Surgical registrars' perceptions of surgical training and capacity in Zambia: Results from three COSECSA affiliated training hospitals

Freitas, Derek; Munthali, James; Musowoya, Joseph; Ismail, Hebah; Herbst, Allyson; Chikoya, Laston; Dhage, Shubhada; Hopkins, Mary Ann

doi:10.1016/j.amjsurg.2017.07.023

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…A few institutions offer an MMed in Plastic Surgery, the equivalent of the US integrated program, where trainees spend 2 years in general surgery and 3 years in plastic surgery. In some countries, trainees can be enrolled simultaneously in Plastic Surgery MMed and COSECSA MCS/FCS programs 20 . If a candidate has completed an MMed in Plastic Surgery, they may be able to sit for the FCS examination 21…”

Section: Resultsmentioning

confidence: 99%

“…Up to 6 months may be spent on rotations outside the COSECSA region at approved sites. Although there are no restrictions on duty hours documented in the regulatory documents, a survey of COSECSA trainees in different surgical specialties reported working an average of 52 hours per week 20 . There are 13 plastic surgery training programs available across the 14 COSECSA countries.…”

Section: Resultsmentioning

confidence: 99%

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Plastic Surgery Across Continents

et al. 2021

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There is a demonstrated need for access to plastic surgical care in low- and middle-income countries worldwide. Recently, there is increasing interest in promoting transcontinental partnerships between academic institutions to improve training opportunities for local surgeons while increasing access to care for patients. Before such programs can be established, it is crucial for US-based surgeons and educators to understand the existing training models in different countries. The aim of this study is to identify the current plastic surgery training model in the College of Surgeons of East, Central, and Southern Africa (COSECSA) group of African nations and compare this to training in the United States. The curricula of 2 accrediting bodies of plastic surgery, COSECSA and the Accreditation Council for Graduate Medical Education of the United States, were compared. Similarities included the length of dedicated plastic surgery training, curriculum content, and final evaluation structure. Differences include training pathways, assessment methodology, and regulation regarding specific competencies, program requirements, and resident benefits. These findings establish a baseline understanding of how plastic surgical training is organized, delivered, and evaluated in Africa, highlight opportunities for educational initiatives, and serve as a foundation for future efforts to develop collaborative partnerships in these communities. Future research will include a survey sent to program directors and plastic surgery attendings in the COSECSA regions to gather additional information.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Plastic Surgery Across Continents

et al. 2021

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“…The requirement for the course and the partnership A lack of confidence in the management of foot and ankle conditions was noted by the senior authors at the Fellowship of the COSECSA Orthopaedics examinations in Mombasa, Kenya in 2016. Indeed a review of feedback from Zambian orthopaedic trainees reported challenges in obtaining training in procedures, such as foot and ankle surgery, which were outside of the core specialties, and that without obtaining specialized training they had difficulty following textbook surgical practice in less common more difficult cases [6]. Similarly until the British Orthopaedic Foot and Ankle Society (BOFAS) developed the "Principles of Foot and ankle surgery" course, there was a perception from UK trainee surgeons towards the end of their training were underprepared in the fundamentals of foot and ankle surgery.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of delivering foot and ankle surgical courses in a partnership in Eastern, Central and Southern Africa

