Long-Term Impact of a Mission-Based Surgical Training Rotation on Plastic Surgery Capacity Building in Rwanda.

OBJECTIVE: Short-term, high-volume surgical training experiences can lead to successful skills transfer and be an effective method of training surgical providers in low-resource settings. However, immediate skills acquisition does not guarantee long-term performance of surgical procedures by trainees. This study aims to determine the long-term impact of a short-term plastic surgery training rotation (STR) on general surgeon contribution to plastic surgery capacity building in Rwanda. DESIGN: A retrospective survey study was conducted. Surveys were distributed to credentialed general surgeons who previously participated in the Operation Smile STR in Rwanda. Questions focused on exposure to procedures during the rotation and current practice demographics. The percentage of current practice volumes dedicated to plastic surgery was mapped to demonstrate participant contribution to plastic surgery capacity in the country. SETTING: Surveys were distributed remotely. Surgeon respondents previously participated in the STR at the Rwinkwavu District Hospital, a primary level hospital in eastern Rwanda. PARTICIPANTS: All 8 prior participants of the STR who completed residency and are currently practicing as general surgeons in Rwanda were included. RESULTS: Six out of 8 prior participants completed the survey (75.0%). All respondents work as general surgeons in governmental hospitals around the country. Up to 75% of surgeon caseloads are dedicated to plastic surgery procedures. Half of respondents work in regions without a credentialed plastic surgeon. Exposure to cleft and congenital hand surgery during the rotation did not lead to durable performance in practice. All participants felt the rotation improved their performance in multiple core competencies. CONCLUSION: Participation in a short-term plastic surgery training experience in Rwanda was associated with increased long-term surgical capacity in the country through a task-sharing model. A mission-based rotation may provide sufficient exposure for basic plastic surgery procedures, but does not provide enough volume or time to durably teach more complicated surgeries such as cleft repair. Further studies are needed to determine how longer durations of training exposure impacts long-term performance of plastic surgery procedures.

Pilot Evaluation of the Impact of a Mission-Based Surgical Training Rotation on the Plastic Surgery Skills and Competencies Development of General Surgery Residents in Rwanda.

OBJECTIVE: Increasing subspecialty surgical capacity in Rwanda requires innovative approaches to augment the skills of pre-existing surgical providers. Short-term, high-intensity training programs can be effective for surgical education, however, few studies have investigated the quality of skills acquired through a condensed surgical experience. This study aims to determine the efficacy of a 3-week surgical training rotation (STR) to teach plastic surgery skills to general surgery residents in Rwanda. DESIGN: A survey-based, prospective observational study of general surgery residents and volunteer plastic surgery educators participating in an Operation Smile STR. Resident self-assessment scores of surgical capabilities at the beginning and end of the rotation were compared to surgeon evaluation of resident performance. Progression of resident performance and change in inter-rater reliability between residents and educators were analyzed. Student's t test with significance at p < 0.05 was used to confirmed statistical significance. SETTING: This study took place during the Operaiton Smile STR at the Rwinkwavu District Hospital, a primary level hospital in Rwinkwavu, Rwanda. PARTICIPANTS: All residents (5) and surgeon evaluators (4) who participated in the STR were included in this study. All study participants completed all study surveys. RESULTS: Residents reported a significant increase in confidence with the majority of procedures performed by the end of the rotation. Surgeons identified significant improvement in all resident skills by 2 weeks (p < 0.05). Resident ability to perform self-assessment improved, as determined by a significant decrease in inter-rater error margin from -0.61 to -0.10 over the course of the rotation (p < 0.01). CONCLUSIONS: In this pilot study, a 3 week rotation improved surgical competencies and technical skills of general surgery residents learning plastic surgery. These findings support using the short-term STR as a method for task-sharing education. Further studies are needed to determine durability of skills transfer and long-term impact on surgical capacity.

Competency-Based Education in Low Resource Settings: Development of a Novel Surgical Training Program.

BACKGROUND: The unmet burden of surgical disease represents a major global health concern, and a lack of trained providers is a critical component of the inadequacy of surgical care worldwide. Competency-based training has been advanced in high-income countries, improving technical skills and decreasing training time, but it is poorly understood how this model might be applied to low- and middle-income countries. We describe the development of a competency-based program to accelerate specialty training of in-country providers in cleft surgery techniques. METHODS: The program was designed and piloted among eight trainees at five international cleft lip and palate surgical mission sites in Latin America and Africa. A competency-based evaluation form, designed for the program, was utilized to grade general technical and procedure-specific competencies, and pre- and post-training scores were analyzed using a paired t test. RESULTS: Trainees demonstrated improvement in average procedure-specific competency scores for both lip repairs (60.4-71.0%, p < 0.01) and palate (50.6-66.0%, p < 0.01). General technical competency scores also improved (63.6-72.0%, p < 0.01). Among the procedural competencies assessed, surgical markings showed the greatest improvement (19.0 and 22.8% for lip and palate, respectively), followed by nasal floor/mucosal approximation (15.0%) and hard palate dissection (17.1%). CONCLUSION: Surgical delivery models in LMICs are varied, and trade-offs often exist between goals of case throughput, quality and training. Pilot program results show that procedure-specific and general technical competencies can be improved over a relatively short time and demonstrate the feasibility of incorporating such a training program into surgical outreach missions.