Pioneering small-group learning in Tanzanian emergency medicine: Investigating acceptability for physician learners

Abstract

Background. Emergency medicine (EM) is a relatively new, but growing medical specialty in sub-Saharan Africa. African EM training programmes have used small-group learning (SGL) modalities in their curricula. However, there is little knowledge of whether SGL modalities are perceived to be effective in these African EM training programmes. Objectives. To investigate the acceptability of SGL for physicians' training in an academic Tanzanian emergency department using a novel EM curriculum. Methods. Using responses to a written questionnaire, we explored the perceived effectiveness of SGL compared with traditional didactic lectures among 38 emergency department physician learners in Dar es Salaam, Tanzania. Perceptions of SGL were identified from qualitative responses, and regression analyses were used to determine strength of association between quantitative outcomes. Results. Reported benefits of SGL included team building, simulation training, enhancement of procedural skills, and the opportunity to discuss opinions on clinical management. SGL scored more favourably with regard to improving clinical practice, enjoyment of learning, and building peer-to-peer relations. Lectures scored more favourably at improving medical knowledge. Preference towards SGL over lectures for overall training increased with years of clinical experience (95% confidence interval (CI) 0.16 -0.62, p=0.002, Spearman's rho 0.51), and the perception that SGL reinforces learner-teacher relationships correlated with seniority within residency training (95% CI 0.14 -0.86, p=0.007, Spearman's rho 0.47). Conclusion. Techniques of SGL were perceived as effective at improving clinical practice in the emergency department setting. These modalities may be more favourably accepted by more experienced physician learners -therefore, new EM teaching programmes in Africa should consider these factors when targeting educational strategies for their respective regions and learner cohorts.

Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review

“…Eleven of the manuscripts discuss general EM programs. These span the years 1999-2018, are published in 10 different journals, and highlight work in nine countries ( Table 3) [35][36][37][38][39][40][41][42][43][44][45]. The components of the eleven manuscripts on broadly focused EM training programs are further highlighted here.…”

“…One of the short programs emphasizes the need for refresher courses, particularly when limited curricula are offered and/or baseline knowledge is varied or limited [39]. One manuscript specifically evaluates the acceptability of a novel-to-context learning modality (small group sessions) within the overall program [45].…”

“…Train-the-trainer techniques are used in two of the programs [39,43]. Two programs mention their learner-to-instructor ratio for hands-on sessions (a range of 3-6:1) [38,45]. One program is structured to have two identical sessions daily in order to accommodate the learners, who must provide continuous coverage in the clinical setting [35].…”