Knowledge and skills retention following Emergency Triage, Assessment and Treatment plus Admission course for final year medical students in Rwanda: a longitudinal cohort study

Abstract

AimTo determine whether, after the Emergency Triage, Assessment and Treatment plus Admission (ETAT+) course, a comprehensive paediatric life support course, final year medical undergraduates in Rwanda would achieve a high level of knowledge and practical skills and if these were retained. To guide further course development, student feedback was obtained.MethodsLongitudinal cohort study of knowledge and skills of all final year medical undergraduates at the University of Rwanda in academic year 2011–2012 who attended a 5-day ETAT+ course. Students completed a precourse knowledge test. Knowledge and clinical skills assessments, using standardised marking, were performed immediately postcourse and 3–9 months later. Feedback was obtained using printed questionnaires.Results84 students attended the course and re-evaluation. Knowledge test showed a significant improvement, from median 47% to 71% correct answers (p<0.001). For two clinical skills scenarios, 98% passed both scenarios, 37% after a retake, 2% failed both scenarios. Three to nine months later, students were re-evaluated, median score for knowledge test 67%, not significantly different from postcourse (p>0.1). For clinical skills, 74% passed, with 32% requiring a retake, 8% failed after retake, 18% failed both scenarios, a significant deterioration (p<0.0001).ConclusionsStudents performed well on knowledge and skills immediately after a comprehensive ETAT+ course. Knowledge was maintained 3–9 months later. Clinical skills, which require detailed sequential steps, declined, but most were able to perform them satisfactorily after feedback. The course was highly valued, but several short courses and more practical teaching were advocated.

Correlates of Performance of Healthcare Workers in Emergency, Triage, Assessment and Treatment plus Admission Care (ETAT+) Course in Rwanda: Context Matters

“…Consistent with previous studies, participating in continuing medical education (CME) courses including ETAT+ is associated with immediate improvement knowledge across a wide variety of professions (e.g. physicians, nurses, midwives, in training healthcare professionals) following the training [ 9 , 15 – 17 ]. While the pass rate in the post-course knowledge assessment was high (78.0%), the overall mean post-test score was only 58.0% (SD 13.4), far below the average score of 71% for Rwandan medical students who undertook the same course and assessment [ 15 ].…”

“…physicians, nurses, midwives, in training healthcare professionals) following the training [ 9 , 15 – 17 ]. While the pass rate in the post-course knowledge assessment was high (78.0%), the overall mean post-test score was only 58.0% (SD 13.4), far below the average score of 71% for Rwandan medical students who undertook the same course and assessment [ 15 ]. Similarly, Rwandan medical students had a higher performance on the skills assessment than the HCWs (pass rate of 98% versus 78.6%) [ 15 ].…”

“…While the pass rate in the post-course knowledge assessment was high (78.0%), the overall mean post-test score was only 58.0% (SD 13.4), far below the average score of 71% for Rwandan medical students who undertook the same course and assessment [ 15 ]. Similarly, Rwandan medical students had a higher performance on the skills assessment than the HCWs (pass rate of 98% versus 78.6%) [ 15 ]. This difference might be explained by language barriers and limited access to computers and the internet among HCWs, but also eagerness/ motivation for students as they were trained in the ETAT+ during their pediatric rotation.…”

Moving towards Routine Evaluation of Quality of Inpatient Pediatric Care in Kenya

“…Our data provide insights on quality of pediatric care in Kenya using methods developed over a period of years that are based on a successful collaboration between researchers and government and that might support wider use at relatively low cost. As the use of similar protocol booklets linked to ETAT+ training is now occurring in Rwanda[ 21 ], and Uganda[ 22 ] in projects supported by The Royal College of Paediatrics and Child Health, with further use being discussed in Somaliland, Sierra Leone, and Zimbabwe, this approach to rapidly assessing quality of care might be used much more widely and allow countries to share experiences of what works. Ministries of health may also adopt some of the tools used in this work for evaluation of resource availability as is planned in Kenya as part of routine performance monitoring.…”

Paediatric life support courses for health centres in low and middle income countries

“…Improved knowledge and clinical skills have been demonstrated following both the ETAT and ETAT+ courses of facility-based health professionals5 6 and medical students 7. The EMJ paper by Kapoor et al 8 describes how they used the ETAT course for primary health centre staff in Latin America.…”