Technical and Programmatic Working Meeting
Thursday 25 May 2017.
Contribution made by the International Federation of Surgical Colleges to WHO
Over the past week we have heard numerous exhortations to increase surgical capacity such as:-
“Surgery needed at 1st referral level”
“No short cut to skills acquisition”
“Desperately need skills development”
The IFSC has been in the business of surgical education and training for the past 18 years during which time we have run 109 skills courses in sub-Saharan Africa and trained a total of 1,879 participants which include 428 trainers, 768 trainees and 683 theatre nurses. The latter group have been included partly because their own training could be improved and the respect between surgeons and nurses in the operating theatre is not always as harmonious as it should be!
We have recently been running, with the Association of Surgeons of Great Britain and Ireland (ASGBI), Management of Surgical Emergencies Courses, Anastomosis Workshops and Critical Care Courses and all these in sub-Saharan Africa.
We have been funded by the UK Government (DFID) and the Grants have been administered by the Tropical Health and Education Trust (THET). We work in partnership with the respective Colleges of Surgery in West and East Africa. This recognition gives us credibility and builds on our reputation for providing much needed surgical training. The respective Colleges choose the venues, the participants and trainers and also contribute to the content of the respective courses because they know the local requirements. We do not lift a course out of the UK, fly it across the Mediterranean and dump it down in Africa! Each course is tailor-made accordingly.
We train a combination of surgical trainees, DMO’s and NPC’s. We are currently designing an advanced surgical course for senior NPCs in Ifakara, Tanzania. They are just as bright and able as their medically qualified colleagues. Some people do not approve of NPC’s undertaking surgery but at the present time and in many countries we have no choice. However, they do need to be registered, regulated, undergo CPD, mentored and, of course, paid an appropriate salary. One question that has not been addressed in many countries is that of career progression.
Essentially what we do is train trainers in order that they learn how to train trainees and thus the courses can be made sustainable. We do not go out and revisit the same site over and over again. We undertake a concentrated one day Train the Trainers Course immediately followed by the Course in question. Under the Faculties tutelage they are essentially running the Course/Workshop themselves on the final day.
Assessment is very important and we have refined this over the years and currently we utilise MCQ’s, previous experience sheets, confidence levels pre and post Course, feedback and evaluation. We compare certain aspects of each event so that the same standard is maintained Course -on-Course.
At the end of each event we issue Certificates of Satisfactory Completion for both the Trainers, who can become accredited Trainers for that particular Course through their College, and for the trainees. Very few of either category fail to satisfactorily complete the Courses/Workshops. Six months later we get subjective and objective assessments from the trainees at their place of work and from their tutors/Consultants. As time goes by it is very rewarding to receive reports of Courses that have been run independently by local trainers.
The potential problems we have had include:-
- Uneven numbers of participants which is a problem as all our Courses involve the trainees working in pairs.
- Unavailability of pigs as dissection material and also on occasions for religious reasons which has meant we have had to use goats which is not as satisfactory.
- Problems with language and this refers mainly to French West Africa. I personally can speak some French but when I am stuck I merely speak English with a French accent! They can understand this but when I am really stuck invariably one of the trainers can speak “proper” French.
This then is our contribution to increasing surgical capacity and we are all clearly going to have to work a lot harder. There is certainly a place to collaborate and co-ordinate our activities with our Anaesthesia colleagues and others to provide across-the-board training in sub-Saharan Africa. At the present time nobody else is running general surgery training Courses in this Region.