Help with overseas surgical training

For generations, surgical training was based on the apprenticeship model – see one, do one and teach one. Increasing patients' expectations mean that, quite rightly, patients expect operations to be performed by properly trained surgeons.

According to Fitts and Posner, ^1,2 acquisition of psychomotor skills is in three stages: cognitive, integrative and autonomous. The cognitive stage can be taught outside the operating theatre. Training methods include the use of prosthetic materials, virtual reality, live animals or cadavers. There is evidence to suggest that the cognitive stage can be achieved using prosthetic materials. ³ The Intercollegiate Basic Surgical Skills course (BSS) of the United Kingdom's Royal Colleges of Surgeons was devised to meet this requirement. In 2001, the Royal college of Surgeons of England adapted the BSS course to suit any teaching institution and designed the Introduction to Surgical Skills course (ISS) to meet the requirements of resource-poor countries. The Overseas Surgical Fellowship Group (OSFG) of the Association of Surgeons of Great Britain and Ireland (ASGBI) has been running such courses in collaboration with the College of Surgeons of East, Central and Southern Africa (COSECSA) and the West African College of Surgeons (WACS). The primary aim of the OSFG is to disseminate these basic surgical skills with local faculty members running the courses, and till date, seventeen ISS courses have been organized, with approximately 522 participants. With generous contribution from Ethicon Johnson and Johnson, fourteen training centres have now been established in East and West Africa.

In this issue of the journal, Dr Ezeome and colleagues at the University of Nigeria Teaching Hospital (UNTH), Enugu describe their experience of running the ISS course. They have been very successful in sourcing and adapting local materials, thereby reducing cost without affecting the quality of the teaching.

The recent decision by the council of WACS to make successful completion of ISS course a mandatory requirement for the Part 1 fellowship examination from April 2010 has added further impetus to the need for widespread local provision of these courses. It is therefore essential that the Enugu model is replicated, as insufficient capacity within the West African sub-region risks creating a bottle-neck to sitting the fellowship examination. However, quality assurance oversight is necessary to maintain a minimum acceptable standard of teaching. In addition, there has to be more Training the Trainers (TTT) courses for local faculty members. Three such courses were organised by the OSFG in Mombasa, Zaria and Freetown with plans for more in the future.

In addition to running ISS and TTT courses, the OSFG has a website with information for overseas trainees who want to train in the United Kingdom. ⁴ In collaboration with the British Journal of Surgery (BJS), OSFG provides annual fellowship awards to senior UK trainees, retired surgeons or consultants about to retire who wish to spend some time in a resource-poor country. The OSFG also manages, on behalf of BJS and ASGBI Trading Limited Annual International Bursaries, to cover the costs of trainees from resource-poor countries who wish to attend the ASGBI annual scientific conference. ⁵

The OSFG is committed to helping overseas institutions and trainees with surgical training. ⁶ Although recent changes to the immigration rules and specialist training programmes ⁷ have limited the opportunities of such trainees to visit UK, there is renewed optimism that the new points-based immigration system ⁸ and International Medical Graduate Sponsorship Scheme spearheaded by the Royal College of Surgeons of Edinburgh ⁹ will go a long way to correcting these anomalies. The UK has a tradition of collaborating with and providing surgical training for overseas doctors and the OSFG will continue to work very hard to maintain this tradition.