Creative Education
2013. Vol.4, No.12B, 105-115
Published Online December 2013 in SciRes (http://www.scirp.org/journal/ce) http://dx.doi.org/10.4236/ce.2013.412A2016
Open Access 105
Educational Practices, Curriculum Design and Implementation
at the MLT Diploma Program in Uganda
Christopher B. Mugimu1, Wilson Rwandembo Mugisha2
1Department Foundations and Curriculum Studies, College of Education and External Studies,
Makerere University, Kampala, Uganda
2Uganda Institute of Allied Health and Management Science (UIAHMS)-Mulago, Kampala, Uganda
Received November 2nd, 2013; revised December 2nd, 2013; accepted December 9th, 2013
Copyright © 2013 Christopher B. Mugimu, Wilson Rwandembo Mugisha. This is an open access article distrib-
uted under the Creative Commons Attribution License, which permits unrestricted use, distribution, and repro-
duction in any medium, provided the original work is properly cited. In accordance of the Creative Commons
Attribution License all Copyrights © 2013 are reserved for SCIRP and the owner of the intellectual property
Christopher B. Mugimu, Wilson Rwandembo Mugisha. All Copyright © 2013 are guarded by law and by SCIRP
as a guardian.
Contemporary curriculum design and implementation require the use of appropriate educational practices
to enhance positive teaching and learning outcomes. This article discusses the study of educational prac-
tices and related curriculum antecedents applied during the design and implementation of the Medical
Laboratory Technology (MLT) at Mulago Paramedical Schools in Uganda. This study utilized mixed
methods (quantitative and qualitative) in which checklists, document analysis, questionnaires, focus group
discussions, and interviews were used to gather data at different compliance levels. The sample comprised
of 10 educators, 30 clinical supervisors and 63 students. This study revealed that the MLT diploma cur-
riculum was implemented with a multi-disciplinary focus in order to develop confident and dependable
health professionals that could function harmoniously in interdisciplinary collaborative teams. The study
also revealed that the curriculum designers and educators complied with important curriculum antece-
dents in its design and implementation process and it’s clear that student-centered approaches were used.
Furthermore, practicum training and strategies used oriented students to basic practical clinical skills and
competencies. The use of a variety of educational practices during curriculum implementation made the
teaching and learning process more friendly and interesting. It was concluded that considerable utilization
of appropriate educational practices during curriculum development was critical. This area of curriculum
development being extremely dynamic further research is needed to ensure continued relevance of curric-
ula in the medical field.
Keywords: Educational Practices; Learning Theories; Curriculum Design; Curriculum Implementation
Introduction
Educational practices are critical in the design and imple-
mentation processes of a curriculum because it creates enabling
environment for teaching and learning. The theoretical orienta-
tion of a curriculum developer or educational planner influ-
ences the educational practices he or she adapts. Educational
practices refer to a variety of activities that get done in the in-
terest of fostering education such as interventions intended to
improve education as well as cultural innovations to address a
broad range of educational issues either by government or
communities. For the purpose of this study, educational prac-
tices are those activities done by the different stakeholders of
education in order to enhance learning outcomes of students.
Educational practices may also include, but not limited to pre-
paring education agenda, curriculum development, teaching and
learning activities, as well as policy initiation and implementa-
tion. Cotton Kathleen (2000) explains how important educa-
tional practices are in boosting students’ learning outcomes and
recommends that they need to be well integrated in order to
effectively help students to internalize the subject contents.
Sullivan (2011) also shows how application of different educa-
tion practices as well as innovational practices can improve
learning outcomes and the understanding of students. As such,
Suryadi and Kudwadi (2010) offer characteristics and compe-
tences of teachers, organization and structure of educational
units, workplace (industry), among others as part of important
curriculum antecedents. From this perspective, educational
practices are part of the society norms, values and notions.
They are therefore part of curriculum antecedents and hence
form a foundation for curriculum development and implemen-
tation. Mugisha (2011) also contends that cultural societal val-
ues underlie any curriculum and are therefore curriculum ante-
cedents. Curriculum antecedents were the occurrences that took
place before the curriculum was developed which affected its
development and implementation. Biesta (2007: p. 2) argues:
“Educational practices should not be left to the opinion of
educators but that work should be based upon research evi-
dence…for a transformation of educational research so that
educational practice could be transformed into evidence-based
practice. The call for a double transformation of educational

C. B. MUGIMU, W. R. MUGISHA
research and educational practice lies at the very center of evi-
dence-based education.”
Biesta rightly indicated that appropriate educational practices
should be informed by research. Furthermore, other great phi-
losophers such as Vygotsky, Piaget, Dewey, and Freire suggest
that appropriate EPs should be grounded in sound educational
theories. Educational practices that are informed by sound edu-
cational theories and philosophies should lead to appropriate
and relevant curriculum design and implementation to promote
effective teaching and learning. The important arising question
is: to what extent are the educational practices used at MLT
informed by sound educational theories and philosophies?
Conceptual and Theoretical framework
The assumption in this study was that when appropriate edu-
cational practices get to be identified and applied, students
should easily acquire the desired learning outcomes. This is
consistent with established educational learning theories like
social learning theories (Rajah; 1993, Feuerstein; 1980, Vygot-
sky; 1978) in which educators and senior professionals act as
sources and motivators of learning. Furthermore, according to
the cognitive development learning theories (Dewey; 1967,
Piaget; 1936, Piaget; 1957), enhanced interaction of students
with the learning environment increases their understanding of
subject contents. The humanistic and learner consciousness
development theories also assume that if students are given
freedom to determine their destiny in learning, they tend to
become more conscious of their development in learning
(Rogers; 1983, Freire; 973, Freire; 1972). Several other theories
such as service-learning cognitive theories (Giles, 1991), Kolb’s
experiential learning theories (Miettinen; 2000, Kolb & Fry,
1975) and Lewin’s experiential learning (field/change) theory
(Atherton; 2013, Lewin; 1951) emphasize that students learn
from their own experiences.
