Competency-Based Education in Low Resource Settings: Development of a Novel Surgical Training Program

World J Surg. 2018 Mar;42(3):646-651. doi: 10.1007/s00268-017-4205-2.

Abstract

Background: The unmet burden of surgical disease represents a major global health concern, and a lack of trained providers is a critical component of the inadequacy of surgical care worldwide. Competency-based training has been advanced in high-income countries, improving technical skills and decreasing training time, but it is poorly understood how this model might be applied to low- and middle-income countries. We describe the development of a competency-based program to accelerate specialty training of in-country providers in cleft surgery techniques.

Methods: The program was designed and piloted among eight trainees at five international cleft lip and palate surgical mission sites in Latin America and Africa. A competency-based evaluation form, designed for the program, was utilized to grade general technical and procedure-specific competencies, and pre- and post-training scores were analyzed using a paired t test.

Results: Trainees demonstrated improvement in average procedure-specific competency scores for both lip repairs (60.4-71.0%, p < 0.01) and palate (50.6-66.0%, p < 0.01). General technical competency scores also improved (63.6-72.0%, p < 0.01). Among the procedural competencies assessed, surgical markings showed the greatest improvement (19.0 and 22.8% for lip and palate, respectively), followed by nasal floor/mucosal approximation (15.0%) and hard palate dissection (17.1%).

Conclusion: Surgical delivery models in LMICs are varied, and trade-offs often exist between goals of case throughput, quality and training. Pilot program results show that procedure-specific and general technical competencies can be improved over a relatively short time and demonstrate the feasibility of incorporating such a training program into surgical outreach missions.

MeSH terms

  • Africa
  • Cleft Lip / surgery*
  • Cleft Palate / surgery*
  • Clinical Competence
  • Competency-Based Education*
  • Developing Countries*
  • Humans
  • Latin America
  • Pilot Projects
  • Program Development
  • Quality Indicators, Health Care
  • Surgery, Plastic / education*