Developing a Surgical Simulation Curriculum for the Rwandan Context

doi:10.1016/j.jsurg.2023.06.007

Journal of Surgical Education

Volume 80, Issue 9, September 2023, Pages 1268-1276

https://doi.org/10.1016/j.jsurg.2023.06.007 Get rights and content

Highlights

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We created a 17-session simulation week with 8 additional sessions in the 11-week clerkship.
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All simulation topics were adopted through a modified Delphi process.
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This work highlights the role of partnership to advance and innovate within surgical education.

Objective

We report on the development and implementation of a surgical simulation curriculum for undergraduate medical students in rural Rwanda.

Design

This is a narrative report on the development of scenario and procedure-based content for a junior surgical clerkship simulation curriculum by an interdisciplinary team of simulation specialists, surgeons, anesthesiologists, medical educators, and medical students.

Setting

University of Global Health Equity, a new medical school located in Butaro, Rwanda.

Participants

Participants in this study consist of simulation and surgical educators, surgeons, anesthesiologists, research fellows and University of Global Health Equity medical students enrolled in the junior surgery clerkship.

Results

The simulation training schedule was designed to begin with a 17-session simulation-intensive week, followed by 8 sessions spread over the 11-week clerkship. These sessions combined the use of high-fidelity mannequins with improvised, bench-top surgical simulators like the GlobalSurgBox, and low-cost gelatin-based models to effectively replace resource intensive options.

Conclusions

Emphasis on contextualized content generation, low-cost application, and interdisciplinary design of simulation curricula for low-income settings is essential. The impact of this curriculum on students’ knowledge and skill acquisition is being assessed in an ongoing fashion as a substrate for iterative improvement.

Section snippets

INTRODUCTION

Simulation-based education plays a critical role in providing a low risk, highly effective teaching environment for both technical and nontechnical surgical skills.¹^-³ Simulation based training is increasingly utilized across medical schools in high-income settings.⁴ However, this is not the case in Low- and Middle-Income Countries (LMIC). Barriers to integrating simulation based surgical education into curricula in these settings- particularly in East, West, and Southern Africa- include high

MATERIALS AND METHODS

The study team generated this curriculum for a new medical school located in the rural, northwest region of Rwanda. It is the second medical school in the country and currently has 3 cohorts of medical students who are engaged in a 6-year dual-degree program that includes a master in global health delivery. Clinical teaching occurs at a district-level hospital and center for excellence in cancer care.⁶

RESULTS

The final product of this surgical simulation curriculum development process is 2-fold: an introductory surgical simulation intensive week (Table 1) and an 8-session surgical simulation curriculum integrated into the junior surgery clerkship (Table 2). The surgical simulation intensive week is a primer for students who have little or no surgical experience and is aimed at preparing students to be contributory participants in the operating room and on the surgical wards by equipping them with

DISCUSSION

Our multidisciplinary team was able to develop a comprehensive and contextually appropriate surgical simulation curriculum within a rural medical school in a low-income country. This effort was driven by providers and professionals working in this setting with support from high-income country partners. In total, a 17-session surgical intensive simulation week and 8-session simulation curriculum was developed.

Simulation continues to grow as an appropriate modality for medical education.17, 18, 19

CONCLUSION

Our team successfully designed and implemented a 17-session surgical intensive simulation week and 8-session simulation longitudinal curriculum for a rural medical school in a low-income country by maximizing the unique strengths of LMIC-HIC partnerships.

Simulation represents an additive component for medical education in LMICs. With careful planning, appropriate leadership, and a systematic approach it is possible to successfully develop and implement a surgical simulation curriculum that is

FUNDING

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

ACKNOWLEDGMENTS

The authors of this manuscript would like to recognize the efforts of Persephone Giannarikas and Drs. Simon Pierre Bigirimana, Jules Iradukunda, Jean Paul Majyambere, Andrew Eyre, and Natalie McCall in making this work possible.

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Using a modified Delphi process to identify critical topics for junior and senior surgery clerkships in the rural Rwandan context

J Am Coll Surg

(2022)

Cited by (6)

