Abstract
Background
Although transfusion medicine (TM) is included in medical curricula, junior doctors still have gaps in practical knowledge. These gaps with limited training increase patient risks, as well as health care costs. The aim of this study is to assess TM knowledge among juniors’ doctors.
Methods
This is a monocentric study, conducted across nine clinical departments. A structured questionnaire was used to assess four TM concepts. Knowledge scores were analyzed according to experience, prior training, and department.
Results
Of the 102 doctors surveyed, 82 (80%) responded. The median age of participants was 27 years old. The percentage of residents was 82%. Among them, 41% had prior and only 10% had more than three years of experience. The average knowledge score was 32.4%, with 41.5% scoring above the mean. Most interns and residents scored in the poor or moderate knowledge range, while the good knowledge group consisted exclusively of residents. Scores were highest for pre-transfusion initiation and monitoring, and lowest for basic knowledge and risk management. Residents generally outperformed interns, with knowledge correlating positively with clinical experience.
Conclusion
Experience alone does not ensure competency. Enhanced curricula with standardized and innovative tools are recommended to reduce transfusion errors and improve patient safety.
Keywords: Transfusion, knowledge, assessment, juniors doctors, Tunisia
PLAIN LANGUAGE SUMMARY
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What is this article about?
This article looks at how much junior doctors in a specific region of Tunisia know about blood transfusions. It focuses on areas where their knowledge might be lacking.
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What were the results?
The study found that most junior doctors had only a fair understanding of blood transfusion practices. Their scores were especially low in two key areas: basic knowledge about blood transfusions (28%) and managing risks during transfusions (11%). Many participants struggled with questions about handling transfusion reactions and performing necessary checks at the patient’s bedside.
The study also showed that doctors with more hands-on experience, like those in residency, scored higher than those still in training (interns). However, knowledge levels tended to drop in the later years of residency. These findings suggest that medical training needs to include better and more structured education on transfusion practices, especially for complex topics like managing risks.
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What do the results of the study mean?
The results show that there is an urgent need to improve how junior doctors are trained in blood transfusion practices. In fact, by providing better training programs and more practical experience, hospitals can make transfusions safer and reduce mistakes. This study is calling for changes in medical education to ensure that doctors are well-prepared to handle blood transfusions safely and effectively.
Article highlights
The study assesses the knowledge level of junior doctors in Tunisia about transfusion medicine. It uncovers substantial knowledge gaps despite its critical role in patient safety.
It reveals that a moderate level of transfusion knowledge among junior doctors is insufficient to meet clinical demands.
Lowest knowledge scores include transfusion risk management and higher response of incompatible RBC transfusion, pointing to an urgent need for targeted education.
Continuous training, hands-on experience, and alignment with real clinical practices are recommended to enhance competency and safety in transfusion procedures.
The study calls for improvements in transfusion medicine education and curriculum integration in Tunisia to reduce transfusion-related errors.
1. Introduction
Blood transfusion practice has transformed the medical landscape and becoming one of the most life-saving medical procedure even with the existence of more affordable and safer alternatives [1]. Despite numerous measures aimed to secure the transfusion chain, this practice can carry risks and may sometimes result in transfusion accidents threatening patients’ lives. The British register of transfusion « serious Hazards of transfusion » (SHOT) states hemolytic reactions as the most common transfusion reaction, witch less than half are due to human error [2].
To ensure the quality of blood transfusion, many countries have implemented new measures. Since the establishment of the European directive 2002/98/EC, 70% of countries have allocated a specific focus on blood transfusion during medical training, while 59% have established credit-training systems [3].
Regarding Tunisia, the country currently has an infrastructure that meets international standards. Also, Tunisia ensures that legislative and regulatory texts are regularly updated to improve transfusion safety [4,5]. Although the medical curriculums include transfusion medicine as a learning unit, several gaps have been identified [6]. The most common complications of blood transfusion in Tunisia are largely attributed to human errors, particularly due to incorrect patient identification or inadequate bedside practices [7].
