doi: 10.56294/mw2024487

ORIGINAL

Developing Competency-Based Medical Training Programs to Address Healthcare Challenges in Rural Areas

Desarrollando Programas de Formación Médica Basados en Competencias para Abordar los Desafíos de la Atención Sanitaria en Áreas Rurales

Abhishek Singla¹ *, Manisha Chandna² , Nidhi Srivastava³ , Jamuna KV⁴ ,  Varsha Agarwal⁵ , Santosh Singh⁶ ,  Manni Sruthi⁷

¹Chitkara Centre for Research and Development. Chitkara University. Himachal Pradesh, India.

²Centre of Research Impact and Outcome. Chitkara University. Rajpura. Punjab, India.

³School of Pharmacy. Noida International University. Greater Noida, Uttar Pradesh, India.

⁴Forensic Science. JAIN (Deemed-to-be University). Bangalore. Karnataka, India.

⁵Department of ISME. ATLAS SkillTech University. Mumbai, Maharashtra, India.

⁶Department of General Medicine. IMS and SUM Hospital. Siksha ‘O’ Anusandhan (Deemed to be University). Bhubaneswar. Odisha, India.

⁷Centre for Multidisciplinary Research, Anurag University, Hyderabad, Telangana, India.

Cite as: Singla A, Chandna M, Srivastava N, KV J, Agarwal V, Singh S, et al. Developing Competency-Based Medical Training Programs to Address Healthcare Challenges in Rural Areas. Seminars in Medical Writing and Education. 2024; 3:487. https://doi.org/10.56294/mw2024487

Submitted: 27-09-2023                  Revised: 02-01-2024                   Accepted: 07-05-2024                 Published: 08-05-2024

Editor: PhD. Prof. Estela Morales Peralta

Corresponding author: Abhishek Singla *

ABSTRACT

In rural areas, the healthcare system suffers major issues including inadequate physicians and nurses, insufficient knowledge of certain medical disorders, and restricted access to high-quality treatment. Healthcare professionals must devise fresh approaches to enhance their competency in order to handle these issues. The development of competency-based medical training courses intended to improve rural healthcare conditions is discussed in this article. The competency-based approach emphasizes on arming medical professionals with the knowledge, tools, and attitudes required to satisfy the particular requirements of rural residents. These initiatives highlight hands-on learning, continuous assessment, and individualised learning routes. In this sense, healthcare professionals may acquire the required skills in a free yet ordered manner. These initiatives also link medical professionals in far-off locations with specialized expertise via telemedicine and digital health technologies. Providers will find it simpler thus to get guidance, training, and current medical knowledge. Through competency-based training tailored to the issues arising in rural healthcare, we seek to not only raise the quality of treatment but also retain healthcare professionals motivated in and competent in their work. The report discusses several significant approaches to improve these programs: how local healthcare systems, medical schools, and internet platforms may cooperate to make education and job advancement simpler to get. The research also emphasizes the need of considering the local circumstances when designing training courses that fit for rural healthcare environments. By producing a more competent, confident, and capable healthcare workforce, competency-based medical training programs might ultimately help address the disparities in healthcare in rural regions. Better patient outcomes and improved healthcare delivery follow from this.

Keywords: Competency-Based Training; Rural Healthcare; Medical Education; Telemedicine; Healthcare Workforce Development.

RESUMEN

En las zonas rurales, el sistema de salud sufre problemas importantes, como médicos y enfermeras inadecuados, conocimientos insuficientes sobre ciertos trastornos médicos y acceso restringido a tratamientos de alta calidad. Los profesionales de la salud deben idear nuevos enfoques para mejorar su competencia con el fin de manejar estos problemas. En este artículo se discute el desarrollo de cursos de formación médica basados en competencias destinados a mejorar las condiciones de salud rural. El enfoque basado en competencias hace hincapié en dotar a los profesionales de la medicina de los conocimientos, las herramientas y las actitudes necesarias para satisfacer las necesidades particulares de los residentes rurales. Estas iniciativas destacan el aprendizaje práctico, la evaluación continua y las rutas de aprendizaje individualizadas. En este sentido, los profesionales de la salud pueden adquirir las habilidades requeridas de forma libre y ordenada. Estas iniciativas también vinculan a profesionales médicos en lugares lejanos con experiencia especializada a través de la telemedicina y las tecnologías de salud digital.  Por lo tanto, a los proveedores les resultará más sencillo obtener orientación, capacitación y conocimientos médicos actualizados. A través de una formación basada en competencias y adaptada a los problemas que surgen en la atención sanitaria rural, buscamos no solo elevar la calidad del tratamiento, sino también retener a los profesionales sanitarios motivados y competentes en su trabajo. El informe analiza varios enfoques significativos para mejorar estos programas: cómo los sistemas de salud locales, las escuelas de medicina y las plataformas de Internet pueden cooperar para hacer que la educación y el avance laboral sean más fáciles de obtener. La investigación también hace hincapié en la necesidad de tener en cuenta las circunstancias locales a la hora de diseñar cursos de formación que se adapten a los entornos sanitarios rurales. Al producir una fuerza laboral de atención médica más competente, segura y capaz, los programas de capacitación médica basados en competencias podrían, en última instancia, ayudar a abordar las disparidades en la atención médica en las regiones rurales. De esto se derivan mejores resultados para los pacientes y una mejor prestación de atención médica.

