Internship Situation Analysis Survey Report

Abstract

Internship is a mandatory pre-registration training required for licensure of doctors in Uganda. During the internship, medical workers acquire practical skills, attitudes and knowledge critical for them to work without supervision. This is when they also acquire skills of working in inter-professional teams to deliver quality health care services to the population. In addition, it is presumed that the internship experiences outside the mainstream teaching hospitals prepare these interns for the real-life work experiences that they are likely to encounter. However, the experiences of the interns and their perceived quality of internship in Uganda have never been described. Knowledge of the experiences of interns and their perceived quality is crucial in the design of interventions and formulation of policies aimed at improving internships and subsequently the quality of health workers. Cognizant of the need to improve the internship experience in Uganda, Makerere University College of Health Sciences (MakCHS) in collaboration with the Uganda Medical and Dental Practitioners Council (UMDPC) under the auspices of the HEPI-NIH Project, conducted a comprehensive study to tap into the experiences of interns while on duty in the various internship placement sites. The primary focus of the study was to explore and assess the experiences of the interns and the perspectives of their supervisors with the aim of identifying the strengths of the current internship program, challenges, weaknesses, and gaps and suggestions for improvement. This was a cross-sectional study that utilized both qualitative and quantitative approaches to capture feedback from interns (2019 to 2020 cohort) about their experiences at the various internship sites in Uganda. A total of 499 interns participated in the study. The interns were from 23 internship sites including regional referral public hospitals, teaching hospitals and private hospitals that usually host interns from various parts of Uganda. This wide inclusion of various hospitals in the country provided a 3600 rigorous analysis of the experiences of interns, which generally reflects the picture for the whole country. Analysis of the findings indicated that the interns generally liked the internship training and rated the internship as a very good training period for them to master clinical skills. They generally reported having high levels of work engagement with limited time for engaging in social activities. The supervisors generally reported that the quality of interns is fair apart from occasional deficiencies in some clinical skills and other generic skills such as communication, teamwork, leadership, and interpersonal skills. In addition, some interns had a deficiency in clinical skills required for internship training. Despite this positive outlook, there are still major gaps in the current internship program. It should be noted that in some cases, there was inadequate equipment, supplies and materials to use during the internship training. The supervisors were not available or provided inadequate support and the inadequate exposure to skills training opportunities, especially during the surgical rotations. The interns also reported high levels of stress, though the quality of supervision and mentorship while at the sites was a major moderator of their overall experience. The study overall revealed a lack of standardization regarding the duration spent in each clinical rotation, internship supervision and assessment of competence across the various sites. Overall, we strongly recommend the development of a standardized internship program to guide both interns and supervisors at the various sites.