We should mention that while this paper does not intend to
analyze the educational theories associated with each of the
educational practices highlighted, it is, however, important to
note that each educational practice has underlying theories
connected with it. Given the amount of space available, the
paper only gives an overview of some aspects of the underlying
theories to emphasize their connection with each of the educa-
tional practices.
Literature Review
Educational practices are characterized by arrangements that
are deliberately designed to get desired learning outcomes from
an education system. For instance, educational practices may
involve the establishment of national and institutional policies
that may promote pedagogical innovative models which en-
courage lifelong learning traits among students (UNESCO
2012). Educational practices should also offer a variety of pro-
visions for creating flexible learning opportunities for students
(Houston, McCune and Osborne: 2011). Flexible learning op-
portunities in terms of ensuring alternative delivery modes used
to implement the educational programs, study patterns such as
permitting fulltime and part-time students, distance work-based,
web-based learning, with flexibility in the study, allowing
face-to-face instructions (sessions), providing online support,
utilizing virtual learning environments, tutor support systems
and friendly/accommodating assessment strategies to meet the
needs of the majority of learners. According to Kuh (2008),
well selected educational practices should benefit students of
diverse backgrounds, which currently have become the com-
mon phenomenon in higher educational institutions. Educa-
tional practices take many forms, depending on learner charac-
teristics as well as on institutional priorities and contexts.
UNESCO (2012) recommends that good educational prac-
tices need to be established in all educational programs. As
such, institutional policies should play a significant role to in-
fluence educational practices. For example, institutional policy
at Mulago Paramedical Schools required the practice of expos-
ing different Allied Health professionals through a multidisci-
plinary training approach which was mandatory to all its stu-
dents including MLT students (MPS Core curriculum, 1998).
Mugisha (2011), in his study evaluating the application of edu-
cational practices during the curriculum implementation of the
Medical Laboratory educational programs in Uganda, describes
how Mulago Paramedical schools have established an [institu-
tional culture] of ensuring that students from different health
professions go through a common basic training together as an
effort of fostering inter-professional cooperation and collabora-
tion. We suggest that sound educational practices should be part
of the culture of any institution. Mugisha and Mugimu (2011)
explain how considering epistemology as a curriculum devel-
opment practice, led to the successful development and imple-
mentation of the MLT diploma curriculum with relevant types
of knowledge and knowing required in MLT education and
practice.
Mugisha and Mugimu (2013) explain how application of
educational theories as a curriculum development practice does
not only lead to the development and implementation of a suit-
able MLT diploma curriculum in Uganda, but promotes and
enhances the utilizations of appropriate educational practices to
facilitate the teaching and learning processes.
 Anderson and Walberg (1994), Chickering and Gamson
(1987), and Duk (2008) also suggest the following theory
grounded educational practices: Encouraging contact be-
tween students and educators. This agrees with theories of
mediated learning whereby knowledgeable individuals act
as intermediaries between the knowledge being learnt and
the students in the process of learning (Feuerstein, 1980).
 Developing strategies that lead learning through the devel-
opment of teamwork and cooperation among stakeholders,
which is consisted with social cognition theories of Vygot-
sky (1978)
 Use of participatory active learning approaches. This prac-
tice is in line with cognitive; learning theories (Ausubel;
1960, Bruners; 1992) as well as humanistic theories (Rogers,
1983)
◦ Application of the time on task principle during pro-
gram implementation, which enables learners to agree
with their teachers on the time lines for completing spe-
cific assignments. This is an aspect of contractual
learning as portrayed in the humanistic learning theories.
According to the humanistic theories, students are given
freedom to determine the pace of their learning (Rogers;
1983), Anderson and Walberg (1994), and Chickering
and Gamson (1987) Ensure that educators use effective
communication strategies that convey high expectations
and standards to students as a means of making them
understand what is expected of them.
◦ Providing support for personalised learning through the
appreciation of diverse talents and learning styles
among different students.
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C. B. MUGIMU, W. R. MUGISHA
 Learners to work on their own in order to develop confi-
dence. Ensuring that alignment of time on task by focusing
on educational goals, professional expectations, institutional
focus and learning expectations is practiced. This educa-
tional practice is in the context of constructive alignment
theories of curriculum development (Errington, 2010; Biggs,
1004; Yorke & Knight, 2004).
 Use of systematic direct teaching to give the main learning
issues, as a practice is suitable for giving students new de-
velopments in the subject and introducing new subjects
(Amri, Ngatia, & Mwakilasa, 1993). The practice has its
roots in the idealism which asserts that knowledge is per-
manent and that educators have unquestionable authority to
knowledge (Ornstein & Levine, 1993; Ornstein & Hunkins,
1988).
 The practice of linking of past learning with the current
teaching (advance organiser), as teaching/learning strategies
and ensuring that students are given a variety of learning
choices and tutoring services are part and parcel of the
principles of teaching (Amri, Ngatia, & Mwakilasa, 1993;
Ausubel,1960; Ausubel, 1978).
