A framework for integrated emergency care education in South African undergraduate medical programmes
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Date
2021-02
Authors
Hagemeister, Dirk Thomas
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Competence to manage emergencies is expected from medical practitioners and should be acquired during undergraduate medical training. Since the causes of emergencies can originate from many different systems, both physiological and psychological, a variety of clinical specialities is involved in the teaching of the diagnosis and treatment of emergencies. Bringing various different people and approaches together in undergraduate medical education constitutes a challenge. The lack of an integrated approach to undergraduate medical education in emergency care was identified as a relevant gap worth investigating in this PhD project. This study was undertaken with the aim to provide a framework for the integration of undergraduate medical education in emergency care with the intention to contribute to the steady improvement of undergraduate medical education and, through this, ultimately, to better health outcomes. Specific objectives of the research included the identification of international and national trends in the field and of current education practices at the medical schools in South Africa, including outcomes, objectives, education strategies and ways of assessment. A constructivist approach was followed in the sense that the mostly qualitative insights from the different methods are regarded as contributions towards a larger overall framework, but without the epistemological claim to discover an ultimate truth behind the subjective facts. As methods, an extensive review of published literature on emergency care training and of the regulatory environment for undergraduate medical training provided an international background of recent developments and a local context for South Africa. Semistructured in-depth interviews were held with key people in the established undergraduate medical programmes in South Africa and this promoted a multi-facetted insight into current education practices in the country, into challenges and successes. A three-staged nominal group technique was applied as the second empirical method, to evaluate the current education practice in the undergraduate medical programme at the University of the Free State and to identify needs and make suggestions for improvements. This process collected prioritised statements on strengths and weaknesses from recent graduates and, informed by these contributions by members, prioritised suggestions by the members of the education team, which were then discussed with academic programme managers. Results of the methods are presented as five publishable manuscripts, with one manuscript each reporting the findings from a rapid review of the international and national regulatory environment, one on a scoping review of peer-reviewed publications on undergraduate medical education in emergency care over the last decade, one on in-depth interviews conducted at South African medical schools and the nominal group technique at the University of the Free State, with the fifth manuscript suggesting a framework for the training. Key findings from the regulatory review show that many international bodies explicitly include emergency competencies in their exit outcome objectives, and that the latest trend is towards expressing those objectives in entrustable professional activities. This trend was confirmed in the literature review, which also found that there is, internationally, a growing role being played by emergency medicine, that training is increasingly based on online resources and simulation, and that experiential training typically happens in emergency rooms. The routine standard use of ultrasound in emergency care and the broad integration of ultrasound teaching in undergraduate training was equally significant. The in-depth interviews provided information on an array of issues, with different medical schools sharing the challenges of integrating emergency skills training across modules, reviewing the outcome objectives for curricular renewal, and trying to map such objectives effectively. Increasing student load against a constrained staff basis, complicated further by joint appointment status, interprofessional teaching and the role of emergency medicine, were found to be relevant. From the nominal group technique conducted at the University of the Free State, the importance of short courses in skills training, the need for integrated and well managed coverage of emergency care, for more in-situ clinical experiential learning opportunities, and for appropriate staff development in the field of health professions education, was re-emphasised. The proposed framework illustrates the complex interaction between the key factors of high-quality clinical practice, best current educational practice, and the institutional culture, with each of the three factors dependent on additional factors. In conclusion, the researcher recommends further research to formulate a national set of entrustable professional activities and enabling competencies, and to achieve a comparative mapping of outcome objectives between different medical schools.
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Keywords
Thesis (Ph.D. HPE (Health Professions Education))--University of the Free State, 2021, In-depth interviews, Nominal group technique, Emergency care - South Africa, Undergraduate medical education - South Africa, Integrated medical education, Emergency competencies