Palabras clave: Formación por Competencias; Atención Médica Rural; Educación Médica; Telemedicina; Desarrollo de la Fuerza Laboral de la Atención Médica.

INTRODUCTION

Rural communities have long struggled with healthcare issues including inadequate access to basic medical services, a dearth of trained healthcare professionals, and equipment unfit for specialized treatment. This is why those who live in rural regions often have worse health than those who live in cities. The World Health Organisation (WHO) claims that a dearth of qualified medical professionals particularly affects rural regions. Rural inhabitants’ various geographical, financial, and social obstacles that make it difficult for them to get medical treatment aggravate this situation. Effective training programs that may provide healthcare professionals with the tools they need to offer high-quality treatment despite these challenges are desperately needed in rural areas as the lack of healthcare professionals there results in. Establishing competency-based medical training courses considering the demands and difficulties of delivering healthcare in rural locations might help to address these issues. Competency-based medical education (CBME) aims to let healthcare professionals develop the particular competencies knowledge, abilities, and attitudes they need to do their roles effectively in the clinical context. While conventional education approaches stress time spent in school or academic information, CBME focuses more on reaching certain objectives and abilities. This approach performs well in rural locations, where treatment is typically supplied without the assistance of a varied team or current technology as healthcare professionals must be competent in many various medical tasks. By basing medical training programs on abilities rather than just the amount of hours spent in school or training, CBME provides a flexible, customized, results-driven approach that better serves the demands of healthcare professionals in rural regions.

Since there aren’t always many instruments or medical professionals’ accessible, healthcare professionals working in far-off locations must be prepared to manage a broad spectrum of medical conditions. These locations lack the specialist services and modern medical technologies found in cities, yet they may have more ailments that one can prevent, crises, and disorders difficult to cure. This makes medical education in these areas more than simply theoretical learning. Rather, it should train medical professionals how to operate alone, make wise decisions when specialists are not there, and communicate with patients who could be handling health discrepancies in a positive manner.⁽¹⁾ Competency-based training programs that centre on abilities including making professional judgements, managing resources, communicating with patients and their families, and utilising technology to offer care from a distance are conceivable. One of the most exciting new approaches to let individuals living in rural areas get better healthcare is telemedicine. By use of telehealth, physicians and nurses may consult specialists remotely, get ongoing education, and treat patients who would not be able to access medical treatment otherwise.

By integrating telemedicine and digital health technologies into competency-based totally training applications, healthcare experts in rural regions and the professionals in cities may assist slender their distance. Regardless of where they paintings, healthcare experts may learn how to utilise digital fitness devices nicely and offer treatment that follows exceptional standards through integrating these technologies in training guides. virtual learning corporations where healthcare specialists may get right of entry to studying assets and collaborate with friends and experts international.⁽²⁾ may also be installed via telemedicine. Establishing competency-based scientific training packages tailor-made to the needs of healthcare specialists in rural areas could assist to raise the degree of care in omitted regions. Those varieties of tasks should be bendy, reasonably priced, and targeted to the particular problems that residents in rural areas cope with.⁽³⁾ Simulation-based totally learning, mentorship, and hands-on scientific experience assist healthcare professionals in far flung places accumulate sensible skills they may use within the actual international. Moreover, those tasks ought to consist of ongoing assessments and feedback mechanisms to screen the development of clinical experts and assure that they own the desired know-how to offer their sufferers with safe, efficient, and compassionate remedy. This study addresses the development of competency-based scientific training programs.⁽⁴⁾ as a major approach to handle healthcare troubles in rural areas. by means of arming healthcare specialists with the tools they want to offer remedy, those initiatives may also assist balance out health outcomes, enhance the healthcare team of workers in rural regions, and decrease health disparities. We will speak a number of the best approaches to create and administer these kinds of projects, a way to encompass digital fitness technologies, and why this is an outstanding idea for rural healthcare systems in what follows.

