Continuous medical education for the diabetic foot adapted for a Caribbean context

Globally, gaps in the education of healthcare professionals (HCPs) have been established regarding diabetes and diabetic foot disease, with many HCPs receiving only diabetes-related education while in basic medical training. Within the landscape of Barbados, (a small island developing state (SIDS)), no structured diabetic foot HCP education programme exists despite the increasing incidence of diabetes. The aim of this study is to map HCP diabetic foot education needs within the Barbadian primary healthcare system and to design an educational programme for HCPs that fits the local cultural context. Thematic analysis, informed by an interpretivist philosophical paradigm with constructivist theory was used to analyse data from nine focus groups with healthcare professionals and nongovernmental stakeholders across Barbadian public and private healthcare settings. Data were collected between June 2023 and February 2024. Organising themes were mapped against International Working Group on the Diabetic Foot guidance to identify minimum competencies for curriculum development. The BDFS-LEARN curriculum was then designed with constructs aligned to Adult Learning Theory and Bloom''s Taxonomy with expert validation informing final content. Three themes emerged from the data analysis namely: (1) “The Gaps”, encapsulating gaps in knowledge of HCPS which acted as barrier to diabetes care; (2) “The Discord”, encompassing tension between evidence-based medicine and alternative medicine; “bush medicine”; and (3) “The Vision”-captures the felt need of how diabetic foot education for HCPs should be offered from the perspective of potential users. Based on these findings, the BDFS-LEARN HCP curriculum was designed for hybrid delivery, consisting of a 90-minute self-guided online component followed by a four-hour in-person workshop for skill refinement. The curriculum includes eight online modules and one in-person module, supporting 11 minimum competencies. It was informed by International Working Group on the Diabetic Foot guidance and designed to provide a culturally appropriate, acceptable, and accessible learning experience for the Barbadian context, with potential relevance to other resource-limited settings.