Surgical simulation in Africa: the feasibility and impact of a 3-day fundamentals of laparoscopic surgery course

Surg Endosc. 2009 Nov;23(11):2493-8. doi: 10.1007/s00464-009-0424-4. Epub 2009 Apr 3.


Introduction: The use of laparoscopy in resource-restricted countries has increased in recent years. Although simulation is now considered an important adjunct to operating-room-based training for learning laparoscopic skills, there is very little literature assessing the use of simulation in resource-restricted countries. The purpose of this study was to determine the feasibility and impact of a 3-day Fundamentals of Laparoscopic Surgery (FLS) course in Botswana, Africa.

Methods: A total of 20 surgeons and trainees participated in a 3-day FLS course. A pretest FLS score was obtained for each subject, followed by 2 days of practice with feedback. A final FLS posttest score was then obtained. Participants also watched the FLS instructional CD-ROM and took the written test on day 3.

Results: Mean posttest scores were significantly higher than pretest scores for each FLS task and for the total normalized FLS simulator score (285 +/- 94 versus 132 +/- 92, p < 0.001). The mean score on the written test was 242 (116). In total, only two surgeons achieved a passing score on both the cognitive and skills assessment required to obtain FLS certification.

Conclusion: To our knowledge, this is the first time the FLS program has been taught in Africa. We have shown that giving the FLS course in a resource-restricted country is feasible and resulted in a significant improvement in FLS technical skills after 3 days. Most surgeons, however, still did not reach FLS passing scores, indicating that more than 3 days will be required in future courses to help surgeons obtain FLS certification.

MeSH terms

  • Adult
  • Botswana
  • Clinical Competence*
  • Competency-Based Education
  • Computer Simulation*
  • Computer-Assisted Instruction*
  • Curriculum
  • Developing Countries
  • Education, Medical, Continuing / methods
  • Education, Medical, Graduate / methods
  • Educational Measurement
  • Feasibility Studies
  • Female
  • General Surgery / education*
  • Humans
  • Laparoscopy
  • Male
  • Middle Aged
  • Probability
  • Socioeconomic Factors