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28
Figure 2 demonstrates the average improvement by competency across all trainees for the first
training mission.
Figure 2: Average Improvement in Competencies from Pre- to Post-training with Standard
Deviation
*indicates statistical significance
Figure 3 A-C graphically represents pre- and post-training improvement for each of the trainees
for general and procedure-specific competencies, with trainees listed by number. The majority
of trainees achieved higher baseline percent scores in unilateral lip procedures but showed a
greater percentage improvement in palate procedures.
0
10
20
30
40
50
60
70
80
90
100
Preop Postop General Unilateral Lip Palate
Average Percentage Score
Competency
Average Change in Competencies
Pre Post
Object Description
| Title | Competency based education in low resource settings: design and implementation of a novel surgical training program |
| Author | McCullough, Meghan Claire |
| Author email | Meghan.McCullough@med.usc.edu;mcculloughmeghan@gmail.com |
| Degree | Master of Science |
| Document type | Thesis |
| Degree program | Clinical, Biomedical and Translational Investigations |
| School | Keck School of Medicine |
| Date defended/completed | 2018-03-30 |
| Date submitted | 2018-05-01 |
| Date approved | 2018-05-01 |
| Restricted until | 2018-05-01 |
| Date published | 2018-05-01 |
| Advisor (committee chair) | Magee, William P., III |
| Advisor (committee member) |
May, Win McKean-Cowdin, Roberta Conti, David |
| Abstract | 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. Increasingly, education is being recognized as essential to addressing this human resource crisis. 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 (LMICs). This manuscript outlines the existing literature on surgical education initiatives within LMICs and describes the development of a competency‐based program to accelerate specialty training of in‐country providers in cleft surgery techniques during ongoing service initiatives with the non‐profit organization Operation Smile. ❧ Methods: A systematic review of the literature was performed utilizing PubMed and Medline databases following PRISMA guidelines. Identified programs were categorized according to model and program evaluation metrics were detailed. The specific development of Operation Smile’s surgical training program and the creation and contextualization of the evaluation instrument was then outlined. The program was designed and piloted among sixteen trainees at ten international cleft lip and palate surgical mission sites in Latin America and Africa. The competency‐based evaluation form was utilized to grade general technical and procedure‐specific competencies. Pre‐ and post‐training scores were analyzed using a paired t‐test and associations between number of completed cases and improvement in scores was evaluated using Pearson’s correlation coefficient. ❧ Results: Trainees demonstrated improvement in average general technical competency scores, from 53.1% to 67.2% (p=0.01), as well as in procedure‐specific competency scores for both cleft lip repairs, from 50.6% to 64.6% (p<0.01), and cleft palate repairs, from 45.16% to 65.1% (p<0.01). Postoperative care competencies improved from 58.5% to 73.3% (p=0.01) while preoperative care competencies improved from 53.8% to 70.6% (p<0.01). There was no significant correlation between the number of cases completed over the mission and the change in self‐perceived confidence for either lip and palate procedures for either knowledge (r=-0.62, p=0.856, n=11 for lip and r=-0.057, p=0.867, n=11 for palate) or technical skill (r=-0.091, p=0.802, n=11 for lip and r=-0.059, p=0.863, n=11 for palate). There was also no correlation between improved procedure‐specific competency scores and number of cases performed for either lip or palate procedures (r=0.032, p=0.917, n=11 for lip and r=0.046, p=0.886, n=11 for palate), although inconsistency with respect to case log completion may have contributed to the lack of apparent association. A positive correlation was seen between improvement in lip and palate‐specific competencies (r=0.774, p<0.01, n=13). ❧ Conclusion: Surgical delivery models in LMICs are varied, and trade‐offs often exist between goals of case throughput, quality and training. This unique program serves as an example of diagonal development, utilizing existing models of care delivery to train in‐country providers and to improve education and sustainability while simultaneously continuing to provide much needed services, and it is the first proposed program that utilizes competency‐based evaluation principles to maximize the unique training opportunities presented by the surgical mission setting. The initial one‐year pilot phase of the program demonstrates significant potential to the model, in addition to identifying challenges and areas for future investigation. The planned expansion and continued analysis hold promise for continuing to merge service and education to build stronger health systems in lower and middle‐income countries. |
| Keyword | surgical education; education; surgery; low and middle-income country; low-resource setting |
| Language | English |
| Format (imt) | application/pdf |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m |
| Contributing entity | University of Southern California |
| Rights | McCullough, Meghan Claire |
| Physical access | The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given. |
| Repository name | University of Southern California Digital Library |
| Repository address | USC Digital Library, University of Southern California, University Park Campus MC 7002, 106 University Village, Los Angeles, California 90089-7002, USA |
| Repository email | cisadmin@lib.usc.edu |
| Filename | etd-McCullough-6299.pdf |
| Archival file | Volume34/etd-McCullough-6299.pdf |
Description
| Title | Page 28 |
| Full text | 28 Figure 2 demonstrates the average improvement by competency across all trainees for the first training mission. Figure 2: Average Improvement in Competencies from Pre- to Post-training with Standard Deviation *indicates statistical significance Figure 3 A-C graphically represents pre- and post-training improvement for each of the trainees for general and procedure-specific competencies, with trainees listed by number. The majority of trainees achieved higher baseline percent scores in unilateral lip procedures but showed a greater percentage improvement in palate procedures. 0 10 20 30 40 50 60 70 80 90 100 Preop Postop General Unilateral Lip Palate Average Percentage Score Competency Average Change in Competencies Pre Post |
