Non-technical skills training for Nigerian interprofessional surgical teams: a cross-sectional survey.

INTRODUCTION: Non-technical skills (NTS) including communication, teamwork, leadership, situational awareness, and decision making, are essential for enhancing surgical safety. Often perceived as tangential soft skills, NTS are many times not included in formal medical education curricula or continuing medical professional development. We aimed to explore exposure of interprofessional teams in North-Central Nigeria to NTS and ascertain perceived facilitators and barriers to interprofessional training in these skills to enhance surgical safety and inform design of a relevant contextualized curriculum. METHODS: Six health facilities characterised by high surgical volumes in Nigeria's North-Central geopolitical zone were purposively identified. Federal, state, and private university teaching hospitals, non-teaching public and private hospitals, and a not-for-profit health facility were included. A nineteen-item, web-based, cross-sectional survey was distributed to 71 surgical providers, operating room nurses, and anaesthesia providers by snowball sampling through interprofessional surgical team leads from August to November 2021. Data were analysed using Fisher's exact test, proportions, and constant comparative methods for free text responses. RESULTS: Respondents included 17 anaesthesia providers, 21 perioperative nurses, and 29 surgeons and surgical trainees, with a 95.7% survey completion rate. Over 96% had never heard of any NTS for surgery framework useful for variable resource contexts and only 8% had ever received any form of NTS training. Interprofessional teams identified communication and teamwork as the most deficient personal skills (38, 57%), and as the most needed for surgical team improvement (45, 67%). There was a very high demand for NTS training by all surgical team members (64, 96%). The main motivations for training were expectations of resultant improved patient safety and improved interprofessional team dynamics. Week-long, hybrid training courses (with combined in-person and online components) were the preferred format for delivery of NTS education. Factors that would facilitate attendance included a desire for patient safety and self-improvement, while barriers to attendance were conflicts of time, and training costs. CONCLUSIONS: Interprofessional surgical teams in the Nigerian context have a high degree of interest in NTS training, and believe it can improve team dynamics, personal performance, and ultimately patient safety. Implementation of NTS training programs should emphasize interprofessional communication and teamworking.

Open Versus Laparoscopic Appendectomy: A Comparison of Outcome in a Teaching Hospital, Northeast Nigeria.

Background: Appendectomy could be open or laparoscopic. Laparoscopic appendectomy (LA) is gradually gaining ground in Nigeria, but its outcome is not entirely known. Objective: This study compared the outcomes of LA with those of open appendectomy (OA) in terms of the surgical site infection rate, post-operative pain, time to return of bowel sounds, length of hospital stay, return to normal activities and direct cost of treatment. Patients and Methods: This was a prospective randomised study. All patients above 18 years who were diagnosed with acute appendicitis in Federal Teaching Hospital, Gombe, were recruited after adequate counselling and consent obtained over the 18 months of the study. Results: Forty (40) patients were recruited with 20 on each arm. The average age was 25 years (±) 6 years and M:F was 1:1.9. The rates of surgical site infection and post-operative pain between both methods were not statistically different, while the time to return of bowel sound, the length of hospital stay and the return to normal activity were significantly reduced in LA compared to OA. However, OA was cheaper in terms of direct cost compared to LA. Conclusion: This study showed that LA may be the preferred method when a quicker recovery from treatment is anticipated, provided the patient can afford the direct cost of the procedure.

The Implementation of Simulation-Based Learning for Training Undergraduate Medical Students in Essential Surgical Care Across Sub-Saharan Africa: a Scoping Review.

Much surgery in sub-Saharan Africa is provided by non-specialists who lack postgraduate surgical training. These can benefit from simulation-based learning (SBL) for essential surgery. Whilst SBL in high-income contexts, and for training surgical specialists, has been explored, SBL for surgical training during undergraduate medical education needs to be better defined. From 26 studies, we identify gaps in application of simulation to African undergraduate surgical education, including lack of published SBL for most (65%) World Bank-defined essential operations. Most SBL is recent (2017-2021), unsustained, occurs in Eastern Africa (78%), and can be enriched by improving content, participant spread, and collaborations.