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Global Outreach Using a Systematic, Competency-Based Training Paradigm for Inguinal Hernioplasty.

Justin P Wagner1, Alexander D Schroeder2, Juan C Espinoza3

  • 1Hernia Repair for the Underserved, Omaha, Nebraska2Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles.

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Summary

Competency-based surgical training programs improved surgeon proficiency in hernia repair across underserved countries. This international collaboration established a standard for technical assessment, reducing complications and enhancing surgical outcomes.

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Area of Science:

  • Global Surgery
  • Medical Education
  • Surgical Training

Background:

  • Addressing the global burden of surgical disease requires sustainable, capacity-building educational collaborations.
  • International training paradigms are crucial for improving surgical care in underserved regions.

Purpose of the Study:

  • To assess an international, competency-based training paradigm for hernia surgery in underserved countries.
  • To establish a standardized method for evaluating surgical technical proficiency.

Main Methods:

  • A prospective, observational study involving 16 hospitals across five Latin American countries.
  • Surgeons underwent initial training, interval proficiency assessments using the Operative Performance Rating Scale (OPRS), and served as regional trainers.
  • Technical proficiency was evaluated using OPRS scores and 6-month video assessments; complication rates were recorded.

Main Results:

  • All 81 participating surgeons successfully completed the program, with a significant improvement in mean OPRS scores from 4.06 to 4.52 (P < .001).
  • No significant variation in final scores was observed across countries. The operative complication rate was low at 1.1%.
  • Trained surgeons maintained proficiency at 6 months, and a subsequent cohort of trainees (second-order trainees) also demonstrated high OPRS scores.

Conclusions:

  • Competency-based training is effective in improving surgical skills and addressing the global burden of surgical disease.
  • The Operative Performance Rating Scale (OPRS) provides an international standard for technical surgical assessment.
  • Further research is warranted on long-term trainer proficiency and expanding this model to other surgical procedures.