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KingPriest PT, Alayande BT, Clement EW, Muhammed M, Egbiri JO, Shanabo M, Osayande EK, Atunrase AA, Abubakar JI, Eze DC, Adekoya S, Chiroma GB, Aikhuomogbe OM, Gaila FS, Yaga D, Thomas NN, Chukwunta CA, Hey MT, Forbes C, Riviello RR, Ismaila BO. A national perspective on exposure to essential surgical procedures among medical trainees in Nigeria: a cross-sectional survey and recommendations. BMC MEDICAL EDUCATION 2023; 23:913. [PMID: 38037034 PMCID: PMC10691202 DOI: 10.1186/s12909-023-04847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND In sub-Saharan Africa, recent graduates from medical school provide more direct surgical and procedural care to patients than their counterparts from the Global North. Nigeria has no nationally representative data on the procedures performed by trainees before graduation from medical school and their confidence in performing these procedures upon graduation has also not been evaluated. METHODS We performed an internet-based, cross-sectional survey of recent medical school graduates from 15 accredited Federal, State, and private Nigerian medical schools spanning six geopolitical zones. Essential surgical procedures, bedside interventions and three Bellwether procedures were incorporated into the survey. Self-reported confidence immediately after graduation was calculated and compared using cumulative confidence scores with subgroup analysis of results by type and location of institution. Qualitative analysis of free text recommendations by participants was performed using the constant comparative method in grounded theory. RESULTS Four hundred ninety-nine recent graduates from 6 geopolitical zones participated, representing 15 out of a total of 44 medical schools in Nigeria. Male to female ratio was 2:1, and most respondents (59%) graduated from Federal institutions. Students had greatest practical mean exposure to bedside procedures like intravenous access and passing urethral foley catheters and were most confident performing these. Less than 23% had performed over 10 of any of the assessed procedures. They had least exposures to chest tube insertion (0.24/person), caesarean Sect. (0.12/person), and laparotomy (0.09/person). Recent graduates from Federal institutions had less procedural exposure in urethral catheterization (p < 0.001), reduction (p = 0.035), and debridement (p < 0.035). Respondents that studied in the underserved North-East and North-West performed the highest median number of procedures prior to graduation. Cumulative confidence scores were low across all graduates (maximum 25/60), but highest in graduates from Northern Nigeria and private institutions. Graduates recommended prioritizing medical students over senior trainees, using simulation-based training and constructive individualized non-toxic feedback from faculty. CONCLUSION Nigerian medical students have poor exposure to procedures and low confidence in performing basic procedures after graduation. More attention should be placed on training for essential surgeries and procedures in medical schools.
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Affiliation(s)
- Paul Tunde KingPriest
- Surgical Equity and Research Hub, Jos, Nigeria
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Barnabas Tobi Alayande
- Surgical Equity and Research Hub, Jos, Nigeria.
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda.
- Harvard TH Chan School of Public Health, Boston, USA.
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- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Callum Forbes
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Bashiru O Ismaila
- University of Jos, Jos, Nigeria
- Jos University Teaching Hospital, Jos, Nigeria
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Valiev T, Morgan HM. Simulation-based learning of invasive procedures skills: A critical appraisal of its organization in undergraduate medical education. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2019.1603336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Timur Valiev
- Center for Simulation-based Learning and Accreditation of Specialists, Tver State Medical University, Tver, Russia
| | - Heather May Morgan
- Postgraduate Education Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Morris M, O'Neill A, Gillis A, Charania S, Fitzpatrick J, Redmond A, Rosli S, Ridgway P. Prepared for Practice? Interns' Experiences of Undergraduate Clinical Skills Training in Ireland. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2016; 3:10.4137_JMECD.S39381. [PMID: 29349313 PMCID: PMC5736273 DOI: 10.4137/jmecd.s39381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND Many previous studies on internship have reported a lack of preparedness for the role. More recently in Ireland, medical schools have introduced formal clinical skills training programmes. This study sought to evaluate the impact, if any, of formal skills training in the medical training on intern's preparedness for practice. METHODS The study utilized a survey approach followed by focus group discussions. The aim was to identify the skills that were taught and assessed in medical training and the skills that were actually required in their intern year. RESULTS Most interns had received skills training in designated skills laboratories. No intern had received training in all skills advised in the European guidelines. Skills taught to all interns were intravenous cannulation, basic life support, and basic suture. Skills required from all interns were intravenous cannulation, phlebotomy, and arterial blood sampling. Removal of peripherally inserted central line (PICC) lines, central lines, and chest drains were commonly requested but not taught. Senior staff underestimated skill abilities and expected failure. CONCLUSION These findings identify discordance between the skills taught and the skills required in the job. There is a need for standardization in the clinical skills training to ensure that all interns enter practice with equal competencies. Consideration should be given to experiential learning opportunities such as subintern programmes to consolidate learning and improve preparedness. Improvement in communications with senior clinicians is indicated to ensure that expectations are realistic and reflective of actual training.
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Affiliation(s)
- M. Morris
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
| | - A. O'Neill
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - A. Gillis
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - S. Charania
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - J. Fitzpatrick
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - A. Redmond
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - S. Rosli
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - P.F. Ridgway
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
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