Defining the Impact of Short-Term Surgical Education Courses in Low- and Middle-Income Countries: A Systematic Review

Abstract

Objective

There is a high burden of surgical disease in low- and middle-income countries (LMICs). One approach for improving surgical service delivery in LMICs is education of health professionals, including short-term education courses. The goal of this review is to evaluate short-term education courses in terms of content, evaluation, and impact.

Materials and Methods

A systematic review of the literature was performed in adherence with PRISMA framework. PubMed and EMBASE databases were queried using six predefined search terms to identify publications from 1990 to 2020. Two independent reviewers screened the records for inclusion and exclusion criteria. Studies of short-term courses (< 1 month) in LMICs that involved health care personnel and evaluated course impact were included.

Results

Of the 2640 records identified in the initial query, 45 articles were ultimately selected for inclusion in this systematic review. Thirty-three unique LMICs were represented, with eight courses held in multiple locations. The majority of courses were developed in high-income countries, lasted three days or less, and were intended for resident and attending doctors. While the specialty-focus of courses varied widely, nearly all courses aimed to teach both knowledge and skills, and the most common educational components included lectures and simulation and/or hands-on practical skills sessions. Written pre and postcourse knowledge testing was the most common method for evaluating course impact; however, there were a large variety of other evaluation methods including review of hospital metrics, clinical skills assessment, and participant survey.

Conclusions

Short-term education courses are held in many LMICs to teach a variety of procedural skills to surgical and anesthetic providers. While there are similarities in course goals and educational components, there is substantial variation in methods used to evaluate course impact, as well as a lack of understanding the long-term retention of skills and impact on practice change and patient outcomes.