M. Bryce1, N. Shimelash2, O. Masimbi2, R. E. Wittenberg3,4, S. Nuss1,7, M. Carroll1,5, M. T. Hey1,6, C. Forbes1, R. Jhunjhunwala1,8, B. Alayande1,2, G. A. Anderson1,6 1Program in Global Surgery and Social Change, Department Of Global Health And Social Medicine, Harvard Medical School, Boston, MASSACHUSETTS, USA 2Center for Equity in Global Surgery, University Of Global Health Equity, Butaro, Rwanda 3Harvard Medical School, Harvard University, Boston, MASSACHUSETTS, USA 4Harvard T.H. Chan School of Public Health, Harvard University, Boston, MASSACHUSETTS, USA 5Department of Surgery, Yale University School Of Medicine, New Haven, CONNECTICUT, USA 6Department of Surgery, Brigham And Women’s Hospital, Boston, MASSACHUSETTS, USA 7Brown University Warren Alpert School of Medicine, Brown University, Providence, RHODE ISLAND, USA 8Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MASSACHUSETTS, USA
Introduction: Simulation-based training (SBT) provides a realistic and safe environment to practice surgical skills. It is particularly valuable in low- and middle-income countries (LMICs) where resources and exposure to intricate cases are limited. However, SBT is mostly developed in high-income countries (HICs) and may not address the needs of LMICs. Thus, we built on a surgical simulation curriculum for medical students in Rwanda and assessed students’ experience.
Methods: Based on a contextual SBT curriculum piloted in 2022, we designed and delivered an intensive week-long surgical simulation course for medical students in Rwanda in January 2023. This was a collaboration between Harvard University and the University of Global Health Equity in Rwanda. Instructors included attending surgeons and surgical residents from both institutions. All sessions began with a short lecture taught by one of the instructors and were complemented with audiovisual and written preparatory materials. Compared to the 2022 pilot, we increased interactive clinical scenarios using high-fidelity mannequins, improved and added benchtop models for training, and incorporated a new post-week assessment of students’ experiences using a survey on the first Kirkpatrick level to determine highest utility sessions.
Results: Eighteen students participated in the simulation course and evaluation. Over five days, we taught 21 hours of sessions on informed consent, preoperative patient preparation, trauma simulations, and procedural skills. The majority of the students’ learning time was spent in predominantly practical sessions (76% of the time; 950/1,250 minutes). Only 9.6% (120/ 1,250 minutes) of their time was spent in theoretical sessions. When asked about their exposure to simulation prior to the course, 14/18 (78%) students reported “a lot” and 4/18 (22%) reported “a little.” None reported “no” exposure to simulation. All students (100%) strongly agreed that simulation is a valuable educational tool and felt that the week enhanced their knowledge and skills to “a great extent”. Ten students (56%) reported that the simulation week made them “a lot” more interested in surgery, 7/18 (39%) reported it made them “a little” more interested, and 1/18 (6%) reported there was no change in either direction. The modules with the highest self-rated level of educational value (Figure 1) were (1) the trauma modules (average rating 2.8/12; 1 being the most worthwhile), (2) the interactive trauma simulations (3.4/12), (3) the knot-tying and suturing practice and competition (3.6/12), and (4) a model-based session on cutaneous lesions (5.5/12). The lowest ranked session was the interactive circuit on integrated skills (9.8/12).
Conclusion: Implementing a locally-informed and locally-sourced surgical simulation curriculum is feasible and effectively engages medical students in low-income settings.
