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Report raises alarm on patient safety, says doctors poorly trained

Report says half of hospitals that accept medical interns are poorly equipped.

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by JOHN MUCHANGI

News18 May 2022 - 20:00

In Summary


  • Interns must perform a total of 36 competency surgeries but in many cases this does not happen.
  • KMPDU secretary general Atellah says most interns find no consultants to mentor them when sent to most hospitals outside Nairobi.
A sick bed at Ikutha Level 4 hospital. Most hospitals lack facilities for interns to learn from.

Patients' safety is at risk of serious medical errors because future doctors are poorly trained and often get accredited without knowledge of operational basics.

They might also end up making significant medical errors while conducting surgeries on patients.

This is according to a report titled 'Characterising Kenyan hospitals’ suitability for medical officer internship training'. 

The report found that half of hospitals that accept medical interns are poorly equipped and many future doctors finish the one-year training without learning some basic procedures.

Doctors on call are forced to take full responsibility for patient care, potentially threatening patient safety, the analysis shows.

At the end of six years of medical school, students undergo a one-year compulsory internship.

This happens under the supervision of a senior doctor, rotating in four major disciplines – surgery, internal medicine, paediatrics and child health and obstetrics and gynaecology.

Mental health and community health were added in 2020.

However, this hardly happens, according to a review of 61 of the 74 hospitals designated as internship centres.

“The potential consequences of poor training and supervision during internship are therefore worth consideration,” report said.

Thereafter, all the interns are licensed as independent doctors by the Kenya Medical Practitioners and Dentists Council.

The report further says “inadequate support and supervision threaten patient safety by creating the conditions for significant medical errors to occur”. 

The research, published by the British Medical Journal last week, was conducted by experts from Kemri-Wellcome Trust, University of Nairobi, Ministry of Health, Kenya Paediatric Research Consortium and University of Oxford.

All hospitals that offer internships should fulfil the minimum requirements outlined in the Kenyan National Guidelines for Internship Training of Medical and Dental Officer Interns and the National Guidelines and Log Book for Medical Officer Interns.

Each centre should have a minimum of five medical specialists, covering paediatrics and child health, general surgery, internal medicine, obstetrics and gynaecology and family medicine.

It must be fully operational on a 24-hour basis, including accident and emergency, diagnostic and pharmacy services.

Interns must perform a total of 36 competency surgeries such as appendicectomy or repair of inguinal hernias (a condition in which soft tissue bulges through the abdominal muscles).

Each facility must also have at least five medical specialists to act as the main clinical teachers and supervisors for medical officer interns.

“However, only 29 out of 61 internship training centres had at least five medical specialists assigned, employed or seconded (including part-time staff),” the report said.

The average score for all facilities was 69 per cent.

The report further said the “quality and safety score was low across all hospitals with an average score of 40 per cent.” 

The Kenya Medical Practitioners, Pharmacists and Dentists Union said the report captures the situation in internship centres accurately. 

KMPDU secretary general Dr Davji Bhimji Atellah said most interns find no consultants to mentor them when sent to hospitals outside Nairobi.

"There is a shortage of consultants across the country because county governments are not employing them," he said. 

"For instance, we have one psychiatry rotation at Mathari National Teaching and Referral Hospital and it's already overwhelmed.

"It's a fact there is need for both national and county governments to employ more consultants."

Medical consultants are usually practitioners who have acquired Masters of Medicine in various disciplines and have thereafter practised for at least two years.

He said the country is now producing more interns, about 1,000 every year, but this is not backed by the employment of fully qualified doctors they can work under. 

He said there are about 4,000 doctors seeking jobs. 

"For instance, in Embu, for the last 10 years, they have only employed 13 doctors. In the whole country, only 20 per cent of the doctors licensed in the last five years have been hired," Atellah said. 

The Star could not independently verify these figures. 

According to the internship report, most of the training hospitals had good capacity for surgery and obstetrics-gynaecology, but had little to learn from in internal medicine and paediatrics and neonatology.

 Many facilities lack ECG machines (for heart tests), CT scans, defibrillators (to revive cardiac arrest patients), dialysis equipment and lumbar puncture kits.

More specific to child health was a lack of capacity to provide exchange transfusion and neonatal Continuous Positive Airway Pressure to help babies breathe.

Capacity to offer mental health and neurological care was especially low particularly in level 4 hospitals.

“This could significantly influence the quality of training as interns might not be able to fully consolidate their knowledge and skills,” the experts said.

The experts said immediate mitigation measures need to be in place so that interns themselves are not disadvantaged further.

“For example, by rotating interns between different level hospitals with different level of resource availability,” they said.

“More widely, our findings point to the need to carefully consider the potential consequences of rapidly expanding medical training and of appropriate planning and financing for new internship centres, especially in rural areas.”

Two medical interns in Murang'a, who sought anonymity, told the Star there's little to learn that's new during the one year. 

"Mostly what we learn is how to improvise the little equipment you have. The situation might be better if you're in the county referral hospital," one of them said.

 

(edited by Amol Awuor)

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