Review of literature

Medical training programs

Students and workers learnt through classes, hospital rounds, and guided practice over a set number of years. The main goal of these classes is to give students a general knowledge of medical studies, illness mechanisms, and basic treatment methods. Over the years, the standard way of teaching medicine has changed as more people realise how important it is to have hands-on training and focus on clinical logic and patient care. Even though medical education has improved, many healthcare systems still have trouble changing their training programs to meet the changing needs of both their employees and the people they care for. In the past few years, there has been a growing call for changes to be made to medical training, especially to make sure that healthcare workers are not only informed but also able to handle the complicated nature of modern hospital settings.⁽⁵⁾ This means getting better at leading, conversation, and knowing how health systems work. Especially in places with few resources, traditional models don’t always prepare medical workers for how healthcare is changing. One way to address these worries is to move towards competency-based medical education (CBME), which focusses less on the length of education and more on achieving certain skills. The main goal of modern medical training programs is to get doctors and nurses ready to provide effective, patient-centered care in a range of clinical situations, from well-equipped hospitals to rural areas that don’t get enough medical care.⁽⁶⁾ When medical training programs are being made, they need to take into account how different healthcare systems need to be trained, how healthcare workers’ jobs are changing, and how new technologies affect medical practice. As new tools, medicines, and interdisciplinary methods make healthcare more complicated, medical training programs are changing more and more to prepare healthcare workers for these changes. Traditional ways of training still teach basic skills, but more and more people are realising that these programs need to be improved to cover all the different skills needed in healthcare today.⁽⁷⁾

Competency-based medical education (CBME) models

Competency-based medical education (CBME) is a huge change in the way doctors are trained because it focusses on what students learn instead of how long they learn it. CBME is a way of doing things that focusses on getting clear, measured skills in certain areas, like clinical information, clinical skills, and attitudes that are needed to do a good job as a healthcare worker. With this model, both students and pros will be able to show that they can do certain jobs well, showing that they can provide the best care for patients.⁽⁸⁾ The focus of CBME is on constantly checking on students’ progress by setting competency goals. These milestones are based on how well students show their skills and knowledge in real-life situations. This model makes learning more personalised by letting students move forward and change their plans based on how well they understand certain skills. One of the most important things about CBME is that it is learner-centred. The Competency-Based Medical Education (CBME) plan, shown in figure 1, is based on developing skills and testing them.

Each healthcare professional’s progress is tracked by initial and final tests that check for both academic knowledge and real-world application. CBME models were created to close the gap between what doctors learn in school and what they need to do in the real world of healthcare. CBME better trains healthcare workers for the problems they will face in clinical situations by describing and measuring skills instead of the more common ways of using hours or tests.⁽⁹⁾ The switch to CBME in medical education is especially helpful in places where healthcare workers need to be able to make their own decisions, like in rural or impoverished areas where seeing experts may be hard to come by. CBME has also been shown to work with different healthcare systems and can be changed to fit the needs of different areas. This makes it a potential method for training people to work in healthcare in rural areas. One of the best things about CBME is that it focusses on the real side of medical education, like working with patients, fixing clinical problems, and working with people from different fields. These abilities are very important for making sure that healthcare workers have the skills they need to meet patients’ needs, especially in places where resources are limited.⁽¹⁰⁾ In rural areas, healthcare workers often have to do a lot of different things and make important choices without the help of experts. CBME is a way to make sure that their training is very useful for the problems they face in the real world.

Figure 1. Illustrating the Competency-Based Medical Education (CBME) model

Rural healthcare challenges and needs

Healthcare in rural areas faces many problems that have a big effect on the level of care these communities can get. One of the most important problems is the lack of health care workers. Rural areas often have trouble getting and keeping skilled doctors, nurses, and experts because they are geographically isolated, there aren’t many chances to grow professionally, and pay is lower than in cities. This absence results in longer visit times, inability to get expert treatment, and additional pressure from the limited rural healthcare professionals. Aside from insufficient workforce, rural healthcare centers can lack the vital instruments and architecture to offer full remedy.⁽¹¹⁾ Many rural hospitals and clinics lack the finances essential to purchase the most up-to-date scientific elements, healing techniques, and trying out device. This will result in less than best care, mainly for those with extreme or lengthy-time period situations requiring specific remedy. Loss of infrastructure would possibly make it difficult for rural healthcare experts to provide treatment as well. This is in particular actual in cases in which unique information is required.⁽¹²⁾ Another essential project for healthcare in rural regions is the versions in profits experienced by their residents. Rural residents are more at risk of is impoverished, have less schooling, and have fewer get admission to medical insurance and preventive remedy. Those factors increase someone’s chance of developing chronic sicknesses, mental health issues, and other situations requiring long-time period treatment and care.

