Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA.
Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia.
BMC Med Educ. 2022 Aug 31;22(1):653. doi: 10.1186/s12909-022-03691-2.
A well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource-constrained settings.
We designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey (n = 25) and qualitative data through in-depth interviews (n = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes.
All mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention.
We offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention's success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.
合格的劳动力对于卫生系统和人口的有效运作至关重要；然而，技能差距在资源匮乏的环境中构成了挑战。虽然越来越多的证据表明，指导可以通过提高卫生服务提供者的能力来改善非洲卫生环境的质量、可及性和系统，但对于其在外科领域的实施情况了解甚少。我们研究了一种新的外科指导干预措施，作为五项埃塞俄比亚农村设施中安全手术干预（Safe Surgery 2020）的一部分，以了解资源有限环境中影响外科指导实施的因素。
我们设计了一项收敛混合方法研究，以了解学员、导师、医院领导和外部利益相关者对指导干预措施的经验。2018 年通过调查（n=25）和深入访谈（n=26）收集定量数据，以收集有关以下方面的信息：（1）干预特征，包括指导领域、学员-导师关系和导师特征；（2）组织背景，包括实施的促进因素和障碍；（3）感知影响；（4）受访者特征。我们分别使用频率分析和常数比较法分析定量和定性数据；我们整合发现以确定主题。
所有学员（100%）都认为干预是积极的。参与者认为影响包括：更安全、更频繁的手术程序、学员和导师之间的同事关系、学员赋权以及持续学习的文化。超过 70%的学员报告说他们的信心和工作满意度提高了。支持性干预特征包括关注系统、学员-导师关系具有心理安全感，以及导师具有慷慨的时间和知识、理解当地背景和人际交往技能等特征。支持性组织背景包括接受的实施氛围。干预挑战包括临床培训不足、导师支持不足以及剂量不足。组织背景挑战包括资源限制以及对干预措施缺乏共同理解。
我们为干预设计者、政策制定者和从业者提供了关于优化资源匮乏环境中的外科指导干预措施的经验教训。我们将干预措施的成功归因于其整体方法、接受的氛围和有效的学员-导师关系。这些素质，以及政策支持和通过用户反馈调整干预措施，对于成功实施至关重要。
