Competency Assessment in Training in African Countries

Progress through surgical training in many institutions in Africa is based on duration of apprenticeship, logbook activity, and success in prescribed examinations. Objective assessment of competency is less rigorous. This paper presents the outcome of two surgical training camps focused on open mesh repair of inguinal hernias and a comparison of trainee self-assessment with trainers' assessment of their competency. It discusses the role of competency-based assessment in training of surgeons in Africa.

A competency-based structured hernia training program lasting 8 days conducted in Uganda and Nigeria provided the materials for this study. Each day, a feedback session was held to discuss the trainee's performance and learning. On the final day, the trainee's performance was assessed using established criteria. The results were summarized using descriptive statistics and statistically analysed.

The training program resulted in a statistically significant rise in six specific parameters of knowledge and skill in hernia surgery (p < 0.0004). Of the 14 trainees, five were judged to be able to perform repair of small hernias independently and eight able to with minimal supervision or occasional help. With scrotal hernias, only one trainee was competent to perform repairs independently but 11 required occasional help only.

Training of junior surgeons or medical officers to a proficient level of competency that is safe and of good quality is possible within a few days as demonstrated by this and other reports. Feedback is critical to the success of competency-based training. Surgical Colleges in Africa need to select index procedures such as inguinal hernia repair that newly trained surgeons are required to be competent in to function.

A shift to competency-based surgical training coupled with formative competency assessments in index procedures may lead to a more rapid manpower capacity building than the traditional approach to training of surgeons.