development process.
‘‘EVALUATION OF ACUTE RESPIRATORY INFECTION CASE MANAGEMENT IN CHILDREN IN BRAZIL.’’ Antonio Ledo Cunha, A. Fontenele, and J. Amaral. CEU, Universidade Federal Do Rio de Janeiro, Ministry of Health, Rio de Janeiro, Brazil. Objective: To determine the quality of assessment and treatment of chil-
‘‘A REVIEW OF REGULATORY FRAMEWORK FOR THE EMERGING PRIVATE HEALTH SECTOR IN UGANDA.’’ D. O. Okello, J. Konde-Lule, R. Lubanga, J. Arube-Wani, and J. Lwanga. CEU, Makerere University, Kampala, Uganda. Objective: To review and analyze existing laws and regulations for the pri-
dren with acute respiratory infection (ARI), a major cause of mortality and morbidity in Brazil. Design: Cross-sectional health facility survey. Setting: This national study was conducted in six state capitals of Brazil where ARI training occurred in the past 5 years. Participants: Health professionals attending children less than 5 years of age and their guardians. Interventions: None. Main Outcome Measure(s): Percent of ARI correctly classified and correctly treated according to WHO standard criteria; percent of pneumonia cases receiving standard management; percent of ARI cases receiving antibiotics unnecessarily; percent of guardians receiving instructions to provide home care. Results: Using a cluster sampling process, 35 hospitals, 112 health centers and 9 health posts were selected; 384 doctors and 9 nurses participated; 1565 children were observed (94 , 2 months, 489 from 2–11 months, and 982 from 1–4 years of age). Severe pneumonia, pneumonia, and other mild ARI cases were correctly classified in 36%, 34%, and 75% and correctly treated in 42%, 44% and 56% of the time, respectively. Only 21% of pneumonia cases received standard management. Standard antibiotics were unnecessarily prescribed for 9% of children, with large variation by state (2 to 16%); 59% of guardians received instructions to provide standard home care. Conclusions: Standard case management of children with ARI is low in Brazil. This has major policy implications regarding mortality reduction and the new IMCI strategy. More training and supervision on ARI case management is necessary.
vate health sector and determine how they affect the operations of the sector. The health care system in Uganda has changed dramatically, with the private sector beginning to take a leading role. Design: Cross-sectional and descriptive. Setting: Ministry of Health (MoH) headquarters and private medical clinics. Participants: Managers of a random sample of 89 clinics selected from a list of registered clinics in three large urban centers in the country, and top management of MoH. Interventions: A critical review of relevant Acts of Parliament and Regulations for the private sector; and structured interviews with clinic managers and top management of MoH. Main Outcome Measure(s): Appropriateness of laws and regulations with relevance to current health policy and practice; consumer protection; enforcement and supervision; presence of copies of the laws and regulations in the clinics; and managers’ knowledge and views on the laws and their enforcement. Results: The existing laws and regulations are comprehensive, but there are some loopholes regarding public protection. They do not cover disposal of medical waste, procedures on how consumers will deal with malpractice, and penalties for operating without a license. 98% of the managers interviewed have never seen a copy of the regulations and had limited knowledge about them. Top management of MoH and clinic managers confirmed that the laws are poorly enforced. Conclusions: Although there are some weaknesses in the regulations for the private health sector, they generally appear reasonable. The major problem relates to lack of enforcement. There is need to create awareness by educating the health care providers and enforce the existing laws and regulations.
