Curriculum development for undergraduate anaesthesiology training in South Africa

Abstract

Safe anaesthesia is imperative for global safe surgery. Due to a paucity of specialists in decentralised public hospitals in South Africa, junior non-specialist doctors are often tasked with providing anaesthesia with limited supervision in these hospitals. South Africa does not meet international benchmarks for surgical access and safety, especially in decentralised areas. This signals an urgent need to ensure that non-specialist doctors are trained in the safe delivery of anaesthesia for essential surgical procedures.

Although undergraduate training in anaesthesia is mandated by the Health Professions Council of South Africa (HPCSA), the content and length of the training is determined independently by each medical school. No national outcomes are defined, and as a result, graduating students enter internship at varying levels of competence. This study explored the existing undergraduate anaesthesia curricula in South Africa, with an emphasis on graduate preparedness and the various factors that affect student learning. Through a modified Delphi process, the study further established standardised national learning outcomes for undergraduate anaesthesia training in South Africa.

The study indicated a higher self-reported competence among students from longer duration anaesthesia training programmes. This finding was ascribed to increased time-on-task, curricular spiralling with capacity for spaced repetition, and student maturity. In this study, students experienced a high cognitive load during undergraduate anaesthesia training. The COLOAD (COgnitive LOad in Anaesthesia eDucation) framework was developed to enable mapping of this load. The framework illustrates how the complexity of tasks and distractions in the learning environment can affect metacognition and student performance. By understanding these interactions, curriculum developers can better align the expected outcomes with the available time and resources, ensuring that students are adequately prepared for clinical practice.

The findings of this study have broader implications beyond curriculum development. They offer the potential to influence national policies and regional collaborations aimed at enhancing anaesthesia care and surgical outcomes in low- and middle-income countries. The national learning outcomes proposed in this study provide a foundation for cooperation between medical schools, healthcare departments, the HPCSA, and hospitals, standardised training and improving educational outcomes. This, in turn, could lead to enhanced healthcare quality. The research could serve as a valuable model for curriculum development initiatives in similar healthcare contexts.