Abstract
Background
Trained health-care personnel are essential for improved outcomes for injured and critically ill patients. The highest injury-related mortality is seen in sub-Saharan Africa, where there is a paucity of skilled personnel. Therefore, the College of Surgeons of East, Central, and Southern Africa (COSECSA) along with Emory University provided an acute trauma care (ATC) and fundamental critical care support course (FCCS). This study evaluates the impact of American-derived courses on the knowledge and confidence of participants from resource-limited countries.
Methods
Courses were held in Lusaka, Zambia, and Nakuru, Kenya. Participants were COSECSA trainees and personnel from local institutions. The evaluation used a pre-/postcourse multiple-choice exam for knowledge acquisition and a pre-/postcourse questionnaire for confidence assessment. Confidence was measured using a 5-point Likert score, with 5 being the highest level of confidence. Confidence or self-reported efficacy is correlated with increased performance of new skills.
Results
There were 75 participants (median age = 31 years, 67% male). Three-quarters of the participants reported no prior specific training in either trauma or critical care. Knowledge increased from an average of 51 to 63.3% (p = 0.002) overall, with a 21.7% gain for those who scored in the lowest quartile. Confidence increased from pre- to postcourse on all measures tested: 22 clinical situations (10 trauma, 9 critical care, 3 either) and 15 procedures (p < 0.001 for all measures both individually and aggregated, Wilcoxon rank sum test). The strongest absolute increase in confidence, as well as the largest number of participants who reported any increase, were all in the procedures of cricothyroidotomy [median: pre = 3 (IQR: 2-3) to post = 5 (IQR: 4-5)], DPL [median: pre = 3 (IQR: 2-4) to post = 5 (IQR: 4-5)], and needle decompression [median: pre = 3 (IQR: 3-4) to post = 5 (IQR: 5-5)].
Conclusions
Participants from resource-limited countries benefit from ATC/FCCS courses as demonstrated by increased knowledge and confidence across all topics presented. However, the strongest increase in confidence was in performing life-saving procedures. Therefore, future courses should emphasize essential procedures, reduce didactics, and link knowledge acquisition to skill-based teaching.
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Acknowledgments
The Society of Critical Care Medicine through their Critical Care Education and Research Foundation (CCERF) provided the instructors’ material for the course content, the textbooks, and the shipping for the critical care component of the curriculum of these courses. The authors thank Dr. Christine Keyes from the Department of Emergency Medicine, Emory University, who assisted substantially with course implementation, served as one of the course faculty, and assisted with data collection. This work was supported in part by a Critical Care Education and Research Foundation Grant from the Society of Critical Care Medicine.
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MacLeod, J.B.A., Okech, M., Labib, M. et al. Evaluation of Trauma and Critical Care Training Courses on the Knowledge and Confidence of Participants in Kenya and Zambia. World J Surg 35, 9–16 (2011). https://doi.org/10.1007/s00268-010-0810-z
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DOI: https://doi.org/10.1007/s00268-010-0810-z