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After a prescribed number of years in active practice, one may complete a further one or two-year residency programme in order to specialize in any approved branch of clinical medicine and surgery such as anesthesia or pediatrics , or get an advanced medical qualification from the university.

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There are no pathways post-basic or post-graduate entry-level conversion programs for nurses and other health workers hence it takes at least eight years of specialised medical training and experience for a clinical officer to graduate with a post-basic qualification. It should be noted, however, that "clinical officer" in some countries such as Tanzania and Zambia refers to a different cadre of health workers, comparable to "medical assistants" in Malawi , who have less than three years of training but who may upgrade to a similar level by becoming Assistant Medical Officers AMOs or Medical Licentiates MLs.

It should be noted that a clinician can specialize in any other field that is deemed appropriate by them and not just clinical medicine. China also has masters of clinical medicine. In countries like Tanzania, UK, and other countries, clinical medicine is regarded as a medical course and graduates are allowed to apply to masters of medicine specialties.

No significant difference has been demonstrated in studies comparing treatment decisions, patient outcomes, quality of care provided and level of knowledge about diseases between a clinical officer and a medical officer a non-specialist physician except in countries where nurses were mistakenly assessed as clinical officers.

However, because of the nature of practice, populations served and resources at ones disposal, a clinical officer is less likely to administer expensive treatment, prescribe expensive but not necessarily better drugs or engage in futile care.

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Access to emergency obstetric care through greater deployment of the clinical officer is one way of attaining the Millennium Development Goals 4 reducing child mortality and 5 improving maternal health. Worldwide, patients are seen by many other practitioners other than the traditional doctor such as:. A clinical officer takes the Hippocratic oath and, depending on jurisdiction, may be registered by the same statutory board as physicians in the southern countries such as Zambia and Malawi or a separate board in the eastern countries such as Kenya and Uganda.

The broad nature of medical training prepares one to work at all levels of the health care system. Most work in primary care health centres and clinics, and casualty departments in hospitals where one will diagnose and treat all common diseases, including serious and life-threatening ones, in all age groups; and stabilise then admit, discharge or refer emergency cases. In smaller hospitals one may work as a hospitalist and one who has specialized in a clinical field provides advanced medical and surgical care and treatment such as administering anesthesia, performing general or specialised surgery, supervising other health workers and other administrative duties.

A clinical officer's scope of practice depends on one's training and experience, jurisdiction and workplace policies. In Malawi, for instance, a clinical officer performs all routine surgical and obstetric operations such as exploratory laparatomy, emergency orthopaedics and Caesarean section.

However, in Kenya, Tanzania and Mozambique one has to undergo further specialized training in order to perform such major operations safely. In rural and small urban health facilities a clinical officer is usually the highest medical care provider and works with minimal resources, relying on the traditional medical history and physical examination , often with little or no laboratory facilities, to make a diagnosis and provide treatment.

In bigger and better equipped facilities a clinical officer generally acquires superior knowledge, experience and skills and provides high quality and a wider range of services in district, provincial and national hospitals, universities and colleges, research institutions and private medical facilities. In most countries, however, wages are usually low compared to training and responsibilities and career progression is usually restricted by awarding terminal degrees and diplomas, training students who have not attained the minimum university entry grade and, in some countries, not awarding any degree or recognition for advanced training.

In such countries, this usually results in a demotivated and low quality workforce and resulting poor health indicators. The United States' Centers for Disease Control and Prevention and other international health and research institutions make extensive use of COs in their projects in Africa and clinical officers have been the backbone of HIV care and treatment enabling the rollout of ARVS to even the most rural hard to reach areas in Africa.

Research done by the University of Birmingham and published in the British Medical Journal concluded that the effectiveness and safety of caeserian sections carried out by clinical officers did not differ significantly compared with doctors. In the multi-country study, poor outcomes were observed in Burkina Faso and Zaire - the only countries where the procedure was performed by trained nurses.

