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.
BACKGROUND: Trained health-care personnel are essential for improved outcomes for injured and critically illpatients. 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.
Authors: Kathryn M Tchorz; Naveen Thomas; Sujatha Jesudassan; Ramegh Kumar; R Chinnadurai; Asha Thomas; Rosemarie I Tchorz; Prabhkara Murthy Chaturvedula; Jennifer K Parks; Rebekah A Naylor Journal: J Surg Res Date: 2007-05-09 Impact factor: 2.192
Authors: Simon Bergman; Dan Deckelbaum; Ronald Lett; Barbara Haas; Sebastian Demyttenaere; Victoria Munthali; Naboth Mbembati; Lawrence Museru; Tarek Razek Journal: J Trauma Date: 2008-10
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Authors: D Hopkinson; K Akuamoah-Boateng; P Banguti; J P Mvukiyehe; C Zerfoss; T Eng; E Tuyishime; K Hertel; D Starling; A Bethea; B Moses; A Syed Journal: South Afr J Crit Care Date: 2022-05-06
Authors: Lauren K Whiteside; Rockefeller Oteng; Patrick Carter; John Amuasi; Ekua Abban; Sarah Rominski; Michelle Nypaver; Rebecca M Cunningham Journal: Int J Emerg Med Date: 2012-09-26
Authors: Louisdon Pierre; Adebayo Adeyinka; Marilyn Kioko; Jose F Hernandez Rivera; Rohit Pinto Journal: J Int Med Res Date: 2018-08-01 Impact factor: 1.671
Authors: Grace Wanjiku; Hannah Janeway; John Foggle; Robert Partridge; Yvonne Wang; Alexis Kearney; Adam C Levine; Jane Carter; John S Tabu Journal: Afr J Emerg Med Date: 2017-05-25