E. D. Johnson2, K. A. Hill1, M. Lutomia4, K. K. Lee1, J. A. Puyana1, J. MacLeod1,3 1University Of Pittsburgh,Surgery,Pittsburgh, PA, USA 2University Of Pittsburgh,School Of Medicine,Pittsburgh, PA, USA 3Egerton University,Surgery,Nakuru, KENYA, Kenya 4Egerton University,Orthopedic Surgery,Nakuru, KENYA, Kenya
Introduction: Trauma is a leading cause of death worldwide and > 90% of injury-related deaths occur in low-and-middle-income countries (LMICs), including Kenya. Trauma skills courses have been modified for low-resource environments in sub-Saharan Africa. Outcomes include knowledge and skills acquisition, as well as improved patient mortality. These courses have primarily been administered to surgeons, surgical residents, medical officers (MOs, initial general practice after medical school), and non-physician providers. Provision of this essential curriculum to undergraduate medical students in LMICs has been infrequently reported.
Methods: The Trauma Evaluation and Management (TEAM) course adapts concepts of trauma assessment for medical students in their clinical years, and includes lecture presentations, video demonstrations, case scenarios, and skills sessions. Materials were donated by the American College of Surgeons (ACS) and regional surgical training sites, for implementation at the Egerton University Medical School in Kenya. The course was taught over 2 days in January 2017, by an interdisciplinary and multi-institutional team of surgical and radiology faculty and residents. Sixty-one undergraduate medical students in their final (6th) year participated. Adaptations for low-resource practice included: didactic emphasis on history and physical, inclusion of alternatives during skills sessions, and demonstration of point-of-care ultrasound. Formative assessment was integrated into small groups, and summative assessment included pre- and post-test evaluations. Tests were developed by instructors, with differences evaluated using paired t-tests. Participants provided voluntary written feedback on the course itself.
Results: 84% of students improved from pre- to post-testing. Mean pre-test score was 57% (range 25-85) and mean post-test score was 72% (range 45-95), demonstrating significant improvement (p<0.001). The poorest-performing decile of students on pre-testing showed more improvement on post-testing, compared to the highest performers on pre-testing (median improvement 30 percentage-points vs. 0 percentage-points, p<0.05). Narrative feedback on the course was positive, from both students and faculty.
Conclusion: Implementing the TEAM course in Kenya was successful, as measured by knowledge acquisition—especially for students with the least pre-existing knowledge. The course presents principles of trauma, which are otherwise not systematically covered, and which are valuable for students’ general practice as MOs. The experience strengthened institutional partnerships among faculty. Future work could include interval post-course surveys during MO-practice, to determine skill and knowledge maintenance and utility. We demonstrated the course’s effectiveness and feasibility, which can translate to future educational initiatives for the students and faculty of this and other medical schools in LMICs.