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‘‘PHILIPPINE GUIDELINES ON THE DETECTION AND MANAGEMENT OF DYSLIPIDEMIA—A CONCEPTUAL FRAMEWORK FOR GUIDELINE DEVELOPMENT IN DEVELOPING COUNTRIES.’’ Antonio L. Dans. CEU, University of the Philippines, Manila, Philippines. Objective: The objectives of the study were: (1) to develop local practice guidelines on the detection and management of dyslipidemia; (2) to assess the validity and reliability of these guidelines. Design: A 4-step guideline development technique. Setting: Metro Manila. Participants: 39 delegates representing 13 medical, civic, governmental and non-governmental organizations. Methods: Guidelines were developed in a 4-phase process designed to address the perceived threats to validity, reliability, acceptability and feasibility. The final guides were considered valid, if panelist acceptance and satisfaction were high as measured in a self-administered questionnaire. The guidelines were considered reliable, if panelist participation was sustained through the various phases (i.e. numerators were preserved). Results: 12 statements were ratified, addressing 3 major questions on the management of dyslipidemia: (1) who should be screened; (2) how should screening be done; and (3) how should treatment be undertaken. Guideline validity was demonstrated by high rates of participant acceptance and satisfaction over the final guidelines. Reliability was demonstrated by sustained panelist participation in the 6-month process. Conclusion: Local practice guidelines for dyslipidemia were developed, using methods which maximized validity and reliability in a developing country setting. In addition, this method helped assure acceptability and sustainability of the guideline development process.
‘‘EVALUATION OF ACUTE RESPIRATORY INFECTION CASE MANAGEMENT IN CHILDREN IN BRAZIL.’’ Antonio Ledo Cunha, A. Fontenele, and J. Amaral. CEU, Universidade Federal Do Rio de Janeiro, Ministry of Health, Rio de Janeiro, Brazil. Objective: To determine the quality of assessment and treatment of chil-
‘‘A REVIEW OF REGULATORY FRAMEWORK FOR THE EMERGING PRIVATE HEALTH SECTOR IN UGANDA.’’ D. O. Okello, J. Konde-Lule, R. Lubanga, J. Arube-Wani, and J. Lwanga. CEU, Makerere University, Kampala, Uganda. Objective: To review and analyze existing laws and regulations for the pri-
dren with acute respiratory infection (ARI), a major cause of mortality and morbidity in Brazil. Design: Cross-sectional health facility survey. Setting: This national study was conducted in six state capitals of Brazil where ARI training occurred in the past 5 years. Participants: Health professionals attending children less than 5 years of age and their guardians. Interventions: None. Main Outcome Measure(s): Percent of ARI correctly classified and correctly treated according to WHO standard criteria; percent of pneumonia cases receiving standard management; percent of ARI cases receiving antibiotics unnecessarily; percent of guardians receiving instructions to provide home care. Results: Using a cluster sampling process, 35 hospitals, 112 health centers and 9 health posts were selected; 384 doctors and 9 nurses participated; 1565 children were observed (94 , 2 months, 489 from 2–11 months, and 982 from 1–4 years of age). Severe pneumonia, pneumonia, and other mild ARI cases were correctly classified in 36%, 34%, and 75% and correctly treated in 42%, 44% and 56% of the time, respectively. Only 21% of pneumonia cases received standard management. Standard antibiotics were unnecessarily prescribed for 9% of children, with large variation by state (2 to 16%); 59% of guardians received instructions to provide standard home care. Conclusions: Standard case management of children with ARI is low in Brazil. This has major policy implications regarding mortality reduction and the new IMCI strategy. More training and supervision on ARI case management is necessary.
vate health sector and determine how they affect the operations of the sector. The health care system in Uganda has changed dramatically, with the private sector beginning to take a leading role. Design: Cross-sectional and descriptive. Setting: Ministry of Health (MoH) headquarters and private medical clinics. Participants: Managers of a random sample of 89 clinics selected from a list of registered clinics in three large urban centers in the country, and top management of MoH. Interventions: A critical review of relevant Acts of Parliament and Regulations for the private sector; and structured interviews with clinic managers and top management of MoH. Main Outcome Measure(s): Appropriateness of laws and regulations with relevance to current health policy and practice; consumer protection; enforcement and supervision; presence of copies of the laws and regulations in the clinics; and managers’ knowledge and views on the laws and their enforcement. Results: The existing laws and regulations are comprehensive, but there are some loopholes regarding public protection. They do not cover disposal of medical waste, procedures on how consumers will deal with malpractice, and penalties for operating without a license. 98% of the managers interviewed have never seen a copy of the regulations and had limited knowledge about them. Top management of MoH and clinic managers confirmed that the laws are poorly enforced. Conclusions: Although there are some weaknesses in the regulations for the private health sector, they generally appear reasonable. The major problem relates to lack of enforcement. There is need to create awareness by educating the health care providers and enforce the existing laws and regulations.
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