Operative Case Volume Minimums Necessary for Surgical Training Throughout Rural Africa
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
Operative Case Volume Minimums Necessary for Surgical Training Throughout Rural Africa Robert K. Parker1,2 • Hillary M. Topazian3 • Andrea S. Parker1,2 • Michael M. Mwachiro1 • Shinji Strain4 • Russell E. White1,2 • Keir Thelander5 Robert Riviello6
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Resident operative case volumes are an important aspect of surgical education, and minimums are required in Accreditation Council for Graduate Medical Education (ACGME) programs. Minimum operative case volumes for training do not exist in rural Africa. Our objective was to determine the optimal minimum operative case volume necessary for general surgery training in rural Africa. Methods A cross-sectional census electronic survey was conducted among faculty (N = 24) and graduates (N = 56) of Pan-African Academy of Christian Surgeons training programs. Three equally weighted exposures (median minimum case volume suggested by participants, operative experience of prior graduates, and comparisons with ACGME minimums), adjusted from responses to targeted questions, were utilized to construct an optimal minimum operative case volume for training. Results Sixty-four surgeons were contacted and 40 (13 faculty, 24 graduates, and 3 graduates who became faculty) participated. All participants thought operative case minimums were necessary, and the majority (98%) felt current training adequately prepared surgeons for their setting. Constructed optimal case volumes included 1000 major cases with fewer required cases than ACGME in abdomen, breast, thoracic, vascular, endoscopy, and laparoscopy and more required cases than ACGME for alimentary tract, endocrine, operative trauma, skin and soft tissue, pediatric, and plastic surgery. Other categories (gynecology, orthopedics, and urology) were deemed necessary for surgical training, with regional differences. Prior graduates satisfied the overall, but not category-specific, proposed minimums. Conclusions The surveyed surgeons highlighted the need for diverse surgical training with minimum exposures. They described increased need for cases reflecting regional variations with a desire for more experience in categories less common at their institutions.
& Robert K. Parker [email protected] 1
Department of Surgery, Tenwek Hospital, PO Box 39, Bomet 20400, Kenya
2
Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
3
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
4
Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
5
Pan-African Academy of Christian Surgeons, Strongsville, OH, USA
6
Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
123
World J Surg
Abbreviations PAACS Pan-African Academy of Christian Surgeons ACGME Accreditation Council for Graduate Medical Education
Introduction Access to surgical care is seve
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