A model for the academic development and implementation of a postgraduate diploma in Transfusion Medicine in the Shool of Medicine at the University of the Free State

Abstract

English: In this research, an in-depth study was done to construct a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine in the School of Medicine at the University of the Free State. Transfusion medicine as a discipline has experienced major advances over the past few decades with an emphasis on increased blood safety and the improvement of systems, technology and administrative processes. Unfortunately, attention has largely been focused on laboratory aspects and clinical transfusion medicine has lagged behind. This has resulted in the present situation where clinical transfusion medicine has become totally underrepresented in medical curricula, despite the fact that many doctors are involved in administering blood and blood products. This has led to a number of studies and publications on the increasing rate of preventable transfusionassociated deaths resulting from errors on the part of medical personnel. Many researchers have made the link between these errors and the inadequate education and training received by doctors in respect of transfusion medicine. This begs the question as to how this gap in the knowledge market can adequately be bridged and further what a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine should look like. Against this background, the problem that was addressed in this study was the absence of such a model. As far as the researcher could ascertain, no such model existed prior to his embarking upon this research. The goal of the research was thus to develop a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine – specific to the South African context – with a view to contributing to safer and more cost-effective transfusion practice by clinicians. A further aim of the study was to develop this model specifically in the School of Medicine at the University of the Free State. Both qualitative and semi-quantitative research methods were employed and used in a complementary fashion. The methods used included a study of the literature, semi-structured questionnaires and a Delphi survey. The literature review provided insights into the current status of education in transfusion medicine with special reference to the changing arena of transfusion practice. Also, a perspective was provided on some of the key issues that should be taken into account during the development and implementation of a model for a Postgraduate Diploma in Transfusion Medicine. Semi-structured interviews were conducted with experts in transfusion medicine from all over the world. Open-ended questions were asked, which allowed for an interactive discussion between the researcher and the interviewees. Prior to the interviews, a letter of request and explanation was provided to the participants and formal, informed consent obtained. The purpose was to collect information on a number of issues related to clinical transfusion medicine practice. As well as wanting to determine the nature of the challenges with which clinicians are faced, the researcher set out to delineate their scope of practice. Questions dealt with the roles, tasks, functions, skills, deficiencies, areas of clinical knowledge and competences practised by doctors involved in transfusion medicine. An attempt was furthermore made to determine not only the relevant outcomes of a Postgraduate Diploma in Transfusion Medicine but also the relevant academic, educational and sustainability factors. The results of the semi-structured interviews were analysed and collated in tables. These, combined with the findings from the literature review, formed the basis of the statements used in compiling the Delphi survey. The Delphi survey was used to test the criteria derived from both the literature review and the semi-structured interviews qualitatively and semiquantitatively. The Delphi questionnaire was provided to South African doctors with appropriate experience in transfusion medicine and medical education subsequent to their receiving an information letter and giving informed consent. The Delphi questionnaire was divided into sections corresponding to the main themes in the semi-structured interviews. After analysis by the researcher, the findings of the Delphi survey were presented in the form of a description of the findings, a discussion and recommendations. Aspects discussed in the model comprised the premises for the development of the model, the points of departure, the key internal and external role players who could potentially influence the model and the different elements that should be included and/or addressed in the model. Perspectives were provided on the model and its implementation, including some thoughts on procedural, policy and management issues. The researcher proposed that, before anything else, a situational analysis had to be done to identify the needs, deficiencies and challenges related to transfusion medicine practice and education. This needed to be done in consultation with all the relevant role players. Subsequently, the educational, academic and sustainability factors relevant to the programme had to be identified. Careful planning was required within the context of a qualified and motivated team. Once the structure, programme content, timeframe, target audience and funding streams had been identified, and the appropriate approvals for the programme obtained, the programme would have to be marketed. Cooperation and networking with all role players through continuous dialogue would allow for the linkage of resources and lay the foundation for long-term collaborative relationships. Finally, continuous feedback from role players, including students would be required to determine whether goals had been achieved and if not, to use this as the basis for continuous improvement. In that the stated problem was addressed and the goal and objectives of the research were met, this study makes a unique contribution to transfusionmedicine education by providing a model for the academic development and implementation of a Postgraduate Diploma in Transfusion Medicine. Final conclusions were drawn and the limitations and recommendations of the study were highlighted. It is hoped that this study will make a contribution to the better education of clinicians in the clinical aspects of transfusion medicine and that this will, in turn, translate into patients’ receiving better and safer transfusions.