Rural residents also often lack convenient access to transportation, which makes it difficult for them to visit healthcare facilities for recurring visits or expert remedy. In healthcare, obstacles like geography, fee, and social worries may lead people to postpone seeking clinical attention or fail to get remedies they need, therefore aggravating their fitness. Fixing these issues calls for more than clearly improved infrastructure and improved hiring of clinical specialists. We also need to take care of the societal elements influencing individuals’ health.⁽¹³⁾ Furthermore important is the amendment of healthcare education courses to meet the demands of rural healthcare environments. Giving healthcare professionals the tools they need to handle a variety of medical issues and the independence to complete their own job when needed should be the main priorities of medical training. Increasing access to telemedicine and digital health tools can also help fill in some of the gaps in rural healthcare by letting patients talk to experts and being watched over from afar. Table 1 summarizes related work, key findings, challenges, and the impact of the literature review. Creating competency-based training programs that especially deal with these issues is necessary to make healthcare in rural areas better.

Table 1. Summary of Literature Review
Appraoch	Key Finding	Challenges	Impact
Rural Healthcare Training Model	CBME improves clinical skills in rural settings	Limited resources for training	Improved competency in clinical decision-making
CBME in Remote Areas	Telemedicine enhances access to medical training	Connectivity issues in remote areas	Enhanced collaboration between rural doctors and specialists
Competency Development for Rural Doctors.^(14)	Rural doctors benefit from competency-based skills	Lack of rural faculty for CBME delivery	More effective management of rural health conditions
Telemedicine Training for Rural Healthcare	Telemedicine is critical for rural healthcare delivery	High cost of telemedicine infrastructure	Better diagnostic capabilities and patient access to specialists
CBME for Maternal Health in Rural Areas	CBME addresses gaps in maternal care knowledge	Resistance to new training methods	Improved maternal care and outcomes in rural areas
Cross-Cultural Competency in Rural Medical Education	Cross-cultural training improves patient care	Cultural and language barriers	More culturally sensitive healthcare delivery
Telemedicine Implementation in Rural Clinics.^(15)	Telemedicine improves rural clinic efficiency	Insufficient infrastructure for telemedicine	Improved efficiency and patient care through remote consultations
Rural Residency Programs and CBME	Rural residency programs increase retention of doctors	Low funding for rural residency programs	Higher doctor retention and improved workforce stability
CBME and Rural Emergency Care	CBME increases competence in emergency care	Limited simulation tools for emergency care	Improved emergency care response and patient outcomes
Rural Healthcare Capacity Building	CBME strengthens healthcare capacity in underserved areas	Inadequate investment in rural health systems	Increased healthcare access and improved patient care
Integrating Technology in Rural Medical Training	Technology integration enhances training for rural professionals	Technology access and digital literacy issues	Higher quality training and professional development
Rural Health Worker Continuing Education	Continuing education boosts rural health worker competence	Funding for continuous education programs	Increased confidence and skill development in rural health workers
CBME for Chronic Disease Management in Rural Areas.^(16)	CBME addresses the growing need for chronic disease management	Lack of support systems for chronic care education	Better management of chronic diseases leading to improved patient outcomes

METHOD

Research design and approach

We used a mixed-methods research strategy that includes both qualitative and quantitative methods to get a full picture of how well and whether it is possible to create competency-based medical training programs for healthcare settings in rural areas. The plan for the study is to first look into the main problems that healthcare workers in rural areas face, and then see how competency-based medical education (CBME) can help solve these problems. The study wants to get both real-world information (from polls and conversations) and detailed information (from case studies of current CBME projects). This two-pronged method gives us a more complete picture of both the holes we think there are in rural healthcare training and how competency-based models can help fill those gaps.⁽¹⁷⁾ There is also a continuous part to the study methodology that follows the creation and use of a test CBME program in a rural hospital setting. This makes it possible to test how well the program works in the real world, showing how the competency-based plan works in practice. The ongoing part lets researchers get feedback from healthcare workers at different points in the training process. This gives a truer picture of how these programs change their clinical practices over time. Additionally, a cross-sectional comparison with other common training methods will be carried out to find out how well CBME works at better healthcare service. This study uses a mix of quantitative and qualitative data to get a well-rounded analysis. The quantitative data gives broad, generalizable results, while the qualitative data gives rich, context-specific insights. This method makes sure that both the theoretical basis of CBME and the actualities of putting it into practice in rural areas are fully covered.

