Standardised Competency‐Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone

Abstract

Introduction In low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training. Methods All trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeon’s Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training. Results During three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery. Discussion and conclusion Mesh repair is the international standard for inguinal hernia repair worldwide. Nevertheless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe. Trial Registration: International Clinical Trial Registry ISRCTN63478884.

Global access to technologies to support safe and effective inguinal hernia surgery: prospective, international cohort study

“…Several barriers to implementation in the Global South have been identified previously, including costs, distribution, and training 8 , 9 . To overcome these, studies reporting the use of mesh based on mosquito net mesh and evaluating training programmes have been conducted 10 , 11 . With these efforts and with global investment in new technologies and the expansion of existing technologies, it was expected that there would be an increase in their use in low–middle-income countries.…”