Surgical trainee supervision during non-trauma emergency laparotomy in Rwanda and South Africa

Objective: The primary objective was to describe the level of surgical trainee autonomy during non-trauma emergency laparotomy (NTEL) operations in Rwanda and South Africa. The secondary objective was to identify potential associations between trainee autonomy, and patient mortality and reoperation. Design, Setting, and Participants: This was a prospective, observational study of NTEL operations at three teaching hospitals in South Africa and Rwanda over a oneyear period from September 1, 2017 – August 31, 2018. A total of 543 operations on adults over the age of 18 years who underwent NTEL performed by the acute care and general surgery services were included. Results: surgical trainees led three quarters of NTEL operations, and of these, 72% were performed autonomously in Rwanda and South Africa. Trainees were less likely to perform the operations autonomously for patients who were: age ≥ 60 years, had ASA classification ≥ III, had cancer or TB. Notably, trainee autonomy was not significantly associated with reoperation or mortality. Conclusions: trainees were able to gain autonomous surgical experience without impacting mortality or reoperation outcomes, while still providing surgical support in a high-demand setting. More in-depth studies to understand the association of high trainee autonomy with surgical competency and patient safety is needed.

Grantor

Division of General Surgery

Year dc:date.issued

2021

Author dc:creator

• Pohl, Linda M

Advisor dc:contributor.advisor

• Chu, Kathryn

• surgery
• training
• education
• supervision
• laparotomy
• Africa

Handle dc:identifier.uri

http://hdl.handle.net/11427/36008

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/36008