Perceptions and valuation of a community-based education and service (COBES) program in Uganda

Figures & data

Table

Practice points

Students and educators have positive perceptions and valuation of COBES. The learning environment and quality of teaching are important factors in affecting student valuation of COBES. COBES allows students to experience a broad spectrum of important “real-world” educational content. More and sustained financial and human resources are needed to improve the quality and impact of COBES programs.

Table 1.  Characteristics of survey respondents

Characteristic	Subcharacteristic	Result
Students (n = 188)
Male gender, n (%)		141 (75%)
Age, years, and mean (range)		22.6 (19–39)
Degree program, n (%)*
	Medicine	143 (76%)
	Nursing	11 (6%)
	Dentistry	7 (4%)
	Radiography	6 (3%)
	Pharmacy	20 (11%)
Year in program
	2	71 (38%)
	3	51 (27%)
	4	38 (20%)
	5	28 (15%)
Faculty (n = 53)
Male gender, n (%)		31 (59%)
Age, years, and mean (range) n = 48		42.3 (26–61)
Site supervisor status
	Current supervisor	15 (28%)
	Non-site supervisor	38 (72%)
Tutors (n = 14)
Male gender, n (%)		13 (93%)
Age, years, and mean (range)		36.4 (28–52)
Years as tutor, mean (range)		4.1 (2–8)
Official title, n
	Medical Officer	8
	District Health Officer	2
	Other (one each District Health Educator, Site Manager, Medical Superintendent, Nurse)	4

Table 2.  Student responses to Likert scale questions^a

Statement	N	Mean (SD) [range]
“I was prepared for the COBES experience.”	186	3.34 (1.1) [1–5]
“The COBES stipend was enough for my financial needs associated with the COBES rotation.”	186	1.63 (0.83) [1–4]
Please rate the quality of your accommodations at your COBES site.	152	3.07 (0.96) [1–5]
Please rate the overall value of the COBES experience to your overall training.	186	4.44 (0.93) [1–5]
Tutor assessment and student valuation
“My tutor is readily available when I need to discuss a case.”	188	3.71 (1.1) [1–5]
–“Important to my education?”^b	187	4.70 (0.58) [1–5]
“My tutor gives constructive feedback.”	187	4.24 (0.81) [1–5]
–“Important to my education?”	188	4.77 (0.60) [1–5]
“My tutor would often fail to show up for scheduled meetings.”	188	2.21 (1.2) [1–5]
–“Important to my education?”	188	4.70 (0.54) [1–5]
“My tutor respects my judgment.”	184	3.98 (0.75) [2–5]
–“Important to my education?”	186	4.47 (0.64) [3–5]
“My tutor demonstrates enthusiasm for teaching.”	187	3.99 (0.89) [1–5]
–“Important for my education”	187	4.64 (0.64) [1–5]
“My tutor is effective in making me aware of clinic and social resources for my patients.”	188	4.04 (0.92) [1–5]
–“Important to my education?”	188	4.78 (0.42) [4–5]
“My tutor provides a good role model of professional behavior.”	187	4.13 (0.88) [1–5]
–“Important to my education?”	188	4.71 (0.54) [1–5]

Notes: ^aLikert scale response options were as follows: 1 = disagree strongly/no value; 2 = disagree; 3 = neutral; 4 = agree; 5 = agree strongly/high value.

^bRefers to statement immediately above, e.g., It is important to “my education that my tutor is readily available …”

Table 3.  Univariate and multivariate analyses of factors associated with high student valuation of COBES

Characteristic	Odds ratio (95% CI)	Adjusted odds ratio (95% CI)	p-value^a
Accommodations of high quality	4.1 (1.7–9.6)	4.7 (1.6–13.4)	0.0043
Free accommodations	2.5 (1.3–5.0)	2.9 (1.2–6.8)	0.015
Seeing patients with a wide range of ages	4.1 (1.5–11.3)	1.3 (0.29–6.0)	0.72
Seeing a wide range of social conditions	2.3 (1.0–5.2)	1.4 (0.45–4.6)	0.54
Seeing a wide range of child and neonatal health problems	2.1 (1.1–3.8)	1.7 (0.71–4.4)	0.22
Seeing a wide range of infectious diseases	2.0 (1.7–3.8)	1.1 (0.42–3.0)	0.81
A tutor who gives constructive feedback	3.4 (1.3–8.3)	0.66 (0.14–3.2)	0.61
A tutor who respects my judgment	2.9 (1.4–5.7)	2.1 (0.71–6.0)	0.18
A tutor who demonstrates enthusiasm for teaching	3.5 (1.7–7.2)	3.4 (1.1–10.0)	0.037
A tutor who provides a good role model	2.3 (1.2–4.7)	1.6 (0.60–4.5)	0.33

Note: ^ap-value is for adjusted odds ratio.

