While there is considerable geographic variation between countries, the regional surgical workforce represents less than 4 % of the equivalent number in developed countries indicating the magnitude of the human resource challenge to be addressed.
High surgical graduate retention rates across the region indicate that the expansion of national surgical training initiatives is an effective solution to addressing the surgical workforce shortage in East, Central and Southern Africa and counters long-held arguments regarding brain drain in this region.
Global surgery is an emerging field of study and practice, aiming to respond to the worldwide unmet need for surgical care. As a relatively new concept, it is not clear that there is a common understanding of what constitutes “global surgery education and training”. This study examines the forms that global surgery education and training programmes and interventions take in practice, and proposes a classification scheme for such activities. A scoping review of published journal articles and internet websites was performed according to the PRISMA Extension for Scoping Review guidelines. PubMed MEDLINE, EMBASE and Google were searched for sources that described global surgery education and training programme. Only sources that explicitly referenced a named education programme, were surgical in nature, were international in nature, were self-described as “global surgery” and presented new information were included. Three hundred twenty-seven records were identified and 67 were ultimately included in the review. “Global surgery education and training” interventions described in the literature most commonly involved both a High-Income Country (HIC) institution and a Low- and Middle-Income Country (LMIC) institution. The literature suggests that significant current effort is directed towards academic global surgery programmes in HIC institutions and HIC surgical trainee placements in LMICs. Four categories and ten subcategories of global surgery education and training were identified. This paper provides a framework from which to study global surgery education and training. A clearer understanding of the forms that such interventions take may allow for more strategic decision making by actors in this field.
IMPORTANCE Surgical conditions are an important component of global disease burden, due in part to critical shortages of adequately trained surgical providers in low-and middle-income countries.OBJECTIVES To assess the use of Internet-based educational platforms as a feasible approach to augmenting the education and training of surgical providers in these settings.
Background Countries in Sub-Saharan Africa lack adequate surgical workforces to achieve safe and affordable care for their populations. The Global Surgery movement highlights the urgent need to address this situation. Interventions include not only financial, material and infrastructural support, but also collaborative information flow to support surgical training. In 2015, an electronic logbook was launched for surgical trainees across Sub-Saharan Africa.Objectives To assess the integration and context sustainability of surgical e-logbooks in Sub-Saharan Africa. Methods In January 2019, a survey analysis of surgical trainees was employed using quantitative and qualitative methods. Participants (active trainees and recent fellows) completed an anonymous internet-based questionnaire evaluating end-user feedback, perceptions and self-reported compliance. Multi-point Likert Scale measures and freetext thematic analysis were used. Results 358 (68.19%) eligible individuals across 21 Sub-Saharan countries and seven surgical specialties voluntarily participated. The e-resource demonstrated integration into local curricula with the majority of users maintaining activity and reporting moderate-high compliance. Context appropriateness measures were high with 203 (69.76%) deeming it convenient to use. The principle obstacle to compliance was internet connectivity (74, 25.96%), while behavioural factors including supervisor engagement were implicated. The e-logbook demonstrated future sustainability with the majority (243, 78.14%) of participants intent on maintaining usage beyond completion of surgical training. Conclusions We describe the successful integration and sustainability of electronic surgical logbooks for trainees across Sub-Saharan Africa. However context-appropriate resources are essential for Low-and Middle-Income Countries. Internet connectivity may hinder the achievement of several Global Surgery objectives in Sub-Saharan Africa.
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