Clinical officer

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Overview

In sub-saharan africa, Clinical officers are healthcare providers. In kenya they developed as a parallel profession in the 1920s when kenya was still a british colony to provide healthcare services to the native population. Their training was thus focused on the diagnosis and management of local health problems which were mostly infectious diseases such as malaria and diarrhea. They also learned to diagnose the more serious cases and to refer them appropriately. They were mostly trained on the job in hospitals and had titles such as hospital assistant, medical assistant etc.

After kenya gained independence in 1963 their training was formalised and standardised, following a compressed medical model. In 1989 the Clinical officers (training registration and licensing) act was passed and hence the profession entrenched in the constitution. They were mandated to prepare legal documents eg medical certificates and fill P3 forms and to produce evidence in a court of law. The act abolished all previous titles and henceforth only the title Clinical officer was legally recognised.

However the term registered clinical officer (RCO), who were the crème of the profession, was in common use and has persisted to date, even in official documents.

In other countries such as malawi, this cadre was introduced in the 80s as a temporary solution to the shortage of medical doctors. Contrary to the situation in kenya, Clinical officers are often the sole care providers for a whole district and are trained to take on the full functions of a medical doctor including emergency surgical procedures such as caeserian section and laparatomies.

Kenya

Training institutions: 1. Kenya medical training colleges (15 colleges countrywide) 2. St. Mary's school of clinical medicine 3. Egerton university 4. Jomo kenyatta university of agriculture and technology 5. Lake institute of tropical medicine 6. Kenya methodist university 7. Mt. Kenya university

Kenya

The Clinical officers council under the ministry of health regulates the training and practice of clinical officers. It accredits training institutions and approves their syllabuses.

Programmes last three years and are followed by one year internship in accredited hospitals before one is registered to practice as a qualified clinical officer.

The training is rigorous and involves classroom instruction as well as bedside tutorials.

The first year is dedicated to the basic sciences including nursing and clinical skills. Students learn to take a complete medical history and perform a thorough physical examination. They also spend some time in a medical laboratory where they learn to perform common laboratory tests such as gramstain and microscopy.

In the second year the clinical subjects are introduced as they polish their history taking and physical examination skills. Much emphasis is placed on community health which is studied throughout the course.

The third year is mostly spent in the teaching hospital where they attend wardrounds, clerk and present cases, write progress notes, assist deliveries, learn to set up iv lines/drips and assist major surgeries as first assistants.

At the end of the course, they sit for the final qualifying examination which is prepared by the clinical officers council.

The examination lasts two weeks. The first week comprises written exams. There are six papers each with two sections. Section one has the notorious multiple choice questions each with five answers to tick as true or false. You lose a mark for each wrong answer, gain a mark for each correct answer and no mark for no answer! Section two has short essay questions and comprises 40% of the paper. The papers are all marked at the clinical officers office in nairobi.

The students rest for one week then have the practicals. These are conducted by consultants in the respective subjects namely medicine, surgery, gynecology/obstetrics, paediatrics, community health and health service management. Marks are awarded on the same day and each practical failed earns a six-month referral and has to be repeated.

Those who pass both exams can obtain internship booklets from the clinical Officers council and start their one year internship.

The booklet outlines the minimum skills a student must attain in each rotation and the students performance is graded by the supervisor. Those whose performance is unsatisfactory repeat the failed rotation before they are registered.