Novel application of existing tools to define the training needs of surgical teams in low resource settings

McKnight, Gerard 2024. Novel application of existing tools to define the training needs of surgical teams in low resource settings. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background Global surgery has developed rapidly from being the “neglected stepchild of global health” to now being a burgeoning academic field with internationally accepted metrics for benchmarking performance and to measure progress alongside an evolving ethical structure to address the social injustices in healthcare. However, in order to ensure that training initiatives are appropriate to the context they are delivered in, the burden of surgical disease, the surgical workforce and the learning needs of the workforce must be identified. Low resource settings are the most frequently affected by humanitarian disasters and increasingly provide the majority of the workforce to humanitarian medical organisations (HMOs). Despite this, the term ‘humanitarian surgery’ is yet to be defined Methods The Synthesis Without Meta Analysis (SWIM) methodology was used to conduct a systematic review to define the burden of surgical disease in low- and middle-income countries (LMICs) using Disability Adjusted Life Years (DALYs). The SWIM methodology was again used to conduct a second systematic review investigating the surgical workforce gap in LMICs using the density of surgical, obstetric and anaesthesia providers per 100,000 population (SAO density). Using the Hennessy-Hicks Training Needs Analysis (TNA) questionnaire as a basis, a bespoke questionnaire was designed and delivered as an online survey across two study locations in Africa; Somaliland and South Africa in collaboration with partner organisations. This mixed-methods survey collected quantitative and qualitative data and allowed respondents to identify key areas of learning needs and offer suggestions as to how novel technologies could be used to address these needs. A secondary aim was to validate this novel TNA questionnaire to encourage its use in similar contexts in future. Finally, an international, collaborative study was designed using Delphi methodology to reach consensus on the term ‘humanitarian surgery’. Results Systematic review 1 revealed a vast, and growing burden of surgical disease and highlighted an ongoing trend of increased disease burden from non- Novel application of existing tools to define the training needs of surgical teams in low resource settings communicable diseases. Systematic review 2 demonstrated the global shortage of the surgical workforce and highlighted the inequitable distribution of the existing workforce. Both studies highlighted the additional inequity of academic interest, as South East Asia was the focus of 9% and 12% of studies respectively, despite representing nearly 25% of the global population. This 3-dimenstional lack of equity creates structural imbalances within global health and must be addressed by the international community The TNA received responses were received from 69 Surgical Providers (SPs) and 41 Anaesthesia Providers (APs) in Somaliland. Responses highlighted ongoing concerns with access to reliable oxygen monitoring in the operating theatre environment and that a majority of SPs used the WHO Surgical Safety Checklist infrequently. The performance of emergency cricothyroidotomy was reported as an area of concern by APs. Mixed training and organisational improvements were desired in every skill, highlighting the importance of wider surgical system strengthening rather than focussing on improving training alone. In Somaliland there was desire to see a greater use of technology in improving communication with patients and colleagues and to improve patient outcome data recording. There was minimal appetite for more advanced use of technology such as tele-proctoring. Responses were received from 59 General Surgeons in South Africa. Overall, the surgeons surveyed felt their training programme prepared them well for clinical practice. Access to technology for use of and training in minimally invasive surgery (MIS) was a key recurring theme amongst respondents. The qualitative analysis also demonstrated that non-technical skills training was an important theme. This highlights that any training intervention or training programme must ensure the wider development beyond the development of technical skills. During the Delphi study to define humanitarian surgery, 107 responses were received from 34 separate countries, generating 25 initial statements. Ten statements met the pre-defined criteria for agreement and consensus and were included in the final definition. Conclusions The burden of surgical disease and the extent of the global surgical workforce crisis have been highlighted in addition to the unequal allocation of academic research creating a 3-dimensional lack of equity. The novel application of the HH Novel application of existing tools to define the training needs of surgical teams in low resource settings TNA has been demonstrated to be useful and practical across different cultural, political and geographic boundaries and it can collect meaningful data. This data can be used in combination with other complimentary data sources such as the Global Burden of Disease (GBD) study and workforce surveys such as the WHO Situational Analysis Tool (SAT) to give a holistic view of the healthcare needs of the local population as well as the density, and training needs, of the local surgical workforce. Further modifications in the application of the HH TNA could also generate long-term data, for example by conducting before and after surveys to measure the impact of any training intervention. Finally, achieving international consensus on the definition of humanitarian surgery facilitates comparison of activity against international standards and enables meaningful data collection and ensures that those who are most likely to be affected by sudden onset disasters, and are most likely to provide the workforce to respond, have their voices represented in defining and standardising this sphere of global health.

Item Type:	Thesis (MD)
Date Type:	Completion
Status:	Unpublished
Schools:	Medicine
Date of First Compliant Deposit:	3 January 2025
Last Modified:	03 Jan 2025 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/174584

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