Designing a Contextually Appropriate Surgical Training Program in Low-resource Settings: The Botswana Experience
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The global burden of surgical disease and severe shortage of trained surgeons around the world are now widely recognized. The greatest challenge in improving access to surgical care lies in sub-Saharan Africa, where the number of surgeons per population is lowest. One part of the solution may be to create programs to train surgeons locally. We present our experience with an approach to designing a contextually appropriate surgical curriculum in Botswana.
Surgical logbooks from the largest tertiary care center in Botswana, dating from 2004 through 2010, were analyzed to yield total case numbers within clearly defined categories. Case numbers and local surgical opinion were combined to design a contextually relevant curriculum, with the Surgical Council on Resident Education curriculum as a template.
Logbook analysis revealed that general surgeons in Botswana manage burns and perform a large number of skin grafts and extremity amputations. However, they perform few colonoscopies and complex laparoscopic procedures. The new curriculum included greater emphasis on surgical subspecialty procedures and surgical management of locally relevant conditions, such as the complications of infectious diseases. Less emphasis was placed on management of uncommon conditions such as inflammatory bowel disease.
There are important differences in the scope of general surgery and the knowledge and skills required by general surgeons in Botswana compared with their North American counterparts. We present a simple and inexpensive approach that could serve as a potential model for designing contextually relevant surgical training programs in other low-resource settings.
- World Health Organization (2009) World Health Statistics 2009. http://www.who.int/whosis/whostat/2009/en/index.html. Accessed 7 April 2009
- Mullan F (2005) The metrics of the physician brain drain. N Engl J Med 353:1810–1818 CrossRef
- Pereira C, Cumbi A, Malalane R et al (2007) Meeting the need for emergency obstetric care in Mozambique: work performance and histories of medical doctors and assistant medical officers trained for surgery. Br J Obstet Gynaecol 114:1530–1533 CrossRef
- Sani R, Nameoua B, Yahaya A et al (2009) The impact of launching surgery at the district level in Niger. World J Surg 33:2063–2068. doi:10.1007/s00268-009-0160-x CrossRef
- Van Amelsfoort JJC, Van Leeuwen PAM, Jiskoot P et al (2010) Surgery in Malawi—the training of clinical officers. Trop Doctor 40:74–76 CrossRef
- Choo S, Perry H, Hesse AAJ et al (2011) Surgical training and experience of medical officers in Ghana’s district hospitals. Acad Med 86:529–533 CrossRef
- Loefler IJP (1998) A short history of surgical training in eastern Africa. East Cent Afr J Surg 5:55–61
- Khambaty FM, Ayas HM, Mezghebe HM (2010) Surgery in the horn of Africa: a 1-year experience of an American-sponsored surgical residency in Eritrea. Arch Surg 145:749–752 CrossRef
- Cameron BH, Rambaran M, Sharma DP et al (2010) The development of postgraduate surgical training in Guyana. Can J Surg 53:11–16
- Keavu I, Watters DAK (2006) Specialist surgical training in Papua New Guinea: the outcomes after 10 years. ANZ J Surg 76:937–941 CrossRef
- Pollock JD, Love TP, Steffes BC et al (2011) Is it possible to train surgeons for rural Africa? A report of a successful international program. World J Surg 35:2175–2176. doi:10.1007/s00268-011-1189-1 CrossRef
- World Health Organization (2009) Botswana health profile. http://www.who.int/gho/countries/bwa.pdf. Accessed 20 Aug 2011
- Surgical Council on Resident Education (2010–2011). General Surgery Residency Curriculum Outline–Patient Care and Medical Knowledge. www.surgicalcore.org. Accessed 1 June 2011
- Frank J (2005) The CanMEDS 2005 physician competency framework. Better standards, better physicians, better care. Royal College of Physicians and Surgeons of Canada, Ottawa
- Batalden P, Leach D, Swing S et al (2002) General competencies and accreditation in graduate medical education. Health Aff (Millwood) 21:103–111 CrossRef
- Designing a Contextually Appropriate Surgical Training Program in Low-resource Settings: The Botswana Experience
World Journal of Surgery
Volume 37, Issue 7 , pp 1486-1491
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Faculty of Medicine, General Surgery Residency Program Office, St. Michael’s Hospital, University of Toronto, QW 3071, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- 2. Princess Marina Hospital, P.O. Box 258, Gaborone, Botswana
- 3. Faculty of Medicine, University of Botswana, Gaborone, Botswana
- 4. Division of General Surgery, The Hospital for Sick Children, Room 1505, Roy C Hill Wing, 555 University Avenue, Toronto, ON, M5G 1X8, Canada