 Encouraging cooperative learning where students support
each other by working in groups on specified tasks. It in-
volves students discussing together, teaching each other and
solving problems more effectively as groups as opposed to
each individual (Barkley, Cross, & Major, 2005; Vidakovic
& Martin, 2004; Vidakovic, 1997, Slavin, 1996; Davis,
1993). Sahel, Al-Tawil and Al-Hahithi (2013) found that
interactive learning was appreciated by students as a suit-
able method of learning among students.
 Applying principles of adaptive education using a variety of
instructional techniques especially utilizing teaching/learn-
ing strategies that may lead to the development of intellec-
tual and practical competencies. This is achieved when stu-
dents are encouraged to work together in groups, which
makes them develop collaborative learning traits, critical
inquiry skills, searching for information, writing, and pres-
entation skills. This is consistent with phenomenological
learning theories (Gross, 2005; Curzon, 2004; Quinn, 1995;
Barnum, 1994; Roth, 1994; Rajah, 1993; Bevis, 1982)
where teaching and learning get adjusted to the demands of
the prevailing situation and interests of the student. This
also is applicable to the humanism (Quinn, 1995; Joseph,
1985; Carter, 1978) and existentialism (Gulino, 1982; Sartre,
1973; Kneller, 1971; Triostontaines, 1971) realms of phi-
losophical interests and experiences of the student. This ap-
proach tends to be learner centred.
 Integrated learning across disciplines. It involves forming
learning communities where learners of different programs
or courses and their teachers form study groups that address
multidisciplinary issues. Such a practice makes students
look at education as being beyond the classroom. This
makes students appreciate the idea of learning communities
as an educational goal. This is consistent with the recon-
structions’ (Lovat & Smith, 2003; Freire, 1972), holism
(Johnson, 1990; Bevis, 1982; Carter, 1978) and humanism
(Quinn, 1995; Joseph, 1985; Carter, 1978) philosophies as
well as phenomenological learning theories (Gross, 2005;
Curzon, 2004; Quinn, 1995; Barnum, 1994; Roth, 1994;
Rajah, 1993; Bevis, 1982).
 Making students work together as colleagues. Collaborative
assignments and joint projects to students makes them learn
to work and solve problems in the context of teamwork
(Giles, 2010; Clark, 2006). They learn from each other’s
experience and eventually gain their own.
Furthermore, meaningful research experience to students as a
practice makes learners work to get solutions for important
questions. This can be given as a research project assignment to
individual learners. The project may be on an identified area of
the program or it may integrate different aspects of the program.
This agrees with realism realm of philosophy where facts need
to be proved using scientific means (Ornstein & Hunkins, 1988;
Bigge, 1982). This is also consistent with the cognition theories
of Ausubel (1978) and Bruner (1992) where it is emphasised
that students learn well when they are active participants in
learning and creation of knowledge. The practice makes them
learn to make empirical observations, make analyses and de-
ductions and as a result derive new meanings. This is consistent
with the theories of knowing. The theories of knowing assert
that when students add new knowledge to old knowledge they
acquire new meanings (Wink, 2010; Spector, 1993). It also
develops the spirit of being appreciated when they do big things.
It is a modelling for making important findings. It prepares
students to appreciate and accept changes. The practice is con-
sistent with the pragmatism realm of philosophy where reality
is dependent on experience of individuals (Ornstein & Hunkins,
1988; Zais, 1976). Involvement in experimental learning, as an
aspect of experiential learning as a practice makes students
appreciate work place challenges. This can be provided in form
of internships or practicum attachments. This is consistent with
social cognition learning theories where students learn from
senior professionals in the places of work (Vygotsky, 1978) as
well as mediated learning theories where those who know act as
intermediaries between the knowledge and the student in the
process of students learning (Feuerstein, 1980).
National policies guide curriculum development and imple-
mentation and likewise, guide educational practices. In Uganda
there is a practice of students contributing to the budget of run-
ning training institution. This practice is guided by a policy in
Higher education which allows institutions to collect funds
from trainees and use it for the day-to-day operations (The
Uganda Higher Education cost, 2003); Uganda Higher Educa-
tion Policy, 2004). This practice has made it possible for insti-
tutions to easily implement their educational programs with
resources generated locally at the institution. In the health sec-
tor, guidelines for provision of health care have been docu-
mented in the Health Policy (1999), the Health Sector Strategic
Plan (2005/6-2010 and 2010/11-2015/16) as well as in the
Minimum Health Care Package (2000). This strategic plan has
led to designing and implementing the Medical Laboratory
Technology curriculum in a manner of mimicking the work
environment of the graduate of the MLT training. The attempt
to mimic the work environment is consistent with the evi-
dence-based education that is widely used in the field of medi-
cine. And so the Health Sciences Education requires to have
specific educational practices applied in order to make it effec-
tive and relevant. Indeed, the application of androgogical ap-
proaches especially those that promote self-directed learning
such as constructivism approach in teaching and learning, re-
flective practices and helping students to convert theory into
practice and development of self-efficacy, are some of the prac-
tices that are recommended to be integrated in medical educa-
tion/health sciences education (Kaufman, 2003).
Flexibility approaches in curriculum implementation are also
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C. B. MUGIMU, W. R. MUGISHA
some of the educational practices that could make individual
learners to have increased participation and access to teaching
and learning by removing restrictions from the way knowledge
is accessed. In this context, restrictions to knowledge access
could be such as using conventional teaching methods, text-
books, etc. This is active learning and leads to the development
of lifelong learning skills. Houston Macune and Osboner
(2011), Morgan-Klein and Osborne (2007), Sankey and Os-
borne (2006) and Percy and Ramsden (1980) explain that ap-
plication of flexibility in learning tends to benefit students in
breaking the bureaucratic mechanisms that usually exist in ac-
quisition of knowledge and accreditation of the past experi-
ences of students. Accreditation of past experience of students
involves thinking and reflecting on the experience by both the
students and the curriculum implementers. This is a reflective
practice in curriculum implementation. Reflection on the past
experience by the students leads them to understand the previ-
ously learnt knowledge in numerous new ways. According to
Kim (2011), learning should also involve unlearning. As such,
reflective practice also involves unlearning some aspects of the
past experiences in order for the student to accept and appreci-
ate the new knowledge. On the part of the student, this is also
an aspect of active learning. Kuh (2008) reveals that if utilize-
tion of active learning practices is not systematically applied in
various institutions, this could undermine students’ learning.