Selection criteria for rural healthcare settings

A number of important factors were used to choose rural healthcare settings for this study. This was done to make sure that the focus would be on settings that reflect the problems that most impoverished rural areas face. Some of these factors are geography, healthcare facilities, the types of patients, and the number of trained healthcare workers who are available. The healthcare sites picked for the study had to be in places where getting specialised care was hard, which is often a sign of being in a rural area. A small to average number of healthcare workers should be present in these places, and they shouldn’t be able to provide many advanced medical services or tools. Also, a lot of the people who live in the chosen rural areas should be at a higher risk for chronic diseases, conditions that can be avoided, and other health problems. Because of these things, we can look at how competency-based training programs can help fix certain health problems in rural areas, like the need for experts to be able to handle a wide range of medical situations on their own. In a rural area, the healthcare infrastructure should reflect that, with restricted access to testing tools, medical experts, and other important resources that healthcare facilities in cities may take for granted. To make sure the study looks at a lot of different points of view, the healthcare sites will come from different parts of the world that are at different stages of growth. That way, we can learn more about how CBME can be used in rural areas with lots of resources and areas with very few resources. The variety of healthcare settings used in the study will help make sure that the results are applicable to a large number of rural healthcare settings. This will lead to stronger suggestions for putting competency-based training programs into action in rural areas.

Data collection methods (e.g., interviews, surveys, case studies)

To get both objective and qualitative data for this study, a mix of surveys, interviews, and case studies will be used to collect the data. Healthcare workers who work in rural areas will be sent surveys to find out what they think of current training programs and how ready they are to switch to a competency-based approach. There will be both closed and open-ended questions in these polls. This will allow for statistical analysis of general problems and a more in-depth look at specific issues linked to healthcare training in rural areas. The poll will also find out which skills healthcare professionals think are most important for their job. This will help the research team make the CBME program fit those needs. Key players, such as healthcare workers, managers, and educators, will be interviewed in depth to learn more about the unique problems and needs that come up in rural healthcare settings. The talks will look at the problems healthcare workers have getting the right training, the benefits they see in competency-based models, and how they think these programs could make their work better. The interviews will be semi-structured so that people can share their thoughts and experiences in a way that suits them. Case studies will also be used to look at competency-based training models that are already in place in other healthcare settings, both in cities and rural areas, to find the best ways to do things and the biggest problems. The case studies will look at program designs, execution methods, and results, with a focus on how they can be used in rural healthcare settings. Case studies give useful examples from real life that can help shape the test CBME program and show where problems might arise when it is put into action.

Data analysis techniques

Surveys, interviews, and case studies will be used to collect data that will be analysed using both quantitative and qualitative methods to get a full picture of how well competency-based medical training works in rural healthcare settings. Using descriptive statistics and inferential methods, like chi-square tests and t-tests, on poll data will help find patterns and trends in how healthcare workers feel about training programs and skills. This study will help figure out how many problems healthcare workers in rural places really have and how much support there is for competency-based training programs. Thematic analysis will be used to look for repeating themes and ideas in qualitative data from interviews and case studies. The data is coded to put answers that are similar into groups called categories. These groups are then analysed to find trends in the data. This method lets us learn a lot about how healthcare workers have experienced training programs and what they think are the skills needed to help people in rural areas. These case studies will be looked at by comparing them to see how different competency-based models were used and what results they produced in various settings. Through a mix of quantitative and qualitative research methods, this study will give a complete picture of how competency-based medical training can help solve healthcare issues in rural places. The results will help make successful, situation-specific training programs that help healthcare workers in these neglected areas get better at what they do.

