Enhancing competency-based dermatology and venereology education for undergraduate medical students in Burundi medical schools: A modified Delphi study

In the bustling clinics of Burundi, a doctor's first line of defense against illness is often a general practitioner who must recognize a skin condition before a specialist is ever consulted. For decades, the training for these future doctors in Burundi relied on a traditional method: a professor stands before a class, delivers a syllabus, and students memorize facts for an exam. This approach focuses heavily on what a student knows, rather than what they can actually do. In contrast, a modern educational philosophy known as competency-based medical education shifts the focus to mastery. Here, the goal is not just to sit through lectures, but to demonstrate specific, real-world skills, such as correctly identifying a rash or safely applying a treatment. The challenge in Burundi has been that the curriculum for skin and sexually transmitted diseases, a critical subject given the prevalence of these conditions, remained stuck in the old model. It lacked a clear, updated list of the exact skills and knowledge a student must possess to be ready for the job, leaving gaps in how common and emerging diseases are managed.

To bridge this gap, a team of researchers set out to rebuild the foundation of skin disease education for medical students in Burundi. They did not simply rewrite a textbook; they engaged in a rigorous process to agree on exactly what a student must be able to do. The team began by gathering existing information from medical literature and holding discussions with faculty and students at four medical schools across the country. From these conversations and documents, they compiled a list of forty-three potential skills and knowledge points, ranging from understanding the basic structure of the skin to recognizing complex viral infections and neglected tropical diseases. These items were organized into ten distinct areas of study to ensure a comprehensive coverage of the subject.

The researchers then turned to a method called the Delphi technique, a structured way for experts to reach a consensus without the pressure of face-to-face debate. In the first round, forty experts from various medical fields, including general practitioners, surgeons, and specialists in internal medicine, reviewed the list. They were asked to rate each item as not important, important, or very important. The results were clear: the vast majority of the proposed skills were deemed essential. On average, more than sixty percent of the experts rated the items as very important, and another thirty percent as important. Only a tiny fraction was considered unimportant. This round confirmed that the proposed list was relevant and necessary for the Burundian context.

In the second and final round, the group narrowed down to a smaller panel of nine specialists, including seven dermatologists and two experts in curriculum design. Their task was to finalize the list and ensure the wording of each skill was precise. During this session, the experts agreed on forty-two of the original forty-three items. One specific skill regarding a laboratory test called a Tzanck smear was removed because the majority of the panel felt it was not essential for a general undergraduate medical student to perform independently. The remaining forty-two competencies were then organized into a clear framework that defined not just what students should know, but how they should learn it and how their skills should be tested.

The final output is a detailed roadmap for teaching dermatology and venereology. It specifies that students must learn to identify everything from common bacterial infections and fungal diseases to the skin manifestations of systemic conditions like diabetes and HIV. The curriculum also addresses the unique challenges of the region, ensuring students can recognize neglected tropical diseases that are prevalent in Burundi but might be overlooked elsewhere. Beyond diagnosis, the plan includes training on the psychological and ethical aspects of treating patients with skin conditions, acknowledging the social stigma that often accompanies these diseases. The researchers outlined specific methods for teaching these skills, such as bedside clinics and small group discussions, and defined how to assess them, ensuring that a student's ability to perform a procedure is observed and verified, not just written about on a test.

This study represents the first time such a structured, competency-based approach has been applied to skin disease education in Burundi. By moving away from a rigid, lecture-only model to one that prioritizes demonstrable skills, the new curriculum aims to produce doctors who are better prepared to handle the diverse and urgent skin conditions they will encounter in their practice. The work confirms that while the core medical knowledge remains universal, the specific skills required for doctors in Burundi must be tailored to the local reality, ensuring that every student graduates with the practical ability to care for their community's skin health.