Long-Term Impact of a Mission-Based Surgical Training Rotation on Plastic Surgery Capacity Building in Rwanda
Naikhoba C.O. Munabi, MD, MPH1; Libby D. Bunker, MPH2; Eric S. Nagengast, MD, MPH1; Faustin Ntirenganya, MD, MMED, PhD3; William P. Magee, MD, DDS1,4,5
1Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA, 2Operation Smile, Inc., Virginia Beach, VA, USA, 3Department of Surgery, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda, 4Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA, 5Division of Plastic Surgery, Shriner's Hospital for Children, Pasadena, CA, USA
Background: Short-term, high-volume surgical training experiences can lead to successful skills transfer and be an effective method of training surgical providers in low-resource settings. However, immediate skills acquisition does not guarantee long-term performance of surgical procedures. This study aims to determine the long-term impact of a short-term plastic surgery training rotation (STR) on general surgeon contribution to plastic surgery capacity building in Rwanda
Methods: A survey-based study was performed of credentialed general surgeons who previously participated in an Operation Smile STR in Rwanda. STRs were held for up to three weeks at a primary level district hospital in Rwinkwavu, Rwanda. Questions focused on exposure to procedures during the rotation and current practice demographics. The percentage of current practice volumes dedicated to plastic surgery were mapped to demonstrate participant contribution to plastic surgery capacity in the country
Results: All eight prior participants of the STR who completed residency and are currently practicing as general surgeons in Rwanda were included and six completed the survey (75.0%). All respondents work as general surgeons in governmental hospitals around Rwanda. Up to 75% of surgeon caseloads are dedicated to plastic surgery procedures. Half of respondents work in regions without a credentialed plastic surgeon (Figure 1). Exposure to cleft and congenital hand surgery during the rotation did not lead to durable performance in practice (Table 1). All participants felt the rotation improved their performance in multiple core competencies including patient care, medical knowledge, communication, and practice-based learning (Table 2)
Conclusion: Participation in a short-term plastic surgery training rotation in Rwanda was associated with increased long-term surgical capacity around the country through a task-sharing model. A mission-based rotation may be sufficient for basic plastic surgery and core competency training but does not provide adequate exposure to more complicated surgeries like cleft repair. Further studies with more study participants must address how longer training experiences impact long-term performance of plastic surgery procedures.
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