Interactive Subject Content, Learner Engagement and Clinical Skills Acquisition of Students at Kenya Medical Training College Campuses’ in Rift Valley, Kenya
DOI:
https://doi.org/10.47604/gjhs.3742Keywords:
Clinical Skills Acquisition, Interactive Subject Content, Learner Engagement, Blended Learning, Medical and Nursing EducationAbstract
Purpose: The training of competent healthcare professionals remains a critical mandate of health education institutions, particularly in contexts such as Kenya where significant skills gaps persist among healthcare workers. Blended learning approaches incorporating interactive subject content (ISC) have the potential to enhance learner engagement (LE) and improve clinical skills acquisition (CSA). However, limited empirical evidence exists on the relationships among these variables. This study aimed to assess the effect of ISC on CSA and examine the mediating role of LE among students in Kenya Medical Training College (KMTC) campuses in the Rift Valley region.
Methodology: A cross-sectional study design was employed targeting 5,519 students and 9 heads of departments (HODs) across nine KMTC campuses. A sample of 373 students was selected using stratified random sampling, while all 9 HODs were purposively included. Data were collected using structured questionnaires and key informant interviews and analyzed using regression and mediation analysis techniques.
Findings: Interactive subject content significantly and positively predicted clinical skills acquisition (β = 0.758, p < 0.0001, 95% CI: 0.672–0.845). Learner engagement partially mediated the relationship between ISC and CSA (β = 0.334, 95% CI: 0.202–0.457), indicating that while ISC directly enhances CSA, its effect is strengthened through improved learner engagement.
Unique Contribution to Theory, Practice and Policy: Despite the demonstrated effectiveness of interactive subject content in enhancing clinical skills acquisition both directly and through increased learner engagement, gaps persist in the optimal integration of learner-centered strategies within blended learning environments. The findings underscore the pivotal role of learner engagement in strengthening skill acquisition and highlight the need for deliberate incorporation of interactive content in medical training. Enhancing curriculum design, learner-centered instructional approaches and institutional policies to support blended learning, while prioritizing interactivity and engagement, may improve the competence of healthcare trainees in Kenya.
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References
Adely, F., Mitra, A., Menatalla Mohamed, M., & Shaham, A. (2021). Poor education, unemployment and the promise of skills: The hegemony of the “skills mismatch” discourse. International Journal of Educational Development, 82. https://doi.org/10.1016/j.ijedudev.2021.102381.
Almarwani, A., & Alzahrani, N. (2023). Factors affecting the development of clinical nurses’ competency: A systematic review. Nurse Education in Practice, 73. https://doi.org/10.1016/j.nepr.2023.103826.
Andretta, V., Elia, R. A., Colangelo, M., Rubbi, I., Santoro, E., Boccia, G., Cascella, M., & Cerrone, V. (2025). Effectiveness of Gamification Versus Traditional Teaching Methods on Learning, Motivation, and Engagement in Undergraduate Nursing Education: A Systematic Review. International Medical Education, 5(1), 5. https://doi.org/10.3390/ime5010005
Barnes, J., & Forde, D. (2021). The encyclopedia of research methods in criminology and criminal justice, Volume II, First Edition. John Wiley & Sons, Inc.
