Background of this Training Program[edit | edit source]
The Lancet Commission proposed a target of 20 specialty-trained surgical, anesthesia, and obstetric providers (SAO) per 100,000 population by 2030. Some countries, including Venezuela and Nicaragua, are nearing the target with 18.13 (V) and 15.47 (N) SAO per 100,000. However, countries like Myanmar, Kenya, and Ethiopia have densities substantially lower at 2.42 (M), 2.35 (K), and 0.54 (E) SAO per 100,000. In an attempt to reduce this disparity in surgical care, these countries rely on general practitioners who graduate from medical school and have no formal surgical education. While referral centers with formally trained surgeons exist, they are limited in number and capacity. Thus, referral centers rely on general practitioners at district-level hospitals to complete simpler operations, especially urgent and emergent cases such as appendectomies. To improve and standardize surgical care in sub-Saharan Africa (SSA) and other LMICs, the World Health Organization (WHO) published a list of infrastructure, supplies, and procedures that should be available at all district-level hospitals. Our GSTC team chose to focus on this list of procedures. We further narrowed our focus to acute appendicitis, and developed a surgical education training intervention aimed at general practitioners to positively affect their learning and performance of surgical skills necessary to complete an open appendectomy.
Appendicitis is the most common cause of operatively managed acute abdominal pathology at many tertiary facilities in SSA. In western Kenya, acute appendicitis affects 18.2% of the population with a surgical need. Morbidity related to appendicitis is three times higher in SSA (37.7%) when compared to high-income countries (12.7%). This multifactorial increase in morbidity is partly related to treatment delays at the local level, to which surgical inexperience may contribute. Open appendectomy requires familiarity with the anatomy of the right lower abdominal quadrant, knowledge of the procedural steps, and several basic surgical skills. Failing to perform these steps competently can lead to devastating consequences for patients. Creating an effective model to teach the necessary appendectomy skills will allow the district hospital general practitioners to perform this procedure safely and effectively thereby reducing the morbidity associated with a lack of access to this procedure and complications of improperly performed appendectomies. Furthermore, if we succeed in solving this problem, we will have created a platform that can be applied to several different procedures which may be performed safely and effectively at the district level hospitals across LMICs that use a similar healthcare delivery system.
Iterative Process for Prototype Development[edit | edit source]
This low-cost model underwent multiple rounds of iteration with resident and expert surgeons. The curriculum also underwent multiple rounds of iteration through content experts as well as education experts.
Estimated cost of the anterior abdominal wall[edit | edit source]
Our training module is free and our simulator costs less than $1 to make. This training module overcomes logistical and cost barriers that exist for a vast majority of doctors performing surgeries in LMICs.
3D Printed Model[edit | edit source]
Within the time period of the Discovery award, our team created a 3D printed model of the open appendectomy. This model underwent four iterations of testing with the same experts who completed the low-cost model testing and each time improved on fidelity. As we continued to develop the model, however, we realized this model is unlikely to be affordable to our target audience. However, we plan to use this model in our evaluation protocol as the post-intervention assessment.
Full Curriculum in PDF Format[edit | edit source]
This is currently undergoing editing and will ultimately be displayed via a mobile phone app.