A framework for a skills laboratory curriculum in an undergraduate medical programme in South Africa

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.