Battestilli, L., Bohórquez, E. B., Khan, S., & Meral, C. (2023). Exploring Students' Perceptions and Engagement in Hybrid Flexible Courses. In Proceedings of the Tenth ACM Conference on Learning@ Scale (pp. 110-119). https://doi.org/10.1145/3573051.3593383
Bond, M., Bedenlier, S., Marín, V. I., & Händel, M. (2021). Emergency remote teaching in higher education: Mapping the first global online semester. International journal of educational technology in higher education, 18(1), 50. https://doi.org/10.1186/s41239-021-00282-x
Cant, R. P., & Cooper, S. J. (2010). Simulation-based learning in nurse education: Systematic review. Journal of Advanced Nursing, 66(1), 3–15. https://doi.org/10.1111/j.1365-2648.2009.05240.x
Carter, O. B., Mills, B. W., Ross, N. P., Miles, A. K., Mould, J. M., & O'Brien, R. P. (2016). Assessing simulation-based clinical training: comparing the concurrent validity of students' self-reported satisfaction and confidence measures against objective clinical examinations. BMJ simulation & technology enhanced learning, 2(2), 30. https://doi.org/10.1136/bmjstel-2015-000089
Conrad, D. L. (2010). Engagement, excitement, anxiety, and fear: Learners’ experiences of starting an online course. The American Journal of Distance Education, 16(4), 205–226. https://doi.org/10.1207/S15389286AJDE1604
Couper, I., Ray, S., Blaauw, D., Ng’wena, G., Muchiri, L., Oyungu, E., Omigbodun, A., Morhason-Bello, I., Ibingira, C., Tumwine, J., Conco, D., & Fonn, S. (2018). Curriculum and training needs of mid-level health workers in Africa: A situational review from Kenya, Nigeria, South Africa and Uganda. BMC Health Services Research, 18, 553. https://doi.org/10.1186/s12913-018-3362-9
De Bruijn-Smolders, M., & Prinsen, F. R. (2024). Effective student engagement with blended learning: A systematic review. Heliyon, 10(23). https://doi.org/10.1016/j.heliyon.2024.e39439
Ellen, S. (2020). Slovin’s formula sampling techniques. Sciencing. https://sciencing.com/slovins-formula-sampling-techniques-5475547.html
Filak, V. F., & Sheldon, K. M. (2008). Teacher support, student motivation, student need satisfaction, and college teacher course evaluations: Testing a sequential path model. Educational Psychology, 28(6), 711–724. https://doi.org/10.1080/01443410802337794
George, T. (2023). What is a retrospective cohort study? /Definition & Examples. Scribbr. https://www.scribbr.com/methodology/retrospective-cohort-study/
Hampton, D., Melander, S., Tovar, E., Falls, C., Makowski, A., Grubbs, A. B., Chitwood, H., & Scott, L. (2024). Value of Miller's pyramid for clinical skills assessment in the evaluation of competency for nurse practitioner students. The Journal for Nurse Practitioners, 20(4), 104952. https://doi.org/10.1016/j.nurpra.2024.104952
Harmon, K., Clark, J., Dyck, J., & Moran, V. (2016). Nurse educator’s guide to best teaching practice (1st ed.). Springer international Publishing Switzerland.
Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford Press.
He, Z., Li, H., Lu, L., Wang, Q., Wu, Q., & Lu, L. (2024). The application of blended teaching in medical practical course of clinical skills training. BMC Medical Education, 24(1), 724.
Hughes, J. N., Luo, W., Kwok, O.-M., & Loyd, L. K. (2008). Teacher-student support, effortful engagement, and achievement: A 3-year longitudinal study. Journal of Educational Psychology, 100(1), 1–14. https://doi.org/10.1037/0022-0663.100.1.1
Imanipour, M., Ebadi, A., Monadi Ziarat, H., & Mohammadi, M. M. (2022). The effect of competency‐based education on clinical performance of health care providers: A systematic review and meta‐analysis. International Journal of Nursing Practice, 28(1), e13003. https://doi.org/10.1111/ijn.13003
Iwanaga, J., Obata, K., Kato, T., Samrid, R., Lesser, E., Cardona, J. J., Kikuchi, K., Kim, C. Y., Ono, K., Dantoni, A., Komune, N., Tabira, Y., Hur, M.-S., Kitagawa, N., Kim, H. J., Loukas, M., Watanabe, K., & Tubbs, R. S. (2025). What is the appropriate sample size in human cadaveric studies? A quantitative review of 770 articles. Clinical Anatomy. https://doi.org/10.1002/ca.70007
Kenya Medical Training College (2019). Expansion policy: Training for better health. https://kmtc.ac.ke
Kweya, J. O., Konyole, O. S., & Wanzala, M. (2020). Factors influencing clinical performance of diploma nursing students in Kenya. International Journal of Healthcare Sciences, 8(1), 136–142. https://www.researchpublish.com/upload/book/paperpdf-1592382023.pdf
Lei, H., Cui, Y., & Zhou, W. (2018). Relationships between student engagement and academic achievement: A meta-analysis. Social Behavior and Personality, 46(3), 517–528. https://doi.org/10.2224/sbp.7054
Lockey, A., Bland, A., Stephenson, J., Bray, J., & Astin, F. (2022). Blended learning in health care education: an overview and overarching meta-analysis of systematic reviews. Journal of Continuing Education in the Health Professions, 42(4), 256-264. https://doi.org/10.1097/CEH.0000000000000455
Long, N. T., & Van Hanh, N. (2020). A Structural Equation Model of Blended Learning Culture in the Classroom. International Journal of Higher Education, 9(4), 99-115. https://doi.org/10.5430/ijhe.v9n4p99
Macnamara, A. F., Bird, K., Rigby, A., Sathyapalan, T., & Hepburn, D. (2021). High-fidelity simulation and virtual reality: an evaluation of medical students’ experiences. BMJ simulation & technology enhanced learning, 7(6), 528. https://doi.org/10.1136/bmjstel-2020-000625
McGee, R. G., Wark, S., Mwangi, F., Drovandi, A., Alele, F., Malau-Aduli, B. S., & ACHIEVE Collaboration. (2024). Digital learning of clinical skills and its impact on medical students’ academic performance: a systematic review. BMC Medical Education, 24(1), 1477. https://doi.org/10.1186/s12909-024-06471-2
Mishra, N. R. (2023). Constructivist approach to learning: An analysis of pedagogical models of social constructivist learning theory. Journal of research and development, 6(01), 22-29. https://doi.org/10.3126/jrdn.v6i01.55227
Mohammad, A., Shehri, T., Alnihier, M., Alshahri, A., Alwaked, M., & Alshammari, N. (2024). The significance of enhancing health workers’ skills and knowledge in driving positive patient experiences. International Journal of Religion, 5(2), 598-608. https://doi.org/10.53730/ijhs.v5nS1.15078.