Teaching With the GlobalSurgBox: Trainer Perceptions of a Portable Surgical Simulator
2024, Journal of Surgical Education
Citation Excerpt :
This makes it suitable for high-, middle-, and low-income settings. Indeed, the GlobalSurgBox has been integrated into a surgical simulation curriculum at a medical school in Rwanda as well as resident training programs at well-resourced institutions in the United States.23,32 Educators may be skeptical that low-cost simulators offer similar training experiences compared to more expensive, high-fidelity simulators, which limits use of simulators that are more accessible.27,28
Evaluate the utility of a low cost, portable surgical simulator (GlobalSurgBox) for surgical teaching and its ability to dismantle barriers faced by trainers when attempting to use surgical simulation.
An anonymous survey was administered to surgical trainers who were involved in leading simulation events using the GlobalSurgBox in the past 2 years. The survey was designed to understand current barriers to using simulation as a trainer, and the utility of the GlobalSurgBox in overcoming these barriers.
Academic medical training centers or conferences in the United States, Rwanda and Kenya.
10 practicing surgeons, 3 practicing physicians, 11 surgical residents, 15 medical students and 1 anesthesia resident.
The top 3 barriers for effective teaching were lack of convenient access to the simulator (50%), lack of trainer time (43%) and cost (28%). After using the GlobalSurgBox, 100% and 98% of respondents felt that it encourages more practice and offers significant advantages over current simulators in their program. About 90%, 88% and 70% of respondents believed that the GlobalSurgBox makes surgical simulation more convenient, affordable, and compatible with trainer time limitations, respectively. 83% of trainers agreed that it is a good replica of the operating room experience, and 85% practicing physicians were more likely to give autonomy to trainees after demonstrating competence on the GlobalSurgBox.
The GlobalSurgBox mitigates several barriers surgical educators experience when practicing surgical skills with trainees. The convenience of the GlobalSurgBox can help facilitate the development of foundational surgical skills outside of the operating room.
Implementation of an Intensive Surgical Simulation Week for Medical Students in Rwanda
2024, Journal of Surgical Research
Citation Excerpt :
Therefore, this study presents the development and implementation of an intensive surgical simulation week for two cohorts of undergraduate medical students in rural Butaro, Rwanda in early 2023. Our work builds on an existing surgical simulation curriculum designed to address the needs of surgical teams practicing in district hospitals, which prioritized content areas based on a modified Delphi process carried across sub-Saharan Africa, and was first taught in 2022.8 We sought to enhance the training of medical students by augmenting interactive clinical scenarios, introducing new benchtop task-trainer models, and evaluating the students’ experiences with these methods.
Simulation-based training often fails to meet the needs of low- and middle-income countries with limited access to high-cost models. We built on an existing surgical simulation curriculum for medical students in Rwanda and assessed students’ experience.
Based on a contextual simulation-based education curriculum that was piloted in 2022, our team designed and delivered an intensive week-long surgical simulation course for medical students. We increased interactive clinical scenarios using high-fidelity mannequins, improved and added benchtop models for training, and incorporated a new postcourse assessment of students’ experiences using a survey on the first Kirkpatrick level to determine sessions with the highest utility. Modules included informed consent, preoperative patient preparation, trauma simulations, and procedural skills. The final day focused on integrating and applying skills learned throughout the week in an interactive circuit.
Thirty-six students participated in the 5-d simulation course and 24 completed an end of course survey. When asked about their exposure to simulation prior to the course, 20/24 (83%) students reported “a lot” and 4/24 (17%) reported “a little”, 24/24 (100%) strongly agreed that simulation is a valuable educational tool and 23/24 (96%) felt that the week enhanced their knowledge and skills to “a great extent”. The modules with the highest self-rated level of engagement were the interactive trauma simulations, knot-tying and suturing practice and competition, and a model-based session on cutaneous lesions. The lowest ranked session was the interactive circuit on integrated skills.
Implementing a locally-informed and locally-sourced surgical simulation curriculum is feasible and effectively engages medical students in low-income settings.
Global viewpoints: proposals for the development of endourology in resource-limited countries in Africa
2024, BJU International
The Implementation of Simulation-Based Learning for Training Undergraduate Medical Students in Essential Surgical Care Across Sub-Saharan Africa: a Scoping Review
2024, Medical Science Educator
Usefulness of a low-cost simulation model for teaching internal manual aortic compression. A survey-based mannequin evaluation
2024, International Journal of Gynecology and Obstetrics
A national perspective on exposure to essential surgical procedures among medical trainees in Nigeria: a cross-sectional survey and recommendations
2023, BMC Medical Education

^a: Denotes cofirst author.

^b: Denotes cosenior author.

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ORIGINAL REPORTSDeveloping a Surgical Simulation Curriculum for the Rwandan Context

Highlights

Objective

Design

Setting

Participants

Results

Conclusions

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

FUNDING

ACKNOWLEDGMENTS

J Am Coll Surg

J Surg Educ

Ann Med Surg (Lond)

J Surg Educ

Am J Surg

J Surg Res

Curr Surg

Afr J Emerg Med

Trends in retention and decay of basic surgical skills: evidence from Addis Ababa university, Ethiopia: a prospective case-control cohort study

World J Surg

Trends and innovations of simulation for twenty first century medical education

Front Public Health

Healthcare simulation: s key to the future of medical education—a review

Adv Med Educ Pract

Using a modified Delphi process to identify critical topics for junior and senior surgery clerkships in the rural Rwandan context

J Am Coll Surg

ORIGINAL REPORTS
Developing a Surgical Simulation Curriculum for the Rwandan Context