Afrikaans: In hierdie navorsing is ʼn diepgaande studie gedoen om ʼn model daar te stel vir die akademiese ontwikkeling en implementering van ʼn nagraadse diploma in transfusiegeneeskunde aan die Universiteit van die Vrystaat. Die terrein van transfusiegeneeskunde het in die laaste aantal dekades groot veranderinge ondergaan met die klem op toenemende veiligheid van bloed, asook die verbetering van stelsels, tegnologie en administratiewe prosesse. Ongelukkig is die aandag grotendeels toegespits op laboratoriumaspekte van transfusiegeneeskunde en het kliniese transfusiegeneeskunde tot ʼn groot mate agterweë gebly. Die gevolg hiervan is die situasie waarin ons ons tans bevind, naamlik dié van ʼn dissipline gekenmerk deur swak verteenwoordiging in mediese kurrikula, ten spyte daarvan dat die meeste dokters bloed en bloedprodukte toedien as deel van hul daaglikse praktykvoering. Dit het gelei tot ʼn verskeidenheid studies en publikasies wat wys op die toenemende aantal voorkombare transfusieverwante sterftes as gevolg van foute deur mediese personeel. Verskillende navorsers het die verband tussen hierdie foute en ontoereikende opleiding in transfusiegeneeskunde kon aantoon. Die vraag wat dus ontstaan het, was hoe hierdie leemte in die kennismark voldoende oorbrug kan word en hoe ʼn model vir die akademiese ontwikkeling en implementering van ʼn nagraadse diploma in transfusiegeneeskunde daar moet uitsien. Teen hierdie agtergrond, is die probleem van die afwesigheid van so ʼn model in hierdie studie aangespreek. So ver as die navorser kon vasstel, was daar ten tyde van die aanvang van die navorsing, geen sodanige model beskikbaar nie. Die doelstelling van die navorsing was dus die ontwikkeling van ʼn model vir die akademiese ontwikkeling en implementering van ʼn nagraadse diploma in transfusiegeneeskunde, spesifiek toegespits op die Suid-Afrikaanse omgewing, ten einde ʼn bydrae te maak tot veiliger en meer koste-effektiewe bloedoortappingspraktyk deur mediese dokters. Die doel was dan ook om die model spesifiek binne die Skool van Geneeskunde aan die Universiteit van die Vrystaat te ontwikkel. Die navorsingsmetodiek het uit sowel kwalitatiewe as semi-kwantitatiewe elemente bestaan wat komplementêr tot mekaar gebruik is. Dit het ʼn literatuuroorsig, semi-gestruktureerde onderhoude en ʼn Delphi-oorsig en - vraelys ingesluit. Die literatuuroorsig het ʼn dieper insig gebied in die huidige stand van sake rakende onderwys in transfusiegeneeskunde met besondere aandag aan die veranderende omgewing van transfusiepraktykvoering. In die lig van die bevindinge uit die literatuur, het die navorser ʼn perspektief probeer gee op die sleutelkwessies van belang by die ontwikkeling van ʼn model vir die ontwikkeling en implementering van ʼn nagraadse diploma in transfusiegeneeskunde. Semi-gestruktureerde onderhoude is gevoer met deskundiges in transfusiegeneeskunde van oor die hele wêreld. Oop-einde vrae is gebruik wat ʼn interaktiewe bespreking tussen navorser en deelnemer tot gevolg gehad het. Vooraf is ʼn brief ter inligting en verduideliking aan die deelnemers verskaf en formele, ingeligte toestemming verkry. Die doel van die semi-gestruktureerde onderhoude was om inligting te versamel betreffende ʼn aantal aspekte van die praktyk van kliniese transfusiegeneeskunde. Hiermee is gepoog om vas te stel wat die uitdagings is waarmee mediese dokters