General Surgery resident, Dr. Mussie Freneh, practicing the surgery using the laparoscopic box trainer.
Medical course data
Location data
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Locations Sodo Christian Hospital, Ethiopia
Mbingo Hospital, Cameroon
Kijabe Hospital, Kenya
University of Michigan, United States
Southern Illinois University School of Medicine, United States

Welcome to the ALL-SAFE Appropedia page

The goal of ALL-SAFE - African Laparoscopic Learners for Safe Advancement for Ectopic Pregnancy - is to teach surgeons in the low-resource setting to perform laparoscopic surgery without special training equipment and without a physical teacher.  The first module of ALL-SAFE teaches the laparoscopic management of ectopic pregnancy. 

Both the cognitive and psychomotor components of the surgical management of ectopic pregnancy are presented on the ALL-SAFE platform.  Our goal is that learners leave the module with all the tools that they need to manage a patient with an ectopic pregnancy competently and confidently.

This effort is a collaboration of members from the Pan-African Academy of Christian Surgeons (PAACS), the College of Surgeons in East, Central, and Southern Africa (COSECSA), the University of Michigan, Southern Illinois University, Soddo Christian Hospital, Mbingo Baptist Hospital, and AIC Kijabe Hospital.  Funding for this study has been provided by the Global Surgical Training Challenge.

To learn more about our project team, please visit our user page here: User:ALL SAFE.

Goals[edit | edit source]

  1. To improve the surgeons' confidence and competence in the laparoscopic management of ectopic pregnancy
  2. To support the development of basic cognitive and technical skills required for the safe laparoscopic management of ectopic pregnancy
  3. To provide surgeons with standardized educational content on the laparoscopic management of ectopic pregnancy to assist in development of relevant clinical judgment
  4. To provide a formative assessment framework and objective quantifiable measures to assess knowledge, judgment, and manual skills in the laparoscopic management of ectopic pregnancy
  5. To promote collaboration between countries of diverse resource levels to provide a low-cost, open source, portable educational and assessment framework to improve quality of surgical care

Overview[edit | edit source]

This course is organized into four components. The first step focuses on the diagnosis and pre-operative management of a patient with ectopic pregnancy in the resource-constrained setting. The second step involves building the laparoscopic box trainer and ectopic simulation. In the third step, learners view and practice skills used in the laparoscopic management of ectopic pregnancy in the box trainer. After they have been able to achieve the elements on a proficiency checklist, they upload a video recording of themselves performing the tasks in the box trainer. In the fourth step, learners will rate other learners' de-identified videos and receive feedback on their video.

How to access our course

To access the ALL SAFE Ectopic Pregnancy Course, you must click on the link below and login to our platform using the following credentials. LINK TO OVERALL PLATFORM

  • Username:
  • Password: Gstc2021 (Case sensitive)

This is a demo version of our platform. You will be able to freely navigate through the modules, repeat modules, and repeat quizzes in order to view our content.

The additional links found below all link to the same course. Once you are inside of the platform, you will need to navigate down to the appropriate module using the navigation pane on the left side of the screen.

What our module looks like (mobile version)

Step 1 Knowledge review[edit | edit source]

Learners will take a pre-test to assess their baseline knowledge of the topic. They will begin an interactive case scenario with embedded course material. The case scenario is presented in a question / answer format. As learners progress through the case, they will digest information that is presented to them as they answer case questions. It is highly recommended that the learner be familiar with this content before proceeding to the skill pages. At the end of the step, learners will take a post-test (which is identical to the pre-test).

Step 2 Simulator build[edit | edit source]

Learners will then follow step-by-step instructions on how to build the laparoscopic box trainer out of cardboard and other local materials. A "how-to" video is available to guide learners in this process. They will also construct the simulation of an ectopic pregnancy out of local materials for performance of the task. Directions on how to create a phone-laptop connection in order to simulate a laparoscope view projected onto a monitor are also provided.

Box Trainer

Step 3 Skills practice[edit | edit source]

Learners will view the simulated surgery performed by an expert surgeon in the box trainer. This curated and annotated video demonstrates the paradigm. Learners will also watch two common mistakes videos to understand things to avoid. They will have our rubric (also known as "Verification of Proficiency") available to them. The Verification of Proficiency serves as a checklist of important elements for competent performance of the procedure as well as the checklist that will be used in the assessment process. Learners can watch the videos and practice as much as they desire.

Step 4 Assessment[edit | edit source]

Learners will record a video of themselves on their phones performing the simulation laparoscopic salpingostomy. They will upload it to our site. All of the learner videos will enter our database and be de-identified, randomized, and redistributed to other learners. Learners will then be required to view 3-4 other learners' videos on the platform. They will then assess these videos using the same Verification of Proficiency.

Because our philosophy is to support the development of surgeons' critical thinking and communication through feedback to peers, learners will be expected to provide feedback on other, de-identified, learners' performances using the provided checklist. Complementing this, learners will receive feedback from other participating learners.

In our pilot study, we observed that there is no significant difference in assessments performed by learner peers and experts when the Verification of Proficiency was utilized. This allows for unlimited scalability without reliance on expert assessment.

Once they have completed these steps, learners will take the post-test and completion competency and confidence survey. In a few weeks, once other learners have had the chance to view their videos, they will receive a report of their performance.

Looking ahead[edit | edit source]

After completion and practice to competency, learners may use their box trainers to practice other laparoscopic surgeries and skills. Future modules will include biliary disease, perforated viscus, bowel obstruction, and appendicitis.

Sample future courses using the ALL SAFE model.

For the judges: Global Surgical Training Challenge 2021[edit | edit source]

Our team has created a comprehensive list of learning objectives for our learners. Please see the document below on how our platform meets these specific learning objectives.

ALL SAFE Pilot 2021[edit | edit source]

For the past several months, we have been running a pilot at three of our sites (Soddo in Ethiopia, Mbingo in Cameroon, and Michigan). The main goals of this pilot were as follows:

  1. Test our platform's capabilities
  2. Collect feedback on usability of our platform
  3. Validate our Verification of Proficiency checklist
  4. See if there is a difference between peer learner and expert raters

Please see here our preliminary pilot validation results. This includes preliminary validation of our assessment rubric, box trainer, and ectopic task simulator.