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Original research
Expert consensus on core topics of sustainable development online learning module for family physicians: a Delphi study
  1. Krishna Suvarnabhumi1,
  2. Sujitra Jorajit2,
  3. Wan Dechpichai2,
  4. Jarus Ativitthayaporn2
  1. 1Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
  2. 2Faculty of Education and Liberal Arts, Hatyai University, Hatyai, Songkhla, Thailand
  1. Correspondence to Krishna Suvarnabhumi; krishna.s{at}psu.ac.th

Abstract

Objectives Medical institutions must provide learning experiences that enhance the knowledge and perspectives of sustainable development (SD) to prepare trainees of family medicine to become competent global citizens. The aim of this study was to develop an SD online learning module for trainees of family medicine.

Design This mixed-methods study was conducted from January 2020 to May 2021, beginning with a literature review concerning Sustainable Development Goals (SDGs) and Education for Sustainable Development in medicine. In-depth interviews were held to assess the relevant needs of family medicine training, followed by a two-round Delphi survey with experienced educators (N=21) in family medicine to refine and achieve consensus on the appropriate SDG topics for family physicians.

Setting All residency training programmes in Thailand.

Participants Members of the Residency Training Committee, Royal College of Family Physicians of Thailand.

Results The literature review and in-depth interviews identified 12 topics of SD that were required for family physicians. The first round of the Delphi survey was concluded by identifying seven core topics with additional suggestions. In the second round, a consensus was obtained among the experienced educators regarding seven core topics as (1) a definition of SD, (2) principles of SD, (3) SDG, (4) a new concept of SD, (5) SD in the context of Thailand, (6) SD and principles of family medicine and (7) SD and family practice. These core topics were grouped within three main objectives and three submodules.

Conclusions An online learning module of SD for family physicians was developed using modified Delphi method. This included three submodules as (1) concept and principles of SD, (2) SDG and (3) SD and its integration with family practice. This online learning module will provide additional resources for trainees of family medicine and Thai family physicians to expand their knowledge and perspectives of SD.

  • PUBLIC HEALTH
  • EDUCATION & TRAINING (see Medical Education & Training)
  • GENERAL MEDICINE (see Internal Medicine)

Data availability statement

Data are available on reasonable request. Extra data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi: 10.5061/dryad.kprr4xh81.

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STRENGTHS AND LIMITATIONS OF THIS STUDY

  • This mixed-methods study developed core topics of sustainable development as an online learning module for family physicians.

  • High response rates were recorded by the Delphi study as 100% for the first round and 90.5% for the second round.

  • The study did not include needs or opinions from trainees of family medicine.

Introduction

Literature concerning global health has grown exponentially, with academic institutions exploring the scope of their public health education programmes to meet the demand of health professionals.1 Global competency is essential for young people to succeed and ultimately support the achievement of the Sustainable Development Goals (SDGs).2 SDGs are the global goals adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet and ensure that by 2030 all people enjoy peace and prosperity. The 17 goals cover global challenges that are crucial for the survival of humanity.3

Education is crucial for the achievement of sustainable development. However, not all forms of education support sustainable development. Education for Sustainable Development (ESD) empowers students to make informed decisions and adopt responsible actions for environmental integrity, economic viability and to develop a just society for present and future generations.4 In the UK, the Royal College of Physicians stated that sustainability is one of the key quality issues.5 Future doctors must prepare for leading roles in providing sustainable health services. Moreover, the Medical Council proposed that medical schools should move towards sustainable health and quality improvement.6 Developmental issues of sustainability and sustainable health services are not clearly stated in the Thai National Curriculum of Family Medicine that only mentions health promotion and disease prevention.7

To prepare trainees of family medicine with the competency to become global citizens, medical institutions must provide learning experiences that enhance and expand the knowledge and perspectives of sustainable development. Currently, blended learning combining face-to-face class-based methods and online learning is well accepted. These teaching methods allow trainees to progress at their own pace.8 This study developed an online learning module of sustainable development for trainees of family medicine.

Method

Study design

This mixed-methods study began by conducting a literature review concerning the applications of SDGs and ESD in medical education. In-depth interviews were also held to assess the relevant needs of family medicine training. The Delphi technique was employed, using experienced educators to determine appropriate topic regarding sustainable development for family physicians.

Setting and participants

Experienced educators were selected from all residency training programmes who were members of the Residency Training and Board Examination Subcommittee of the Royal College of Family Physicians of Thailand. All of them must older than 35 years old and had more than 10 years teaching experience in family medicine. They were chosen from the training institution representatives throughout Thailand.

Patient and public involvement

No patient involved.

