Introduction
The second COSECSA /OPERATION HERNIA Training Workshop was successfully completed on June 3, 2017. Nine Ugandan surgical residents were trained in mesh and non-mesh hernia repair (Shouldice) by a faculty of three UK Operation Hernia surgeons. The surgeons were Chris Oppong, Plymouth; Prof Jacob Akoh, Plymouth and Scott Caplin, Swansea. They were supported by Dr Francis Basimbe, Deputy Head of the Surgical Department and Dr Lois Assimwe both at Nsambya Hospital. The training took place at St Francis Nsambya and Naggalama Hospitals. The first workshop was also held in Uganda, in September 2016.
Accreditation
The Executive of the College of Surgeons of Eastern, Central and Southern Africa (COSECSA) accredited Operation Hernia surgeons as trainers in hernia surgery at their May 2015 meeting in Geneva and designated St Francis Hospital at Nsambya in Uganda as the COSECSA HERNIA TRAINING CENTRE.
Programme
The training comprised academic and hands-on apprenticeship in the operating theatres. A pre-workshop survey of the surgical experience of the residents was undertaken to provide valuable information to the trainers. The majority of residents had little or no personal experience in hernia surgery although they had performed a considerable number of Caesarean sections.
Lectures on relevant aspects of hernia surgery were delivered on the first day. This was a Sunday but all the trainees were committed to the course and attended in spite of some personal issues. During the following five days each trainer took three trainees through hands-on tutoring in the three operating theatres at Naggalama Hospital. The training, like last year’s, was very intensive.
Assessments and Feedback
At the end of the workshop, each trainer assessed their trainees using a format similar to that used to assess UK trainees. All nine surgical residents were assessed as “Able to perform the procedure” with various levels of supervision/assistance. This is a tremendous achievement, considering the experience of the residents prior to the training workshop. The trainees also assessed themselves using the same instrument. The trainees gave very positive feedback on all aspects of the course and were very grateful.
Examples of feedback comments are given below:
- “Absolutely, this has been a game changer. Am now very confident I will be able to do the surgeries and even train other individuals”
- “I have appreciated the anatomy of the inguinal region and various approaches for repair of inguinal and ventral hernia”
- “I was able to appreciate every layer of the canal as it was displayed systematically. For the first time in my surgical training, I could identify and independently dissect the sac in more than one case”
- “This is the first time I have had structured surgical training”
Overall Competence of Trainees at the end of the Training Course
| Large Hernias | Small to Moderate Sized Hernias | |
| Unable to Perform procedure | ||
| Able to Perform Aspects of the procedure | ||
| Able to Perform Procedure with Supervision | 2 | 2 |
| Able to Perform with minimal supervision / Occasional Help | 6 | 5 |
| Able to perform independently | 1 | 2 |
Post Training Experience
It is hoped that the mentors of the residents would provide them with opportunities to employ their new skills under supervision.
Operation Hernia has provided mesh for further training and will provide more material to the residents.
Each resident will keep a logbook of their hernia experience.
Future Plans
Operation Hernia has been invited back for further training of surgical trainees in 2018. Surgeons will be invited from the COSECSA countries to be trained as Trainers.
Chris Oppong, Consultant Surgeon and Lead of Faculty
Chairman, Board of Directors, Operation Hernia