Learning Curve Characteristics for Caesarean Section Among Associate Clinicians: A Prospective Study from Sierra...

Area of Science:

• Global Health
• Surgical Education
• Obstetrics & Gynecology

Background:

• High maternal mortality in Sierra Leone necessitates innovative solutions.
• Task-sharing surgical training for associate clinicians is a key strategy.
• Learning curves for caesarean sections by associate clinicians are not well understood.

Purpose of the Study:

• To evaluate the learning curve for caesarean sections performed by associate clinicians.
• To determine the number of procedures needed for significant reduction in operation time.

Main Methods:

• Prospective study of 1174 caesarean sections by 24 associate clinician trainees.
• Analysis of total operating time (incision to suturing) for the first 50 procedures.
• Secondary outcomes included blood loss, infections, hospital stay, and mortality.

Main Results:

• Total operation time significantly decreased within the first 15 caesarean sections (72 to 51 minutes).
• Surgical site infections were higher in the initial 15 procedures (6.8%) compared to later ones (2.3%).
• Estimated blood loss and maternal mortality showed no significant change with experience.

Conclusions:

• Associate clinician experience significantly reduces caesarean section operation time within the first 15 cases.
• Blood loss is not directly correlated with trainee experience in these procedures.
• Task-sharing programs can improve surgical efficiency but require further evaluation for mortality impact.