Evaluation of the Rwandan Emergency Medicine Clinical Guidelines: AQuantitative and Qualitative Review Open Access
Braxley, Nicole Marie (2016)
Abstract
Rwanda is a small, landlocked country in East Africa devastated by genocide in 1999 where nearly one third of its inhabitants were killed. Over the past twenty years, with the help of significant foreign aid, the country has shown tremendous progress in reducing poverty, increasing the life expectancy of its people, advancing technology and growing and developing its healthcare infrastructure. With the initiation of the Human Resources for Health (HRH) program in 2012, Rwanda seeks to "meet the health needs of its citizens by 2020" by partnering with 23 US Institutions of medicine, dentistry, and health management to bring full-time foreign faculty to Rwanda on an annual basis to work on a transfer of knowledge to Rwandan physicians. Emergency Medicine (EM) specialists are included among the invited participants with the goal of introducing and advancing emergency care to Rwanda by establishing the country's first EM residency program and implementing emergency and critical care concepts in the capital teaching hospital. Individual training in emergency care is not available to every Rwandan physician. As a side project, the author edited a new handbook for Rwandan general practioners called Emergency Medicine Clinical Guidelines. Because there are no Rwandan EM specialists, the handbook was authored by foreigners who practiced emergency medicine in Rwanda. This thesis offers the results of a quantitative and qualitative analysis of the new guideline text, as tested and reviewed by Rwandan physicians. Participants gathered for a pre- and post-test analysis and stayed to participate in a focus group interview. Quantitative results showed a significant improvement in post-test scores using the new guidelines as a tool to answer clinical questions. Themes that arose from the focus group interview session offered an overall positive review of the guidelines with recommendations on how to make it more accessible for the Rwandan general practitioner who is not trained in emergency medicine but cares for critically ill patients on a daily basis.
Table of Contents
Introduction 8
Statement of the Problem
Rwanda, The Country
Rwanda, The Genocide
Rwanda, The Healthcare System, Then and Now
Human Resources for Health Program
Emergency Medicine in Rwanda, Then
Emergency Medicine, SidHARTe
Emergency Medicine Clinical Guidelines
Research Question 18
Goals and Objectives
Review of the Literature 20
Methodology 26
Setting and Selection of Participants
Intervention
Outcome Measures
Primary Data Analysis
Limitations and Delimitations
Results 32
Characteristics of Study Participants
Quantitative Results
Qualitative Results
Limitations of Study 39
Conclusions, Implications, and Recommendations 43
References 47
Appendix 48
Copy of application to Rwanda Council of Medicine and Dentistry
for CPD Accreditation
Focus Interview Questions
Focus Interview Transcript
Focus Interview Notes
Copy of Consent for Participation in Study
About this Master's Thesis
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