Conradie N J, Vincent-Lambert C, Stassen W
Division of Emergency Medicine, University of Cape Town, South Africa.
Department of Emergency Medical Care, University of Johannesburg, South Africa.
South Afr J Crit Care. 2022 May 6;38(1). doi: 10.7196/SAJCC.2022.v38i1.498. eCollection 2022.
Critical care transport (CCT) involves the movement of critically ill patients between healthcare facilities. South Africa (SA), like other low- to middle-income countries, has a relative shortage of ICU beds, making CCT an inevitability. In SA, CCTs are mostly done by emergency care practitioners; however, it is unclear how universities offering Bachelor in Emergency Medical Care (BEMC) courses approach their teaching in critical care and whether the content taught is consistent between institutions. In our study we formally evaluate and compare the intensive and critical care transport modules offered at SA universities in their BEMC programmes.
The electronic version of curricula of the critical care transport modules from higher education institutes in SA offering the BEMC were subjected to document analysis. Qualitative (inductive content analysis) and quantitative (descriptive analysis) methods were used to describe and compare the different components of the curriculum. Curricula were assigned into components and sub-components according to accepted definitions of curricula. The components included: aims, goals, composition and objectives of the course; content or teaching material and work-integrated learning.
The four universities that offer BEMC programmes were invited to participate, and three (75%) consented and provided data. The duration of the modules ranged from 6 to 12 months, corresponding with notional hours of 120 - 150. A total of 83 learning domains were generated from the coding process. These domains included content on mechanical ventilation, patient monitoring, arterial blood gases, infusions and fluid balance, and patient preparation and transfer. Two universities had identical structures and learning outcomes, while one had a different structure and outcomes; it corresponded with a 58% similarity. Clinical placements were in critical and emergency care units, operating theatres and prehospital clinical services.
In all components compared, the universities offering BEMC were more similar than they were different. It is unclear whether the components taught are relevant to the SA patient population and healthcare system context, or whether students are adequately prepared for clinical practice. Postgraduate educational programmes might need to be developed to equip emergency care practitioners to function in this environment safely.
Owing to the limited availability of ICU beds in South Africa, optimising and standardising critical care transport is an important consideration. This study identifies important elements for improving emergency medical care training in South Africa, as well as areas needing further research.
重症监护转运（CCT）涉及危重症患者在医疗机构之间的转运。与其他低收入和中等收入国家一样，南非（SA）的重症监护病房床位相对短缺，这使得重症监护转运成为必然。在南非，重症监护转运大多由急救从业者完成；然而，目前尚不清楚提供急诊医疗护理学士学位（BEMC）课程的大学在重症监护教学方面采用何种方式，以及各机构所教授的内容是否一致。在我们的研究中，我们正式评估并比较了南非各大学在其BEMC课程中提供的重症和危重症监护转运模块。
对南非提供BEMC课程的高等教育机构的重症监护转运模块课程电子版进行文献分析。采用定性（归纳性内容分析）和定量（描述性分析）方法来描述和比较课程的不同组成部分。根据公认的课程定义，将课程分为组成部分和子组成部分。这些组成部分包括：课程的目的、目标、构成和宗旨；内容或教材以及实践学习。
邀请了四所提供BEMC课程的大学参与，其中三所（75%）同意并提供了数据。这些模块的时长从6个月到12个月不等，相应的理论学时为120 - 150小时。编码过程共产生了83个学习领域。这些领域包括机械通气、患者监测、动脉血气、输液与液体平衡以及患者准备与转运等内容。两所大学的结构和学习成果相同，而另一所大学的结构和成果不同；相似率为58%。临床实习安排在重症和急诊护理单元、手术室以及院前临床服务部门。
在所有比较的组成部分中，提供BEMC课程的大学之间的相似之处多于不同之处。目前尚不清楚所教授的内容是否与南非患者群体和医疗系统背景相关，也不清楚学生是否为临床实践做好了充分准备。可能需要制定研究生教育计划，以使急救从业者能够在这种环境中安全地履行职责。
由于南非重症监护病房床位有限，优化和规范重症监护转运是一个重要的考虑因素。本研究确定了改善南非急诊医疗护理培训的重要因素以及需要进一步研究的领域。
