The Impact of a Laparoscopic Surgery Training Course in a Developing Country
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
The Impact of a Laparoscopic Surgery Training Course in a Developing Country Esther Westwood1 • Balaram Malla2 • Jeremy Ward3 • Roshan Lal1,4 • Kamal Aryal1,4
Ó The Author(s) 2020
Abstract Introduction Surgeons training junior colleagues to perform laparoscopic surgery find the ‘apprenticeship’ model of surgical training inadequate. Therefore, the use of training courses involving simulation have become an important way to teach laparoscopic surgery. An annual laparoscopic surgery course began in Nepal in 2013. It is difficult to assess the impact of the course on trainees and demonstrate a subsequent improvement in patient outcomes, but one way is to ask delegates for reflections on their experience of the course and their perception of how it has impacted patients. Methods The course involved simulation and patient-based training. A questionnaire to collect quantitative data and qualitative comments was sent to all 80 previous delegates (at least 9 months after the course) in September 2018. Results Twenty-eight delegates responded. The majority demonstrated career progression since completing the course (independent practitioners increased from 7 to 50%) and progression in their practice (18% had performed [20 laparoscopic procedures at the time of the course, vs 70% at the time of the questionnaire). All delegates felt that laparoscopic training is useful in the Nepalese context. Delegates felt the course was useful in developing skills, and improving confidence and safety. Suggestions for improvement included lengthening the course and increasing the amount of practical exposure. Conclusion There was a positive outcome of the course to Kirkpatrick level 2. There is a need to expand the course’s scope to an advanced level, increase its length and start courses in other centres, to ensure the most possible benefit to patients.
Introduction & Esther Westwood [email protected]
Training in laparoscopic surgery
& Kamal Aryal [email protected]; [email protected]
Historically, surgical training has been based around an expert training an apprentice in clinical and surgical skills [1]. However, this approach is no longer considered robust enough to develop the surgeons of tomorrow, who are being trained in increasingly technologically advanced methods. It has been shown to be time-consuming, costly and does not give consistent results. Furthermore, this approach exposes patients to risk, as it necessitates that
1
James Paget University Hospitals NHS Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth NR31 6LA, UK
2
Dhulikhel Hospital, Dhulikhel 45200, Nepal
3
Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston PR2 9HT, UK
4
East Anglia University, Norwich Research Park, Norwich NR4 7TJ, UK
123
World J Surg
trainees perform skills that they have never done before on real patients [2]. A major change in the practice of surgery in the last 30 years has been the introduction and widespread use of laparoscopic
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