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

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
• non-physician
• licensing examination

Abbreviation

CGPA, cumulative grade point average; GPA, grade point average; LMICs, low and middle-income countries; NLE, National licensing examination.

Data Sharing Statement

The datasets generated during and analyzed during the current study are not publicly available due to privacy and ethical concerns but are available from the corresponding author on reasonable request.

Ethical Approval and Informed Consent

Ethical approval for the study was obtained from the Ethiopian Public Health Institute (EPHI-IRB-380-2021) and the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB # 17778). Given that we require de-identified secondary data stored in higher education institutions, individual consent was waived by the ethics review boards. However, permission to conduct the study was obtained from the Ministry of Education, and the deans of training institutions. Measures were taken to protect autonomy and data confidentiality.

Acknowledgment

The study authors would like to thank the Federal Ministry of Health, Ministry of Education, Ethiopian Association of Anesthetists and study site teaching institutions for their support. The authors would like to express special appreciation to data collectors and supervisors.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

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.