Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty.
JAMA Surg
; 152(1): 66-73, 2017 01 01.
Article
en En
| MEDLINE
| ID: mdl-27706482
ABSTRACT
Importance Sustainable, capacity-building educational collaborations are essential to address the global burden of surgical disease. Objective:
To assess an international, competency-based training paradigm for hernia surgery in underserved countries. Design, Setting, andParticipants:
In this prospective, observational study performed from November 1, 2013, through October 31, 2015, at 16 hospitals in Brazil, Ecuador, Haiti, Paraguay, and the Dominican Republic, surgeons completed initial training programs in hernia repair, underwent interval proficiency assessments, and were appointed regional trainers. Competency-based evaluations of technical proficiency were performed using the Operative Performance Rating Scale (OPRS). Maintenance of proficiency was evaluated by video assessments 6 months after training. Certified trainees received incentives to document independent surgical outcomes after training. Main Outcomes andMeasures:
An OPRS score of 3.0 (scale of 1 [poor] to 5 [excellent]) indicated proficiency. Secondary outcomes included initial vs final scores by country, scores among surgeons trained by the regional trainers (second-order trainees), interval scores 6 months after training, and postoperative complications.Results:
A total of 20 surgeon trainers, 81 local surgeons, and 364 patients (343 adult, 21 pediatric) participated in the study (mean [SD] age, 47.5 [16.3] years; age range, 16-83 years). All 81 surgeons successfully completed the program, and all 364 patients received successful operations. Mean (SD) OPRS scores improved from 4.06 (0.87) before the initial training program to 4.52 (0.57) after training (P < .001). No significant variation was found by country in final scores. On trainee certification, 20 became regional trainers. The mean (SD) OPRS score among 53 second-order trainees was 4.34 (0.68). After 6-month intervals, the mean (SD) OPRS score among participating surgeons was 4.34 (0.55). The overall operative complication rate during training series was 1.1%. Conclusions and Relevance Competency-based training helps address the global burden of surgical disease. The OPRS establishes an international standard of technical assessment. Additional studies of long-term surgeon trainer proficiency, community-specific quality initiatives, and expansion to other operations are warranted.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Educación Basada en Competencias
/
Países en Desarrollo
/
Educación Médica Continua
/
Herniorrafia
/
Hernia Inguinal
Tipo de estudio:
Observational_studies
/
Prognostic_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Humans
/
Middle aged
País/Región como asunto:
America do sul
/
Brasil
/
Caribe
/
Ecuador
/
Haiti
/
Paraguay
/
Republica dominicana
Idioma:
En
Revista:
JAMA Surg
Año:
2017
Tipo del documento:
Article