6 research outputs found
The need for hands-on training and supervision for entry-level physicians in a country with low surgical staffing density: a nationwide survey in Ghana
No full textAbstract Background Despite the largely unmet need, relatively few medical school graduates enrol in surgical residency and fewer surgical specialists work rurally in low- and middle-income countries. Surgical housemanship is the only formal training for medical graduates who will become the main surgical care providers in underserved areas. This study aimed to evaluate Ghanaian surgical housemanship (internship) and its impact on independent medical practice. Methods A nationwide questionnaire survey of surgical trainees from seven teaching or regional-level hospitals ascertained the experience and self-confidence levels for 35 training objectives set by the Medical and Dental Council of Ghana, and suggestions to improve surgical training quality. Results Of 310 respondents, 59.7% experienced ≤ 10 cases for each topic, and 24.8% reported self-confidence as ≤ 2 points (out of 5). More than 90% of respondents experienced ≤ 10 cases for gastric, colorectal and liver cancer management. Teaching hospital trainees had lower proportions of those experiencing > 10 cases (36.6% versus 43.7%) and reporting self-confidence ≥ 4 (46.5% versus 55.8%), respectively, compared with those from regional/other-level hospitals. 40% of respondents were not confident about their surgical skills, and 70.5% requested better-supervised and practical surgical skills training. The proportion of respondents who reported limited supervision was higher among those from teaching hospitals, reported self-confidence scores < 4, and experienced ≤ 10 cases for each topic. 67% of respondents were satisfied with their surgical housemanship and 75.8% perceived surgical rotation as relevant to their future work. Conclusions Most surgical trainees are concerned about their surgical skills. A structured curriculum with specific goals and better-supervised surgical skills training should be established. Inclusion of regional/other-level hospitals in surgical training may reduce the supervisory burden in teaching hospitals
Additional file 1 of The need for hands-on training and supervision for entry-level physicians in a country with low surgical staffing density: a nationwide survey in Ghana
No full textAdditional file 1: Fig. S1. Key lessons learned during the surgical rotation. Table S1. Details of the evaluation form. Table S2. Reasons for not feeling confident in surgical conditions or procedures (multiple responses)
A community-focused cervical and breast cancer screening program using a sustainable funding model in a training center in Ghana
No full textAbstract Background While Ghana prepares to roll out a nationwide breast and cervical (pre)cancer screening policy, it is necessary to continuously document high-impact and scalable models. Over the years, the Cervical Cancer Prevention and Training Centre (CCPTC), Battor, has utilized a sustainable funding model in which each trainee pays for 15 women to be screened with visual inspection with acetic acid. This paper details the framework of community-focused trainer-led coordinated cervical and breast screening outreaches carried out under this model. The paper further reports the outcomes of screening over a 5-year period and discusses the advantages and shortcomings of the model in an effort to make recommendations for the development and scale-up of combined cervical and breast screening in a largely opportunistic setting. Methods This descriptive retrospective cross-sectional study investigated women who underwent cervical precancer screening using visual inspection with acetic acid or mobile colposcopy and/or high-risk human papillomavirus (hr-HPV) DNA testing between September 2017 and July 2022 (n = 2,273) and clinical breast examination between June 2021 and March 2023 (n = 622) by trainees of the CCPTC on outreaches conducted primarily to solidify their practical skills. For women screened using HPV DNA testing and visual inspection, respectively, the study explored factors associated with HPV infection or visual inspection ‘positivity’ using nominal logistic regression. Results The overall prevalence of hr-HPV infection was 14.3% (95% CI, 10.0–19.6) among women with valid results for hr-HPV DNA testing, while the overall visual inspection ‘positivity’ rate was 2.8% (95% CI, 2.2–3.6). After controlling for age, earning an income was the only factor associated with hr-HPV infection (aOR = 3.00; 95% CI, 1.35 − 6.64; p-value = 0.007). Factors associated with visual inspection ‘positivity’ after adjusting for age were: number of births (aOR = 0.71; 95% CI, 0.52 − 0.97; p-value = 0.029), number of lifetime pregnancies (aOR = 0.79; 95% CI, 0.67 − 0.93; p-value = 0.004), being single (aOR = 2.42; 95% CI, 1.19 − 4.90; p-value = 0.014), and earning an income (aOR = 0.44; 95% CI, 0.26 − 0.74; p-value = 0.002). Breast examination showed clinically significant masses in 20 women (3.2%), lymphadenopathy in 13 (2.1%), and nipple discharge in 37 women (6.0%) and only n = 3/67 women (4.5%) requiring referral followed up for further management. Conclusion While the outreach approach adopted by the CCPTC has myriad benefits, further evidence-based studies and structured program evaluations are needed to assess if this approach can be adopted on a large scale, especially without the backing of a training institution with the needed resources and capacity to investigate and manage screen positives
Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries
No full textIntroductionTelemedicine is being adopted for postoperative surveillance but requires evaluation for efficacy. This study tested a telephone Wound Healing Questionnaire (WHQ) to diagnose surgical site infection (SSI) after abdominal surgery in low- and middle-income countries.MethodA multi-centre, international, prospective study was embedded in the FALCON trial; a factorial RCT testing measures to reduce SSI in seven low- and middle-income countries (NCT03700749). It was conducted according to a pre-registered protocol (SWAT126) and reported according to STARD guidelines. The reference test was in-person review by a trained clinician at 30 postoperative days according to US Centres for Disease Control criteria. The index test was telephone administration of an adapted WHQ at 27 to 30 postoperative days by a researcher blinded to the outcome of in-person review. The sum of item response scores generated an overall score between 0 and 29. The primary outcome was the diagnostic accuracy of the WHQ, defined as the proportion of SSI correctly identified by the telephone WHQ, and summarized using the area under the receiving operator characteristic curve (AUROC) and diagnostic test accuracy statistics.ResultsPatients were included from three upper-middle income (396 patients, 13 hospitals), three lower-middle income (746 patients, 19 hospitals), and one low-income country (54 patients, 4 hospitals). 90.3% (1088 of 1196) patients were successfully contacted. Those with non-midline incisions (adjusted odds ratio: 0.36, 95% c.i. 0.17 to 0.73, P=0.005) or a confirmed diagnosis of SSI on in-person assessment (odds ratio: 0.42, 95% c.i. 0.20 to 0.92, P=0.006) were harder to reach. The questionnaire correctly discriminated between most patients with and without SSI (AUROC 0.869, 95% c.i. 0.824 to 0.914), which was consistent across subgroups. A representative cut-off score of ≥4 displayed a sensitivity of 0.701 (0.610-0.792), specificity of 0.911 (0.878-0.943), positive predictive value of 0.723 (0.633-0.814) and negative predictive value of 0.901 (0.867-0.935).ConclusionSSI can be diagnosed using a telephone questionnaire (obviating in-person assessment) in low resource settings
Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis
No full textBackground: The Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation. Methods: This was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model. Results: In the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever). Conclusion: This study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways
