Akoh Jacob A
Nuffield Health Plymouth Hospital, Plymouth, United Kingdom.
J Abdom Wall Surg. 2025 Aug 29;4:14060. doi: 10.3389/jaws.2025.14060. eCollection 2025.
Progress through surgical training in many institutions in Africa is based on duration of apprenticeship, logbook activity, and success in prescribed examinations. Objective assessment of competency is less rigorous. This paper presents the outcome of two surgical training camps focused on open mesh repair of inguinal hernias and a comparison of trainee self-assessment with trainers' assessment of their competency. It discusses the role of competency-based assessment in training of surgeons in Africa.
A competency-based structured hernia training program lasting 8 days conducted in Uganda and Nigeria provided the materials for this study. Each day, a feedback session was held to discuss the trainee's performance and learning. On the final day, the trainee's performance was assessed using established criteria. The results were summarized using descriptive statistics and statistically analysed.
The training program resulted in a statistically significant rise in six specific parameters of knowledge and skill in hernia surgery (p < 0.0004). Of the 14 trainees, five were judged to be able to perform repair of small hernias independently and eight able to with minimal supervision or occasional help. With scrotal hernias, only one trainee was competent to perform repairs independently but 11 required occasional help only.
Training of junior surgeons or medical officers to a proficient level of competency that is safe and of good quality is possible within a few days as demonstrated by this and other reports. Feedback is critical to the success of competency-based training. Surgical Colleges in Africa need to select index procedures such as inguinal hernia repair that newly trained surgeons are required to be competent in to function.
A shift to competency-based surgical training coupled with formative competency assessments in index procedures may lead to a more rapid manpower capacity building than the traditional approach to training of surgeons.
在非洲的许多机构中，外科培训的进展基于学徒期的长短、日志记录活动以及在规定考试中的成绩。对能力的客观评估则不够严格。本文介绍了两个专注于腹股沟疝开放网片修补术的外科训练营的成果，以及学员自我评估与培训师对其能力评估的比较。它讨论了基于能力的评估在非洲外科医生培训中的作用。
在乌干达和尼日利亚开展的一项为期8天的基于能力的结构化疝修补培训项目为该研究提供了材料。每天都会举行反馈会议，讨论学员的表现和学习情况。在最后一天，根据既定标准对学员的表现进行评估。结果使用描述性统计进行总结并进行统计分析。
该培训项目使疝修补手术中六个特定知识和技能参数有了统计学上的显著提高（p < 0.0004）。在14名学员中，有5人被判定能够独立进行小疝修补，8人在最少监督或偶尔帮助下能够进行。对于阴囊疝，只有1名学员有能力独立进行修补，但11人仅偶尔需要帮助。
正如本报告和其他报告所表明的，在几天内将初级外科医生或医务人员培训到安全且高质量的熟练能力水平是可能的。反馈对于基于能力的培训的成功至关重要。非洲的外科医学院需要选择诸如腹股沟疝修补等指标程序，要求新培训的外科医生具备相应能力才能开展工作。
转向基于能力的外科培训并结合对指标程序进行形成性能力评估，可能比传统的外科医生培训方法带来更快的人力能力建设。
