The Delphi Technique as a Needs Assessment for Family

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					140     February 2009                                                                              Family Medicine

Lao PDR                                  used to generate a prioritized list     Sudan
                                         of objectives. The final lists were
The Delphi Technique                     reviewed by the clinical specialists    How IMCI Can Be
as a Needs Assessment for                and FMSP leadership to ensure           Integrated Into Medical
Family Medicine Curriculum               consensus.                              School Curriculum and
(Kanashiro J, Hollaar G, Wright             The response rate for the consul-    Impact Health
B, Nammavongmixay K, Roff S.             tant group of clinicians was 86%        (Abdelrahman SH, Alfadil SM.
Setting priorities for teaching and      (96/111). There were notable dif-       Introducing the IMCI community
learning: an innovative needs as-        ferences in prioritization between      component into the curriculum of
sessment for a new family medicine       FMS teachers with rural or provin-      the faculty of medicine of the Uni-
program in Lao PDR. Acad Med             cial experience and specialty clini-    versity of Gezira. East Mediterr
2007;82:231-7.)                          cians and emergency physicians          Health J 2008;14(3):731-41.)
                                         and surgeons. Respondents faced
The estimated 6 million inhabitants      the dilemma of teaching what ought      The World Health Organization
of Lao People’s Democratic Repub-        to be learned versus what can be        (WHO)/United Nations Children’s
lic (Lao PDR) have a health status       practiced with restricted resources.    Fund (UNICEF) Integrated Man-
that is considered one of the worst      In the pediatric examples provided,     agement of Childhood Illnesses
in the region and social indicators      items such as diagnosis and treat       (IMCI) is an algorithm-based pro-
that are similar to Sub-Saharan          dengue fever, malaria, diarrhea,        cess derived from expert opinion
Africa. Approximately 80% live in        hyperthermia, dehydration and           and research results for identifica-
rural communities. The Lao Min-          shock, appropriate referral, and        tion, management, and prevention
istry of Health (MOH) identified         acute wound management were             of illness in children under 5 years
that trained primary care physicians     rated most high.                        at the community level in resource-
were necessary to improve the               The authors think they achieved      poor settings using simple signs
health of the people. In 2004, the       a robust assessment of needs to be      and empiric treatment. To facilitate
Faculty of Medical Sciences at the       met by the new FMSP resulting in        successful implementation of IMCI
National University of Laos (FMS         a “made in Laos” program. The           in Sudan, six Sudanese universities
NUL), the MOH, and the Ministry          University of Calgary assisted with     introduced IMCI into their medical
of Education (MOE) partnered             process, not content. The Delphi        school curriculum in 2001. The au-
with the University of Calgary to        technique identified the priorities     thors aim to describe the integration
develop a 2-year Family Medicine         for the FMSP, functioned as a fac-      of the IMCI community component
Specialists Program (FMSP).              ulty development tool, developed        into the curriculum of the Faculty
   The authors report on the use of      relationships, provided important       of Medicine of the University of
a modified Delphi technique as the       qualitative data, and generated lists   Gezira (FMUG).
needs assessment for the FMSP first-     for program evaluation.                    An eight-step process was used to
year curriculum. Key aspects of this                                             integrate IMCI into the community-
technique are anonymity, iteration          Comment: This report describes       oriented, problem-based FMUG
with controlled feedback, statistical    one model for developing country-       curriculum. Following crafting of
group response, and expert input.        appropriate family medicine objec-      the rationale, guiding principles for
Expert input by leaders from the         tives and engaging leaders who are      planning and implementation of the
MOH, MOE, the Institute of Public        key for program success. Existing       curriculum were developed. These
Health, FMS NUL, training hos-           family medicine programs in the         principles directed the determina-
pitals, and specialty departments        same region can also be a worth-        tion of education objectives and
generated recommended clinical           while resource for developing ob-       content, teaching methodologies,
knowledge and skill objectives.          jectives, curriculum, and relation-     and course modules for IMCI in-
A consultant group of clinicians         ships. Tailoring family medicine        tegration. Six curricular modules
from surgery, pediatrics, internal       education to meet the needs of the      were identified for IMCI, and im-
medicine, obstetrics-gynecology,         country is important and necessary.     plementation occurred across the 10
and emergency medicine and FMS           Details of the process used with the    semesters of the 5-year curriculum
teachers with rural or provincial        “expert leaders,” a response rate       simultaneously. Finally, outcomes
experience then ranked these objec-      for this group, and a description of    and impact of student activities
tives with respect to priority for the   the prioritized objectives for each     were assessed. The National and
health care needs of the Lao popula-     content area are not provided.          Gezira State IMCI program and the
tion and the level of competence to                                              Ministry of Health provided mate-
be achieved by a FMSP graduate.                                                  rial and process support for IMCI
A weighted average system was                                                    student activities.
International Family Medicine Education                                                     Vol. 41, No. 2    141

   Assessment of short-term im-         timely vitamin A supplementation       tionally sound approach to cur-
pact of student activities on family    (P<.0001).                             riculum integration. The preexisting
health practices was conducted in          Organized theoretical and practi-   permeation of primary care, fam-
2001–2002. Comparison between           cal integration of IMCI into FMUG      ily medicine, and rural experience
families visited by 240 medical stu-    curriculum resulted in a positive      throughout the FMUG curriculum
dents during their Primary Health       short-term impact on some IMCI         facilitated IMCI integration. While
Care Centre Practice and family         family health practices. The chal-     IMCI is not evidence based and
medicine module with families not       lenges encountered included lack       does not use analytical decision
visited showed statistically sig-       of implementation of IMCI by some      making, it is an effective means
nificant improvements in children       supervising doctors and medical        to address childhood illness in
under 5 years and pregnant women        assistants, turnover in and burden     resource-poor settings. Physicians
sleeping under insecticide-treated      upon IMCI-trained health care          working in such settings need to
bed nets (P=.002), mothers prac-        staff, photocopying costs, cost for    understand IMCI. Hopefully long-
ticing exclusive breast-feeding         MOH staff, and the large number        term assessments of this curricular
(P=.0129), families following cor-      of students.                           innovation that include evaluation
rect nutritional practices (P<.0001),                                          of student competency will be
children completing immunizations         Comment: The authors describe        forthcoming.
(P=.0027), and children receiving       a strategic, organized, and educa-