The use of internet i.e. e-learning is another educational
practice (Luke, Solomon, Baptiste, Orchard, Rukholm, & Car-
ter, 2009) recommended by Luke, Salomon et al. for enhancing
inter-professional Health Sciences Education. These authors
contend that a core curriculum for various Health Professionals
can be best transmitted through e-learning/web-based learning.
Development of inter-professional education that leads to the
emergence of inter-professional practice is yet another Educa-
tional Practice that is used in training of Health Professionals.
This is a very important practice because it gives a common
inter professional agenda to the various health cadres involved
in various related inter-professional practices. For example, this
practice is characterised as having common subjects together,
holding inter-professional projects, and clinical attachment.
Jelesiewicz (2011) discusses educational practices applied in
the teaching of Health Practices applied in the teaching of
Health Sciences at Temple University in the United States of
America (USA). These educational practices include, but not
limited to, a) identifying and solving common issues of dif-
ferent disciplines as a team of educators from the concerned
disciplines, b) emphasizing clinical teaching, c) team teaching,
and d) practicing the taught knowledge simultaneously in a
manner that takes interests of patients and trainees. Furthermore,
the integration of professionalism in the teaching and assess-
ment of trainees is vital and needs to be applied. Adams (2009)
also describes how educationists in laboratory-based education
in the United Kingdom agreed in a conference that using en-
quiry based approach in laboratory teaching allows trainees to
observe phenomena, test hypotheses, design experimental stra-
tegies and reach conclusions as a result of recording and mak-
ing critical analyses of experimental results. It was further
noted that laboratory teaching and learning needed to be plan-
ned and executed in an exciting and realistic context.
 All the mentioned educational practices and curriculum
antecedents are crucial especially in managing the challenge
of examination tensions that should occur when students are
ineffectively taught theory and practical skills.
Methodology
This study utilized mixed methods in which we used check-
lists and document analysis as instruments to gather data at
different compliance levels during the design and implementa-
tion of the MLT curriculum. The checklists were developed
drawing on the information extracted from the literature review
and policy documents guidelines. The checklists also contained
the standard descriptions of the expected status for an ideal
medical education program. The checklists were also used dur-
ing the focus group discussions.
Purposive Sampling
Technique was used to select educators and clinical supervi-
sors who participated in the study because they were few and
highly specialised in their subject disciplines. The research
sample comprised of 10 educators and 30 clinical supervisors.
The educators were both part-and full-time tutors at the School
of MLT, at Mulago Paramedical Schools. The supervisors were
employees of the Ministry of Health based at Mulago Hospital,
and others were employed by Makerere University at The Col-
lege of Health Sciences. Supervisors and educators were in-
cluded because they carried out the supervision of MLT stu-
dents during the practicum attachments. This implies that the
sample constituted 100% of the educators and supervisors. A
sample of 63 students in SMLT were selected based on eligibil-
ity. The eligibility criteria for inclusion in the study were as
follows: the student should have completed one year of study at
the institution and was not yet in the specialised part of the
program.
Documents
Documents were selected according to their relevance to the
study. The documents selected included the MLT curriculum
documents, the Health Sector Strategic Plan (HSSP) 2005/06-
2009/10, 2005; Poverty Eradication Action Plan (PEAP), 2005;
Curriculum of Diploma in Medical Laboratory Sciences, 2006;
Guidelines for Private Practice of Nurses and Allied Health
Professionals, 2002; The Guidelines for Medical Laboratory
Practice, 2002; The health policy, 1999; The education White
Paper, 1998); International directory of Biomedical Laboratory
Sciences Education (Karlton & Turner, 1998); The Uganda
Constitution, 1995; school time tables, school administration
files, office assessment results records, students’ note books
and practical assessment record books, educators’ notes and
schedules and the United Nations Organisation (UNO) agencies
publications. All these documents were critically analysed to
understand the situation. Situational analysis also involved
investigating whether the curriculum antecedents were consid-
ered during curriculum development. This was done by analys-
ing the relevant documents which represented the different
curriculum contexts using check lists and observational sched-
ules.
Data Collection
Self-reporting questionnaires were also administered to dif-
ferent respondents (learners, educators and supervisors). These
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C. B. MUGIMU, W. R. MUGISHA
Open Access 109
instruments were used to generate data that enabled us to com-
pare the curriculum content and implementation strategies with
requirements of the various curriculum contexts. The question-
naires also investigated the assessment practices, in particular,
to establish whether there was evidence of institutional support
to the teaching and learning processes, in particular, the con-
gruence between the official and curriculum in action and stu-
dents’ attainment of learning outcomes. Furthermore, the study
also investigated how educators applied various educational
practices in their teaching and how they coped with the cur-
riculum schedules. Focus group discussions were also con-
ducted using semi-structured interviews among the students,
educators and supervisors. A check list of issues covered during
the focus group interviews was developed drawing on key ideas
arising from the situational analysis, document analysis and the
surveys. The aim of the focused group discussions was to get
verbatim responses as well as obtain clarifications and explana-
tions of the written responses arising from the situational
analysis and survey.