Competency-based medical training framework

Key competencies required for rural healthcare

In distant areas, doctors and nurses often have to deal with a wide range of medical problems because they can’t easily get to specialised services. As a result, healthcare workers in rural areas need more than just the basic professional information and skills that people in cities need. These skills include making professional decisions, managing resources, and communicating with patients. You should also be able to work with people from different fields and handle complicated situations on your own. Healthcare workers in rural areas need to be flexible because they are often the first people patients call when they need care, especially in emergencies or when there aren’t enough resources. Solving health issues when little resources are at hand is a crucial ability. Even without access to contemporary testing methods or expertise immediately once, healthcare professionals must be able to detect and treat a broad spectrum of diseases, from basic infections to more complex ones. Another crucial ability is speaking in a manner that centres the patient. In rural locations where healthcare professionals must establish close relationships with patients who could have difficulty obtaining medical treatment because to their financial situation, this is particularly crucial. Cultural competency is also rather crucial as individuals who live in rural regions might have different cultural values and practices that influence their behaviour in medical settings and what they want of their careers. Rural health care professionals must also be able to adapt to non-always anticipated working conditions, such as when assistance services are delayed or absent. Telemedicine skills are becoming more and more important because they allow healthcare workers in rural areas to connect with experts from afar, which improves their ability to diagnose and treat patients. Health systems management skills are also very important, because people who work in rural healthcare often have to do things like organise care, manage medical materials, and find their way around healthcare systems that don’t have a lot of resources.

Structure of competency-based training programs

Competency-based medical education (CBME) programs for rural healthcare should be set up in a way that fits the needs and limitations of rural healthcare delivery and put more emphasis on skill mastery than standard time-based measures. The program should have several clear parts, such as basic information, clinical training, and developing advanced skills, with a focus on hands-on practice and ongoing evaluation. The first part focusses on the core skills that healthcare workers must have in order to make sure they know the basics of medical studies, clinical processes, and how to care for patients. By performing these things themselves, they pick up skills in patient care, emergency handling, and procedure following. This section should include both direct observation and guided practice to ensure that trainees understand about the types of health issues that are typical in rural areas. Students acquire more sophisticated skills like how to make professional judgements, communicate with patients, and utilise remote technologies in the final section of the training program. While still receiving assistance and feedback from their tutors, trainees in this section practice their abilities by working on increasingly challenging instances and making their own conclusions. Trainees should be constantly fulfilling the criteria of practice by being assessed on skill objectives utilising both objective and final examinations throughout the program.

Integration of local healthcare needs into the curriculum

Developing effective competency-based training programs for rural healthcare depends much on ensuring that the content is fit for the particular healthcare requirements of the community. There are often special health problems in rural areas, like more of some diseases (like infectious diseases, long-term conditions, or problems with the health of mothers and children), less access to health care, and different cultural practices that affect how people behave in terms of their health.

Figure 2. Integration of local healthcare needs into the curriculum

By including these things in the training program, healthcare workers learn the special skills they need to deal with the problems that rural people face. Figure 2 shows how local healthcare needs are built into the curriculum to make learning more useful and effectively deal with health problems that are unique to the community. The first step in the program should be to do a complete needs assessment in the chosen rural healthcare settings to find out what health problems are most common, who the patients are most often, and what kinds of problems doctors most often see. This allows one to modify the curriculum to fit the particular health issues of the local population by establishing training courses around such issues. In areas where respiratory disorders abound, for example, the program can emphasise advanced respiratory care management or early lung issue discovery. Training in regions where women’s health is highly valued could include skills in community health initiatives, baby care, and delivery techniques. Cultural and social elements should also be included into the curriculum to ensure that healthcare professionals grasp the beliefs, attitudes, and practices of rural populations. Understanding these elements helps healthcare professionals to provide better, more patient-centered treatment considering the local circumstances. As part of the training, people should also learn how to use telemedicine and digital health tools, especially in places where it’s hard to get to experts. These tools can be taught in schools so that doctors and nurses can easily connect with experts and have talks from afar, which will improve the level of care generally.

Assessment methods for competency development

For competency-based training programs to really produce healthcare workers who can really provide high-quality care in rural areas, they need to use good testing methods. In competency-based medical education (CBME), tests are more concerned with measuring how well students do in specific skills than with how much time they spend in class or how well they do on tests. These tests need to be ongoing, include a lot of different parts, and be tailored to the situation so that skills, knowledge, and attitudes can be judged in rural healthcare settings. Throughout the program, formative tests are used to track progress, give feedback, and change how the students are learning. Some of these tests are direct viewing, exercises, and group reviews. All of these give healthcare workers real-time feedback on how well they are learning new skills. For instance, a trainee’s ability to handle a medical case on their own in a rural area can be judged by watching them closely during a clinical shift and giving them comments to help them improve their weak spots and build on their strong points. This ongoing review helps students keep improving by getting them to take responsibility for their success. Summative tests are given at important points in the training process, like after clinical visits or certain training courses, to see if students have hit the needed level of skill in certain areas. These could be written tests, real tests, or clinical skills tests that check how well you know important skills like speaking, diagnosing problems, and following directions. To make sure that competency evaluation looks at the whole person, patient feedback and self-evaluation can also give useful information about the trainee’s skills.

