Abstract:
Background: Providing basic surgical and emergency care in rural settings is essential, particularly in Tanzania,
where the mortality burden addressable by emergency and surgical interventions has been estimated at 40%.
However, the shortages of teaching faculty and insufficient learning resources have hampered the traditionally
intensive surgical training apprenticeships. The Muhimbili University of Health and Allied Sciences consequently
has experienced suboptimal preparation for graduates practising surgery in the field and a drop in medical
graduates willing to become surgeons. To address the decline in circumstances, the first step was to enhance
technical skills in general surgery and emergency procedures for senior medical students by designing and
implementing a surgical skills practicum using locally developed simulation models.
Methods: A two-day training course in nine different emergency procedures and surgical skills based on the
Canadian Network for International Surgery curriculum was developed. Simulation models for the surgical skills
were created with locally available materials. The curriculum was pilot-tested with a cohort of 60 senior medical
students who had completed their surgery rotation at Muhimbili University. Two measures were used to evaluate
surgical skill performance: Objective Structured Clinical Examinations and surveys of self-perceived performance
administered pre- and post-training.
Results: Thirty-six students participated in the study. Prior to the training, no student was able to correctly
perform a surgical hand tie, only one student was able to correctly perform adult intubation and three students
were able to correctly scrub, gown and glove. Performance improved after training, demonstrated by Objective
Structured Clinical Examination scores that rose from 6/30 to 15/30. Students perceived great benefit from
practical skills training. The cost of the training using low-tech simulation was four United States dollars per
student.
Conclusion: Simulation is valued to gain experience in practising surgical skills prior to working with patients. In
the context of resource-limited settings, an additional benefit is that of learning skills not otherwise obtainable.
Further testing of this approach will determine its applicability to other resource-limited settings seeking to
develop skill-based surgical and emergency procedure apprenticeships. Additionally, skill sustainability and
readiness for actual surgical and emergency experiences need to be assessed.
