Survey of surgical training and experience of associate clinicians compared with medical officers to understand task‐shifting in a low‐income country

Abstract

BackgroundA workforce crisis exists in global surgery. One solution is task‐shifting, the delegation of surgical tasks to non‐physician clinicians or associate clinicians (ACs). Although several studies have shown that ACs have similar postoperative outcomes compared with physicians, little is known about their surgical training. This study aimed to characterize the surgical training and experience of ACs compared with medical officers (MOs) in Tanzania.MethodsAll surgical care providers in Pwani Region, Tanzania, were surveyed. Participants reported demographic data, years of training, and procedures assisted and performed during training. They answered open‐ended questions about training and post‐training surgical experience. The median number of training cases for commonly performed procedures was compared by cadre using Wilcoxon rank sum and Student's t tests. The researchers performed modified content analysis of participants' answers to open‐ended questions on training needs and experiences.ResultsA total of 21 ACs and 12 MOs participated. ACs reported higher exposure than MOs to similar procedures before their first independent operation (median 40 versus 17 cases respectively; P = 0·031). There was no difference between ACs and MOs in total training surgical volume across common procedures (median 150 versus 171 cases; P = 0·995). Both groups reflected similarly upon their training. Each cadre relied on the other for support and teaching, but noted insufficient specialist supervision during training and independent practice.ConclusionsACs report similar training and operative experience compared with their physician colleagues in Tanzania.

Task Shifting and Task Sharing to Strengthen the Surgical Workforce in Sub‐Saharan Africa: A Systematic Review of the Existing Literature

“…The general shortage of physicians, especially in rural areas, yielded difficulties in ensuring the supervision of NSCs during training and operations [44, 50]. To address this problem, associate clinicians and medical officers supervised and taught each other during operations in Tanzania [50]. The degree of supervision is questionable.…”

“…One study reported ongoing supervision of 9 months and a 94.4% compliance rate of supervision in the first year after training [35]. In contrast, another study reported that less than three-fifths of trainees met the required number of ''performed under supervision'' cases [50].…”

There is a need for a paradigm shift in laparoscopic surgical training: results of a nationwide survey among teaching hospitals in Switzerland

“…A goal-directed approach that aims to achieve a grade of expertise is far more reliable than depending on a case log alone [ 32 ]. The mere number of procedures conducted cannot be equated with mastery and is only a poor surrogate at best [ 33 ]. Making proficiency the primary requirement for board certification would emphasize the individualization of training, which has proven to be cost effective and appropriate in many cases.…”

Improving Maternal and Reproductive Health in Kigoma, Tanzania: A 13-Year Initiative

“…14 The quality of surgical care in Tanzania by AMOs and medical doctors was similar, 13 and both groups reported similar training experiences and post-training challenges. 15 In addition to task sharing, Dr. Mbaruku recommended the simultaneous upgrade of existing, mostly rural, health centers with operating theaters, critical renovations, equipment, and supplies. This meant that health providers could perform all critical EmONC services on location, rather than referring women with life-threatening complications to hospitals several hours away.…”