Specialist Surgical Training in Papua New Guinea: The Outcomes After 10 Years

Abstract

Surgical training commenced in 1975, the year that Papua New Guinea (PNG) gained independence. The training involves a 4-year programme leading to a Master of Medicine (MMed), awarded by the University of Papua New Guinea. In the past 30 years just over 50 general surgeons have graduated. There have also been 9 graduates in the area of ear nose and throat, 10 in ophthalmology and 2 in oral surgery. The subspecialization of general surgeons began in 1994 with four trainees, two orthopaedic, one head and neck and one urological. The model used was to develop specialist skills over 2-3 years only qualified (MMed) general surgeons so that their ability to carry out general surgical procedures and work in a remote hospital was not lost. The different specialties required different balances of in-country and out-of-country training depending on the local ability to provide training in PNG. An important sponsor has been the PNG National Department of Health, which has funded the training posts by using existing general surgical positions and covering the loss of manpower while surgeons are training overseas, sometimes for up to 2 years. Medical education and tertiary health service projects, funded by Aus-Aid, have also contributed significantly to the teaching and training. These projects have provided visiting specialists to teach and hospital attachments for national surgeons to train in Australasia. Various individual surgeons and their specialist societies in Australasia have also provided invaluable support. Three surgeons have been recipients of the Rowan Nicks scholarship. Twelve surgeons have been awarded a specialist diploma and a further five are in training. The posting of national specialist surgeons to Port Moresby has resulted in all modules of the General surgery MMed programme being taught by Papua New Guineans, which would have been hard to imagine back in 1993. The MMed is now a sustainable programme and can be provided without external support. National surgeons carry out a wide range of specialist procedures, formerly carried out only by visiting teams. They are also able to make outreach visits within PNG and specialist visits to neighbouring Pacific Island countries.

Surgical training programmes in the South Pacific, Papua New Guinea and Timor Leste

“…Twenty‐two surgeons have completed UPNG's higher postgraduate diploma in a subspecialty, a qualification that was introduced in 1994. The relevant subspecialties are orthopaedics (8), urology (3), head and neck/plastics (3), paediatric surgery (4), neurosurgery (2) and cardiothoracic surgery (2), with eight surgeons currently undergoing subspecialty training.…”

“…Even without the addition of five surgeons who practised abroad for some years, but have since returned, the rate would have been 91 per cent (85 of 93). Retention has been helped in recent years by improving remuneration and conditions for specialists working in the public sector (including rights to limited private practice), but also by the opportunities to develop a subspecialty interest and receive further training beyond the broad base of general surgery.…”

Academic Surgery in Papua New Guinea

“…Sankar left in early 1991, and David Watters succeeded him (1992–2000). Under his leadership, and with the support of Jacob Ollapallil, the number of general surgeons trained increased and surgical subspecialities were developed in orthopaedics, urology, head and neck surgery, paediatric surgery and neurosurgery 11,12 . The capabilities of national surgeons took a giant step forward 13 .…”

“…Up to 2007, 57 surgeons, including 3 Solomon Islanders, 1 Micronesian and 1 Tongan, have successfully completed postgraduate surgical training and passed the Master of Medicine (Surgery) examination 12 . Thirteen have completed subspecialty training (orthopaedics 5, head and neck 3, urology 2, paediatric surgery 2 and neurosurgery 1) and acquired the higher diploma in surgery.…”

Template for Surgical Training in Resource‐poor Countries

“…It is a truly remarkable achievement to have then met the surgical needs of all major public hospitals with locally trained general surgeons and have further trained and retained a dozen in specialty surgical disciplines. The history of the Papua New Guinea (PNG) surgical programme that Kevau and Watters have described offers a needed template for international collaboration promoting the development of surgical services in low‐income countries 1 …”