te kampe het en wat die omvang van hul praktykvoering is. Vrae het gehandel oor die rolle, funksies, vaardighede, gebreke, areas van kliniese kennis en bevoegdhede van mediese dokters wat kliniese transfusiegeneeskunde praktiseer. ʼn Poging is ook aangewend om die relevante uitkomste en die akademiese, onderwyskundige en volhoubaarheidsaspekte van ʼn nagraadse diploma in transfusiegeneeskunde te bepaal. Die bevindinge van die semi-gestruktureerde onderhoude is ontleed en in tabelvorm opgesom. Hierdie bevindinge, tesame met die literatuuroorsig, het die grondslag vir die Delphi-oorsig gevorm. Die Delphi-oorsig is gebruik as ʼn kwalitatiewe en semi-kwantitatiewe toets vir die kriteria voorstpruitend uit die ontleding van die literatuuroorsig en die onderhoude. Die Delphi-vraelys is aan Suid-Afrikaanse dokters met toepaslike ondervinding in transfusiegeneeskunde en mediese onderwys voorsien nadat hulle ʼn inligtingsbrief ontvang en ingeligte toestemming gegee het. Die Delphi-vraelys is in afdelings onderverdeel in ooreenstemming met die hooftemas van die semi-gestruktureerde onderhoude. Die bevindinge van die Delphi-oorsig is ontleed, gevolg deurʼn beskrywing van die bevindinge, ʼn bespreking en toepaslike aanbevelings. Aspekte wat met betrekking tot die model bespreek is, het die basiese voorveronderstellings vir die ontwikkeling van die model, die vertrekpunte, die sleutel interne en eksterne rolspelers wat die model kan beïnvloed, asook die onderskeie elemente wat ingesluit behoort te word, omvat. Benewens ʼn perspektief op die model en sy implementering, is oor aspekte rakende prosedures, beleid en bestuur besin. As eerste stap het die navorser voorgestel dat ʼn situasie-ontleding gedoen word om die behoeftes, gebreke en uitdagings rakende transfusiegeneeskundepraktyk en -onderwys te identifiseer – uiteraard in oorleg met al die relevante rolspelers. Hierna behoort die onderwyskundige, akademiese en volhoubaarheidsaspekte relevant tot die program bepaal te word. Omsigtige beplanning behoort binne die konteks van ʼn toepaslik gekwalifiseerde en gemotiveerde span gedoen te word. Sodra die struktuur, programinhoud, tydsraamwerk, teikengehoor en bronne vir befondsing geïdentifiseer is en die toepaslike goedkeuring vir die program verkry is, moet die program bemark word. Samewerking en deurlopende gespreksvoering met alle rolspelers is van die grootste belang om beskikbare hulpbronne saam te snoer en sodoende die grondslag te lê vir suksesvolle langtermyn samewerking. Laastens behoort deurlopende terugvoer vanaf rolspelers, insluitend studente, verkry te word om te bepaal of doelwitte behaal is al dan nie. Dit kan ook help om die program oor tyd te verbeter. Deurdat die gestelde probleem aangespreek en die oorhoofse doelstelling en doelwitte van die studie bereik is, maak hierdie studie ʼn unieke bydrae tot transfusiegeneeskunde-onderwys by wyse van ʼn model vir die akademiese ontwikkeling en implementering van ʼn nagraadse diploma in transfusiegeneeskunde. Finale gevolgtrekkings is gemaak, die beperkinge van die studie is uitgelig en aanbevelings is gemaak. Die navorser koester die hoop dat hierdie studie ʼn daadwerklike bydrae sal maak tot beter onderrig van mediese dokters, veral met betrekking tot die kliniese aspekte van transfusiegeneeskunde en dat dit uitdrukking sal vind in beter en veiliger bloedoortappings vir pasiënte.