Figure 1. Student rankings of likelihood they will pursue work in a rural setting after they graduate (n = 187).

Table 4.  Faculty and tutor responses to Likert scale questions

Statement	N	Mean (SD) [range]
Tutors
“I felt well trained to be a good tutor.”	14	3.57 (0.85) [2–5]
“I would like to have more trainings in being a good tutor.”	14	4.64 (0.63) [3–5]
“I can easily contact Makerere faculty for help with problems related to COBES.”	14	3.86 (1.1) [1–5]
“Feedback from Makerere was useful in improving the COBES experience.“	14	3.57 (1.3) [1–5]
“I felt poorly prepared to do a good job as a tutor.”	14	2.21 (0.98) [1–4]
“I felt supported in my job as a tutor by Makerere faculty and staff.”	14	3.50 (1.2) [1–5]
“I had enough time to teach the students.”	14	3.57 (0.85) [2–5]
“I believe COBES will encourage students to work in rural communities after they graduate.”	14	4.14 (0.95) [2–5]
“I enjoyed being a tutor.”	14	4.43 (0.85) [2–5]
Faculty
“Students are prepared for going into the field during their COBES course.”	52	3.67 (0.71) [1–5]^a
“Students should receive more teaching at Makerere before going on their COBES course.”	52	3.56 (1.1) [1–5]^b
“The COBES course has been valuable for students.”	51	4.33 (0.77) [2–5]^a
“I believe COBES will encourage students to work in rural communities after they graduate.”	52	3.73 (1.1) [1–5]^a
“The tutors receive enough training to do a good job.”	53	2.87 (0.98) [1–4]
“The tutors should have yearly re-trainings.”	53	4.38 (0.81) [2–5]^a
“Tutors have a hard time contacting Makerere faculty for help with problems related to COBES.”	53	3.36 (0.90) [1–5]

Notes: ^aCurrent site supervisors answered more positively than non-site supervisors, all p-values < 0.05.

^bCurrent site supervisors answered more negatively than non-site supervisors, p-value < 0.05.

Table 5.  Student, faculty, and tutor responses to COBES experience statements

	Students (n = 188)	Faculty (n = 52)	Tutors (n = 14)
Statement	Mean (SD) [range]	Mean (SD) [range]	Mean (SD) [range]
“During the COBES rotation, the students …”
“Saw a wide range of medical conditions.”	3.42 (1.1) [1–5]^a	3.90 (0.93) [1–5]^a,b	4.21 (0.98) [2–5]^a
“Saw patients with a wide range of ages.”	4.20 (0.84) [1–5]	4.15 (0.72) [2–5]^b	4.57 (0.65) [3–5]
“Saw a poor balance between men and women.”	3.97 (1.0) [1–5]^a	2.75 (1.0) [1–5]^a	3.50 (1.2) [1–5]^a
“Identified a number of community health needs.”	4.56 (0.61) [2–5]	4.33 (0.68) [3–5]^b	4.57 (0.51) [4–5]
“Learned a great deal about the district health administrative system.”	4.32 (0.80) [1–5]	4.10 (0.80) [3–5]^b	4.57 (0.51) [4–5]
“Saw a wide range of social conditions.”	4.15 (0.83) [1–5]	4.21 (0.70) [3–5]^b	4.57 (0.51) [4–5]
“The students saw a wide range of maternal health problems.”	3.93 (1.0) [1–5]	4.08 (0.71) [3–5]	4.21 (0.70) [3–5]
“Saw a wide range of child and neonatal health problems.”	3.59 (1.1) [1–5]	4.02 (0.75) [2–5]	3.86 (0.95) [2–5]
“Saw a wide range of infectious diseases.”	3.77 (1.1) [1–5]^a	4.25 (0.68) [3–5]^a	4.08 (0.86) [2–5]^a
“Saw a wide range of environmental health problems.”	4.11 (0.89) [1–5]	4.31 (0.76) [3–5]^b	4.21 (0.70) [3–5]
“Worked in-depth on a community health problem.”	3.85 (0.96) [1–5]	3.92 (0.81) [2–5]	4.29 (0.47) [4–5]

Notes: ^aSignificantly different mean score across the three groups, all p-values < 0.05.

^bCurrent faculty site supervisors answered more positively than non-site supervisors, all p-values < 0.05.