Background

Most patients with orthopedic pathology in low to middle income countries are treated by non-specialists. A curriculum to prepare undergraduate medical students for this should reflect the local pathology and skills required to manage patients in a resource restricted environment. The aim of this study was to establish and prioritize a list of core orthopedic related knowledge topics, clinical cases, and skills that are relevant to medical students in Southern Africa and areas with a similar clinical context.

Methods

A modified Delphi consensus study was conducted, in form of three interactive iterative rounds of communication and the prioritization of items by experts from Africa, Europe, and North America. For this, preferred priorities were selected but were limited to 50% of all of the possible items. Percentage agreement of more than 75% was defined as consensus on each of these items.

Results

Most of the 43 experts who participated were orthopedic surgeons from seven different countries in Southern Africa, but 30% were general practitioners from Southern Africa or international educational experts. Experts prioritized cases like a multiple injured patient, a limping child, and orthopedic emergencies. The manipulation and immobilization of dislocations and fractures, were prioritized skills. The most important knowledge topics included orthopedic infections, the treatment of common fractures and dislocations, red flags alerting to specialist referral, as well as backpain. The treatment of common sport injuries (besides dislocations) were included by some experts who saw a specific need in their clinical practice, only reached a 25% agreement.

Conclusion

A wide geographic, academic, and expertise-specific footprint of experts informed this international consensus through their various clinical and academic circumstances. Knowledge, skills, and cases in orthopedic trauma and infections were prioritized with the highest percentage agreement. Acute primary care for fractures and dislocations ranked high. Furthermore, the diagnosis and treatment of conditions not requiring specialist referral were prioritized. Sports specific injuries ranked low. This study can inform national curricula in Southern Africa and assist in the allocation of student contact times but sports-orthopedic care might be side-lined.