Interns and residents in transfusion clinical services play a crucial role among the actors in transfusion in hospitals. It is essential to be aware of these risks and to adhere to established protocols to reduce the risk and blood components wastage. These protocols align with Tunisians laws on transfusion medicine, which require practitioners to possess adequate knowledge. The prevailing belief is that transfusion knowledge is better acquired through clinical experience rather than formal education. This prompted us to evaluate the knowledge level of junior doctors regarding the entire transfusion process in Mohamed Taher Maamouri (MTM) University Hospital in Nabeul, Tunisia. This initiative was conducted by the transfusion and hemovigilance committee of MTM hospital regarding the major gaps found in residents from various medical specialty [8]. The investigation using a comprehensive questionnaire, seeks to assess the knowledge gained about the safe management of patients requiring transfusions. Our focus was not only on assessing competencies and identifying potential gaps, but also proposing an action plan. This plan focuses on evaluating the effectiveness of traditional teaching methods in response to the current needs observed in clinical settings.
2. Materials and methods
2.1. Design
This cross-sectional descriptive study was conducted from February to April 2023. It is focusing on junior doctors involved in administering blood transfusions across nine clinical departments at the MTM University Hospital in Nabeul. These departments included intensive care, emergency medicine, surgery, orthopedics, internal medicine, gastroenterology, pulmonology, cardiology, and otorhinolaryngology (ORL). The study included approximately 102 interns and residents with at least two months of work experience.
2.2. Measurement tool
The questionnaire was conducted by specialized field interviewers and validated by members of the transfusion and hemovigilance committee. It covered all aspects of the transfusion process, from prescribing blood components to monitoring transfused patients and implementing hemovigilance practices. The questions were based on the undergraduate curriculum of the medical faculty affiliated with the hospital, as well as the common objectives for the residency examination [9]. All the questionnaires were the closed type to avoid the problems related to scoring the open-ended responses. The option of responding “I don’t know,” was also included to prevent guessing. The questionnaire included four different concepts (C) of transfusion process with a total of 15 questions, as detailed bellow (single and multiple response):
C1: Basic Knowledge: Prescription, compatibility rules
C2: Pre-Transfusion Initiation: consent, preparation and bedside testing.
C3: Transfusion Monitoring: Flow rates and monitoring.
C4: Transfusion risk management: Incident handling and hemovigilance
The questionnaire included four eliminatory questions, where incorrect answers could pose life-threatening risks. These questions are as follows:
Q5 under C1, related to ABO, Rh, and Kell compatibility
Q9 under C3, addressing the administering flow transfusion
Q11 under C2, concerning the bedside rules
Q14 under C4, regarding the procedures to follow in case of adverse events
It is important to note that any response to these questions, whether partially or completely incorrect or incomplete, was assigned a score of 0. In such instances, the training for the corresponding concept was considered not acceptable.
The evaluation of these four concepts used two scoring systems:
The first scoring system assessed satisfaction with the training on the four studied concepts through standard questions. All results for each concept were standardized on a common scale of 10 points (Table 1).
The second scoring system differentiated between standard questions and eliminatory questions within each concept.
Table 1.
Evaluation scale for responses.
| Concepts assessed | Training qualification |
|
|---|---|---|
| Not acceptable | Acceptable | |
| C1: Basic Knowledge of Blood Prescription; Q1 to Q7 (7 pts) | ≤4 | >4 |
| C2: Pre-Transfusion Initiation; Q8, Q10, Q11 (3 pts) | <2 | ≥2 |
| C3: Transfusion Monitoring; Q9 and Q12 (2 pts) | <1 | ≥1 |
| C4: Transfusion risk management; Q13, Q14, Q15 (3 pts) | <2 | ≥2 |
C: Concept; Q: Question; pts: points
2.2.1. Validation and pilot study
A first version was initially applied to a small group of residents to detect ambiguous question and formulation leading to confusion. All modifications were applied. The final version was validated by the hemovigilance committee members to enhance the readability and clarity of the questionnaire. Specialized items were not included in this version.
The final version was distributed to 102 junior doctors. Only departments with direct involvement in transfusion were included. Laboratory residents were excluded to avoid biased interpretations, as transfusion topics are part of their training program.
