Evaluation of the Emergency Care Preparedness of Frontline Junior Doctors: A Training Needs Assessment in Ghana

Abstract

Introduction: In low- and middle-income countries (LMICs) like Ghana, junior doctors - house officers and medical officers - serve as the primary frontline providers of emergency care, often in resource-limited settings. Despite their critical role, emergency medicine (EM) training in undergraduate and horsemanship curricula remains non-standardized. This study conducted a bottom-up training needs assessment to identify clinical and procedural gaps among junior doctors in Ghana. Methods: A cross-sectional digital survey was conducted among 75 junior doctors (house officers and medical officers with not more than five years of practice) between October and December 2018. Using 5-point Likert scales, participants self-assessed their comfort with life-saving procedures and their confidence in managing acute medical and trauma presentations. Data were analyzed using descriptive statistics and thematic categorization of qualitative responses. Results: Although 40% (n = 30) of participants reported managing emergencies “always” in their current roles, only 17.8% (n = 13) felt extremely comfortable as the first-on-call to attend to an emergency or acutely ill patient. While comfort was high for basic tasks like venipuncture (85.9%), it was critically low for advanced procedures; only 8.9% felt comfortable with chest tube insertion, and 87.5% had never performed defibrillation. Confidence was high for managing asthma (90.6%) and hypertensive emergencies (85.0%), but significantly lower for peri-arrest conditions like bradyarrhythmias (70.8% low confidence) and tension pneumothorax. Only 13.5% felt medical school provided excellent preparedness for emergency care, while 100% expressed interest in regular simulation-based training. Conclusion: A profound mismatch exists between the clinical responsibilities and the formal emergency care training of junior doctors in Ghana. These findings have informed the development of targeted simulation-based training initiatives and have strengthened the case for mandatory EM integration into undergraduate and housemanship curricula across Ghana. To bridge this gap nationally, we recommend that EM be transitioned from an optional to a mandatory component of undergraduate and housemanship training, integrated with decentralized simulation-based medical education.