Competency‐Based Education in Low Resource Settings: Development of a Novel Surgical Training Program
Open accessAbstract
Background: The unmet burden of surgical disease represents a major global health concern, and a lack of trained providers is a critical component of the inadequacy of surgical care worldwide. Competency‐based training has been advanced in high‐income countries, improving technical skills and decreasing training time, but it is poorly understood how this model might be applied to low‐ and middle‐income countries. We describe the development of a competency‐based program to accelerate specialty training of in‐country providers in cleft surgery techniques. Methods: The program was designed and piloted among eight trainees at five international cleft lip and palate surgical mission sites in Latin America and Africa. A competency‐based evaluation form, designed for the program, was utilized to grade general technical and procedure‐specific competencies, and pre‐ and post‐training scores were analyzed using a paired t test. Results: Trainees demonstrated improvement in average procedure‐specific competency scores for both lip repairs (60.4–71.0%, p < 0.01) and palate (50.6–66.0%, p < 0.01). General technical competency scores also improved (63.6–72.0%, p < 0.01). Among the procedural competencies assessed, surgical markings showed the greatest improvement (19.0 and 22.8% for lip and palate, respectively), followed by nasal floor/mucosal approximation (15.0%) and hard palate dissection (17.1%). Conclusion: Surgical delivery models in LMICs are varied, and trade‐offs often exist between goals of case throughput, quality and training. Pilot program results show that procedure‐specific and general technical competencies can be improved over a relatively short time and demonstrate the feasibility of incorporating such a training program into surgical outreach missions.
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Competency-based training has been shown to work in various low-resource health care fields, such as surgery and obstetric care.
“Competency-based training approaches have already demonstrated success in diverse areas of health care in low resource settings, including surgery and obstetric care 5,6 .”
From Ensuring Quality in Psychological Support (WHO EQUIP): developing a competent global workforce (2020) · cites this paper as [5]
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- Authors
- McCullough, M., Campbell, A., Siu, A., Durnwald, L., Kumar, S., Magee, W. P., & Swanson, J.
- Affiliations
- University of Southern California (US)
- Division of Education Operation Smile Virginia Beach VA USA
- McGregor Comprehensive Cleft Center Operacion Sonrisa Nicaragua Colonia Bolonia, Managua Nicaragua
- Shriners for Children Medical Center - Pasadena (US)
- Corresponding author
- McCullough, Meghan
- Venue
- World Journal of Surgery
- Publisher
- Wiley
- Published
- 2017-09-06
- Volume
- 42
- Issue
- 3
- Pages
- 646-651
- ISSN
- 0364-2313 (ISSN-L)
- 1432-2323
- PMC
- PMC5801372
- OpenAlex
- W2750845457
- Cited by
- 47
- References
- 19
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 7 · 2020: 5 · 2019: 6 · 2018: 3
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- World Journal of Surgery (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Keywords
- competency-based training, cleft lip and palate surgery, surgical curriculum, low- and middle-income countries, surgical outreach, surgical skill assessment, surgical training, surgical workforce shortage, Latin America, Africa
- MeSH terms
- Africa, Cleft Lip, Cleft Palate, Clinical Competence, Competency-Based Education, Developing Countries, Humans, Latin America, Pilot Projects, Surgery, Plastic, Program Development, Quality Indicators, Health Care
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