Influence of the training experience of Makerere University medical and nursing graduates on willingness and competence to work in rural health facilities.

INTRODUCTION The global human resources crisis in the rural health sector is characterized by an unwillingness or inability of health workers to locate to a rural area, and/or function effectively there. To assist in addressing this issue in Uganda, Makerere University Faculty of Medicine designed and implemented a problem-based learning (PBL) curriculum in which health students underwent experiential training on community placements. This study sought to assess the influence of this training experience on students' willingness, readiness and competence to work in rural health facilities by surveying 60 recent graduates of Makerere University Faculty of Medicine, who completed their studies during the transition from traditional to PBL curriculum. METHODS During a comprehensive evaluation of the PBL curriculum conducted from 19 to 31 October 2008, 60 graduates were assessed. Their distribution between the traditional and PBL curricula was equal. Using a participatory approach and open-ended questionnaires, the 2 groups were compared for the effect of their training on willingness and readiness to work in a rural location. Influential training experience factors were compared according to whether the students were educated in the PBL curriculum or the traditional curriculum (with or without PBL influence). RESULTS The community based training experience of graduates significantly influenced their choice to work in a rural and underserved area of Uganda, compared with their counterparts from the traditional curriculum. In addition, PBL/community based curriculum graduates showed greater motivation to take up employment in a rural area, and confidence about practicing there effectively. CONCLUSION While personal values may impact on a decision to work in a rural area, training experience also shapes these personal values and choices.