Higher rates of wound infection and Wound dehiscence in these countries was thought to be due to the nurses' poor surgical technique and need for enhanced training. Kenya has a comprehensive framework of parallel laws and regulations that govern the medical practice of medical officers and clinical officers. The supreme health policy and medical authorities in the republic are the cabinet secretary of health and the director of medical services who oversee the registration and licensing of medical institutions and the training, registration and licensing of medical practitioners through the Medical Practitioners and Dentists Board and the Clinical Officers Council.

As a British colony in , Kenya started training a select group of natives to practice medicine and care for the local population who were increasingly accepting and seeking western medicine. After independence from Britain in , medical training in Kenya initially adopted the four-year medical school system used in the US rather than the six-year UK model.

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This was heavily influenced by the Kennedy Airlift [14] which followed initial funding by the African-American Students Foundation AASF in and led to hundreds of young Kenyan students getting scholarships to study in American institutions: These students came back to Kenya after their studies and joined the civil service in the early post-independence Kenya.

It was also around this time that the first DOs were accepted as medical officers by the US civil service and by the structure and duration of medical training in Kenya was similar to the US MD training. When the University of Nairobi split from the University of East Africa and became the first university in Kenya in , it continued to teach the six-year British degree which led to the creation of two statutory bodies: the Kenya Medical Practitioners and Dentists Board in which had jurisdiction over medical officers and physicians, and the Clinical Officers Council in which had jurisdiction over clinical officers.

Instead of residency for the clinical officer, the higher diploma in paediatrics, ophthalmology and other specializations was introduced in the late s as a post-basic course for those who had worked for three or more years and, after ten years of service, one became a Senior Clinical Officer and qualified for a license to practice under his own name as a private medical practitioner.

The BSc. Clinical Medicine and Surgery degree was later introduced in Clinical officers play a central role in Kenya's medical sector today. There were 8, clinical officers on the register in compared to 7, medical officers. Mary's School of Clinical Medicine and other private institutions. The Ministry of Health, through the Clinical Officers Council COC [17] regulates their training and practice, accredits training institutions, and approves the syllabi of the universities and colleges. Mary's School of Clinical Medicine and St.

Mary's Mission Hospital in Mumias , owned by the Roman Catholic diocese of Kakamega , was the first private institution to train clinical officers. It admits students who got the minimum university entry grade in high school and have passed a written examination and oral interview. The students sit the same examination as their counterparts at the KMTC and are examined by consultants from the public service. The dual diploma in clinical medicine and surgery plus an internship year is the standard qualification for clinical officers which is awarded on completion of a four-year training programme which started as various programmes that were used to train medical practitioners in the East Africa Protectorate in the s and which now resembles the North American four-year MD and DO medical school programmes including being structured in 9 trimesters over 3 years to meet the minimum weeks of instruction recommended by the Liaison Committee on Medical Education instead of the more recent six-year MBChB programme that was introduced in the s and is more common in European and commonwealth countries:.

The current training follows international guidelines and the two qualifications are awarded jointly on successful completion of a comprehensive nine trimester programme of full-time study, practicals and examinations which are covered over three years leading to a fourth mandatory year of internship in a teaching hospital. A fifth and sixth residency specialisation years are undertaken after registration by the Clinical Officers Council and three years of work experience in general medicine which leads to the award of a general degree in clinical medicine or a specialist diploma in pediatrics , orthopedics , psychiatry , anaesthesia , reproductive health and other specialties.

A clinical officer is therefore able to graduate and join the workforce in a minimum of four calendar years and provides medical services within the full scope of family and emergency medicine or within a narrower scope depending on their area of specialisation. Registration by the Clinical Officers Council COC entitles one to render medical services in any public or private medical institution or to practice medicine independently as a private practitioner.

As per the government's Revised Scheme of Service for Clinical Personnel a clinical officer works at any of 8 grades depending on ones seniority. As [18] [19] gazetted officers all registered clinical officers are legally authorized to prepare, sign, issue and keep safe custody of official state documents such as medical examination reports, sick notes , postmortem examination reports and death certificates and to appear in courts of law as expert witnesses.

