Competency-Based Education in Low Resource Settings: Development of a Novel Surgical Training Program

Area of Science:

• Global Surgery
• Medical Education
• Cleft Lip and Palate Surgery

Background:

• Surgical disease presents a significant global health challenge, exacerbated by a shortage of trained providers.
• Competency-based training models, successful in high-income nations, have potential but are understudied in low- and middle-income countries (LMICs).
• A novel competency-based program was developed to expedite specialized cleft surgery training for local healthcare professionals.

Purpose of the Study:

• To develop and evaluate a competency-based training program for cleft surgery techniques.
• To assess the program's effectiveness in improving technical skills of in-country providers.
• To determine the feasibility of integrating this training model into international surgical missions.

Main Methods:

• The program was piloted with eight trainees across five international cleft lip and palate surgical mission sites in Latin America and Africa.
• A custom competency-based evaluation form assessed general technical and procedure-specific skills.
• Pre- and post-training competency scores were analyzed using paired t-tests.

Main Results:

• Trainees showed significant improvements in both lip repair (60.4% to 71.0%) and palate repair (50.6% to 66.0%) competency scores (p < 0.01).
• General technical competency scores also increased significantly (63.6% to 72.0%, p < 0.01).
• Notable gains were observed in surgical markings, nasal floor/mucosal approximation, and hard palate dissection.

Conclusions:

• Competency-based training can effectively enhance both general and procedure-specific surgical skills in LMICs.
• The program's feasibility was demonstrated within surgical outreach missions, suggesting a viable model for improving cleft care.
• This approach offers a potential solution to the trade-offs between case volume, quality, and training in LMIC surgical delivery models.