A Comparative Analysis of Perceptions of the Outcome-Based Approach and the Competence-Based Approach in Nursing Education in Mbandaka, DRC: An Analysis of the Determinants of Teacher Adherence

Abstract

Background: The Democratic Republic of the Congo has recently adopted the Bachelor’s-Master’s-Doctorate (LMD) system, requiring a pedagogical transition from the Objective-Based Approach (OBA) to the Competence-Based Approach (CBA). This transition faces severe structural constraints in peripheral medical training institutions.

Objective: To compare the perceived effectiveness of the OBA and the CBA for patient safety and to identify factors associated with staff adherence to the reform.

Methods: A cross-sectional analytical survey was conducted among 50 teachers (84% men, 62% lecturers) at ISTM-Mbandaka. A 4-point Likert scale questionnaire measured perceptions. Analyses included logistic and linear regression, hierarchical clustering (Ward) and correspondence analysis.

Results: 72% of respondents preferred APC for patient safety. LMD training increased the probability of adopting APC by a factor of 3.5 (OR=3.49; 95% CI [1.21–10.05]; p=0.02). The lack of laboratories (mean=3.44), overcrowded placements (mean=3.48) and unreliable internet connection (β=-0.31; p=0.019) are the main obstacles. Seniority exerts a negative moderating effect (β = −0.26; p = 0.049). An oppositional typology distinguishes a pro-APO cluster (untrained seniors) from a pro-APC cluster (trained young people).

Conclusion: Despite strong support in principle for the competency-based approach, infrastructure and digital deficits hinder its effective implementation. A strategic plan incorporating compulsory training, low-threshold laboratories and hybrid connectivity is recommended.

Keywords: Competency-based approach, medical training, patient safety, LMD, Mbandaka, digital divide.

Received Date: February 22, 2026

Accepted Date: March 14, 2026

Published Date: April 02, 2026

Available Online at: https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/660