Fitzgerald Laura, Tibyehabwa Leopold, Varallo John, Ernest Edwin, Patted Anmol, Bertram Margaret Mary, Alidina Shehnaz, Mshana Stella, Katoto Adam, Simba Dorcas, Charles Kevin, Smith Victoria, Cainer Monica, Hellar Augustino
Jhpiego, 1615 Thames St, Baltimore, MD, United States.
Safe Surgery 2020 Project, Jhpiego Tanzania, Dar es Salaam, Tanzania.
Surg Open Sci. 2023 Jul 23;14:109-113. doi: 10.1016/j.sopen.2023.07.014. eCollection 2023 Aug.
COVID-19 has dramatically affected the delivery of health care and technical assistance. This is true in Tanzania, where maternal mortality and surgical infection rates are significantly higher than in high-income countries. This paper describes lessons learned about the optimal application of in-person and virtual mentorship in the Safe Surgery 2020 program to improve the quality of surgical services in Tanzania before and after the COVID-19 pandemic.
From January 2018 through December 2020, Safe Surgery 2020 supported 40 health facilities in Tanzania's Lake Zone to improve the quality of surgical care. A blended surgical mentorship model, employing both onsite and virtual mentorship, was central to the program's capacity development approach. With COVID-19, the program pivoted to full virtual mentorship. Through continuous learning and adaptation processes, including a human-centered design workshop, surveys assessing mentors' confidence with different competencies, and focus group discussions with mentors, mentees and safe surgery program staff, the program distilled the optimal use of mentorship models.
Developing complex surgical skills, addressing contextual considerations, problem-solving, and building trusting relationships were best suited to in-person mentorship, whereas virtual mentorship was most effective in supporting mentees' quality improvement projects, data use, case discussions, and reinforcing clinical practices. Leading successful virtual learning required enhanced facilitation skills and active engagement of health facility leadership.
In-person and virtual mentorship offer distinct benefits and complement each other when combined. Investing more in-person mentorship at the beginning of programs allows for the establishment of trust that is foundational to effective mentorship.
新冠疫情对医疗保健服务和技术援助的提供产生了巨大影响。在坦桑尼亚就是如此，该国的孕产妇死亡率和手术感染率显著高于高收入国家。本文介绍了在“2020年安全手术”项目中，关于在新冠疫情前后优化运用面对面指导和虚拟指导以提高坦桑尼亚手术服务质量所吸取的经验教训。
从2018年1月至2020年12月，“2020年安全手术”项目支持了坦桑尼亚湖区的40家医疗机构，以提高手术护理质量。一种融合了现场指导和虚拟指导的手术指导模式是该项目能力发展方法的核心。随着新冠疫情的出现，该项目转向了完全的虚拟指导。通过持续学习和调整过程，包括一次以人为本的设计研讨会、评估导师对不同能力的信心的调查，以及与导师、学员和安全手术项目工作人员的焦点小组讨论，该项目总结了指导模式的最佳使用方法。
培养复杂的手术技能、考虑实际情况、解决问题以及建立信任关系最适合面对面指导，而虚拟指导在支持学员的质量改进项目、数据使用、病例讨论以及强化临床实践方面最为有效。引领成功的虚拟学习需要提高促进技能以及医疗机构领导层的积极参与。
面对面指导和虚拟指导各有独特优势，结合使用时相辅相成。在项目开始时投入更多的面对面指导能够建立起信任，而信任是有效指导的基础。