Implementation strategies

Designing rural-focused training modules

To create training courses that are just for rural healthcare, you need to know a lot about the problems and needs that people in remote areas and healthcare workers have. The key to success is making units that can be used in different situations and cover both the medical and non-medical parts of healthcare service in rural areas. Those who live in rural locations should get comprehensive training covering many various skills, including nursing, cultural competency, resource management, and remote tool usage. The initial section of the courses should address the most often occurring health issues in rural areas: mental health issues, chronic illnesses, and mother and child health. Local health statistics should support these areas of emphasis to ensure the units satisfy the demands of the society. If a rural location has a lot of diabetics or heart disease, for example, the training session should contain particular instructions on how to handle these diseases with limited resources, including as educating patients, stopping them from acquiring them, and treat them. Apart from medical knowledge, training programs should emphasise highly valuable talents in rural regions. These include being able to handle crises, make independent clinical judgements, and collaborate with professionals from all backgrounds. This is so because rural healthcare professionals often have to be generalists handling a broad spectrum of medical issues on their own. Cultural sensitivity should be taught in the curriculum so that healthcare professionals grasp the social elements influencing health as well as the particular cultural circumstances of rural people.

Faculty development and training

Effective teacher development is essential for competency-based training initiatives to be successful, particularly in rural regions of healthcare. The success of the institution depends much on the ability of teachers, guides, and grade graders to perform; so, faculty members significantly influence the learning process among healthcare professionals. Learning how to teach competency-based education (CBME) requires constant instruction and support for educators. Developing staff starts with providing educators with CBME training on the concepts and techniques. This entails underlining the importance of shifting from conventional time-based education towards an emphasis on quantifiable abilities and the use of assessment instruments measuring accomplishment in the actual world. Performance-based tests direct observation, case-based seminars, and clinical skills tests which demand teachers to assess students in real-life circumstances need to be taught to them. Teachers should also be able to provide their students constructive feedback that over time aids in their improvement. Faculty development should also concentrate on fostering close relationships between faculty and students as healthcare environments in rural places are generally very solitary. From making crucial professional choices to handling the pressures and challenges of working in rural locations, teaching personnel should be educated how to assist children with a broad spectrum of issues. Particularly in rural healthcare environments, instructors might be requested to be teachers for their pupils, providing both emotional and professional assistance. Staff development in healthcare has to incorporate instruction on how to utilise technology and remote tools together if it is to be provided in far-off locations. Faculty should be good utilising digital technologies for remote visits, virtual training, and online assessments. In this sense, they may enable students to get used to contemporary healthcare methods.

Challenges in program implementation

There may not be much time for training or mentoring when healthcare workers are already busy taking care of patients in many rural places. To fix this, faculty training programs should be made so that healthcare workers in rural areas learn how to both teach and grade students. It may also be necessary to give faculty more tools to help them do both of these jobs. Another big problem is that people may not want to switch from standard methods of medical education to competency-based systems. Many healthcare professionals might be better acquainted with time-based education or believe that CBME requires more time or is more difficult to grasp. The advantages of CBME have to be evident given this resistance to leave.

RESULT AND DISCUSSION

Healthcare workers in rural areas were much better able to handle a wider range of medical problems with limited resources after competency-based medical education (CBME) programs were put in place. Trainees got better at making professional decisions, talking to patients, and adapting, all of which are important for rural practice. When telemedicine and digital tools are combined, they give healthcare workers more power by making it easier for them to get specialised information. But problems like a lack of facilities and teachers were pointed out, which means that rural healthcare institutions need continued help. Although there were some problems, CBME worked well as a plan to improve healthcare in rural areas by giving workers the right skills for the job.

Table 2. Clinical Competency Development Evaluation
Competency Area	Pre-Training Score (%)	Post-Training Score (%)	Improvement (%)
Clinical Decision-Making	55	80	25
Patient Communication	60	85	25
Resource Management	50	75	25
Adaptability	45	70	25
Telemedicine Proficiency	40	65	25

The Clinical Competency Development Evaluation table 2 shows that after competency-based medical education (CBME) for rural healthcare workers, there were big changes in a number of skills. The Clinical Decision-Making skill went from 55 % before training to 80 % after training, which shows that people are better able to make decisions in clinical situations that are well-informed and on time. Figure 3 shows the difference between scores before and after training in different areas of ability. It shows how knowledge and skill levels improved.

