Cultivating rural surgical leaders through a structured training program: a qualitative case study

Area of Science:

• Global Health
• Surgical Education
• Health Systems Strengthening

Background:

• 5 billion people lack safe surgical care, disproportionately affecting rural LMICs.
• Pakistan's rural areas face surgical workforce shortages and infrastructural deficits.
• The Rural Surgical Leadership Program (RSLP) was developed to train surgeons in procedural and leadership skills for rural settings.

Purpose of the Study:

• To explore the feasibility of the RSLP in Pakistan.
• To assess the perceived impact of the context-adapted RSLP on rural health systems.

Main Methods:

• Embedded qualitative single case study of the RSLP.
• Semi-structured interviews with 3 graduates and 2 supervisors.
• Thematic analysis of interview transcripts with inductive coding.

Main Results:

• Rural facilities face isolation, staff shortages, and equipment issues.
• Graduates improved in obstetrics and trauma care, with noted gaps in orthopedics and radiology.
• Graduates reduced urban referrals by 50-60%, mentored staff, and initiated community outreach.

Conclusions:

• The RSLP shows transformative potential for surgical training in LMICs.
• Context-adapted training can strengthen rural surgical systems and improve access.
• Recommendations include integrated simulation, telehealth, extended rotations, and policy alignment.