C4 - 11: CHARACTERIZATION OF SURGICAL EDUCATION IN ZAMBIA USING A NEWLY DEVELOPED SURGICAL EDUCATION CAPACITY TOOL
David E Wang, BS1, Darren Sultan, BA1, Hebah Ismail, MD, JD2, Elizabeth Robinson, MPH, MA1, Robert Zulu, MMed, Surgery3, Joseph Musowoya, MMed, Surgery4, James C Munthali, MMed, Orthopaedics3, Mary Ann Hopkins, MD, MPhil1, Shubhada Dhage, MD1; 1New York University, 2Beth Israel-Deaconess Medical Center, 3University Teaching Hospital, 4Kitwe Teaching Hospital
Introduction: Approximately 100 surgeons in Zambia serve a population of 16 million, resulting in a significant lack of access to care for basic surgical needs. Training surgeons to manage surgical disease is paramount as it can potentially rectify this shortage. Surgical education in Zambia and other low-middle income countries has not been well characterized. The aim of this study is to pilot a Surgical Capacity Tool to evaluate surgical training programs which can lead to systematic improvements in surgical education.
Methods: 6 COSECSA-accredited major medical centers, where most surgical residents in Zambia are trained, were surveyed spanning the Copperbelt, Lusaka, and Southern provinces. We developed a Surgical Capacity Tool to evaluate hospital characteristics including infrastructure, education, and research. The questionnaire was completed by administrators and registrars. Responses were collected on iPhones using Qualtrics offline surveys.
Results: There are a total of 42 trainees and 22 full time faculty members in Zambia, of which 18 were surveyed. Caseloads and number of faculty per trainee varied widely. None of the centers had surgical skills, simulation, or research labs. 83% had medical libraries and access to internet, 67% had lecture halls, and 50% had access to electronic databases. All sites had training in outpatient clinics, 83% had bedside teaching and M&M conferences, and 67% had supervision by faculty and senior registrars. 50% of sites had weekly didactics. One site had journal club. All sites had obstetrical and gynecological, urological, and orthopedic surgery. 83% of sites had pediatric surgery, 67% of sites had neurological and ophthalmological surgery, and none had vascular or cardiothoracic surgery. Regarding research, 83% had clinical research opportunities but only 33% had research mentors available. None of the sites had opportunities in basic science research or grant application guidance.
Conclusions: Lack of access to proper infrastructure, research, and personnel all impact surgical training and education. The Surgical Capacity Tool offers insights into areas of potential advancement. Further utilization of this tool in other LMICs can ultimately lead to positive systemic changes in surgical care globally.