Alayande Barnabas T, Forbes Callum W, Iradakunda Jules, Majyambere Jean Paul, Hey Matthew T, Powell Brittany L, Perl Juliana, McCall Natalie, Paul Tomlin, Ingabire Jc Allen, Shimelash Natnael, Mutabazi Emmanuel, Kimto Emmanuel O, Danladi Gambo Musa, Tubasiime Ronald, Rickard Jennifer, Karekezi Claire, Makiriro Gabriel, Bigirimana Simon Pierre, Harelimana James G, ElSayed Ahmed, Ndibanje Alain Jules, Mpirimbanyi Christophe, Masimbi Ornella, Ndayishimiye Mick, Ntabana Frederick, Haonga Billy Thomson, Anderson Geoffrey A, Byringyiro Jean Claude, Ntirenganya Faustin, Riviello Robert R, Bekele Abebe
General Surgery, Center for Equity in Global Surgery, University of Global Health Equity, Kigali, RWA.
Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA.
Cureus. 2023 Aug 17;15(8):e43625. doi: 10.7759/cureus.43625. eCollection 2023 Aug.
Background Developing a contextually appropriate curriculum is critical to train physicians who can address surgical challenges in sub-Saharan Africa. An innovative modified Delphi process was used to identify contextually optimized curricular content to meet sub-Saharan Africa and Rwanda's surgical needs. Methods Participants were surgeons from East, Central, Southern, and West Africa and general practitioners with surgical experience. Delphi participants excluded or prioritized surgical topic areas generated from extensive grey and formal literature review. Surgical educators first screened and condensed identified topics. Round 1 screened and prioritized identified topics, with a 75% consensus cut-off based on the content validity index and a prioritization score. Topics that reached consensus were screened again in round 2 and re-prioritized, following controlled feedback. Frequencies for aggregate prioritization scores, experts in agreement, item-level content validity index, universal agreement and scale-level content validity index based on the average method (S-CVI/Ave) using proportion relevance, and intra-class correlation (ICC) (based on a mean-rating, consistency, two-way mixed-effects model) were performed. We also used arithmetic mean values and modal frequency. Cronbach's Alpha was also calculated to ascertain reliability. Results were validated through a multi-institution consensus conference attended by Rwanda-based surgical specialists, general practitioners, medical students, surgical educators, and surgical association representatives using an inclusive, participatory, collaborative, agreement-seeking, and cooperative, consensus decision-making model. Results Two-hundred and sixty-seven broad surgical content areas were identified through the initial round and presented to experts. In round 2, a total of 247 (92%) content areas reached 75% consensus among 31 experts. Topics that did not achieve consensus consisted broadly of small intestinal malignancies, rare hepatobiliary pathologies, and transplantation. In the final round, 99.6% of content areas reached 75% consensus among 31 experts. The highest prioritization was on wound healing, fluid and electrolyte management, and appendicitis, followed by metabolic response, infection, preoperative preparation, antibiotics, small bowel obstruction and perforation, breast infection, acute urinary retention, testicular torsion, hemorrhoids, and surgical ethics. Overall, the consistency and average agreement between panel experts was strong. ICC was 0.856 (95% CI: 0.83-0.87). Cronbach's Alpha for round 2 was very strong (0.985, 95% CI: 0.976-0.991) and higher than round 1, demonstrating strong reliability. All 246 topics from round 4 were verbally accepted by 40 participants in open forum discussions during the consensus conference. Conclusions A modified Delphi process and consensus were able to identify essential topics to be included within a highly contextualized, locally driven surgical clerkship curriculum delivered in rural Rwanda. Other contexts can use similar processes to develop relevant curricula.
背景 制定符合当地实际情况的课程对于培养能够应对撒哈拉以南非洲地区外科挑战的医生至关重要。采用了一种创新的改良德尔菲法来确定符合当地实际情况的优化课程内容，以满足撒哈拉以南非洲地区和卢旺达的外科需求。方法 参与者包括来自东非、中非、南非和西非的外科医生以及有外科经验的全科医生。德尔菲法参与者对通过广泛的灰色文献和正式文献综述产生的外科主题领域进行排除或排序。外科教育工作者首先对确定的主题进行筛选和浓缩。第一轮对确定的主题进行筛选和排序，基于内容效度指数和排序分数设定75%的共识阈值。达成共识的主题在第二轮中再次进行筛选并重新排序，之后进行有控制的反馈。基于比例相关性的平均法（S-CVI/Ave）计算了总体排序分数的频率、达成一致的专家人数、项目级内容效度指数、普遍一致性以及量表级内容效度指数，并计算了组内相关系数（ICC）（基于平均评分、一致性、双向混合效应模型）。我们还使用了算术平均值和众数频率。还计算了克朗巴哈系数以确定可靠性。通过由卢旺达的外科专家、全科医生、医学生、外科教育工作者和外科协会代表参加的多机构共识会议，采用包容性、参与性、协作性、寻求共识性和合作性的共识决策模型对结果进行了验证。结果 通过第一轮确定了267个广泛的外科内容领域并提交给专家。在第二轮中，31位专家中有247个（92%）内容领域达成了75%的共识。未达成共识的主题大致包括小肠恶性肿瘤、罕见的肝胆疾病和移植。在最后一轮中，31位专家中有99.6%的内容领域达成了75%的共识。优先级最高的是伤口愈合、液体和电解质管理以及阑尾炎，其次是代谢反应、感染、术前准备、抗生素、小肠梗阻和穿孔、乳腺感染、急性尿潴留、睾丸扭转、痔疮和外科伦理。总体而言，专家小组之间的一致性和平均一致性很强。ICC为0.856（95%置信区间：0.83 - 0.87）。第二轮的克朗巴哈系数非常高（0.985，95%置信区间：0.976 - 0.991），高于第一轮，表明可靠性很强。在共识会议的公开论坛讨论中，40名参与者口头接受了第四轮中的所有246个主题。结论 改良的德尔菲法和共识能够确定在卢旺达农村地区实施的高度本地化、由当地驱动的外科实习课程中应包含的基本主题。其他情况可以使用类似的方法来制定相关课程。
