VitalSurg: Outcomes From a Surgical Task-Shifting Training Program in a Humanitarian Context

Objective

The Vital Surgery Training Program (VitalSurg) is a task-shifting initiative designed to build local surgical capacity in surgical deserts by training generalist doctors to perform essential procedures. Implemented in partnership with Médecins Sans Frontières (MSF), the program has undergone 2 pilot iterations in South Sudan. This study evaluates the second iteration, which reflects a refined curriculum and integrated assessment strategy informed by lessons learned from the first iteration. We sought to examine the feasibility, effectiveness, and adaptability of competency-based surgical training embedded within humanitarian clinical care.

Design

We conducted a mixed-methods summative evaluation of the training program. Quantitative trainee performance data—including pre- and postmodule quizzes, oral and written exams, case logs, and Entrustable Professional Activities (EPAs)—were analyzed alongside qualitative data from Key Informant Interviews (KIIs) with trainers, trainees, and MSF stakeholders.

Setting

This study was conducted at Aweil State Hospital, an MSF-supported district hospital in Northern Bahr El Ghazal, South Sudan, which provides maternity and pediatric surgical care in a resource-limited setting.

Participants

Two local medical doctors were enrolled in the second VitalSurg cohort.

Results

Over the 18-month training program, trainees performed an average of 1305 procedures and improved across all evaluation domains. 446 EPAs were completed, with significant variation between trainees (281 vs. 165 EPAs completed; 162 vs. 53 passed), reflecting differing levels of engagement and skill acquisition. EPA pass rates ranged widely, from 81.7% for skin graft to 43.5% for Caesarean section and 22.0% for laparotomy. Competency-based education tools were feasibly implemented despite infrastructure constraints. KIIs highlighted common training challenges—including case mix, service to education ratios, and trainer variability—as well as opportunities for refinement.

Conclusion

VitalSurg demonstrates the feasibility of embedding task-shifting surgical training into humanitarian clinical activities. This model offers a promising, scalable strategy to expand access to safe surgical care in conflict-affected settings.