Medical interns' perceptions of competence and readiness for obstetrics and gynaecology practice at selected tertiary hospitals in Uganda: A qualitative study
This qualitative study of medical interns in Uganda reveals that while they feel theoretically prepared for obstetrics and gynaecology, their perceived readiness for independent practice is significantly hindered by a lack of hands-on procedural experience and inconsistent supervision, highlighting the need for strengthened competency-based undergraduate training.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In Uganda, as in many places, the journey from medical student to independent doctor includes a mandatory year of supervised training known as an internship. During this critical period, new doctors rotate through essential departments like internal medicine, surgery, and pediatrics, but perhaps most importantly, they work in obstetrics and gynecology. This is the field dedicated to pregnancy, childbirth, and women's reproductive health. In Uganda, the stakes are exceptionally high. The country faces a significant shortage of specialist obstetricians, meaning that these newly graduated interns often find themselves providing the frontline care for mothers and babies, sometimes with only limited direct supervision. For a new doctor to be safe and effective, they need more than just book knowledge; they need clinical competence, which is the ability to combine what they know with the practical skills to handle real patients. While medical schools teach the theory, the transition to actually performing procedures like delivering a baby or managing an emergency is where many graduates feel the most uncertainty. Understanding how these young doctors perceive their own readiness is vital, because their confidence directly influences how they seek help, how they make decisions, and ultimately, the safety of the patients they serve.
A team of researchers set out to understand this transition by listening directly to the interns themselves. They conducted a study at two major teaching hospitals in Uganda, Kawempe National Referral Hospital and Naguru Regional Referral Hospital, interviewing doctors who had just finished their rotation in obstetrics and gynecology. The researchers did not test the doctors' skills in a lab; instead, they held in-depth conversations and group discussions to hear the interns' own stories about their training, their fears, and their confidence levels. They wanted to know what the doctors felt they were good at, where they felt unprepared, and what parts of their medical school education or their internship experience helped or hindered them. The study involved twenty-three participants from various medical schools across the country, ensuring a wide range of perspectives on how different training programs prepared them for the realities of the hospital ward.
The conversations revealed a clear and consistent pattern in how these doctors viewed their own abilities. They felt very confident in their theoretical knowledge. They could explain the causes of pregnancy complications, discuss the management of high blood pressure during pregnancy, and reason through complex medical cases. In their minds, they knew the "what" and the "why" of obstetrics very well. However, a sharp divide appeared when they talked about the "how." Many interns admitted that while they understood the theory behind procedures, they felt shaky about actually performing them. They felt less prepared to do things like assist in a cesarean section, perform a vacuum extraction, or manage a difficult delivery on their own. The gap was not in their intelligence or their understanding of the disease, but in their hands-on experience. They had watched and assisted, but they had not had enough chances to do the procedures themselves under close guidance before starting their internship.
This feeling of being theoretically ready but practically unsure was not just a personal insecurity; it was shaped by the environment in which they learned. The interns described their medical school rotations as varying widely. Some had long, structured periods where they could practice repeatedly, while others had shorter stints with fewer opportunities. A key factor they highlighted was the use of simulation. When schools used models or dolls to teach them how to deliver a baby, the interns felt a significant boost in their readiness. It allowed them to make mistakes and learn without risking a patient. Yet, even with good simulation, the real-world environment presented hurdles. In the hospitals, there were often too many students competing for too few patients, meaning that individual hands-on time was scarce. Furthermore, the quality of supervision varied. Some senior doctors were encouraging and allowed the interns to practice under their watch, while others were discouraging or simply too busy to provide the necessary guidance. This inconsistency meant that some interns gained confidence through repeated practice, while others remained hesitant.
The study also showed that readiness is not a switch that flips the moment a student graduates. Instead, it is a process that evolves during the internship itself. At the very start of their year of training, many interns felt they needed constant guidance and reassurance from senior doctors to feel safe. They relied heavily on supervision to translate their knowledge into action. However, as they continued to work, seeing more patients and performing more procedures, their confidence grew. They learned to recognize emergencies faster and felt more capable of making decisions. This growth was directly tied to the amount of supervised practice they received. The more they were allowed to do, and the more support they had while doing it, the more ready they felt to handle the job independently.
The researchers concluded that the path to a competent doctor in Uganda requires changes in how medical schools and hospitals work together. The current system produces graduates who know the theory but often lack the procedural confidence to act safely on their own. To fix this, the study suggests that medical schools need to focus more on competency-based training, where the goal is not just passing an exam but proving one can perform a skill. This means creating more structured opportunities for students to practice procedures, ensuring they have consistent supervision from experienced mentors, and using assessments that check their actual ability to do the work, not just their ability to answer questions. By strengthening these practical elements and ensuring that the internship environment supports learning rather than just filling a staffing need, the country can better prepare its doctors. This would not only boost the confidence of the new graduates but also improve the safety and quality of care for the mothers and babies who depend on them.
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