Addressing gaps in surgical skill s training by means of low-cost simulation at Muhimbili University in Tanzania

Abstract Background: Providing basic surgical and emergency care in rura l settings is essential, particularly in Tanzania, where the mortality burden addressable by emergency an d surgical interventions has been estimated at 40%. However, the shortages of teaching faculty and insufficie nt learning resources have hampered the traditionally intensive surgical training apprentice ships. The Muhimbili University of He alth and Allied Sciences consequently has experienced suboptimal preparation for graduates pr actising surgery in the fi eld and a drop in medical graduates willing to become surgeons. To address the decline in circumstan ces, the first step was to enhance technical skills in general surgery and emergency procedures for senior medical students by designing and implementing a surgical skills practicum using locally develope d simulation models. Methods: A two-day training course in nine different emergency procedures an d surgical skills based on the Canadian Network for International Su rgery curriculum was developed. Simula tion models for the surgical skills were created with locally avai lable materials. The curriculum was pilot-te sted with a cohort of 60 senior medical students who had completed their surger y rotation at Muhimbili University. Two measures were used to evaluate surgical skill performance: Objective Structured Clinical Examinations and su rveys of self-perceived performance administered pre- and post-training. Results: Thirty-six students participated in the study. Prio r to the training, no stud ent was able to correctly perform a surgical hand tie, only one student was able to correctly perform adult in tubation and three students were able to correctly scrub, gown and glove. Performance improved after training, demons trated by Objective Structured Clinical Examination scores that rose from 6/30 to 15/30. St udents perceived great benefit from practical skills training. The cost of the training using low-tech simulation was four United States dollars per student. Conclusion: Simulation is valued to gain experience in practisi ng surgical skills prior to working with patients. In the context of resource-limited settings, an additional benefit is that of le arning skills not otherwise obtainable. Further testing of this approach will determine its ap plicability to other resource -limited settings seeking to develop skill-based surgical and emer gency procedure apprenticeships. Ad ditionally, skill sustainability and readiness for actual surgical and emergency experiences need to be assessedtraining by simulation in surgeryUSC