Structured hernia surgery training program for general practitioners in Rwanda - feasibility and evaluation

Hernias are among the most common surgical conditions worldwide, with significant prevalence in Africa. However, according to recent WHO statistics, Africa faces a critical shortage of trained surgeons. Structured surgical training programs are also scarce. Since 2016, Surgeons for Africa in collaboration with Operation Hernia have developed structured training course on hernia surgery specifically for surgeons in Rwanda. Due to the severe shortage of surgeons, a new initiative was launched in 2023 to train general practitioners (GPs) to support the country's surgical care needs. This study aims to assess the feasibility and effectiveness of these training programs for general practitioners.

Six standardized questionnaires were used to evaluate the structured training program before, during, and after the one-and-a-half-week courses conducted in Rwanda. Both trainees and trainers completed the relevant evaluations. The results were anonymized, ummarized using descriptive statistics, and statistically analysed. Trainers also assessed the surgical competence of each participant at the end of the course.

Between 2023 and 2024, 47 general practitioners received hernia surgery training in several Rwandan hospitals. The course significantly improved both the theoretical knowledge and practical surgical skills of the participants. Of the 47 GPs, 22 were able to independently perform simple inguinal hernia surgeries after the training. Three were able to perform complex inguinal hernia repairs independently. 12 participants required minimal supervision, while 22 required full supervision.

This study confirms the feasibility and effectiveness of a standardized hernia surgery training program for general practitioners in Rwanda. The results demonstrate the rogramme's potential to address the surgical care gap by enabling GPs to perform basic hernia surgeries.