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Original Investigation | Pacific Coast Surgical Association

A Consortium Approach to Surgical Education in a Developing Country Educational Needs Assessment

Mackenzie Cook, MD1; Benjamin M. Howard, MD, MPH2; Angela Yu3; Douglas Grey, MD4; Paul B. Hofmann, DrPH5; Alexis M. Moren, MD, MPH1; Mabula Mchembe, MD6; Abbas Essajee, MD6; Omari Mndeme, MD6; James Peck, MD1; William P. Schecter, MD2
[+] Author Affiliations
1Department of Surgery, Oregon Health & Science University, Portland
2Department of Surgery, University of California, San Francisco
3Department of Public Health, University of California, Berkeley
4Alliance for Global Clinical Training, San Francisco, California
5Hofmann Healthcare Group, Moraga, California
6Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
JAMA Surg. 2015;150(11):1074-1078. doi:10.1001/jamasurg.2015.2205.
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Importance  Surgical disease is a global health priority, and improving surgical care requires local capacity building. Single-institution partnerships and surgical missions are logistically limited. The Alliance for Global Clinical Training (hereafter the Alliance) is a consortium of US surgical departments that aims to provide continuous educational support at the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (MUHAS). To our knowledge, the Alliance is the first multi-institutional international surgical collaboration to be described in the literature.

Objective  To assess if the Alliance is effectively responding to the educational needs of MUHAS and Muhimbili National Hospital surgeons.

Design, Setting, and Participants  During an initial 13-month program (July 1, 2013, to August 31, 2014), faculty and resident teams from 3 US academic surgical programs rotated at MUHAS as physicians and teachers for 1 month each. To assess the value of the project, we administered anonymous surveys.

Main Outcomes and Measures  Anonymous surveys were analyzed on a 5-point Likert-type scale. Free-text answers were analyzed for common themes.

Results  During the study period, Alliance members were present at MUHAS for 8 months (1 month each). At the conclusion of the first year of collaboration, 15 MUHAS faculty and 22 MUHAS residents completed the survey. The following 6 areas of educational needs were identified: formal didactics, increased clinical mentorship, longer-term Alliance presence, equitable distribution of teaching time, improved coordination and language skills, and reciprocal exchange rotations at US hospitals. The MUHAS faculty and residents agreed that Alliance members contributed to improved patient care and resident education.

Conclusions and Relevance  A multi-institutional international surgical partnership is possible and leads to perceived improvements in patient care and resident learning. Alliance surgeons must continue to focus on training Tanzanian surgeons. Improving the volunteer surgeons’ Swahili-language skills would be an asset. Future efforts should provide more teaching coverage, equitably distribute educational support among all MUHAS surgeons, and collaboratively develop a formal surgical curriculum.

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