title: Lessons learnt from comprehensive evaluation of community-based education in Uganda: a proposal for an ideal model community-based education for health professional training institutions.
abstract: BACKGROUND
  Community-based education (CBE) can provide contextual learning that addresses manpower scarcity by enabling trainees acquire requisite experiences, competence, confidence and values. In Uganda, many health professional training institutions conduct some form of community-based education (CBE). However, there is scanty information on the nature of the training: whether a curriculum exists (objectives, intended outcomes, content, implementation strategy), administration and constraints faced. The objective was to make a comprehensive assessment of CBE as implemented by Ugandan health professional training institutions to document the nature of CBE conducted and propose an ideal model with minimum requirements for health professional training institutions in Uganda.
  
  
  METHODS
  We employed several methods: documentary review of curricula of 22 institutions, so as to assess the nature, purpose, outcomes, and methods of instruction and assessment; site visits to these institutions and their CBE sites, to assess the learning environment (infrastructure and resources); in-depth interviews with key people involved in running CBE at the institutions and community, to evaluate CBE implementation, challenges experienced and perceived solutions.
  
  
  RESULTS
  CBE was perceived differently ranging from a subject, a course, a program or a project. Despite having similar curricula, institutions differ in the administration, implementation and assessment of CBE. Objectives of CBE, the curricula content and implementation strategies differ in similar institutions. On collaborative and social learning, most trainees do not reside in the community, though they work on group projects and write group reports. Lectures and skills demonstrations were the main instruction methods. Assessment involved mainly continuous assessment, oral or written reports and summative examination.
  
  
  CONCLUSIONS
  This assessment identified deficiencies in the design and implementation of CBE at several health professional training institutions, with major flaws identified in curriculum content, supervision of trainees, inappropriate assessment, trainee welfare, and underutilization of opportunities for contextual and collaborative learning. Since CBE showed potential to benefit the trainees, community and institutions, we propose a model that delivers a minimum package of CBE and overcomes the wide variation in the concept, conduct and implementation of CBE.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, P,O, Box 7072, Kampala, Uganda. dankkaye@yahoo.com
authors.forename: Dan K
authors.initials: DK
authors.lastname: Kaye
authors.forename: Wilson W
authors.initials: WW
authors.lastname: Muhwezi
authors.forename: Ann N
authors.initials: AN
authors.lastname: Kasozi
authors.forename: Steven
authors.initials: S
authors.lastname: Kijjambu
authors.forename: Scovia N
authors.initials: SN
authors.lastname: Mbalinda
authors.forename: Isaac
authors.initials: I
authors.lastname: Okullo
authors.forename: Rose C
authors.initials: RC
authors.lastname: Nabirye
authors.forename: Hussein
authors.initials: H
authors.lastname: Oria
authors.forename: Lynn
authors.initials: L
authors.lastname: Atuyambe
authors.forename: Sarah
authors.initials: S
authors.lastname: Groves
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
authors.forename: Andrew
authors.initials: A
authors.lastname: Mwanika
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D005069:Evaluation Studies as Topic; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007858:Learning; D017145:Models, Educational; D020380:Needs Assessment; D012111:Residence Characteristics; D013663:Teaching; D014454:Uganda