Mohamoud, G., & Mash, R. (2022). Clinical skills of general practitioners in Nairobi, Kenya: a cross-sectional study. BJGP Open; 6(3). https://doi.org/10.3399/BJGPO.2021.0233
Oh, H. K. (2022). Effects of blended learning on nursing students’ clinical competence, clinical judgment, and skill performance ability. Asia-pacific J Convergent Res Interchange (APJCRI), 57-67. http://dx.doi.org/10.47116/apjcri.2022.04.06
Plackett, R., Kassianos, A. P., Mylan, S., Kambouri, M., Raine, R., & Sheringham, J. (2022). The effectiveness of using virtual patient educational tools to improve medical students’ clinical reasoning skills: a systematic review. BMC medical education, 22(1), 365. https://doi.org/10.1186/s12909-022-03410-x
Schunk, D. H., & Mullen, C. A. (2012). Self-efficacy as an engaged learner. In S. L. Christenson, A. L. Reschly, & C. Wylie (Eds.), Handbook of research on student engagement (pp. 219–235). Springer.
Seed, M., Soltani, A., Zahra, D., Allouch, S., Al Saady, R. M., Nasr, A., Saleh, N., Saeed, A., Awad, A. K., Baraka, A. S., Ahmed, O., Babiker, R., Mohammed, E., Ali, K. (2025). Remote online learning reimagined: perceptions and experiences of medical students in a post-pandemic world. BMC Medical Education, 25(1), 215. https://doi.org/10.1186/s12909-025-06815-6
Setia, M. (2016). Methodology series module 3: Cross-sectional studies. Indian J Dermatol., 61(3), 261-264. https://doi.org/10.4103/0019-5154.182410
Shah, J., Ikram, N., Rabbani, M., Sadiq, M., Sheikh, A., Fazal, A., & Tahir, F. (2024). Simulation-based training vs. traditional bedside teaching: An RCT on clinical skills acquisition. Afr.J.Bio.Sc.6(16). https://doi.org/10.48047/AFJBS.6.16.2024.4603-4613
Shea, P., & Bidjerano, T. (2010). Learning presence: Towards a theory of self-efficacy, self-regulation, and the development of a communities of inquiry in online and blended learning environments. Computers & Education, 55(4), 1721–1731. https://doi.org/10.1016/j.compedu.2010.07.017
Sweller, J. (2024). Cognitive load theory and individual differences. Learning and Individual Differences, 110, 102423. https://doi.org/10.1016/j.lindif.2024.102423
van Gaalen, A. E., Brouwer, J., Schönrock-Adema, J., Bouwkamp-Timmer, T., Jaarsma, A. D. C., & Georgiadis, J. R. (2021). Gamification of health professions education: a systematic review. Advances in Health Sciences Education, 26(2), 683-711. https://doi.org/10.1007/s10459-020-10000-3
Wang, R., & Raman, A. (2025). Systematic literature review on the effects of blended learning in nursing education. Nurse Education in Practice, 82, 104238. https://doi.org/10.1016/j.nepr.2024.104238
Xiang, H., Wu, K., Shen, N., & Zhu, J. (2022). Research on multi-dimensional interactive process of blended learning oriented by ability cultivation. In Proceedings of ICMETSS 2022 (pp. 787–794). Atlantis Press. https://doi.org/10.2991/978-2-494069-45-9_95
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