Data Analysis
Data were organised in tabular and chart forms to facilitate
the establishment of the relationships that existed in the data.
The quantitative data was analysed using a statistical package
(SPSS 11.0). The quantitative data analysis generated descrip-
tive statistics presented in tables and charts. It also involved
calculation of correlation coefficients and statistical signifi-
cance.
Drawing on the Ground Theory principles, the analysis of
qualitative data involved the organisation of responses from
respondents into common themes and sub-themes. This in-
volved studying responses presented in the narratives as con-
tained in each of the questionnaires, focus group discussions
and a careful analysis of all curriculum policy documents.
Results
We probed to find out what educational practices were being
used by educators to implement the MLT diploma curriculum
program. Findings revealed that the MLT diploma curriculum
was implemented at MPS which is a multi-disciplinary institu-
tion. Thus, MPS developed confident and dependable health
professionals, enabling them to function harmoniously in an
interdisciplinary team. It is also the only Allied Health Training
Institution preparing different cadres of Allied Health Profes-
sionals. The learners were oriented to appreciate the interde-
pendency of different health cadres and to uphold ethical prin-
ciples underlying their professional practice while making
clinical decisions.
Mulago Paramedical Schools used a core multidisciplinary
curriculum in order to make all the students of the diverse
backgrounds have a uniform standard in basic sciences. Stu-
dents of the MLT diploma program followed a multidiscipli-
nary core. Curriculum comprised of basic sciences such as
anatomy, physiology, microbiology and psychology during
their first semester of the first year of study (MPS Core Cur-
riculum, 1998). Educators at MPS used student-centred ap-
proaches during curriculum implementation.
This made students achieve the desired learning outcomes as
evidenced by their performance in their examinations in Table
1. Table 1 shows the performance of learners at the end of each
year between 2000 and 2007. From this table it is clear that
performance of learners in the examinations was relatively
good, which is a reflection that the appropriate educational
practices are being used in the MLT program.
Curriculum Designers Co mplied with
Curriculum Antecedents
Investigations were done to establish whether the design of
the MLT curriculum was in accordance with its antecedents.
The investigations were done by use of checklists containing
statements extracted from the curriculum depicting characteris-
tics of various antecedents of the curriculum indicated in the
table below. The study results established that the curriculum
design process was compliant with the curriculum antecedents
as indicated in Table 2.
The results in the Table 2 show that most of the items tested
had compliance at 100%. The items which did not have 100%
compliance were also very high i.e. more than 82%. It is not
surprising that during the focus group discussion with the
clinical supervisors, it was revealed that, the supervisors confi-
dently expressed satisfaction with their contribution to the im-
plementation of the curriculum and explained that they ex-
pected compliance to be at 100% all through (Supervisor 1).
They explained that where the performance fell short of their
expectations, it was because they did not know what to be ex-
pected. However, they blamed it to the inadequate communica-
tion among the educators.
 The institution (MPS) has a practice of regular Assessment
of Progressive Achievement of Learning Outcomes;
 Progressive achievement of learning outcomes was investi-
gated analysing responses of students, educators and clini-
cal supervisors. What comes out clearly is that responses
depicted the 100% administrative support given towards the
practice of progressive assessment of students’ learning
outcomes as presented in Table 3. From the results in Ta-
ble 3, it is clear that the curriculum implementation process
carried out progressive assessment of students learning out-
comes at the rate of 90%.
Table 3 shows that curriculum implementation had adminis-
trative support towards the assessment process to ensure that
Table 1.
Shows examination results of MLT students by year.
Year 2000 2001 2002 2003 2004 2005 2006 2007
Number of candidate 36 41 43 50 45 18 63 77
Number passed 32 31 27 40 37 12 44 48
% pass 89 76 63 80 82 67 70 62
Average pa ss rate per year = 74%

C. B. MUGIMU, W. R. MUGISHA
Table 2.
Shows how the curriculum design compiled with the curriculum antecedents.
Antecedents No of
statements per item Full Compliance % Partially Comply % Total compliance % Does not comply % Total %
Following pricipal leading
to career path 20 85 5 90 10 100
Following curriculum
design principles 7 86 14 100 0 100
Using outcomes that lead
to skills development 25 80 20 100 0 100
Curriculum content relevance 34 76 24 100 0 100
Applying established
educational strategies. 11 73 9 82 18 100
Using existing facilities
for clinical exposure 12 100 0 100 0 100
Following curriculum administration
and assessment recommendations 36 9 86 95 5 100
Table 3.
Shows percentage compliance of the administration to curriculum recommendations.
Item Complies Partially complies Total Compliance Does not comply Total
N %N % N % N % N %
Assessment Process 12 851 5 13 90 1 10 14 100
Assessment Administrative support 7 861 14 8 100 0 0 8 100
n = Number of statements
this process followed key curriculum recommendations. This is
an important educational practice for an educational institution
because assessment of learning is the only sure way of meas-
ureing whether learning is taking place or not.
For instance, during the focus group discussion some of the
educators and clinical supervisors indicated that the time of
assessment and the nature of assessment were well known to
them. The curriculum document is clear of the nature and time
of assessment in the implementation schedule (Educator 1). It is
clear that at the end of each semester there would be an as-
sessment and the content to be assessed would be in alignment
with the procedures students performed during that semester
(Supervisor 2). Both educators and supervisors were in agree-
ment that the guide lines were strictly followed during the im-
plementation of the curriculum. This showed that there was
collaborative understanding and interest among the different
stakeholders of the MLT curriculum and its implementation.
