A framework for a skills laboratory curriculum in an undergraduate medical programme in South Africa
Jansen van Vuuren, Martin Versfeld
English: The last decade has been characterised by profound worldwide changes in undergraduate medical education. These changes have included a new approach for training in clinical skills. The change has been brought about by a change in the disease profile of patients as well as the increase in medico-legal litigation against doctors in South Africa. The disease profile has changed, especially due to the big increase in AIDS related diseases, as well as illness among the aged. When students come into contact with patients, they should already have mastered certain skills, for example venesection in a secure and safe environment, such as a skills laboratory. The student should be skilled in this procedure of venesection, because in this way needle pricks with contaminated blood can - in the majority of cases - be prevented, as well as the concomitant morbidity and serious side effects of anti-retroviral drugs. The other example is that patients are more aware of their human and legal rights and that litigations against doctors are increasing. This makes it important that students become acquainted with intimate physical examinations in a skills laboratory. These are some of the reasons why skills laboratories were developed in medical schools. Presently all the medical schools in South Africa have developed their own skills curriculum. The aim of this study was to develop a framework for a skills curriculum which can be used as a guideline for the training of undergraduate medical students. This framework should be able to comply with the needs of South African circumstances, where doctors after their intern years very often have to work alone in remote hospitals and clinics. The Delphi technique was used to develop the curriculum framework. Initially a questionnaire with skills topics was compiled from the literature. This list was sent to heads of departments of the Medical School at the University of the Free State. They had to indicate which topics were important and also suggest additional topics for a skills laboratory. Subsequently seven experts who were closely involved in skills laboratories at different universities over South Africa were approached to participate in the research. The Delphi technique was then used to determine which skills topics were essential for a skills laboratory. The Delphi panel also had to make suggestions for additional topics. In this way a list of skills topics was developed which can serve as a framework for a skills curriculum. After three Delphi rounds, consensus (80% or more votes) was reached on 89,9% topics as essential. Only 4% of the topics were indicated as useful but not essential and on 6,1% of the topics no consensus was reached. The Delphi panel also indicated the ideal time frame in the curriculum for each topic, as well as the lecturer who should present the specific topic. The panel indicated 58% of the essential topics for the middle third of the curriculum, 10 % for the first third and 12,49% for the last third of the curriculum. The Delphi panel also indicated in 50,4% of topics the specialist from an appropriate discipline as the lecturer. In 34,9% of the topics the panel indicated the staff from the skills unit and in 14,7% no consensus was reached on who the lecturer should be. The outcome of this research makes a unique contribution to undergraduate medical training in South Africa. For the first time a framework for a skills laboratory curriculum is now available for local as well as national use.
Afrikaans: In die afgelope dekade is die voorgraadse geneeskundige onderrig gekarakteriseer deur ingrypende wêreldwye veranderinge. Hierdie veranderinge het ook ‘n nuwe benadering tot die opleiding in kliniese vaardighede ingesluit. Die verandering is meegebring deur die veranderde siekteprofiel van pasiënte, asook die toename in medies-geregtelike eise teen geneeshere in Suid Afrika. Die siekteprofiel onder andere het verander ten opsigte van die groot toename in MIV-verwante siektes asook siektes by bejaardes. Wanneer studente met pasiënte te doen kry, behoort hulle reeds sommige van die vaardighede, -byvoorbeeld die trek van bloed - in ’n veilige omgewing soos ’n laboratorium baas te geraak het. Deur vaardig hiermee te wees, kan voorkom word dat ’n student ’n naaldeprik met besmette bloed opdoen met die gepaardgaande morbiditeit en moontlike ernstige newe-effekte van anti-retrovirale middels. Die ander voorbeeld is die pasiënte wat meer bewus geword het van hul menseregte en van litigasie teen dokters. Dit het dit noodsaaklik gemaak dat studente reeds in ’n beskutte omgewing vertroue met intieme ondersoeke ontwikkel. Hierdie is van die redes waarom vaardigheidslaboratoria by mediese skole ontwikkel het. Tot dusver het elke skool sy eie vaardigheidskurrikulum ontwikkel. Die doel van hierdie navorsing was om ’n raamwerk vir ’n kurrikulum daar te stel wat as riglyn kan dien vir die opleiding van voorgraadse geneeskundestudente. Hierdie raamwerk behoort aan die vereistes van Suid-Afrikaanse omstandighede te voldoen; omstandighede waar geneeshere reeds na hul internjare alleen in afgeleë hospitale en klinieke moet werk. Die Delphimetode is gebruik om hierdie raamwerk saam te stel. Aanvanklik is ’n lys van vaardighede uit die literatuur opgestel. Daarna is hierdie lys voorgelê aan die hoofde van verskeie kliniese dissiplines aan die Skool van Geneeskunde van die Universiteit van die Vrystaat. Hulle moes die belang van die onderwerpe aandui en ook voorstelle maak vir addisionele onderwerpe. Vervolgens is sewe deskundiges genader wat nou betrokke was by voorgraadse geneeskundige opleiding in vaardigheidseenhede by verskillende universiteite dwarsoor die land om deel te neem aan die navorsing. Hulle moes deur middel van hierdie Delphimetode aandui welke onderwerpe belangrik vir ’n vaardigheidseenheid is. Hulle moes ook met voorstelle van nuwe onderwerpe kom. Met hierdie metode is ’n lys van vaardighede saamgestel wat kan dien as ’n raamwerk vir ’n vaardigheidskurrikulum. Na drie Delphirondtes was daar konsensus (80% of meer stemme) bereik vir 89,9% van vaardigheidsonderwerpe. Slegs 4% van die onderwerpe is as nuttig aangedui, maar nie essensieel nie en vir 6,1% van die onderwerpe is geen konsensus bereik nie. Die ideale tydperk of fase in die kurrikulum asook watter dosente die betrokke vaardighede moet aanbied, is ook deur die Delphitegniek aangedui. Die paneel het aangedui dat in 58,1% van die noodsaaklike onderwerpe in die middelste derde van die kurrikulum aangebied behoort te word, terwyl 10% vir die eerste derde en 12,49% vir die laaste derde geallokeer is. Die paneel het ook aangedui dat 50,4% van die onderwerpe deur ‘n spesialis van ‘n betrokke dissipline aangebied behoort te word, terwyl 34,9% van die onderwerpe deur die personeel van die vaardigheidseenheid aangebied kan word. By 14,7% van die onderwerpe is geen konsensus bereik oor wie die dosent behoort te wees nie. Die resultate van hierdie navorsing maak ‘n unieke bydrae tot voorgraadse geneeskundige onderrig in Suid Afrika. Vir die eerste keer is ‘n raamwerk vir ‘n vaardigheidslaboratorium kurrikulum nou beskikbaar vir plaaslike asook nasionale gebruik.
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