Pediatric surgical capacity building – a pathway to improving access to pediatric surgical care in Haiti

doi:10.1016/j.jpedsurg.2017.11.033

Journal of Pediatric Surgery

Volume 53, Issue 2, February 2018, Pages 298-301

https://doi.org/10.1016/j.jpedsurg.2017.11.033 Get rights and content

Abstract

Purpose

Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region.

Materials/methods

A pediatric surgical program with a pediatric surgical rotation for general surgery residents in a tertiary hospital in Haiti in 2015 was established. We conducted twice daily patient rounds, ran an outpatient clinic, and provided emergent and elective pediatric surgical care, with tasks progressively given to residents until they could run clinic and perform the most common elective and emergent procedures. We conducted baseline and post-intervention knowledge exams and dedicated 1 day a week to teaching and research activities. We measured the following outcomes: number of residents that completed the rotation, mean pre and post intervention test scores, patient volume in clinic and operating room, postoperative outcomes, resident ability to perform most common elective and emergent procedures, and resident participation in research.

Results

Nine out of 9 residents completed the rotation; 987 patients were seen in outpatient clinic, and 564 procedures were performed in children < 15 years old. There was a 50% increase in volume of pediatric cases and a 100% increase in procedures performed in children < 4 years old. Postoperative outcomes were: 0% mortality for elective cases and 18% mortality for emergent cases, 3% complication rate for elective cases and 6% complication rate for emergent cases. Outcomes did not change with increased responsibility given to residents. All senior residents (n = 4) could perform the most common elective and emergent procedures without changes in mortality and complication rates. Increases in mean pre and post intervention test scores were 12% (PGY1), 24% (PGY2), and 10% (PGY3). 75% of senior residents participated in research activities as first or second authors.

Conclusions

Establishing a program in pediatric surgery with capacity building of general surgery residents for pediatric surgical care provision is feasible in a resource constrained setting without negative effects on patient outcomes. This model can be applied in other resource constrained settings to increase human resources for global pediatric surgical care provision.

Level of evidence

III

Section snippets

Setting

The program was implemented at a tertiary hospital in rural Haiti with training programs in general surgery, obstetrics and gynecology, internal medicine, emergency medicine, and pediatrics. At the start of the pediatric surgical program, the general surgical training program had just received its third class of residents. The general surgical program is a 5 year program in General Surgery. There had been no prior rotations in pediatric surgery. Before the implementation of the pediatric

Results

Nine out of 9 residents completed the pediatric surgical rotation. Over the course of the year, 987 patients were seen in outpatient clinic, and 564 procedures were performed in children < 15 years old.

We demonstrated an increase in pediatric surgical volume; Fig. 2 shows the 50% increase in the volume of cases performed in patients < 15 years old; and the 100% increase in procedures performed in children < 4 years old.

Table 1 depicts the patterns and distribution of common elective pediatric

Discussion

Over the course of the year, we were able to establish a pediatric surgical program dedicated to the care of children that resulted in increased pediatric surgical care provision as shown by increased pediatric surgical volume. In addition, we demonstrated increased surgical trainee knowledge and skill; and increased research capacity.

Although, the literature describes baseline studies demonstrating the need for pediatric surgical capacity building in resource constrained countries such as

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S. Krishnaswami et al.
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World Bank

There are more references available in the full text version of this article.

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Clinical PaperPediatric surgical capacity building – a pathway to improving access to pediatric surgical care in Haiti

Abstract

Purpose

Materials/methods

Results

Conclusions

Level of evidence

Section snippets

Setting

Results

Discussion

Semin Pediatr Surg

Clinical Paper
Pediatric surgical capacity building – a pathway to improving access to pediatric surgical care in Haiti