Experiences and Perceptions of Ophthalmic Simulation-Based Surgical Education in Sub-Saharan Africa

Abstract

BACKGROUND Simulation-based surgical education (SBSE) can positively impact trainee surgical competence. However, a detailed qualitative study of the role of simulation in ophthalmic surgical education has not previously been conducted. OBJECTIVE To explore the experiences of trainee ophthalmologists and ophthalmic surgeon educators’ use of simulation, and the perceived challenges in surgical training. METHODS A multi-center, multi-country qualitative study was conducted between October 2017 and August 2020. Trainee ophthalmologists from six training centers in sub-Saharan Africa (SSA) (in Kenya, Uganda, Tanzania, Zimbabwe and South Africa) participated in semi-structured interviews, before and after an intense simulation training course in intraocular surgery. Semi-structured interviews were also conducted with experienced ophthalmic surgeon educators. Interviews were anonymized, recorded, transcribed and coded. An inductive, bottom-up, constant comparative method was used for thematic analysis. RESULTS Twenty-seven trainee ophthalmologists and 12 ophthalmic surgeon educators were included in the study and interviewed. The benefits and challenges of conventional surgical teaching, attributes of surgical educators, value of simulation in training and barriers to implementing ophthalmic surgical simulation were identified as major themes. Almost all trainees and trainers reported patient safety, a calm environment, the possibility of repetitive practice, and facilitation of reflective learning as beneficial aspects of ophthalmic SBSE. Perceived barriers in surgical training included a lack of surgical cases, poor supervision and limited simulation facilities. CONCLUSIONS Simulation is perceived as an important and valuable model for education amongst trainees and ophthalmic surgeon educators in SSA. Advocating for the expansion and integration of educationally robust simulation surgical skills centers may improve the delivery of ophthalmic surgical education throughout SSA.

The utility of urological clinical and simulation training for Sub‐Saharan Africa

“…International tele‐collaboration, mentoring, and augmented reality have become indispensable in maintaining strong international ties during the pandemic and have aided global efforts to reduce the carbon footprint of F‐2‐F education [48]. However, these technologies rely on key infrastructure such as power supply and adequate internet access, which are still challenges that apply to, and are recognised as being issues for many locations in LMICs [49,50].…”

“…Whilst SBE has increased in both extent and scope in many HICs, a lack of funding, a limited pool of trainers, and sub‐optimal infrastructure have all been identified as barriers to its implementation in SSA [23,49]. Resistance to change, a lack of financial incentive, unsupported trainers and sustainability are all perceived obstacles to SBE’s adoption [50]. For a programme to succeed, a structured approach needs to be considered involving all stakeholders, with particular attention given to curriculum integration/reform, professional regulation, innovative teaching strategies, partnerships and collaboration, capacity building (simulation champions, trainers), infrastructure, and the sustainable provision of appropriate resources.…”

The Impact of Simulation-Based Trabeculectomy Training on Resident Core Surgical Skill Competency

“…Recent observations suggest that adopting surgical simulation training is widely accepted as a safer alternative to conventional surgical teaching. 16 Finally, there remains very limited data on surgical trabeculectomy rates and post-operative outcomes in SSA. We therefore suggest a follow-up comprehensive, comparative analysis of trabeculectomy outcomes in centers incorporating SBSE, to evaluate the real world effectiveness of the intervention on patient glaucoma care.…”

“… 15 Conventional ophthalmic surgical teaching in SSA typically uses theoretical-based learning, observation, low use of SBSE (mostly using low to moderate-fidelity simulation models), followed by live surgical teaching for advanced skill development. 16 Importantly, the use of SBSE varies across the different training institutions in the region and is not uniformly integrated into ophthalmic surgical training. For those using SBSE in their ophthalmic surgical training, many report inadequacy of training facilities and tools, as well as a lack of trainer supervision.…”

“…Importantly, the use of SBSE varies across the different training institutions in the region and is not uniformly integrated into ophthalmic surgical training. For those using SBSE in their ophthalmic surgical training, many report inadequacy of training facilities and tools, as well as a lack of trainer supervision 15. Yet, compared with the traditional Halstedian apprenticeship model of “see one, do one, teach one,” SBSE offers a safer alternative for junior surgeons to refine their skills in the absence of patient harm, by using artificial training models.…”