COSECSA Mobile Surgical Skills Training Unit

Background Information
The Mobile Surgical Unit (MSU), like the name suggests is a state of the art surgical training unit in form of a trailer driven caravan. The unit has the following resources: 5 Laparoscopic ProMIS simulator stations; lecture room facility for 10 delegates with individual desk LCD monitors; and in built Public Address System complete with video conferencing ideal for telemedicine. It is also equipped with general surgery instrumentation sets, laparoscopic instrumentation sets plus surgical consumables. Some of the training programs that can be run using this facility includes but not limited to the following; Basic Surgical Skills (BSS), Basic Laparoscopic Skills (BLS) and Colorectal Surgery.

This training caravan was a gift given to College Of Surgeons East Central & Southern Africa (COSECSA) through joint donation from the Royal College of Surgeons in Ireland (RCSI) and Irish Aid. The intention of this donation was to enable surgeons within the ECSA region advance their skills thereby enhance the surgical outcomes. Johnson & Johnson MD&D through their infrastructural network within the region such as Nairobi Surgical Skills Centre (NSSC) and long standing partnership with RCSI and COSECSA/ASEA were given the mandate to implement the surgical training programs. As such, the first course using the mobile skills unit was held in Arusha Tanzania at the Arusha Lutheran Medical Centre (ALMC) in November 2015, hopefully many more courses are to be rolled out in 2016 onwards. Mobile Surgical Skills Training Unit – A New Paradigm in Surgical Education

Basic surgical skills are an integral part of surgical training while advancement various surgical skills and specialties are integral part of enhancing patient surgical outcomes. Faisal M. Shaikh et al., alluded that simulation-based surgical training offers an opportunity both to trainees and trainers to learn and teach surgical skills outside the operating room in a non-patient, non-stressed environment. However, widespread adoption of simulation technology especially in medical education is prohibited by its inherent higher cost, limited space, and interruptions to clinical duties. Mobile skills laboratory has been proposed as a means to address some of these limitations.

Thanks to the Royal College of Surgeons in Ireland (RCSI) for coming up with an innovative approach to teach its postgraduate basic surgical trainees the necessary surgical skills, by making the use of mobile innovative simulation technology in their own hospital settings thereby mitigating the challenges highlighted above. With the success of this innovation in Ireland and United Kingdom, we are glad that RCSI have replicated the same concept through their kind donation of a Mobile Surgical Unit to its affiliate surgical college and surgical association, that is, COSECSA and ASEA respectively. This is probably the first and only surgical education innovation of its kind within Sub Saharan Africa. This new paradigm shift in surgical education intends to bridge the massive surgical skills gap in ECSA region by providing a world class surgical training while overcoming the limitations highlighted above.

The Inaugural BLS Course & Demographics

Since the arrival of the Mobile Surgical Unit, the first course to be conducted was a Basic Laparoscopic Skills (BLS) Course held at Arusha Lutheran Medical Centre (ALMC) for 2 days, 26th – 27th November 2015. There were 10 delegates who participated in the BLS training. These delegates were drawn from ALMC and Kilimanjaro Christian Medical Centre (KCMC) on a 50: 50 distribution, that is, 5 delegates from ALMC and the other 5 delegates from KCMC. Since Basic Laparoscopic Skills course cuts across both General Surgery and Gynecological Surgery, we had a mix of the two specialties but with general surgery being the most predominant with 80% share. Interesting to note that 70% of the delegates were surgical residents (5 from KCMC and 2 from ALMC); and that Consultant Surgeons and Consultant Gynecologists both from ALMC were 10% and 20% respectively. As for gender parity, it was disappointing to note that there was only 1 female delegate out of 10 delegates, representing 10%.

BLS Delegate Distribution

                                                                         ALMC    KCMC

 Surgical Residents 2 5
 Consultant Surgeons  1  0
 Consultant Gynecologists  2  0
 Total  5  5

Way Forward

The best but at the same time least suitable object for a surgeon's training is the patient. Surgical simulators of the latest generation allow the training of surgical skills as well as the perfecting of specific manipulations needed during various surgical operations. Through consequent use of simulation, a great variety of training can be offered, and programs can be custom-tailored to the individual skills of the trainee that again considerably increase the efficiency of the training.

The Mobile Surgical Skills Training Unit provides surgeons and surgical residents with the opportunity to obtain a high-quality and efficient training, in the context of a well-structured training course, with professional knowledge transfer, with the use of simulation and audio-visual means. Constant and repeated practical exercises, which are indispensable for the difficult learning process, can be documented and retrieved at any time. The quality of the training is reflected in the improved performance of the trainees.

In surgical practice, the principles for gentle handling of living tissues established over a century ago by Dr. William Halsted have not changed. However, with the evolution of surgery, techniques of interacting with tissue have become more complex. For instance, the surgeon’s eyes are being replaced by visual optics, while the surgeon’s hands are being replaced by metals and plastics, and with the recent advancement in robotic surgery, precision and spatial/geographical challenge is a thing of the past. For these reasons that we believe that the Mobile Surgical Skills Training Unit is of absolute necessity in the advancement of surgical education within the ECSA region and Sub Sahara Africa at large.


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