Operative Self-Confidence, Hesitation, and Ability Assessment of Surgical Trainees in Rural Kenya.

BACKGROUND: The education of surgical trainees is ideally designed to produce surgeons with both confidence and competence. This involves the development of autonomy in the operating room. Factors associated with autonomy and entrustment have been studied in high-resource settings. In a resource-limited context, where autonomy is solely at the discretion of faculty, and there are fewer external constraints to restrict it, we hypothesized that assessment of a trainee's performance would be dependent upon reported confidence levels of both faculty and trainees in those trainees' abilities. MATERIALS AND METHODS: At a teaching hospital in rural Kenya, operative experience surveys were administered to eleven general surgery trainees (PGY1-5) and six faculty paired dyads immediately following operative procedures in May 2016 to elicit self-reported assessments of confidence, hesitation, and ability as measured by the Zwisch Scale. We examined factors related to learning and used dyadic structural equation models to understand factors related to the assessment of ability. RESULTS: There were 107 paired surveys among 136 trainees and 130 faculty evaluations. Faculty scrubbed into 76 (72%) cases. In comparison to trainees, faculty were more likely to give a higher average score for confidence (4.08 versus 3.90; P value: 0.005), a lower score for hesitation (2.67 versus 2.84; P value: 0.001), and a lower score for the ability to perform the operation independently (2.73 versus 3.02; P value: 0.01). Faculty and trainee perceptions of hesitation influenced their ability scores. Trainee hesitation (OR 12.1; 1.2-127.6, P = 0.04) predicted whether trainees reported experiencing learning. CONCLUSIONS: Between trainees and faculty at a teaching program in rural Kenya, assessment scores of confidence, hesitation, and ability differ in value but remain fairly correlated. Hesitation is predictive of ability assessment, as well as self-reported learning opportunities. Focus upon identifying when trainees hesitate to proceed with a case may yield important educational opportunities.

The African Esophageal Cancer Consortium: A Call to Action.

Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of cancer-related death; however, worldwide incidence and mortality rates do not reflect the geographic variations in the occurrence of this disease. In recent years, increased attention has been focused on the high incidence of esophageal squamous cell carcinoma (ESCC) throughout the eastern corridor of Africa, extending from Ethiopia to South Africa. Nascent investigations are underway at a number of sites throughout the region in an effort to improve our understanding of the etiology behind the high incidence of ESCC in this region. In 2017, these sites established the African Esophageal Cancer Consortium. Here, we summarize the priorities of this newly established consortium: to implement coordinated multisite investigations into etiology and identify targets for primary prevention; to address the impact of the clinical burden of ESCC via capacity building and shared resources in treatment and palliative care; and to heighten awareness of ESCC among physicians, at-risk populations, policy makers, and funding agencies.

Baseline assessment of inpatient burn care at Tenwek Hospital, Bomet, Kenya.

BACKGROUND: Burn injuries are a significant source of both death and disability in developing countries. The objective of this project was to create a database of baseline inpatient burn care data to facilitate improvement of preventive measures and clinical outcomes at Tenwek Hospital, Bomet, Kenya. METHODS: Both demographic and clinical data were obtained through a retrospective chart review conducted on inpatient burn patients admitted to Tenwek Hospital between January 1, 2006 and May 31, 2010. RESULTS: Of the 269 patients studied, 53 % were male and 47 % were female. More than half (59 %) of the burns occurred in children younger than age 5 years. All-cause mortality rate of inpatient burn patients was 12 %. Cardiac arrest, sepsis, and respiratory failure/pneumonia caused 81 % of the deaths. Scalds caused 55 % of the burns. Thirteen percent of the burns were seizure-related. Second degree burns accounted for 76 % of the burns. Forty-three percent of patients received at least one surgical debridement during their hospital stay. Thirty-seven percent of patients received at least one split-thickness skin graft. Antibiotic treatment was administered to 55 % of patients. Fifty-three percent of patients presented to Tenwek Hospital 1 day or more from the time of injury. CONCLUSIONS: We propose that prevention efforts focus on minimizing children's exposure to boiling liquids and open flames in homes, providing appropriate and consistent treatment to epileptics to prevent seizure-related burns, and stressing the importance of early presentation for treatment. A more selective approach to antibiotic use should be encouraged to decrease costs to the patient and hospital and lessen the risk of antibiotic resistance.