Students’ Views about application of student-centred ap-
proaches during Curriculum Implementation further reflected
on students’ responses and enquiry into their views concerning
teaching and learning strategies, learning experiences, content
presentation, learning environment/climate and assessment of
their learning outcomes during the curriculum implementation
at the MLT, the findings clearly show that the teaching-learning
approaches applied were student-centred (SCA) i.e. ranging
between 76% and 93%. For instance, during the focus group
discussion with students revealed that: Discussing academic
issues with our peers is pleasurable, makes one compare one-
self with colleagues and increases understanding. Carrying out
projects on our own with moderation of educators, makes us
develop confidence (Student 1). This quote indicates that stu-
dents appreciated their participation and engagement with peers
during the teaching and learning process. These views also
show that there was positive development of lifelong learning
habits among the students.
Teaching-Learning Approaches: Sixty three students’ re-
spondents returned the questionnaires. The results in Tables 4
and 5 reflect students’ views with respect to the implementation
of the teaching and learning strategies.
Table 4 shows that 69% of students felt that the theoretical
contents offered at the Medical Laboratory Technology (MLT)
were generally presented drawing on student-centred ap-
proaches. 59% of students felt that student-centred approaches
were also utilized during practical teaching as well as practicum
attachment. Although there were some aspects of teach er-cen-
tred tendencies, however, student-centred approaches predomi-
nated. This is reflected in the following quotes:
1) When students stay on the MLT program for at least one
year they become confident and do most of the learning
amongst each other and individually on their own (Educator1)
2) When supervising senior students of the MLT program,
one only gives minimum guidance because they appear to be
confident and to perform most of the procedures on their own
as well as consulting amongst each other (Supervisor 3). This
explains the low rating of the teacher-centred approach in Ta-
ble 3.
This implies that both educators and supervisors applied stu-
dent-centred educational practices. It also implies that the MLT
program is practical-oriented, promoted critical thinking, and
problem-solving skills. Indeed, learning was enhanced by doing
so and through active individual participation of students.
Table 5 shows that educators’ application of teacher-centred
strategies especially during the teaching of theoretical knowl-
edge was 86%, practical 75% and practicum 73% respectively.
From these results, it is clear that even in practical programs
uch as the MLT there was some application of teacher-centred s
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C. B. MUGIMU, W. R. MUGISHA
Table 4.
Shows Students’ Perception about the Application of SCA by Educators.
Strongly agree Agree Total agree Strongly disagree To tal disagree
SCA Learning experiences n % n % n % n % n %
In theoretical learning 25 40 18 29 43 69 20 31 20 31
In Practical learning 13 20 25 39 37 59 41 26 26 41
In Practicum 13 20 25 39 37 59 41 26 26 41
n = Number of learners
Table 5.
Shows students’ perception of the application of TCA practices by educators.
Always Often Seldom Total ever Never
TCA n % n % n % n % n %
In theoretical sessions 20 32 20 32 14 22 54 86 9 14
In practical sessions 18 29 13 21 16 25 47 75 16 25
In Practical attachment 16 25 14 23 16 25 46 73 17 27
n = number of students
approaches especially in the teaching of underlying principles
and theories on which various experiments are based. Teacher-
centred approaches were also used when educators carried out
demonstrations of procedure, especially during the time of in-
troducing students to basic laboratory procedures.
Furthermore, during focused group discussions, some of the
educators explained how they usually take a lot of time in ex-
plaining principles and cultures of the medical profession to the
newcomers (freshmen) as a way of orienting them into the
medical related training/profession. This is usually done in
form of direct lecturing to the students. For instance, one of the
educators indicated that “It takes a lot of time explaining new
concepts and demonstrating laboratory procedure especially in
the first year of the program” (educator 13). The clinical su-
pervisors elaborated on how students take time to get used to
routines of the clinical laboratories. They said this made them
take some time inducting students.
Learning Experiences were more of student-centred than
teacher-centred. The results of the investigations into the com-
mon learning experiences encountered by students during cur-
riculum implementation indicated that the experiences in theo-
retical subject contents was predominantly student-centred
(69%) and in practical teaching and practicum attachment the
tendency was at 59%. These tendencies provided the learning
experiences during curriculum implementation as reflected in
Tables 6. As earlier observed, although there were tendencies
of TCA during curriculum implementation, the SCA domi-
nated.
MLT being a ‘hands on program’, supervisors during the fo-
cused group discussion narrated how students needed to gradu-
ally gain confidence and to work on their own in clinical sites
(clinic, hospital, and medical laboratory) during practicum at-
tachments.
The analysis of the responses in Table 6 seems to be com-
plementary to the explanations given in Table 4. At the begin-
ning of the program, educators tend to use more of teacher-
centred than student-centred approaches while towards the end
of the program, the approaches get predominantly student-
centred. This is important because students at this point in their
education cycle need to gather a lot of information on their own
about the new field they will have joined.
Discussions
From the findings of the study it was also revealed that the
curriculum design phase at the MLT extensively considered
relevant curriculum development principles. For example, cur-
riculum designers identified important curriculum antecedents
of the MLT program. It was therefore not surprising that the
professional context had been fulfilled.
The curriculum enhanced outcomes that led to the develop-
ment of appropriate and relevant skills required for the func-
tional practice of MLT.
The findings also showed that the curriculum document
identified the different levels of existing Health facilities as
described in the Health policy (The Health Policy, 1999). This
was found to have been considered during the planning of at-
tachment in the practicum training sites where students carried
out their practical clinical orientation. There were also docu-
mented strategies for exposure of students in the practicum
sites.