2.3. Questionnaire distribution
The questionnaire was created in digital format and distributed by sharing a web link with each department’s hemovigilance correspondent, after the approval from their departments heads. Additionally, posters featuring a quick response (QR) code were displayed in the meeting rooms of each department to facilitate access to the questionnaire.
2.4. Data analysis
Data analysis was conducted using IBM SPSS® Statistics version 22 with a significance threshold of p = 0.05. In this study we used both qualitative and quantitative analyses. We applied the Chi-square (χ²) test for qualitative data. For quantitative data, the Student’s t-test was used for normally distributed data with homogeneous variance of single category, while ANOVA was used for multiple categories. If these conditions were not fulfilled, the non-parametric Mann–Whitney test was applied for single modalities, and the Kruskal–Wallis test for multiple modalities.
2.5. Ethical considerations
Permission was obtained from the responsible of the local ethics committee at MTM Hospital to initiate the study. Participation was voluntary, and anonymity was guaranteed.
3. Results
3.1. Participants’ characteristics and training
In this study, 82 of interns and residents among 102 members of medical staff participated, giving a return rate of 80%. Of the participants, 82% (67/82) were residents. The sex ratio was 0.82 with a median age of 27 years. Only 41% (34/82) of participants had received prior training in blood transfusion practices. Most participating doctors were from Surgery, Orthopedics, ICU and Pneumology departments (Table 2).
Table 2.
General characteristics of the participants.
| Variable | Residents | Interns | Total |
|---|---|---|---|
| Participants (n, %) | 67 (82%) | 15 (18%) | 82 (80%) |
| Sex (M/F) | (34/33) | (3/12) | (37/45) |
| Age, median, range | 25 [24-26] | 27.4 [25-32] | 27 [24-32] |
| Departments | |||
| Orthopedics | 10 (76.9%) | 3 (23.1%) | 13 (16%) |
| Surgery | 12 (85.7%) | 2 (14.3%) | 14 (17%) |
| ICU | 8 (80%) | 2 (20%) | 10 (12%) |
| Emergency | 7 (100%) | 0 | 7 (9%) |
| Pneumology | 7 (70%) | 3 (30%) | 10 (12%) |
| Gastrology | 6 (75%) | 2 (25%) | 8 (10%) |
| Internal medicine | 5 (83.3%) | 1 (16.7%) | 6 (7%) |
| Cardiology | 7 (77.8%) | 2 (22.2%) | 9 (11%) |
| ORL | 5 (100%) | 0 | 5 (6%) |
| Work experience | |||
| [0-2] years | 44 (65.7%) | 15 (100%) | 59 (72%) |
| [2-3] years | 15 (22.3%) | 0 | 15 (18%) |
| [3-4] years | 5 (7.5%) | 0 | 5 (6%) |
| More than 4 years | 3 (4.5%) | 0 | 3 (4%) |
| Previous training | 30 (44.8%) | 4 (26.7%) | 34 (41%) |
| Score (median, range) | 6.5 [0-12.5] | 2.3 [0-9] | 6.2 [0-12.5] |
| Total Knowledge (median, range) | 43% [0-83%] | 17% [0-60%] | 41.5% [0-83%] |
| Poor* (n,%) | 22 (68.7%) | 10 (31.3%) | 32 (39%) |
| Moderate* (n,%) | 35 (87.5%) | 5 (12.5%) | 40 (48.8%) |
| Good* (n,%) | 10 (12.2%) | 0 | 10 (12.2%) |
M = male; F = female; Poor: total knowledge of correct answers <30%; Moderate: total knowledge = 30–65%; Good: total knowledge ≥65%.
Of all participants, 72% (59/82) had less than one year of experience, whereas only 10% (8/82) had over three years of experience in transfusion services.
3.2. General knowledge
Overall, the knowledge score scaled to 100%, ranged from 0 to 83% with a mean of 32.4% across the entire questionnaire indicating that no one had correctly answered all the questions. Analyzing results according to the average score, 41.5% (34/82) had an average score over 5/10 with 70% (47/67) of residents.
