Integrating emergency care into the MBChB, problem-based learning curriculum at the Nelson R Mandela School of Medicine, University of KwaZulu-Natal : student and staff perceptions : a research project.
CONTEXT: The aim of the Emergency Care Practitioner (Basic), ECP (B), Course enables students to acquire knowledge and skills in basic life support, obtain a certificate and register with the Health Professions Council of South Africa as an Emergency Care Practitioner. The ECP (B) Course became a compulsory component of the Curriculum in 1996. During 1996 to 1999, the Course was conducted by Ambulance and Emergency Services - College of Emergency Care. In January 1999, the researcher was appointed to the Nelson R Mandela School of Medicine and integrated the Course into the Traditional Curriculum. The Course was run as a three-week stand-alone module in the traditional didactic format In 2001, a Problem-based learning Curriculum was introduced into which the ECP (B) Course was integrated. The Course was thus integrated into the entire first year of the Curriculum in the PBL format. OBJECTIVES: Since the Course was taught in both the Traditional and PBL Curricula, the study was aimed at exploring the impact of the ECP (B) Course on both categories of students' ability. In the Traditional Curriculum, the Course was taught in the first year of study, although the students were only exposed to clinical practice in their fourth year. With the PBL students, the ECP (B) Course runs through their first year, they are also taught clinical skills during their first and second year in the Skills Lab by the Labbased Clinical Tutors. During their third year, they undertake a Clinical Methods Course that exposed them to patient care in the Wards. This is supervised by Registrars and Consultants - Ward Tutors. The study also explored the perceptions of both the Skills Lab Tutors and the Ward Tutors regarding the impact of the ECP (B) Course on the students' clinical ability. DESIGN: The study involved students and staff presently working with the MBChB Curriculum at the Nelson R Mandela School of Medicine. The subjects were selected from a convenience sample as follows: • 30 3rd year students in the PBL Curriculum • 30 5th year students in the Traditional Curriculum • 5 Clinical Skills Tutors in the Skills Lab • 5 Clinical Tutors at King Edward Hospital. A questionnaire containing both a rating scale and open-ended questions was designed. The purpose of the questionnaire was to ascertain whether the students were able to perform the various emergency skills in the Lab (pre-clinical) setting and then to ascertain whether they were able to perform these emergency skills on real patients in the clinical situation. It was also used to determine the answer to the first key question of the study: What are the Traditional versus PBL students' perceptions on the role of the ECP (B) Course in the MBChB Curriculum and its effects on their clinical ability? Semi-structured interviews were conducted with the Clinical Tutors. These interviews were conducted individually lasting 30 minutes. All the interviewees were posed the same questions according to an interview schedule. The purpose of the interviews was to answer the second key question of the study: What are the staffs' perceptions on the role of the ECP (B) Course in the MBChB Curriculum and its effects on the clinical abilities of the Traditional students versus that of the PBL students? MAIN OUTCOMES: Both groups of students felt that the ECP (B) Course was a rewarding learning experience. In general, most of the skills were learnt during the Course on models and/ or simulated patients by both the 3rd and 5th year students, except for the simulated foetal and placental delivery. The 3rd years have not been exposed sufficiently to real patients and were thus not given the opportunity of performing all the skills learnt during the ECP (B) Course on real patients in the clinical setting whereas all the skills except for CPR on an adult and infant patient have been performed by the 5th years on real patients. Both groups of students were satisfied with the Tutor's ability to teach the ECP (B) Course in both the PBL and Traditional formats. Both the Lab and Ward Tutors were familiar with the ECP (B) Course. They were of the opinion that the skills were relevant and extremely beneficial to all medical students. They said that the skills training had a positive impact on the students' clinical ability. It gave them confidence to deal with real patients and competence with the procedures and the relevant equipment. The Tutors were able to differentiate between the PBL students and the Traditional students' clinical ability to perform skills both in the simulated and real environments. The 5th years lacked the confidence and approach that the 3rd years had achieved with the models and patients. They expressed a concern that some basic sciences should be taught before clinical skills training and there should not be too long a delay between when the skills are taught in the Lab, to when the students are placed in the real situation. Finally, all interviewees felt that the ECP (B) Course should be a compulsory first year module. CONCLUSION: The evidence collected from the research tools was insufficient to conclusively find a marked difference in the learning of the Traditional versus PBL students. The Lab Tutors and the Ward Tutors were, however, able to differentiate between the two groups of students based on their clinical skills ability. The students in the Traditional Curriculum, although being able to perform the clinical skills on real patients, seemed less confident and did not have a structured approach to patient care, whereas the PBL students seemed very confident and had a systematic approach to patient care. These differences may be attributed to the teaching and learning styles of the students and Tutors involved.