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Abstract：
Background Developing a contextually appropriate curriculum is critical to train physicians who can address surgical challenges in sub-Saharan Africa. An innovative modified Delphi process was used to identify contextually optimized curricular content to meet sub-Saharan Africa and Rwanda\'s surgical needs. Methods Participants were surgeons from East, Central, Southern, and West Africa and general practitioners with surgical experience. Delphi participants excluded or prioritized surgical topic areas generated from extensive grey and formal literature review. Surgical educators first screened and condensed identified topics. Round 1 screened and prioritized identified topics, with a 75% consensus cut-off based on the content validity index and a prioritization score. Topics that reached consensus were screened again in round 2 and re-prioritized, following controlled feedback. Frequencies for aggregate prioritization scores, experts in agreement, item-level content validity index, universal agreement and scale-level content validity index based on the average method (S-CVI/Ave) using proportion relevance, and intra-class correlation (ICC) (based on a mean-rating, consistency, two-way mixed-effects model) were performed. We also used arithmetic mean values and modal frequency. Cronbach\'s Alpha was also calculated to ascertain reliability. Results were validated through a multi-institution consensus conference attended by Rwanda-based surgical specialists, general practitioners, medical students, surgical educators, and surgical association representatives using an inclusive, participatory, collaborative, agreement-seeking, and cooperative, a priori consensus decision-making model. Results Two-hundred and sixty-seven broad surgical content areas were identified through the initial round and presented to experts. In round 2, a total of 247 (92%) content areas reached 75% consensus among 31 experts. Topics that did not achieve consensus consisted broadly of small intestinal malignancies, rare hepatobiliary pathologies, and transplantation. In the final round, 99.6% of content areas reached 75% consensus among 31 experts. The highest prioritization was on wound healing, fluid and electrolyte management, and appendicitis, followed by metabolic response, infection, preoperative preparation, antibiotics, small bowel obstruction and perforation, breast infection, acute urinary retention, testicular torsion, hemorrhoids, and surgical ethics. Overall, the consistency and average agreement between panel experts was strong. ICC was 0.856 (95% CI: 0.83-0.87). Cronbach\'s Alpha for round 2 was very strong (0.985, 95% CI: 0.976-0.991) and higher than round 1, demonstrating strong reliability. All 246 topics from round 4 were verbally accepted by 40 participants in open forum discussions during the consensus conference. Conclusions A modified Delphi process and consensus were able to identify essential topics to be included within a highly contextualized, locally driven surgical clerkship curriculum delivered in rural Rwanda. Other contexts can use similar processes to develop relevant curricula.
摘要：
背景开发适合上下文的课程对于培训能够解决撒哈拉以南非洲外科手术挑战的医生至关重要。一个创新的修改后的德尔菲过程被用来确定上下文优化的课程内容，以满足撒哈拉以南非洲和卢旺达的外科需求。方法参与者是来自东部的外科医生，中央,南方,西非和有手术经验的全科医生。Delphi参与者排除或优先考虑从广泛的灰色和正式文献综述中产生的手术主题区域。外科教育工作者首先筛选并浓缩了确定的主题。第一轮筛选并确定了确定的主题，根据内容有效性指数和优先级得分，达成75%的共识截止值。达成共识的主题在第二轮中再次筛选并重新确定优先顺序，以下受控反馈。聚合优先级评分的频率，专家同意，项目级内容有效性索引，使用比例相关性的基于平均方法(S-CVI/Ave)的普遍一致性和量表级内容有效性指数，和类内相关性(ICC)(基于均值评级，一致性,进行双向混合效应模型)。我们还使用了算术平均值和模态频率。还计算了Cronbach的Alpha以确定可靠性。结果通过由卢旺达外科专家参加的多机构共识会议得到验证，全科医生,医学生,外科教育工作者，和外科协会代表使用包容性，参与性,协作,寻求协议,合作,先验共识决策模型。结果通过第一轮确定了二百六十七个广泛的手术内容区域，并提交给专家。在第2轮中，共有247个（92％）内容领域在31位专家中达成了75％的共识。没有达成共识的话题广泛包括小肠恶性肿瘤，罕见的肝胆疾病，和移植。在最后一轮，99.6％的内容领域在31位专家中达成了75％的共识。最优先考虑的是伤口愈合，流体和电解质管理，阑尾炎,其次是代谢反应，感染,术前准备,抗生素,小肠梗阻和穿孔，乳腺感染,急性尿潴留,睾丸扭转,痔疮,和外科伦理。总的来说,小组专家之间的一致性和平均一致性很强。ICC为0.856（95%CI：0.83-0.87）。第2轮的Cronbach的Alpha非常强（0.985，95％CI：0.976-0.991），并且高于第1轮，证明了很强的可靠性。在共识会议期间，第4轮的所有246个主题在公开论坛讨论中被40名参与者口头接受。结论修改后的德尔菲过程和共识能够确定要包含在高度语境化的基本主题，在卢旺达农村地区提供当地驱动的外科文员课程。其他上下文可以使用类似的过程来开发相关课程。