Based on Yami et al study, knowledge score was categorized in 3 groups. According to this classification, the majority of juniors doctors have a moderate knowledge. Most interns (31.3%; 10/32) and residents (66.6%; 10/15) have been located in the poor and moderate groups, respectively. The good knowledge group was established exclusively with residents (15%; 10/67). According to department, the highest scores were those of Gastrology (42.8%, 6.4/10), emergency (41.2%, 6.1/10) and pulmonology (38.1%, 5.7/10). Resident from gastrology and orthopedics specialties have the higher knowledge score.
3.3. Surveyed items by concept
Among all participants, the evaluation of knowledge on blood transfusion concepts indicates a satisfactory response rate (SRR) of 28% (23/82) and 43% (35/82) for basic knowledge of blood prescription (C1) and pre-transfusion initiation (C2), respectively. In contrast, transfusion monitoring (C3) received a satisfactory rating from 60% (49/82) of participants. However, the SRR for transfusion risk management at C4 was alarmingly low, at only 11% (9/82).
As shown in Table 3, analysis of correct answer rates (CARs) by question reveals a marked heterogeneity, with significant differences between the CARs for each question. In fact, of the 15 questions proposed, only 3 had a CARs above 50%. These are questions Q5, Q9 and Q11, with CARs of 78% (64/82), 60% (49/82) and 52% (43/82) respectively. It is essential to note that these three questions are all eliminatory questions relating to three different concepts, C1, C3 and C2, respectively.
Table 3.
Correct answer rate among items.
| Concepts | Questions | Correct answer | Number of correct answer | % of correct answers |
|---|---|---|---|---|
| C1: Basic knowledge | ||||
| Q1 | Indications of RBC transfusion | c | 6 | 7% |
| Q2 | PSL qualifications | a, c, d | 7 | 9% |
| Q3 | dosage and transfusion yield | c, d, e | 14 | 17% |
| Q4 | Regular pre-transfusion tests in Tunisia | a,b,c,d | 26 | 32% |
| Q5 | Compatibility rules ABO, RH, Kell | b,d | 64 | 78% |
| Q6 | Compatibility rules of FFP et PC | a,c,e | 7 | 9% |
| Q7 | handle of compatibilized and not transfused RGCs in the department | d,e | 9 | 11% |
| C2: Pre-Transfusion Initiation | ||||
| Q8 | Indications of RBC transfusion | a,c,d | 11 | 13% |
| Q10 | PSL qualifications | a,b,c,d | 1 | 1% |
| Q11 | Bedside test | a,c,e | 43 | 52% |
| C3: Transfusion monitoring | ||||
| Q9 | Regulation of transfusion flow rate | a,d | 49 | 60% |
| Q12 | Surveillance | c | 13 | 16% |
| C4: Transfusion risk management | ||||
| Q13 | Tracaebility | a,b,c,e | 6 | 7% |
| Q14 | Management of Transfusion reaction | a,c,d,e | 15 | 18% |
| Q15 | Hemovigilance | A,b,c,e | 3 | 4% |
RBC: red blood cells; PSL: labile blood product; FFP: fresh frozen plasma; PC: platelet concentrates; C: concept; Q: question.
CAR was low, with a rate of 32% (26/82) for Q4 and rates below 19.5% (16/82) for the remaining 11 questions, six of which had rates under 10%. Notably, Q10 recorded a poor CAR, reaching just 1% with only one correct answer.
3.4. Eliminatory questions
The rate of unsatisfactory responses (URR) varies by question but remains consistently high, with an overall rate of 49% (40/82). Specifically, the URR was 40% for transfusion monitoring flow and 47.5% (39/82) for bedside control. In contrast, the rate for RBC compatibility rules was comparatively lower at 22% (18/82). However, the URR for incident transfusion handling reached 82% (67/82), highlighting a significant area of concern.
The eliminated answers for Q14 and Q11 with a difference of ≥ 2 from the correct answer, as well as “I don’t know” answers, account for more than three-quarters of the eliminated responses. For Q5 and Q9, the eliminated answers with a difference of ≥ 2 from the correct answer, along with “I don’t know” answers, make up nearly half of the eliminated responses.
