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Pediatric surgical capacity building - a pathway to improving access to pediatric surgical care in Haiti
Neema Kaseje1, Hillary Jenny2, Andre Patrick Jeudy1
1Hopital Universitaire Mirebalais, Partners in Health, Mirebalais, Haiti.
Insights
A new pediatric surgical training program for general surgery residents in Haiti successfully increased surgical capacity. This model demonstrates feasibility in resource-limited areas, improving pediatric surgical care access without compromising patient outcomes.
Area of Science:
- Global Health
- Surgical Education
- Pediatric Surgery
Background:
- Limited human resources pose a significant barrier to pediatric surgical care access worldwide.
- Resource-constrained regions face particular challenges in providing specialized surgical services for children.
Purpose of the Study:
- To establish a sustainable model for training general surgery residents in pediatric surgical care within a resource-limited setting.
- To assess the feasibility and impact of a pediatric surgical training program on resident competency and patient outcomes in Haiti.
Main Methods:
- A pediatric surgical program was implemented in a Haitian tertiary hospital, including rotations for general surgery residents.
- Residents progressively gained experience in clinic management and performing common pediatric surgical procedures.
- Knowledge assessments, patient volume, and postoperative outcomes were monitored throughout the intervention.
Main Results:
- Nine residents completed the program, with a 50% increase in pediatric cases and a 100% increase in procedures for children under 4.
- Postoperative outcomes showed 0% mortality for elective cases and 18% for emergent cases, with low complication rates.
- Senior residents demonstrated proficiency in common procedures, and knowledge test scores improved significantly across all resident levels.
Conclusions:
- Implementing a pediatric surgery training program for general surgery residents is feasible in resource-limited environments.
- This model effectively builds capacity for pediatric surgical care provision without adversely affecting patient outcomes.
- The established program can serve as a template for other resource-constrained settings to enhance global pediatric surgical workforce capacity.
Purpose:
Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region.
Materials/Methods:
A pediatric surgical program with a pediatric surgical rotation for general surgery residents in a tertiary hospital in Haiti in 2015 was established. We conducted twice daily patient rounds, ran an outpatient clinic, and provided emergent and elective pediatric surgical care, with tasks progressively given to residents until they could run clinic and perform the most common elective and emergent procedures. We conducted baseline and post-intervention knowledge exams and dedicated 1 day a week to teaching and research activities. We measured the following outcomes: number of residents that completed the rotation, mean pre and post intervention test scores, patient volume in clinic and operating room, postoperative outcomes, resident ability to perform most common elective and emergent procedures, and resident participation in research.
Results:
Nine out of 9 residents completed the rotation; 987 patients were seen in outpatient clinic, and 564 procedures were performed in children <15years old. There was a 50% increase in volume of pediatric cases and a 100% increase in procedures performed in children <4years old. Postoperative outcomes were: 0% mortality for elective cases and 18% mortality for emergent cases, 3% complication rate for elective cases and 6% complication rate for emergent cases. Outcomes did not change with increased responsibility given to residents. All senior residents (n=4) could perform the most common elective and emergent procedures without changes in mortality and complication rates. Increases in mean pre and post intervention test scores were 12% (PGY1), 24% (PGY2), and 10% (PGY3). 75% of senior residents participated in research activities as first or second authors.
Conclusions:
Establishing a program in pediatric surgery with capacity building of general surgery residents for pediatric surgical care provision is feasible in a resource constrained setting without negative effects on patient outcomes. This model can be applied in other resource constrained settings to increase human resources for global pediatric surgical care provision.
Level Of Evidence:
III.
