Surgical Training Throughout Africa: A Review of Operative Case Volumes at Multiple Training Centers
Corresponding Author
Robert K. Parker
Department of Surgery, Tenwek Hospital, PO Box 39, 20400 Bomet, Kenya
Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
[email protected]Search for more papers by this authorHillary M. Topazian
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
Search for more papers by this authorWairimu Ndegwa
Department of Surgery, Tenwek Hospital, PO Box 39, 20400 Bomet, Kenya
Search for more papers by this authorPatricia Chesang
Department of Surgery, Tenwek Hospital, PO Box 39, 20400 Bomet, Kenya
Search for more papers by this authorShinji Strain
Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
Search for more papers by this authorKeir Thelander
Pan-African Academy of Christian Surgeons, Strongsville, OH, USA
Search for more papers by this authorAndrea S. Parker
Department of Surgery, Tenwek Hospital, PO Box 39, 20400 Bomet, Kenya
Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
Search for more papers by this authorRobert Riviello
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
Search for more papers by this authorCorresponding Author
Robert K. Parker
Department of Surgery, Tenwek Hospital, PO Box 39, 20400 Bomet, Kenya
Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
[email protected]Search for more papers by this authorHillary M. Topazian
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
Search for more papers by this authorWairimu Ndegwa
Department of Surgery, Tenwek Hospital, PO Box 39, 20400 Bomet, Kenya
Search for more papers by this authorPatricia Chesang
Department of Surgery, Tenwek Hospital, PO Box 39, 20400 Bomet, Kenya
Search for more papers by this authorShinji Strain
Department of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
Search for more papers by this authorKeir Thelander
Pan-African Academy of Christian Surgeons, Strongsville, OH, USA
Search for more papers by this authorAndrea S. Parker
Department of Surgery, Tenwek Hospital, PO Box 39, 20400 Bomet, Kenya
Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
Search for more papers by this authorRobert Riviello
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
Search for more papers by this authorAbstract
Background
Adequate surgical training is paramount to produce competent surgeons to address the global burden of surgical disease. The Pan-African Academy of Christian Surgeons (PAACS) has general surgery training programs in eight countries. Operative case volumes have been positively associated with improved trainee performance and patient outcomes. For certification in the USA, 850 total operations are required from defined case categories. Yet, little is known about the operative experience of surgical trainees throughout Africa.
Methods
Operative procedures were reviewed, categorized, and validated from a cohort of PAACS graduates and compared to graduates from Accreditation Council for Graduate Medical Education (ACGME) programs. The primary and secondary outcomes were total case volumes and cases within ACGME-defined categories. Regional variations were explored.
Results
Twenty PAACS trainees, from five programs in four countries, performed 38,267 unique procedures. ACGME reports on 1211 residents from 251 programs. PAACS graduates logged more major cases (median 1448) than ACGME graduates (median 993) (p value = 0·0001). PAACS graduates performed more gynecology and obstetrics, orthopedics, head and neck, urology, endocrine, operative trauma, pediatric surgery, plastic surgery, and skin and soft tissue cases. US graduates performed more cases in abdomen, alimentary tract, breast, thoracic, and vascular categories. Comparison between regions demonstrated volume and category variations between Kenya and Gabon, Ethiopia, and Cameroon.
Conclusion
PAACS trainees perform more operations than ACGME trainees with differences in distribution. This experience can serve as a model for regional educational programs seeking to address the broad and largely unmet burden of surgical disease.
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