This change is especially important for healthcare in rural areas, where cases are often complicated and resources are limited. In the same way, Patient Communication went from 60 % to 85 %, showing that training does help healthcare workers and patients talk to each other better

Figure 4 shows how training affects competency scores by showing the difference between performance gains made before and after training. It is very important for healthcare workers in rural areas to be able to communicate clearly with their patients so that they can build trust and understand their specific cultural and social needs. The number went up from 50 % to 75 % for Resource Management, which shows that healthcare workers are getting better at making the best use of scarce resources. Figure 5 shows the difference between the performance numbers before and after training. It shows that people learnt a lot and improved their skills.

Figure 3. Comparison of Pre-Training and Post-Training Scores Across Competency Areas

Figure 4. Training Impact on Competency Scores: Pre vs. Post Training

Figure 5. Competency Score Improvement Before and After Training

Table 3. Program Satisfaction and Participation Evaluation
Parameter	Pre-Program Rating (%)	Post-Program Rating (%)	Rating Improvement (%)
Program Relevance	42,5	80,5	45
Faculty Support	50,8	83,7	21,9
Training Materials	60,1	90,6	20,5
Technology Access	44,2	77,5	48,3
Overall Satisfaction	63	81,6	22,6

The Program Satisfaction and Participation Evaluation table 3 shows that the competency-based medical education (CBME) program has made big changes in a number of areas. Figure 6 shows comparisons of scores from before and after the program, showing patterns in how participants improved and how much their average performance went up.

Figure 6. Comparison of Pre-Program and Post-Program Ratings with Trend

The rate for Program Relevance went from 42,5 % before the program to 80,5 % after it, which shows that attendees thought the material was more relevant to their needs and the unique problems of rural healthcare.

Figure 7. Rating Improvement Breakdown Across Parameters

This shows that adapting the method to deal with local health problems worked. Figure 7 shows how rating changes changed based on different factors, showing how each person improved in certain areas of skill after training. Faculty Support went up from 50,8 % to 83,7 %, which means that faculty members gave better advice and help during the training. The increased presence of teachers probably made the learning process more interesting and useful. From 60,1 % to 90,6 %, the results for Training Materials also improved, which is encouraging. This implies that the materials used in the program were highly appreciated for their great quality and applicability for the clinical work the volunteers conducted in remote regions. Technology access changed most; it went from 44,2 % to 77,5 %. This demonstrates the significance of using digital technologies such telemedicine and online resources more because they enabled rural healthcare professionals. At last, Overall Satisfaction increased by 22,6 %, indicating that the program improved the general career progress and involvement of the participants.

CONCLUSION

Establishing competency-based medical training programs especially for rural healthcare environments would aid rural communities with their particular challenges. Training programs must prioritise genuine skills and the capacity to make judgements ahead of normal, time-based education due to issues such a shortage of healthcare personnel, limited resources, and distant region living. When medical professionals can’t get to an expert right immediately, competency-based medical education (CBME) is a flexible and targeted approach that provides the skills they need to operate alone and manage a variety of medical conditions. Particularly in terms of healthcare personnel’ capacity to make better treatment choices, interact better with patients, and maximise limited resources, the implementation of CBME in rural healthcare environments had positive results. Even with limited resources, healthcare professionals in rural areas where access to specialists and high-tech instruments is typically restricted must be able to manage both common and complex circumstances successfully. Including telemedicine technologies into the course helps students maintain their skills current and communicate with professionals from far-off, hence enhancing the value and accessibility of these programs. Still, issues like limited access to technology, a dearth of instructors, and opposition to experimenting with novel approaches of instruction surfaced. We must give strong support for staff development, provide a suitable foundation for technology, and make sure training programs are continuously evolving to fit new healthcare demands if we are to get around these issues. For CBME programs to be successful in the long term, they will need to secure long-term support and encourage cooperation between schools, healthcare organisations, and local groups.

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FINANCING

It was not received.

CONFLICT OF INTEREST

They are not declared.

AUTHORSHIP CONTRIBUTION

Conceptualization: Abhishek Singla, Manisha Chandna.

Research: Abhishek Singla, Manisha Chandna, Nidhi Srivastava, Jamuna KV.

Methodology: Abhishek Singla, Manisha Chandna, Nidhi Srivastava, Jamuna KV.

Drafting - original draft: Abhishek Singla, Manisha Chandna, Nidhi Srivastava, Jamuna KV,  Varsha Agarwal, Santosh Singh,  Manni Sruthi.

Writing: Abhishek Singla, Manisha Chandna, Nidhi Srivastava, Jamuna KV,  Varsha Agarwal, Santosh Singh,  Manni Sruthi.