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Knowledge and skills retention following Emergency Triage, Assessment and Treatment plus Admission course for final year medical students in Rwanda: a longitudinal cohort study
  1. Lisine Tuyisenge1,
  2. Patrick Kyamanya2,
  3. Samuel Van Steirteghem3,
  4. Martin Becker4,
  5. Mike English5,6,
  6. Tom Lissauer7
  1. 1Department of Paediatrics, University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
  2. 2School of Medicine, University of Rwanda, Kigali, Rwanda
  3. 3Department of Paediatrics, Ambroise Pare University Hospital, Mons, Belgium
  4. 4Department of Paediatrics, Hinchingbrooke Hospital, Hinchingbrooke, UK
  5. 5KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
  6. 6Nuffield Department of Medicine, University of Oxford, UK
  7. 7Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Tom Lissauer, Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK; t.lissauer{at}


Aim To determine whether, after the Emergency Triage, Assessment and Treatment plus Admission (ETAT+) course, a comprehensive paediatric life support course, final year medical undergraduates in Rwanda would achieve a high level of knowledge and practical skills and if these were retained. To guide further course development, student feedback was obtained.

Methods Longitudinal cohort study of knowledge and skills of all final year medical undergraduates at the University of Rwanda in academic year 2011–2012 who attended a 5-day ETAT+ course. Students completed a precourse knowledge test. Knowledge and clinical skills assessments, using standardised marking, were performed immediately postcourse and 3–9 months later. Feedback was obtained using printed questionnaires.

Results 84 students attended the course and re-evaluation. Knowledge test showed a significant improvement, from median 47% to 71% correct answers (p<0.001). For two clinical skills scenarios, 98% passed both scenarios, 37% after a retake, 2% failed both scenarios. Three to nine months later, students were re-evaluated, median score for knowledge test 67%, not significantly different from postcourse (p>0.1). For clinical skills, 74% passed, with 32% requiring a retake, 8% failed after retake, 18% failed both scenarios, a significant deterioration (p<0.0001).

Conclusions Students performed well on knowledge and skills immediately after a comprehensive ETAT+ course. Knowledge was maintained 3–9 months later. Clinical skills, which require detailed sequential steps, declined, but most were able to perform them satisfactorily after feedback. The course was highly valued, but several short courses and more practical teaching were advocated.

  • Medical Education
  • Accident & Emergency
  • Resuscitation
  • Low income populations
  • Rwanda

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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