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Advancing congenital cardiac surgical training in low- and middle-income countries-challenges and opportunities
Sivakumar Sivalingam1, Brijesh Parayaru Kottayil2, Richard Andrew Jonas3
1Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
Insights
Congenital heart surgery training faces challenges in low- and middle-income countries (LMICs) due to resource limitations. Proactive measures and structured curricula offer hope for improving surgical education and competency.
Area of Science:
- Medical Education
- Cardiovascular Surgery
- Global Health
Background:
- Congenital heart surgery training faces challenges from evolving procedures and public scrutiny.
- An imbalance exists between training conditions and competency achievement, particularly in low- and middle-income countries (LMICs).
- LMICs face significant hurdles including inadequate infrastructure, funding, trainers, curricula, and reimbursement.
Purpose of the Study:
- To assess the current state of congenital heart surgery training in LMICs.
- To identify challenges and limitations in training programs.
- To propose future directions for enhancing training quality.
Main Methods:
- Review of training status in India and Malaysia.
- Analysis of challenges and limitations faced by training programs.
- Discussion of proactive measures by leadership and NGOs.
Main Results:
- Significant disparities in training resources and outcomes were observed in LMICs.
- Lack of structured curricula and inadequate funding impede training quality.
- Collaborative efforts by specialty organizations and NGOs are crucial.
Conclusions:
- Improving congenital heart surgery training in LMICs requires addressing infrastructure, funding, and curriculum development.
- Structured training programs and international collaboration are essential for advancing surgical competency.
- Proactive leadership and non-governmental organization involvement are vital for sustainable progress.
Abstract:
The specialty of congenital heart surgery has met with numerous challenges in the current era, with the changing landscape towards catheter-based interventional procedures, increasing complexity of procedures because of sequelae from previously corrected cardiac lesions, and the constant scrutiny of outcomes in the public domain. There exists an imbalance between conditions that are favorable for quality education and the achievement of the level of competency during training in the specialty. These challenges are more pronounced in the low- and middle-income countries (LMICs) due to lack of infrastructure and funding available for training, lack of trainers, non-availability of a curriculum for training, and poor reimbursement in the specialty. However, there is a glimmer of hope with more proactive measures taken by the leadership from the specialty societal organization of various countries and various national and international non-governmental organizations (NGOs) that include establishing a structured curriculum and several medical education activities. In this article, we would like to share the status of training in congenital heart surgery at the LMICs, namely India and Malaysia, and share our experience on the status of training, the challenges, and limitations to training, and the future directions to promote high-quality training in congenital heart surgery.
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