3.5. Correlations
To measure the strength and correlation between variables, non-parametric tests were performed. As shown in Table 4, the Spearman correlation analysis revealed a significant positive correlation between junior doctors’ work experience and their obtained scores (p = 0.007, r = 0.36). Furthermore, the Kruskal–Wallis H test confirmed a statistically significant difference in work experience among different knowledge groups, (χ2(2)=7.4,p = 0.001) with median ranks of work experience being 16.5 for the poor knowledge group, 52.5 for the moderate group, and 77.5 for the good group.
Table 4.
Correlation of categorized knowledge scores with demographic data.
| Variables | Total knowledge |
p | ||
|---|---|---|---|---|
| Poor (n = 32) | Moderate (n = 40) | Good (n = 10) | ||
| Sex | 0.5 | |||
| Female | 17 (37.8%) | 24 (53.3%) | 4 (8.9%) | |
| Male | 15 (40.5%) | 16 (43.2%) | 6 (16.2%) | |
| Age (median, range) | 26 [24-32] | 27 [25-30] | 28.5 [27-30] | 0.07 |
| Statue | ||||
| Intern | 10 (66.7%) | 5 (33.3%) | 0 | 0.03 |
| Resident | 22 (32.8%) | 35 (52.2%) | 10 (14.9%) | |
| Work experience (median, range) | 0.9 [0-4] | 1.1 [0-3] | 2 [1-4] | 0.007 |
| Previous training (n, %) | 0.08 | |||
| Yes | 10 (29.4%) | 18 (52.9%) | 6 (17.7%) | |
| No | 22 (45.8%) | 22 (45.8%) | 4 (8.4%) | |
| Score (median, range) | 2.1 [0-4.2] | 7.6 [4.5-9.2] | 10 (9.75-12.5] | <0.001 |
Additionally, the Mann–Whitney U test was performed to compare knowledge scores between junior doctors’ degrees and prior training. The results indicated that residents (n = 67, mean rank = 44.1) achieved higher knowledge scores compared to interns (n = 15, mean rank = 29.5) (p = 0.02, Mann–Whitney U = 322.50). Junior doctors with prior training (n = 34, mean rank = 47.4) tend to have higher knowledge scores than those without training (n = 48, mean rank = 37.3) (p = 0.05, Mann–Whitney U = 615). The knowledge scores for doctors with prior training reached a median of 7.2 [0–12.5], compared to 5.2 [0–11] for those without previous training (p = 0.01, r = 0.2).
To assess the impact of various factors on knowledge score, we opted for qualitative approach that involves a comparison between categorized knowledge scores and demographic data (Table 4).
When analyzing the influence of various factors on the transfusion concepts studied, status had a significant impact only on C1. In fact, residents showed a higher level of knowledge and achieved a median score of 5.12 compared to 3.82 for interns (p = 0.015). The correct response rate (CRR) was 34% for residents, while interns had no CRR. Work experience of more than 3 years had a positive effect on C1, C2, and C4. No statistically significant association was found between gender, department, prior training and juniors’ doctors knowledge.
4. Discussion
A key factor in the success of any transfusion process is the involvement of residents and interns, whose practical skills and knowledge are critical to patient management, from initiation to post-transfusion care. However, their level of expertise varies, often depending on the quality of training they received. This links directly to the findings of this study where the limited experience in transfusion highlights a significant gap in practical experience. Despite having a solid theoretical foundation, insufficient prior training reported by 56% of participants, reflects a broader issue. This issue was observed across various countries, including Tunisia (42%), Marrakech (41.5%), France (43%), Bangladesh (59%), Mali (29.1%), Niger (22.2%) and Brazil (27.3%) [10–15]. In the study conducted by Wheeler et al, gaps in transfusion knowledge during medical school and residency were only slightly addressed [16]. These gaps emphasize the need for targeted training programs to enhance practical skills, ensuring a safe and efficient transfusion process.