et al. 2022

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Background Foot and ankle pathology if not treated appropriately and in a timely manner can adversely affect both disability and quality adjusted life years. More so in the low- and middle-income countries where ambulation is the predominant means of getting around for the majority of the population in order to earn a livelihood. This has necessitated the equipping of the new generation of orthopaedic surgeons with the expertise and skills set to manage these conditions. To address this need, surgeons from the British Orthopaedic Foot & Ankle Society (BOFAS) and College of Surgeons of Eastern, Central and Southern Africa (COSECSA) transferred the “Principles of Foot and Ankle Surgery” course to an African regional setting. The course was offered to surgical trainees from 14-member countries of the COSECSA region and previously in the UK. The faculty was drawn from practicing surgeons experienced in both surgical education and foot and ankle surgery. The course comprises didactic lectures, case-based discussions in small groups, patient evaluations and guided surgical dissections on human cadavers. It was offered free to all participants. The feasibility of the course was evaluated using the model defined by Bowen considering the eight facets of acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited efficacy. At the end of the course participants were expected to give verbal subjective feedback and objective feedback using a cloud based digital feedback questionnaire. The course content was evaluated by the participants as “Poor”, “Below average”, “Average”, “Good” and “Excellent”, which was converted into a value from 1–5 for analysis. The non-parametric categorical data was analysed using the Two-sample Wilcoxon rank-sum (Mann–Whitney) test, and significance was considered to be p < 0.05. Results Six courses in total were held between 2018 and 2020. Three in the UK and three in the COSECSA region. There were 78 participants in the three UK courses and 96 in the three courses run in the COSECSA region. Hundred percent of the UK participants and 97% of the COSECSA participants completed the feedback. Male to female ratio was 4:1 for the UK courses and 10:1 for the COSECSA Courses. In both regions all the participants responded that they would recommend the course to their colleagues. Among the COSECSA participants 91% reported that the course was pitched at the right level, which is similar to the 89% of the UK participants (p = 0.28). Conclusion The BOFAS Principles of Foot and Ankle Surgery course design provides core knowledge, with an emphasis on clinical examination techniques of the foot and ankle, while at the same time, caters for the anticipated difference in the local clinical case mix and resources. This study establishes that by attending the course surgical trainees can achieve their learning goals in foot and ankle surgery with the same high quality qualitative and quantitative feedback in both regions. This would improve their clinical practice and confidence. The multifaceted approach adopted in this course blending didactic teaching, small group discussions, interactive sessions, case-based discussions, cadaveric surgical skills training printed educational materials and feedback helped fulfil these educational objectives. Working in partnership with local expert orthopaedic surgeons from a number of Sub-Saharan countries, was key to adapting the course to local pathology and the COSECSA setting.

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“…The College of Surgeons of East, Central, and Southern Africa (COSECSA) have reported a large increase in the number of locally led training resources alongside career planning workshops for local physicians. The initial implementation of Zambian training programs, within the COSECSA partnership, has shown the potential benefit to increase the number of surgeons in Zambia by a substantial margin in the coming years (Freitas et al, 2018). Furthermore, Operation Smile has recently partnered with Jimma University in Ethiopia to create a traveling fellowship, where general surgeons complete their plastic surgery training at 3 different international sites over the course of 3 years.…”

Section: Discussionmentioning

confidence: 99%

The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review

Wester

Weissman

Reddy

et al. 2021

The Cleft Palate-Craniofacial Journal

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Objective To identify practices and limitations of cleft care in sub-Saharan Africa (SSA). Design A retrospective narrative nonsystematic literature review was performed. Setting Literature exploring the management practices of cleft lip and/or palate across regions in SSA was included. Participants Full text case reports, retrospective studies, prospective studies, clinical trials, and review articles written and published in English between 1966 and February 1, 2021, were included in this analysis utilizing PubMed, MEDLINE, EMBASE, and Google scholar databases. Main Outcome Measures Qualitative themes identified in analysis were clinical practice patterns, current infrastructure and limitations of cleft repair, training and interdisciplinary teams, economic analyses, and international partnerships. Results Significant barriers to care identified in SSA include lack of hospital resources, craniofacial training, access to multidisciplinary specialists, and public awareness. These problems make the entire care journey difficult for patients. Increasing public education has the power to diminish late presentations to hospitals. Providing adequate hospital resources and craniofacial training through international and organizational partnerships can ensure that more patients will receive care. Increasing the availability and number of multidisciplinary specialists is crucial to follow up care which aims at improving functional outcomes. Conclusion This narrative review highlights current practices and limitations in cleft care, emphasizing the importance of effective and timely repair of clefts in SSA. Targeted efforts aimed at establishing sustainable infrastructure for cleft care in SSA can have significant individual and community health and economic benefits.

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Surgical registrars' perceptions of surgical training and capacity in Zambia: Results from three COSECSA affiliated training hospitals

Cited by 10 publications

References 14 publications

Plastic Surgery Across Continents

Plastic Surgery Across Continents

Feasibility of delivering foot and ankle surgical courses in a partnership in Eastern, Central and Southern Africa

The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review

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