Efficacy of Surgical Simulation Training in a Low-Income Country

World J Surg. 2016 Nov;40(11):2643-2649. doi: 10.1007/s00268-016-3573-3.


Introduction: Simulation training has evolved as an important component of postgraduate surgical education and has shown to be effective in teaching procedural skills. Despite potential benefits to low- and middle-income countries (LMIC), simulation training is predominately used in high-income settings. This study evaluates the effectiveness of simulation training in one LMIC (Rwanda).

Methods: Twenty-six postgraduate surgical trainees at the University of Rwanda (Kigali, Rwanda) and Dalhousie University (Halifax, Canada) participated in the study. Participants attended one 3-hour simulation session using a high-fidelity, tissue-based model simulating the creation of an end ileostomy. Each participant was anonymously recorded completing the assigned task at three time points: prior to, immediately following, and 90 days following the simulation training. A single blinded expert reviewer assessed the performance using the Objective Structured Assessment of Technical Skill (OSATS) instrument.

Results: The mean OSATS score improvement for participants who completed all the assessments was 6.1 points [95 % Confidence Interval (CI) 2.2-9.9, p = 0.005]. Improvement was sustained over a 90-day period with a mean improvement of 4.1 points between the first and third attempts (95 % CI 0.3-7.9, p = 0.038). Simulation training was effective in both study sites, though most gains occurred with junior-level learners, with a mean improvement of 8.3 points (95 % CI 5.1-11.6, p < 0.001). Significant improvements were not identified for senior-level learners.

Conclusion: This study supports the benefit for simulation in surgical training in LMICs. Skill improvements were limited to junior-level trainees. This work provides justification for investment in simulation-based curricula in Rwanda and potentially other LMICs.

MeSH terms

  • Canada
  • Clinical Competence
  • Curriculum / standards*
  • Developed Countries
  • Developing Countries*
  • Education, Medical, Graduate / standards*
  • Educational Measurement
  • General Surgery / education*
  • Humans
  • Ileostomy / education*
  • Internship and Residency / methods
  • Internship and Residency / standards*
  • Poverty
  • Rwanda
  • Simulation Training / standards*
  • Socioeconomic Factors