For this reason, a clinical officer is the officer in-charge of a health center or a district hospital and is part of the medical team in bigger hospitals where one may head a department or work under a senior clinical officer or a physician. Clinical officers are direct healthcare providers who manage and administer health institutions, medical schemes and projects in primary healthcare PHC settings and are frontline stakeholders in Universal Health Coverage in Kenya which is one of the key pillars of the government's 5-year development plan under President Uhuru Kenyatta.

The four pillars of the 5-year development plan are 1. Manufacturing 2. Affordable housing 3. Universal Health Coverage and 4. Food security. In Kenya's public health system, a clinical officer is an alternative practitioner who is trained and authorized by law to perform any technical, administrative or legal duties that require a medical doctor. However, due to the shorter training period when compared to medical officers i.

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Like the term medical officer , the term clinical officer is a protected title whose use without the authority of the Clinical Officers Council is prohibited and a punishable offense under Kenyan laws. Court rulings uphold that a registration certificate or a license issued by the council automatically confers the status of a medical officer or a qualified medical practitioner to a clinician and the titles are used interchangeably in medico-legal documents because a qualified clinical officer has a recognized medical qualification and is eligible for registration as a medical practitioner under Section 11 1 of the Medical Practitioners and Dentists Act in addition to being expressly authorized to practice medicine, surgery or dentistry by Section 7 4 of the Clinical Officers Act Criminal Appeal of - Kenya Law Criminal Case 6 of - Kenya Law CAP.

From the Anatomy Act , the legal definition of a medical officer is any public officer who is entitled to be registered as a medical practitioner if he applied under any law in the country: Section 14 1 of the Medical Practitioners and Dentists Act and Section 7 4 of the Clinical Officers Act are the only two laws that can authorize one to practice medicine and render medical or dental services in the public sector if they hold a registration certificate or in the private sector if they hold a current license as well.

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Like his counterparts in the public service, a clinical officer in the private sector has the same practice rights and privileges as a medical officer and both are authorized to work independently and specialize in any approved branch of general or specialised medicine. The Competition Act No. A register of active clinical officers and medical institutions is available online on the Clinical Officers Council and Ministry of Health websites. Although training programmes existed as early as , the first university to train clinical officers was Egerton University [25] in Clinical Medicine and Surgery is completed over 4 years.

Students study the biomedical and clinical sciences such as anatomy , physiology and pathology in the first year followed by the clinical subjects medicine , surgery , pediatrics , obstetrics and gynecology in the second year. The third and fourth year involves supervised clinical practice and internship in teaching hospitals where they rotate in all the departments, receive beside lectures, attend consultants' ward rounds, clerk patients and present medical histories, perform deliveries and first-assist in major surgery.

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They also attend clinical meetings and write prescriptions which at this stage must be counter-signed by a supervising clinician. There is special emphasis on primary care with modules on community health taught throughout the course.

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Before starting their internship after the third year, clinical officers spend at least one month in a Provincial Rural Health Training Centre where they immunize children, examine pregnant women and offer family planning services in mother and child health clinics. They also treat in-patients and out-patients under the guidance of qualified Clinical officers and organise outreach services where they venture into remote rural villages, seeing patients and immunising children. During this time they complete a project in community diagnosis.

They also learn Health Service Management which prepares them for their management and leadership roles in health centers and other institutions. All clinical officers must work as full-time interns for one year without pay or any form of motivation at an approved public or mission hospital before getting a license to practice medicine, a situation that has resulted to major strikes by clinical officers in the past leading to operation standstills in public hospitals when these strikes occur.

On passing the final qualifying examination, they take the hippocratic oath then apply for provisional registration by the Clinical Officers Council, [17] the statutory body that regulates the practice of clinical officers in the country. The internship involves supervised rotations in the major clinical departments namely casualty , medicine , paediatrics , surgery , obstetrics and gynecology.