Data collection and analysis

Literature review

To develop initial concepts of sustainable development to present to family medicine educators, comprehensive search was conducted from core bibliographic databases. These databases recommended by BEME Guide No.3: Systematic Searching for Evidence in Medical Education including Medline, the Cumulative Index of Nursing and Allied Health Literature and the Educational Resources Information Centre.9 Grey literature was searched from the System for Information on Grey Literature, ProQuest Dissertation & Theses, Scopus (Conference papers), Books via Collections of Prince of Songkla University Library and Hatyai University Library, HEA Resources Centre, GMC Publications and the Education Database of the Thai Ministry of Education. The inclusion and exclusion criteria were showed in table 1. The two main search key phrases were SDGs and ESD in medical education. Only articles in Thai and English published between 2009 and 2019 were included. Abstracts and full articles were reviewed to exclude duplication and irrelevant papers. Each article was summarised into data extraction form and then coded and synthesised.

Table 1

The inclusion and exclusion criteria for literature review

Needs assessment and additional key issues of SDGs and ESD in postgraduate family medicine education

In-depth interviews were conducted to assess the relevant needs of family medicine training. All participants were experienced educators. We used the snowballing technique to identify experienced educators, started from the most senior one. There were six questions in the interview guide as showed in box 1. We interviewed experienced educators until reaching data saturation. Saturation has attained widespread acceptance as a methodological principle in qualitative research. Saturation means that no additional data are being found.10 We coded from the interview fieldnotes. The analysis was done by hand. Then, the codes were reduced to themes (core topics).

Box 1

Interview guide for in-depth interview

  1. What are Sustainable Development Goals (SDGs)?

  2. Did your teaching relate to Sustainable Development Goals (SDGs)? If yes, how?

  3. Are there any topics related to Sustainable Development Goals (SDGs) in the family medicine curriculum?

  4. How did Sustainable Development Goals (SDGs) relate to family medicine?

  5. Is there an online learning need about sustainable development for family medicine trainees?

  6. Is there anything else you would like to add?

Delphi study

A Delphi method was used to achieve consensus on the core topics of a sustainable development learning module for family physicians. In the Delphi method, equal weights are given to the opinions of each individual. The surveys are blinded to ensure anonymity and several rounds or iterations are conducted so that the experts can consider the results of previous rounds and change their answers if they wish.11

We modified the Delphi method. We used both questionnaire survey and open-ended questions as the first round. All issues emanating from the open-ended questions and free-text comments were added to the questionnaire in the second round.

Delphi expert panelists

There are 22 members of the Residency Training Committee of the Royal College of Family Physicians of Thailand. All of them were invited, except for Krishna Suvarnabhumi as the principal investigator of this study. The total number of Delphi expert panellists was 21 persons. They are experienced educators of family medicine and representatives from their residency training programmes. Names of the participants and institutions were coded to ensure confidentiality and anonymity.

Delphi starting documents

Three documents were sent to the participants including (1) A summary of the literature review on SDGs and ESD in medical education, (2) Needs assessment and additional key issues of SDGs and ESD in postgraduate family medicine education from the in-depth interviews and (3) Education for SDGs Learning Objectives developed by United Nations Educational, Scientific and Cultural Organisation.4

Delphi protocol first round

The questionnaire, using Google Forms, was developed based on analysis of the Delphi starting documents. The response format was a five-point Likert scale as (1) strongly disagree, (2) moderately disagree, (3) neither agree nor disagree, (4) moderately agree and (5) strongly agree. The questionnaire was tested to ensure that there were no technical errors, and it was user-friendly. The questionnaire was tested by three supervisors from Doctoral programmes of Faculty of Education and Liberal Arts, Hatyai University. Then, the questionnaire survey was open for 4 weeks. We sent an email to remind participants if there was no response and set up criteria for agreement as follows: (1) Median more than 3.5, (2) Median and Mode difference less than 1.0, (3) IQR less than 1.5 and (4) Coefficient of variation between 0 and 0.5.

Delphi protocol second round

The revised version was then sent to the participants. This second questionnaire survey included opinions from the open-ended questions and free-text comments from the first round. Participants were asked to rescore their agreement on the core topics of the sustainable development learning module for family physicians and re-rate each item on the same five-point Likert scale. They were encouraged to make free-text suggestions on the current items and any additional items that should be included. Similar to the first round, the second round of the questionnaire survey was open for 4 weeks. We sent an email to remind participants if there was no response and used the same criteria for agreement as in the first round.

