Influence of resource adequacy on the implementation of competence-based medical education among lecturers at Kenya Medical Training College: A Cross-sectional mixed-methods study

Abstract

Objective: This research aimed at establishing the influence of the resource adequacy on the implementation of CBME among lecturers at KMTC.

Methodology: A cross-sectional mixed-methods design was used and aimed at about 1,200 lecturers in 24 KMTC campuses in all eight Kenyan regions. Proportionate stratified random sampling resulted in 224 participants. A structured Likert-scale questionnaire gauging resource adequacy in seven domains, including infrastructure, simulation, ICT, staffing, funding, policy support, and administrative support, was used to gather quantitative data. Six (6) Focus Group Discussions (FGDs) each comprising eight participants and eight (8) Key Informants Interview (KII) were used for qualitative data. STATA was used to do descriptive statistics, Pearson correlation and multivariate linear regression; NVivo version 12 was used to thematically analyze qualitative data.

Results: The study had a response rate of 91.52% (205 out 224) with males being 50.2% (n=103). The average index of the resource availability was 3.07 (SD = 0.94). The most favorable domain perceived to influence CBME implementation was simulation resources (87%, n=178) followed by ICT (78%, n=160), and staffing (74%, n=152). The largest perceived negative impact was infrastructure (16%, n=33) and funding (13%, n=27). The most statistically significant positive predictor of CBME implementation was resource adequacy
(β = 0.228, p < 0.001, R² = 0.133). The qualitative results indicated serious gaps in skills laboratory access, simulation devices, clinical supervision, ICT infrastructure, and CBME compliant capacity building.

Conclusion: Adequate resources is the basis of scaffolded, learner-based competency building. KMTC needs to invest in developing its skills laboratories, beefing up its ICT infrastructure, institutionalizing faculty development specific to CBME, and increasing its clinical placement capacity. CBME plans at the policy level should have clear resource allocation structures aligned to CBME grading systems.