Mixed-Methods Assessment Of A Pilot Decentralized Surgical Training Program For House Officers In Ghana

Abstract

Introduction : There is a critical surgical workforce gap in low- and middle-income countries, particularly at first-level referral (i.e. district) hospitals. To address this gap we piloted a decentralized surgical training program for house officers at a district hospital in Ghana.
Methods : Six house officers took part in the pilot program. Trainees participated in : i) didactic, videobased, and practical modules ; ii) intensive surgical immersion at a district hospital with consultant surgeon oversight ; and iii) a 12-month supervised rotation as a
surgical care provider at a district hospital. Case mix and volume, complications, and perioperative mortality rate during the program were tracked. Anonymous feedback from the trainees was analysed with a content analysis framework.
Results : In the 12-month pilot training program, 6 trainees were actively involved in carrying out 606 procedures either independently, under supervision or as assistant (mean : 101 procedures/trainee). The most frequent pre-operative diagnoses were hernia and complications of labour (432, 71.3%), followed by acute abdomen requiring laparotomy (85, 14.0%), soft tissue mass (21, 3.5%), hemopneumothorax or plearal effusion (19, 3.1%), hydrocele (16, 2.6%), abscess (12, 2.0%) and other (47, 7.8%). Twenty-three (3.8%) patients experienced complications, with the most common being surgical site infections (superficial : 8, 1.3% ; deep : 3, 0.5%). The perioperative mortality rate was 1.2%. Feedback from trainees was generally positive, but revealed several unmet challenges.
Conclusion : Through the decentralized surgical training program Ghanaian trainees gained useful experience with essential surgical care at a first-level hospital and provided timely surgical care to patients.