In comparison with similar studies, junior doctors consistently demonstrate insufficient knowledge, with scores below 50% in most cases [17–-22]. A study involving 1,467 residents across six countries (US, UK, Brazil, Canada, Singapore, Netherlands) reported a mean score of 37.1%, with scores ranging from 9.5% to 71.4% [10]. Similarly, studies in Brazil (43.5%) [23] and India (48.3%) [21,24–26], reflect persistent knowledge gaps, while Moroccan and Tunisian studies reveal substantial deficiencies, with scores as low as 31.5% [11,27,28]. These results indicate that the issue is widespread and requires urgent attention [29,30].
Regarding specific topics in transfusion medicine, this study found the highest scores in pre-transfusion initiation (C2=43%) and transfusion monitoring (C3=60%). Topics with the lowest scores were basic knowledge of blood transfusion (C1=28%) and transfusion risk management (C4=11%). The lower scores in C1 and C4 may be explained by their theoretical nature, whereas C2 and C3 are more practical and systematic, applied during each transfusion procedure. Similar results were observed in a study by Rock G, where technical knowledge (63%) outperformed basic knowledge (37%) [31].
Despite the second best understood topic rank, the low score in the SRR of C2 highlights a concerning issue. This may be due to residents and interns overly relying on compatibility test results from the laboratory, neglecting that these tests only reflect the sample provided during the direct compatibility test. They often fail to consider the risks of patient misidentification during blood collection and potential errors during the administration of RBC units.
The low SRR of C1 can be attributed to the lack of a solid academic foundation in transfusion medicine within the country’s medical schools. This issue appears to be a global issue, as evidenced by Al-Riyami AZ et al across a study of 31 countries on four continents. It revealed that 25% of the surveyed medical schools did not provide structured education in transfusion medicine [32].
One of the most concerning findings is the low general knowledge level in transfusion reaction management. This result aligns with most previous studies in this field, reporting rates below 25% in the study by Halford B [33] and 12% in the study by Viena M [23]. Effective incident management is crucial for minimizing transfusion-related adverse events. However, the underperformance in this area, along with 48% of URR about bed-side controls, presents a significant safety risk. Transfusion incidents can lead to serious, life-threatening complications if not managed properly. This issue may stem from minor incidents and the tendency of medical personnel to prioritize immediate patient safety during transfusion accidents. They often relegate the initiation of investigations and the exploration of underlying causes to a secondary concern.
The analysis of URR for eliminatory questions shows high variability across items, with consistently elevated rates for transfusion reaction management (Q14) and bed-side test (Q11: validation of an incompatible transfusion) increased dissatisfaction linked to a higher number of correct options. Similar to others studies, this finding highlighted the complexity of these items that could compromise the safety of patients [20,34].
Responses that include “I don’t know” make up the majority of eliminations in transfusion reaction management and regulation of transfusion flow rate (Q9), indicating a genuine lack of knowledge gap rather than simple errors of confusion. These findings reflect not only cognitive limits in processing complex elimination tasks but also a clear gap in subject mastery.
Several factors contributed to the variation in knowledge among participants. Residents exhibited a higher level of competence compared to interns, particularly in the “Basic Knowledge of Blood Prescription” concept, where their median score was significantly higher. This highlights the significance of clinical experience in enhancing practical knowledge, challenging the hypothesis that interns possess a better understanding of foundational concepts due to their recent academic training. Additionally, it seems that essential knowledge is more frequently acquired through hands-on experience in transfusion services rather than through the medical school curriculum. This trend may also be influenced by information gained during residency preparation courses. The analysis by department reveals that gastroenterology and emergency medicine have the highest average scores. This may be explained with the frequency of transfusion.
Experience was found to positively affect performance, with senior doctors scoring higher in transfusion-related concepts [26,34]. However, knowledge levels decreased in later residency years. This decline may result from reduced exposure to transfusion medicine as residents focus more on their specialties [23,26].
