Article

World Journal of Surgery

, Volume 37, Issue 7, pp 1486-1491

First online:

Designing a Contextually Appropriate Surgical Training Program in Low-resource Settings: The Botswana Experience

  • Dorotea MutabdzicAffiliated withFaculty of Medicine, General Surgery Residency Program Office, St. Michael’s Hospital, University of Toronto Email author 
  • , Alemayehu G. BedadaAffiliated withPrincess Marina Hospital
  • , Balisi BakanisiAffiliated withFaculty of Medicine, General Surgery Residency Program Office, St. Michael’s Hospital, University of TorontoPrincess Marina HospitalFaculty of Medicine, University of Botswana
  • , Joseph MotsumiAffiliated withPrincess Marina HospitalFaculty of Medicine, University of Botswana
  • , Georges AzzieAffiliated withFaculty of Medicine, General Surgery Residency Program Office, St. Michael’s Hospital, University of TorontoFaculty of Medicine, University of BotswanaDivision of General Surgery, The Hospital for Sick Children

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.