Learning Design, Learner Engagement and Clinical Skills Acquisition of Students at Kenya Medical Training College Campuses’ in Rift Valley, Kenya

Abstract

Clinical skills acquisition (CSA) is fundamental to effective patient care. However, many low-and middle-income countries, including Kenya, face persistent gaps in clinical competencies among healthcare workers. Blended learning (BL), integrating in-person and e-learning modalities, has the potential to enhance learner engagement (LE) and improve CSA. Despite this, limited empirical evidence exists on how learning design (LD) and LE interact to influence CSA, particularly in sub-Saharan Africa. This study assessed the effect of learning design on CSA among students at Kenya Medical Training College (KMTC) campuses in the Rift Valley and determined the mediating role of LE in this relationship. A cross-sectional design with a retrospective cohort component was employed. The study was conducted across nine KMTC campuses in the Rift Valley, offering both nursing and clinical medicine programmes. The target population comprised 5,519 students and 9 heads of departments. A sample of 373 students was selected using stratified random sampling, alongside 9 heads of departments selected purposively. Data were collected using structured questionnaires, key informant interviews, and observation checklists. Quantitative data were analysed using multiple linear regression and mediation analysis (PROCESS Macro Model 5) in SPSS-v26 and Stata-v14, with bootstrapped confidence intervals used to assess indirect effects. Both in-person learning [b=0.26, 95% CI (0.12–0.39), p<0.001] and e-learning [b=0.20, 95% CI (0.03–0.38), p=0.024] significantly predicted CSA. No significant interaction effect was observed, indicating additive contributions. LE partially mediated the relationship between LD and CSA [indirect effect b=0.300, 95% CI (0.163–0.472)], with a unit increase in LD indirectly influencing CSA by 9%. A dual LD combining experiential in-person training and e-learning enhances LE and improves CSA. Health training institutions should prioritise integrated instructional designs that actively foster learner engagement and develop curricula that contain well-aligned in-person and e-learning modules to optimize clinical competency development