Analysis of blood transfusion content in undergraduate curriculum and the knowledge, perceptions, and training needs of medical doctors in Kenya

Abstract

Background: Blood transfusion (BT) is essential to modern health care, yet blood is scarce, costly, and associated with risks. Blood therapy prescribers need to have adequate knowledge, skills, attitudes, and confidence for safe and effective use. However, research have indicated that doctors lack these competencies due to inadequacy of BT content in undergraduate curriculum. Objectives: (1) Assess the adequacy of BT in Kenyan medical school curricula (2) Determine Kenyan medical doctors' BT competencies, confidence, and associated factors Methodology: The study employed quantitative with a cross-sectional approach. Kenyan medical school curricula and doctors were the target population. Six eligible medical schools and 200 non-specialist doctors were recruited using purposive and stratified sampling, respectively. The doctors were selected from 11 hospitals in Western and North Rift. Data was collected using pre-tested questionnaires and data abstraction forms. Medical school curricular data was analyzed using frequency tables and percentages, while doctors’ data was summarized using percentages, mean (SD), and median (IQR), bivariate analysis by way of Mann-Whitney, Spearman's correlation coefficient, and Kruskal-Wallis tests, and multivariate analysis was done using logistic regression, where associations were reported using OR and 95% CI. A p < 0.05 was deemed statistically significant. Results: All the six curricula (100%) analyzed contained topics in BT essential for safe practice and had the content of BT integrated into the haematology course taught during the third year. Only one (16.7%) medical school had the subject incorporated into all the clinical years, but with no explicit learning outcomes and content indicated. The mean age of the medical doctor participants was 29.9±3.6) and 60% were males. The median knowledge score was 53.3 % (IQR: 40.0, 66.7%), and it was independently associated with orientation (AOR = 3.157, 95% CI = 1.194–8.337). About 73.0 % had a positive attitude towards BT, which was associated with participation in training (z = -1.143, p = 0.036). Only 43.7% of reported practices conformed with recommended best practices. The median self-confidence score was 86% (IQR 76.0, 96.0) and was independently associated only with orientation (AOR = 3.960, 95% CI = 1.314–11.929). There was no association between the medical school attended (curricula) and the medical doctor’s knowledge (p = 0.501), attitude (p = 0.627), practice competency (p=0.319), and confidence (p = 0.132). The vast majority (96%) of the participants reported that knowledge of transfusion medicine was important to their clinical practice, and all (100%) felt that additional training in BT would be useful. Conclusion: All Kenyan medical schools had fundamental BT concepts, but only one included the subject in all clinical years albeit without explicit learning objectives or content. Despite their suboptimal BT knowledge levels, doctors had a positive attitude towards BT coupled with a high level of self, and less than half of the reported practices conformed to best practices. Both knowledge and confidence among doctors were associated with orientation in BT. Most clinicians regarded the knowledge of BT as important to their medical practice but still felt that their knowledge of the discipline was not good enough and needed more training on the subject. Recommendations: Kenyan medical schools should enhance the teaching of theoretical and practical clinical aspects of BT and include the content of blood transfusion in all the clinical years of undergraduate medical education with explicit learning outcomes. Orientation in BT should be offered to medical interns, and BT-related continuing medical education activities are recommended to all practicing doctors.