The Ethiopian Anesthetist Licensing Examination and Associated Improvement in in-School Student Performance: A Retrospective Study

Yohannes Molla Asemu; Tegbar Yigzaw; Firew Ayalew; Leulayehu Akalu; Fedde Scheele; Thomas van den Akker

doi:10.2147/AMEP.S414217

The Ethiopian Anesthetist Licensing Examination and Associated Improvement in in-School Student Performance: A Retrospective Study

Adv Med Educ Pract. 2023 Jul 13:14:741-751. doi: 10.2147/AMEP.S414217. eCollection 2023.

Authors

Yohannes Molla Asemu^{1

2}, Tegbar Yigzaw¹, Firew Ayalew¹, Leulayehu Akalu^{3

4}, Fedde Scheele^{2

5

6}, Thomas van den Akker^{2

7}

Affiliations

¹ Health Workforce Improvement Program, Jhpiego, an Affiliate of Johns Hopkins University, Ethiopia Country Office, Addis Ababa, Ethiopia.
² Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
³ Ethiopian Association of Anesthetists (EAA), Addis Ababa, Ethiopia.
⁴ School of Anesthesia, Addis Ababa University, Addis Ababa, Ethiopia.
⁵ Department of Obstetrics and Gynecology, OLVG Teaching Hospital, Amsterdam, the Netherlands.
⁶ Department of Obstetrics and Gynecology, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands.
⁷ Department of Obstetrics and Gynecology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands.

Abstract

Background: Ethiopia introduced a national licensing examination (NLE) in response to growing concerns about the competence of graduates and the quality of education. This study aimed to assess the associated in-school student performance changes in anesthetist training programs following NLE implementation.

Methods: Academic records of 1493 graduate anesthetists were retrospectively obtained from eight universities before (n=932) and after (n=561) NLE implementation. Four universities were first-generation (oldest), three were second-generation, and one was third-generation (newest). We compared the yearly (Y1 to Y4) and cumulative grade point averages (GPA) to assess if there were in-school student performance differences between the two periods. The Kruskal-Wallis and Mann-Whitney U-tests were used to compare groups. Results are presented as a median, interquartile range, a 95% confidence interval (CI) for median differences, and Cohen's r effect size.

Results: Overall, there was a small to moderate improvement in student academic performance following NLE implementation. However, the statistically significant differences were limited to first-generation university students and those entering directly from high school. We found considerable positive differences in all five performance measures in first-generation university students, with Year-1 GPA and cumulative GPA measurements exhibiting large effect sizes (Cohen's r = 0.96 and 0.79, respectively, p <0.005). Those entering from high school demonstrated significant differences in four of five performance measures, with the largest positive gains on the year-1 GPA (median before [n=765] and after [n=480]: 3.11-3.30, 95% CI (0.09, 0.22), r=0.46, p <0.005)). Second- and third-generation university students showed no significant differences, while nurse entrants exhibited a significant difference in their Y2GPA scores only with an actual drop in performance.

Conclusion: The Ethiopian anesthetist NLE is associated with an overall modest in-school academic performance improvement, supporting its use. The stagnant or declining performance among nurse entrants and the newest (second and third) generation university students deserve further scrutiny.

Keywords: anesthesia; anesthetist; associate clinician; licensing examination; non-physician.

Grants and funding

This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the Cooperative Agreement No. 72066320CA00008. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.