Pediatric surgical capacity building – a pathway to improving access to pediatric surgical care in Haiti

Neema Kaseje, Hillary Jenny, Andre Patrick Jeudy, Jean Louis MacLee, John G. Meara, Henri Ford

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Purpose: Lack of human resources is a major barrier to accessing pediatric surgical care globally. Our aim was to establish a model for pediatric surgical training of general surgery residents in a resource constrained region. Materials/methods: A pediatric surgical program with a pediatric surgical rotation for general surgery residents in a tertiary hospital in Haiti in 2015 was established. We conducted twice daily patient rounds, ran an outpatient clinic, and provided emergent and elective pediatric surgical care, with tasks progressively given to residents until they could run clinic and perform the most common elective and emergent procedures. We conducted baseline and post-intervention knowledge exams and dedicated 1 day a week to teaching and research activities. We measured the following outcomes: number of residents that completed the rotation, mean pre and post intervention test scores, patient volume in clinic and operating room, postoperative outcomes, resident ability to perform most common elective and emergent procedures, and resident participation in research. Results: Nine out of 9 residents completed the rotation; 987 patients were seen in outpatient clinic, and 564 procedures were performed in children < 15 years old. There was a 50% increase in volume of pediatric cases and a 100% increase in procedures performed in children < 4 years old. Postoperative outcomes were: 0% mortality for elective cases and 18% mortality for emergent cases, 3% complication rate for elective cases and 6% complication rate for emergent cases. Outcomes did not change with increased responsibility given to residents. All senior residents (n = 4) could perform the most common elective and emergent procedures without changes in mortality and complication rates. Increases in mean pre and post intervention test scores were 12% (PGY1), 24% (PGY2), and 10% (PGY3). 75% of senior residents participated in research activities as first or second authors. Conclusions: Establishing a program in pediatric surgery with capacity building of general surgery residents for pediatric surgical care provision is feasible in a resource constrained setting without negative effects on patient outcomes. This model can be applied in other resource constrained settings to increase human resources for global pediatric surgical care provision. Level of evidence: III

Original languageEnglish (US)
Pages (from-to)298-301
Number of pages4
JournalJournal of Pediatric Surgery
Volume53
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Keywords

  • Capacity building
  • Global pediatric surgery
  • Implementation science

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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