Results

Literature review

A total of 2035 articles were collected from the core databases, with 576 articles from grey literature. After reviewing the abstracts and full articles, 26 articles were included in the literature review. We coded from the article summaries. The analysis was done by hand. Then, the codes were reduced to themes (core topics) of SDGs and ESD in medical education (table 2).

Table 2

Literature review: core topics of Sustainable Development Goals (SDGs) and Education for Sustainable development (ESD) in medical education

Needs assessment and additional core topics of SDGs and ESD in postgraduate family medicine education

We used the snowballing technique to identify experienced educators and interviewed 11 educators using the interview guide until reaching data saturation. Ten educators stated that SDGs were closely related to family medicine, while eight suggested that we needed to provide postgraduate student online learning modules blended with learning from real experience in family practices. Most core topics of the SDGs and ESD were identical to the summary of literature review. Only two core topics were added (table 3).

Table 3

In-depth interviews: additional core topics relevant to family medicine training

Delphi study

Delphi expert panel

All of the 21 experienced educators contacted agreed to participate in the study. All educators responded in the first Delphi round (response rate of 100%), while the second Delphi round had a response rate of 90.5% because two educators were busy with the COVID-19 pandemic (table 4). The first round was conducted in March 2021 and the second in April 2021.

Table 4

Participant characteristics (n=21)

In the first Delphi round, all 45 topics of sustainable development for family physicians met the criteria (table 5). Following the additional comments and suggestions, seven core topics were not changed. Only 13 topics (C5, C6, C8, C10, C30, C31, C34, C35, C39, C42, C43, C44, C45) were revised for the second round of the questionnaire. The example of revision was demonstrated in table 6. A consensus was agreed, with no addition or change at the end of the second round. The summary results of the Delphi study are shown in table 7.

Table 5

Delphi survey: core topics of sustainable development for family physicians

Table 6

Example of topic revision

Table 7

Summary of results

Discussion

Twelve core topics of sustainable development were identified for family physicians from the literature review and in-depth interviews. The first round of the Delphi survey was concluded by identifying seven core topics and additional contents. The second round developed consensus among the experienced educators of the seven core topics as (1) a definition of sustainable development, (2) principles of sustainable development, (3) SDGs, (4) a new concept of sustainable development, (5) sustainable development in the context of Thailand, (6) sustainable development and principles of family medicine and (7) sustainable development and family practice. All core topics were sourced from the literature review and in-depth interviews and then confirmed by the experienced educators in the Delphi surveys. Students were prepared to have global competency, but local context is still important. The fifth core topics showed that global and local contexts in education programmes must be balanced to allow students to adapt to the requirements of a rapidly changing future in local and global healthcare.12 The sixth core topics comprised expert opinions in the field of family medicine collected by in-depth interviews and the Delphi survey. Lastly, the seventh core topics presented suggestions as to how this should be done. Sustainable development must be integrated with patient care. Students should have knowledge and skills and be able to work with other health professions.13 Integration with patient care also demonstrated that health and sustainable development are inseparable in an increasingly globalised and interconnected world.14 15 These seven core topics were grouped within three main objectives and three submodules including (1) Concept and principles of sustainable development, (2) SDGs and (3) Sustainable development and its integration with family practice. Objectives, learning experiences and evaluation of sustainable development online learning module for family physicians were demonstrated in table 8.

Table 8

Objectives, learning experiences and evaluation of sustainable development online learning module for family physicians

Student assessments can be integrated with the online module to ensure module consistency and identify precise connections between learning objectives, learning experiences and evaluations.16 Module evaluation can be conducted using the CIPP Model and include Context Evaluation, Input Evaluation, Process Evaluation and Product Evaluation.

The limitation of this study was that it includes only the development phase of the online module. Moreover, there was no similar previously published literature to be compare. We would like to demonstrate how we generated online learning module contents. It may be useful for whom would like to develop online course.

Conclusions

An online learning module of Sustainable Development for family physicians was developed using a modified Delphi method that included three submodules as (1) Concept and principles of sustainable development, (2) SDGs and (3) Sustainable development and its integration with family practice. This module will provide additional resources for family medicine students and Thai family physicians to expand their knowledge and perspectives of sustainable development.

Data availability statement

Data are available on reasonable request. Extra data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi: 10.5061/dryad.kprr4xh81.

Ethics statements

Patient consent for publication

Ethics approval

This study was approved by the Research Ethics Committee of Hatyai University (REC.2563.6119060010). Participants gave informed consent to participate in the study before taking part.

References

Footnotes

  • Contributors KS, SJ, WD and JA initiated the study concepts. All authors contributed to data collection and analysis. KS wrote the first draft of the manuscript that was then read and revised by the rest of the team. All authors read and approved the final version of the manuscript. KS is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.