The strategies emphasised the use of senior professionals as
supervisors during clinical placement of students. In this con-
text, the educational practice of having teaching as a shared
responsibility between educators and clinicians was upheld.
This enabled students to acquire relevant professional skills.
This was mainly reinforced by utilizing curriculum implement-
tation strategies that emphasized both clinical and team teach-
ing.
The exposure to clinical practice was mandatory for the ful-
filment of the professional registration of graduates as de-
scribed in the Allied Health Statute (Allied Health Statute;
1996). The MLT curriculum therefore integrated educational
practices that enabled students/trainees to be professionally
qualified. This educational practice ensured that the MLT cur-
riculum development process followed relevant curriculum
design principles and aligned the curriculum to its professional
context.
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C. B. MUGIMU, W. R. MUGISHA
Table 6.
Shows application of TCA during the teaching/learning process.
Strongly Agree Agree Total agree Disagree Strongly disagree Total disagree
Learning Experiences TCA n % n %n % n %n % n %
In Theoretical learning 13 21 20 3233 53 18 299 14 30 47
In practical learning 13 21 23 3636 57 9 1418 29 27 43
In practicum attachment 11 17 23 3734 54 23 366 10 29 46
n = number of students
The results of the study also indicated that various educa-
tional practices were applied during the implementation of the
curriculum. The implementation process included providing
flexible learning opportunities for trainees during individual
projects and in all areas where student-centered approaches
were applied.
Flexibility approaches in curriculum implementation took
care of the diversity of students; thus, encouraged individuals to
have increased participation and access to learning thus remov-
ing restrictions on the way knowledge was accessed. This ap-
proach benefited students as it breaks bureaucratic mechanisms
that usually exist in the acquisition of knowledge and accredita-
tion of the past experiences. This is in agreement with other
authors (Sankey and Osborne, 2006) who explain that using
flexible approaches as a curriculum implementation practice
enables individual students to actively participate in the teach-
ing and learning process; given that it removes restrictions on
the part of students in the process of accessing knowledge. This
is often referred to as active learning and may lead to the de-
velopment of lifelong learning skills. This is in agreement with
the views of Houston Macune and Osboner (2011), Mor-
gan-Klein and Osborne (2007), Sankey and Osborne (2006) and
Percy and Ramsden (1980) explain that application of flexibil-
ity in learning benefits students in breaking the bureaucratic
mechanisms that usually exist in acquisition of knowledge and
accreditation of the past experiences.
The curriculum implementation process encouraged group
and individual studies as strategies to promote the development
of lifelong learning skills among students. Furthermore, the use
of a variety of educational practices during curriculum imple-
mentation made the teaching and learning process more
friendly and interesting. As such, many students experienced a
good masterly of the subject content as indicated in the exami-
nations results in Table 1. Responses from the students also
showed that they were satisfied with the assessment schedules
as well as assessment strategies which subsequently reduced the
tensions among students which usually accrue from examina-
tions.
Indeed, the flexible approaches used during the MLT cur-
riculum implementation were overwhelmingly appreciated by
the students.
For instance, the assessment strategies that encouraged the
use of group discussions were found to be flexible and allowed
students to take responsibility of their own learning as opposed
to educators dominating the teaching/learning process; as it
gives students the opportunity to teach each other as well as to
communicate their individual ideas to external audience.
Through such, they also gain experience in communicating
with peers. They also developed confidence in their intellectual
capacities as well as get opportunity to compare themselves
with their colleagues thus developing self-acceptance and self-
confidence. Using small group teaching/discussion approaches
as an educational practice also helped teachers to deal with
large classes in terms of enhancing students’ opportunities to
discuss content in small groups more effectively which would
be difficult in the large class.
This study further revealed that there was an institutional
policy for a core curriculum, that enabled students from differ-
ent disciplines to study a uniform curriculum in basic sciences,
research, information technology and management. The ap-
proach involved having students from these different disci-
plines study together, getting collaborative assignments and
joint projects. They were also assessed together which made
them look at each other as members of the same calling. This
was intended to enable them to learn to work and solve prob-
lems as team members. This approach to health sciences educa-
tion is in line with the practice at Temple University in the
USA (Jelesiewicz, 2011). This approach in health training has
also been encouraged and recommended by scholars as ideal
practice for forming learning communities where students of
different programs or courses and their teachers form study
groups that address multidisciplinary issues. The multidiscipli-
nary core curriculum approach in health sciences education
helped students look at classroom teaching and learning as a
professional practice aimed at addressing community-oriented
services rather than simply acquiring knowledge in classrooms
per se. This inculcates their desires to value working for and in
communities as teams as opposed to individuals or individual
professionals. Establishing a culture of this nature is a good
example of establishing strategic educational practices. Mugi-
sha (2011) recommends that establishing unique institutional
ethos (educational practices) should be a culture of any tertiary
institution.
The results of analysis of the curriculum document also
showed that the curriculum content had some component of
integrated Information communication Technology (ICT). This
prepared students to make use of the Internet in facilitating their
learning. The use of Internet is an educational practice which
involves e-learning. Luke, Solomon, Baptiste, Orchard, Ruk-
holm and Carter (2009) observed that the use of e-learning is an
ideal educational practice for enhancing inter-professional
Health Sciences Education.
Subsequently, the inter-professional education and e-learning
training have both been integrated into the MLT program.
