Forbes Callum, Nzobele Bruce Mutembe, Alayande Barnabas T, Nizeyimana Françoise, Mvukiyehe Jean Paul, Booth Jocelyn M, Woldegiorgis Selam Degu, Pierre Benoucheca, Littlejohn James, Tabaie Sheida, Bekele Abebe, McClain Craig D, Nyirigira Gaston
Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda.
Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
BMC Med Educ. 2025 Apr 7;25(1):489. doi: 10.1186/s12909-025-07046-5.
Low anaesthesia workforce numbers contribute to shortfalls in access to surgical care globally. Investment in contextualised education and training can help address this issue by inspiring graduates to enter into training and imparting important knowledge and skills to non-specialists. We undertook a modified Delphi study to identify physician anaesthesiologist consensus on themes, topics, and skills for inclusion in undergraduate anaesthesia and critical care (ACC) medical school curricula in sub-Saharan Africa (SSA) and Rwanda.
A list of ACC topics/skills was compiled through grey literature review, guiding survey development for a 3-round Delphi process. The first two rounds solicited responses from physician anaesthesiologists across SSA. The final round included only Rwandan physician anaesthesiologists. Respondents rated topics/skills on a 4-point Likert scale from 1 ("exclude from the curriculum") through 4 ("essential for inclusion"). Item-level Content Validity Index (I-CVI, the proportion of respondents rating a topic/skill as 3 or 4) was used for stratification. A first-round I-CVI threshold of 80% and 70% for subsequent rounds was used to define consensus for inclusion. Excluded topics/skills were considered for re-inclusion in subsequent rounds; 50% agreement was set as threshold for re-inclusion. The first round also sought consensus regarding aims, objectives, and delivery methodology.
A total of 147 topics/skills across 12 domains were identified for initial survey inclusion. Fifty-one respondents from 12 countries completed round one. Ninety-six (65.3%) topics/skills met consensus threshold. One additional skill ("pain assessment") was incorporated into round two following suggestions from respondents. The clerkship outcome ranked as most important and achievable was to 'inspire students to undertake anaesthesia specialty training' (n = 25, 49.0% and n = 26, 51.0% respectively). Thirty-six respondents from 12 countries completed round two. Eighty (82.5%) topics/skills met consensus threshold. Seventeen Rwandan specialists completed round three. Seventy-eight (97.5%) topics/skills met consensus threshold. From 67 previously excluded topics/skills, 14 (20.9%) met re-inclusion threshold.
A modified Delphi process identified 92 essential topics/skills for inclusion in a Rwandan undergraduate ACC clerkship. Experts prioritised 'inspiring students' over 'achieving clinical competence' for undergraduates. A similar Delphi approach may be useful for educational content development in other settings across the African continent and for other specialties.
Not applicable (study described is not a clinical trial). UGHE IRB protocol number: 194.
麻醉专业人员数量不足导致全球外科护理的可及性出现短缺。投资于情境化教育和培训有助于解决这一问题，激励毕业生参加培训，并向非专科医生传授重要知识和技能。我们开展了一项改良德尔菲研究，以确定撒哈拉以南非洲（SSA）和卢旺达的内科麻醉医生对于本科麻醉与重症监护（ACC）医学院课程中应包含的主题、课题和技能的共识。
通过灰色文献综述编制了一份ACC课题/技能清单，为三轮德尔菲流程的调查制定指南。前两轮征求了SSA各地内科麻醉医生的意见。最后一轮仅包括卢旺达的内科麻醉医生。受访者根据4级李克特量表对课题/技能进行评分，从1分（“从课程中排除”）到4分（“必须纳入”）。项目层面的内容效度指数（I-CVI，将一个课题/技能评为3分或4分的受访者比例）用于分层。首轮I-CVI阈值设定为80%，后续轮次设定为70%，以确定纳入的共识。被排除的课题/技能在后续轮次中会被考虑重新纳入；重新纳入的阈值设定为50%的同意率。第一轮还就目标、目的和授课方法征求了共识。
初步调查纳入了12个领域的总共147个课题/技能。来自12个国家的51名受访者完成了第一轮。96个（65.3%）课题/技能达到了共识阈值。根据受访者的建议，一项额外技能（“疼痛评估”）被纳入第二轮。被认为最重要且可实现的见习成果是“激励学生参加麻醉专科培训”（分别为n = 25，49.0%和n = 26，51.0%）。来自12个国家的36名受访者完成了第二轮。80个（82.5%）课题/技能达到了共识阈值。17名卢旺达专家完成了第三轮。七十八个（97.5%）课题/技能达到了共识阈值。在67个先前被排除的课题/技能中，14个（20.9%）达到了重新纳入阈值。
改良德尔菲流程确定了92个纳入卢旺达本科ACC见习课程的核心课题/技能。专家们将本科生的“激励学生”置于“实现临床能力”之上。类似的德尔菲方法可能对非洲大陆其他地区的教育内容开发以及其他专业有用。
不适用（所描述的研究不是临床试验）。UGHE IRB协议编号：194。
