Pilot Evaluation of the Impact of a Mission-Based Surgical Training Rotation on the Plastic Surgery Skills and Competencies Development of General Surgery Residents in Rwanda

Abstract

Objective: Increasing subspecialty surgical capacity in Rwanda requires innovative approaches to augment the skills of pre-existing surgical providers. Short-term, high-intensity training programs can be effective for surgical education, however, few studies have investigated the quality of skills acquired through a condensed surgical experience. This study aims to determine the efficacy of a 3-week surgical training rotation (STR) to teach plastic surgery skills to general surgery residents in Rwanda.

Design: A survey-based, prospective observational study of general surgery residents and volunteer plastic surgery educators participating in an Operation Smile STR. Resident self-assessment scores of surgical capabilities at the beginning and end of the rotation were compared to surgeon evaluation of resident performance. Progression of resident performance and change in inter-rater reliability between residents and educators were analyzed. Student's t test with significance at p < 0.05 was used to confirmed statistical significance.

Setting: This study took place during the Operaiton Smile STR at the Rwinkwavu District Hospital, a primary level hospital in Rwinkwavu, Rwanda.

Participants: All residents (5) and surgeon evaluators (4) who participated in the STR were included in this study. All study participants completed all study surveys.

Results: Residents reported a significant increase in confidence with the majority of procedures performed by the end of the rotation. Surgeons identified significant improvement in all resident skills by 2 weeks (p < 0.05). Resident ability to perform self-assessment improved, as determined by a significant decrease in inter-rater error margin from -0.61 to -0.10 over the course of the rotation (p < 0.01).

Conclusions: In this pilot study, a 3 week rotation improved surgical competencies and technical skills of general surgery residents learning plastic surgery. These findings support using the short-term STR as a method for task-sharing education. Further studies are needed to determine durability of skills transfer and long-term impact on surgical capacity.

Keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; international plastic surgery skills education.