Granted the promotion of inter-professional education as an
educational practice could enhance understanding, confidence
and teams of inter-professional nature. This helps in making
individuals belonging to the various professionals work to-
gether to solve inter-professional problems (Clark: 2006, An-
drews: 2005, Epstein: 1999). This is a very important approach
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C. B. MUGIMU, W. R. MUGISHA
for the training of various cadres involved especially in con-
temporary healthcare delivery services because it gives them an
opportunity to follow a common inter-professional agenda. It
may also help them to identify common problems and get their
solutions. This approach is also in line with educational prac-
tices at Temple University where teaching of professionalism
has been integrated in the Medical Education curriculum (Jele-
siewicz, 2011).
The results of the investigations showed that students were
exposed to problem-based learning procedures either on their
own or in groups, where they are given assignments and pro-
jects that are problem-solving in nature. As such, students were
prepared to discover the trends in their learning and future
working environments. This approach required them to deeply
think about their enquiries into issues related to contemporary
healthcare services in order to find out appropriate solutions.
Most of the assignments tend to focus on the practical aspects
of their clinical profession, with the aim of enhancing the de-
velopment of practical competencies. In this regard, students
were also encouraged to develop research skills such as; taking
credit for making appropriate empirical observations, and ob-
taining important findings. The other attributes of this approach
promoted collaborative learning skills, critical inquiry skills,
ability to search for information, report writing, and presenta-
tion skills.
What comes out clearly from this research is that utilization
of appropriate educational practices leads to relevant curricu-
lum design and implementation that in turn contributes to the
effective learning experiences reflected in Figure 1. This re-
search has also revealed that considerable utilisation of appro-
priate educational practices during curriculum development is
critical in a sense that it may enhance identification and use of
appropriate curriculum antecedents that could consequently
influence the relevance of curriculum content. Thus, identifica-
tion of curriculum antecedents is a very important educational
practice in curriculum development. As such, government poli-
cies concerning the national disease burden and international
trends have been integrated in the MLT curriculum and thus
have significantly influenced the MLT curriculum content.
These are the real antecedents of this curriculum. This area of
curriculum development is extremely dynamic and therefore
needs to be studied carefully and exhaustively in order to en-
sure continued relevance of curricula.
It is also clear that the establishment of institutional ethos
and culture may influence the character of trainees, which may
extend into their future professional life and practices. This
study has revealed that the institutional ethos of MPS focused
on multidisciplinary, multi-professional, multi-cultural institu-
tion practices and principles. The MLT curriculum was
Appropriate
Educational
Practices
Effective
Learning
Relevance of
Curruculum
Design and
Implementation
Figure 1.
Shows the curriculum design and Implementation model.
therefore developed under a multicultural, multidisciplinary ar-
rangement which was relevant for diversity of backgrounds of
its trainees. This arrangement was ideal to meet educational
needs of students from different backgrounds. The curriculum
was also relevant to the diverse educational standards and cul-
tures of students. It contained also relevant strategies for en-
hancing multidisciplinary educational experiences. The imple-
mentation of the MLT curriculum fitted within this culture. The
curriculum was therefore relevant to the institutional context in
which it was designed and implemented. As such, what came
out clearly from this study is that multidisciplinary education
requires good organisation and coordination. This also implies
that ideal management models for such institutions and educa-
tional programs need to be developed.
Further research is needed in the field of curriculum design
and implementation especially in the developing countries.
Given that Health Sciences Education is extremely dynamic in
terms of the delicate manner/nature in which healthcare ser-
vices are delivered to the diverse communities. Thus, the train-
ing of health professionals demands that it has to utilize a vari-
ety of appropriate educational practices to enhance the acquisi-
tion of needed professional experiences and competencies of
the trainees and graduates. Consequently, the implementation
of curricula for Health Sciences Education needs to use educa-
tional practices that involve as many stakeholders as possible in
order to offer appropriate training environments as an imple-
mentation strategy. By doing so, such an approach would ad-
dress concerns and demands of the different stakeholders. It
should also deal with the concerns of educators who implement
the curriculum, the students, the institutional settings in which
implementation takes place, the clinical sites that give/provide
the ideal professional experiences and the communities who
will be affected by the implementation of the curriculum. There
should also be linkage between the innovators and the users of
the innovation. Furthermore, research into these curriculum
issues, particularly looking into the best educational practices in
curriculum design and implementation of healthcare related
programs within the resources constrained contexts, particularly
in developing countries is needed. For instance, the integration
of training programs in one institution, as an educational prac-
tice, could be the way to go, however, this needs to be experi-
mented and its cost benefit analysis for several programs may
be necessary. Educational practices that could support and en-
courage institutions in optimizing the opportunities arise from
practices of utilizing economies of scale. Such institutions may
also need to develop a culture which models characteristics of
its students. Studies of development and management of such
institutions need to be done in order to develop bulk of knowl-
edge in this healthcare education. This would add on the
knowledge and experience from Temple College already re-
viewed in this study.
Conclusion
From the results and discussions in this study, it is clear that
proper application of appropriate educational strategies and
practices which promote students’ interests and positive learn-
ing experiences is done at the MLT. The application of flexible
strategies was central in the process of curriculum implementa-
tion and it positively influenced the teaching/learning process.
This study had shown that students not only enjoyed student-
centred approaches being used at the MLT, but also benefited a
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C. B. MUGIMU, W. R. MUGISHA
great deal in terms of gaining relevant clinical practical skills.
This is reflected by the high performance rates of students.
However, it remains to be a huge challenge for educators to
ensure that they apply appropriate educational practices. Edu-
cational institutions therefore need to put up professional de-
velopment programs for their educators, to equip them with
current emerging trends in educational practices especially in
the medical field. This may empower them with the needed
competencies to apply appropriate and current educational
practices in their work place.
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