Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
Dept. Health and Society, Wageningen University and Research, Wageningen, The Netherlands.
PLoS One. 2021 Sep 29;16(9):e0257597. doi: 10.1371/journal.pone.0257597. eCollection 2021.
Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach.
Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method.
The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation.
Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders.
外科专家的监督是有益的，因为他们可以向地区医院级别的外科团队传授技能。赞比亚的 SURG-Africa 项目包括在选定地区进行的指导试验，涉及两个省级指导团队。本文的目的是通过参与式建模方法探讨将这种外科指导纳入现有政策结构的政策选择。
在地区和中心医院各举行了两次小组建模研讨会，参与者来自不同的机构，具有临床和/或行政背景。两位独立评审员对这些研讨会产生的因果关系图（CLD）进行了两两比较，以构建一个综合的 CLD。使用图形理论对综合 CLD 进行了分析，并使用增强循环变量关系分析方法（MARVEL）探索了动态系统行为。
与利益相关者合作建立省级指导教师队伍，将是协调和维持外科指导以及监测地区一级外科绩效的必要步骤。建议在省级层面进行季度外科指导审查，以评估并在需要时调整指导。地区医院管理人员需要密切监测学员的积极性。
外科指导可以在扩大地区一级手术方面发挥关键作用，但实施起来很复杂，需要指定省级协调，并与相关利益相关者定期联系。