Unlike previous studies [18,20,22], this research did not found a positive correlation between knowledge and prior training in transfusion medicine. These findings align with two studies from India and Brazil, reported similar findings [21,23]. The lack of data on transfusion medicine training hours could explain this result, as studies suggest that training hours and recent education are linked to higher physician knowledge and better evaluation outcomes [18,22]. Research across various countries [18,21,35], including Tunisia [8,28], has highlighted the need for further training in transfusion medicine to improve clinical practices. To support evidence-based education, transfusion medicine should be taught in alignment with available guidelines, featuring clear learning objective and effective assessments to build students’ clinical skills. Additionally, innovative educational tools are essential for building skills in this field that are currently gained mostly through practical experience [36–38]. According to our knowledge, no reports in the literature are available concerning the evaluation of knowledge of Tunisian Junio’s doctors with a validated instrument that could guide the planning of national actions. According to Lin and Haspel, the development of a curriculum for transfusion medicine requires problem identification and assessments [39].
4.1. Study limitations and perspectives
Although the restricted sample size in a single institution that limits the generalization of the results, this study reinforces previous findings. These findings emphasized the need of more transfusion medicine programs targeting medical students, graduates, residents, and decision-makers. A combination of strategies is likely to be more effective, especially when it is implemented consistently (Table 5).
Table 5.
Strategies for enhancing transfusion medicine education.
| Strategy | Description |
|---|---|
| Standardizing Global Curriculum | Ensuring consistent training in transfusion practices, including competencies in blood component prescription and patient management [32]. |
| Simulation Training | Using high-fidelity simulators to practice transfusion procedures and manage complications in a controlled environment. Studies show that simulation enhances clinical skills and confidence [40,41]. |
| Serious Gaming | Serious gaming refers to the use of game design elements to create an immersive and educational experience in blood component selection, transfusion management, and dealing with complications. Using interactive, game-based learning to engage students and improve knowledge retention [42,43]. |
| Interactive Online Modules | Digital and e-learning platforms can provide directed learning and improve accessibility and knowledge retention, positively impacting clinical outcomes, such as reduced blood ordering and improved patient care. Regular updates are essential for retaining transfusion competencies [32,44,45]. |
| Case Team-Based Learning and OSCE | Presenting real-life scenarios facilitates critical thinking and knowledge application. Research indicates that these tools improve retention and understanding [36,46,47]. |
| Workshops and Seminars | Organizing workshops and seminars promotes collaboration and discussion, enhancing a deeper understanding of transfusion practices. |
| National Certification Program for Medical Trainers | Implementing a national certification program for trainers in transfusion medicine ensures consistent and effective education across institutions. |
| National-level Hemovigilance System | Introducing a hemovigilance system to monitor transfusion practices and outcomes, providing feedback and continuous education to junior doctors based on real-time data. |
Future research should expand the scope to include multiple hospitals across Tunisia to determine whether the knowledge gaps observed here are pervasive nationwide. Additionally, while the study used a validated questionnaire to assess knowledge, more comprehensive evaluations incorporating practical simulations could provide a more accurate measure of transfusion competencies.
5. Conclusion
This study offers valuable insights into knowledge gaps in transfusion medicine among junior doctors in Tunisia. With only a moderate knowledge score, it is evident that substantial educational deficiencies exist. These gaps, which pose risks to patient safety and transfusion efficacy, highlight an urgent need for targeted enhancements in medical education. Implementing continuous training sessions, hands-on experience, and better alignment between educational content and real-world clinical demands, along with enriched curricular materials, are essential to help junior doctors apply their knowledge effectively. By addressing these gaps, healthcare systems can meaningfully improve patient safety and reduce the likelihood of transfusion-related errors.
Acknowledgments
We thank all authors who contributed to this work. We thank all juniors’ doctors who participated in this study. We thank Dr Ghachem Ichrak for accepting the revision of this manuscript.
Funding Statement
This article was not funded.
Authors contributions
A. Abed, I. Ghachem and Y. Kaabar contributed to the conception and design of the study. A. Abed and Y. Kaabar were responsible for acquisition of data and analysis. I. Ghachem and A. Abed were responsible for writing draft. I. Ghachem, S. Chouaib, A. Bachali and M. Y. Kaabar were responsible for revision of the manuscript and the final approval of the version to be published.
Disclosure statement
The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Ethical declaration
Permission was obtained from the responsible of the local ethics committee at MTM Hospital to initiate the study.
Data sharing statement
The data that support the finding are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the finding are available from the corresponding author upon reasonable request.