American Council of Academic Plastic Surgeons
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Pilot Evaluation of the Impact of a Mission-Based Surgical Training Rotation on the Plastic Surgery Skills and Competencies Development of General Surgery Residents in Rwanda
Naikhoba CO Munabi, MD MPH1; Libby Durnwald, MPH2; Eric S Nagengast, MD MPH1; Allyn Auslander MPH3; Faustin Ntirenganya MD MMED PhD4; William P Magee III, MD DDS1,3,5
1Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA 2Operation Smile, Inc., Virginia Beach, VA, USA 3Children's Hospital Los Angeles, Los Angeles, CA, USA 4University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda 5Shriner's Hospital for Children, Pasadena, CA, USA

Background: Increasing subspecialty surgical capacity in Rwanda requires innovative approaches to augment the skills of pre-existing surgical providers. Short-term, high-intensity training programs can be effective for surgical education. However, few studies have investigated the quality of skills acquired through a condensed surgical experience. This study aims to determine the efficacy of a 3-week surgical training rotation (STR) to teach plastic surgery skills to general surgery residents in Rwanda.
Methods: A survey-based, prospective observational study was performed of general surgery residents and volunteer plastic surgery educators participating in a 3-week Operation Smile STR at Rwinkwavu District Hospital, a primary level hospital in Rwinkwavu, Rwanda. Surveys questions were developed from ACGME and American Board of Plastic Surgery (ABPS) surveys assessing technical skills and plastic surgery core competencies. Resident self-assessment scores at the beginning and end of the STR were compared to surgeon evaluation of resident performance. Improvement in resident performance and change in inter-rater reliability between resident self-assessment and surgeon evaluation were analyzed. Studentís t test with significance at p < 0.05 was used to confirmed statistical significance.
Results: Surveys were completed by all residents (n=5) and surgeon evaluators (n=4) who participated in the STR. All residents were in their third year of a 4-year general surgery residency at the University of Rwanda. All plastic surgery educators were board certified by the ABPS. Residents reported a significant increase in confidence with 63.6% (7/11) of plastic surgery procedures at 3 weeks (Fig1). Surgeons noted significant improvement in 100% (8/8) of technical skills evaluated by week 2 of the STR (p < 0.05, Fig2). Resident ability to accurately self-assess their skill level improved, as determined by a decrease in inter-rater error margin from -0.61 to -0.10 over the course of the 3-weeks (p < 0.01).
Conclusion: In this pilot study, a 3-week STR improved surgical competencies and technical skills of general surgery residents learning plastic surgery in Rwanda. These findings support using the short-term STRs as a method for task-sharing education. Further studies are needed to with a larger cohort of trainees to determine durability of skills transfer and long-term impact on surgical capacity.

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