Improving Surgical Skills of OBGYN Residents through Partnership with Rural Hospitals: Experience from Southeast Nigeria

Abstract

Background: surgical burden of disease is enormous in sub-Saharan Africa where conditions amenable to surgery also contribute to high maternal mortality ratio in the region. Training of specialists in Obstetrics and Gynaecology must include acquisition of requisite surgical skills. Aim: To evaluate the impact of clinical rotations at rural hospitals on the clinical knowledge, and surgical and administrative skills of residents in Obstetrics and Gynaecology. Subjects and Methods: This was a cross-sectional study using mixed methods involving resident doctors in Obstetrics and Gynaecology at the Federal Teaching Hospital, Abakaliki, Nigeria who had undergone rural postings. Information was obtained from consented residents (June 2013 to February 2015) using a questionnaire and focused group discussion. Data was analyzed using Epi info (CDC, Atlanta USA). Results: Thirty-four questionnaires (89.5%) were analyzed; 70.6% were junior residents. Junior residents had a 900% and 460% rise in the rates of emergency and elective caesarean sections they performed, and had similar increases with regard to gynaecological procedures. Senior residents had a 100% and 80% rise in performance of total abdominal hysterectomy and myomectomy respectively. Seventy-five percent of all the residents believed that their surgical skills improved tremendously while 87.5% of the senior residents believed their administrative skills greatly improved also. Conclusion: Residents in Obstertics and Gynaecology at the Federal Teaching Hospital Abakaliki believed that supervised clinical rotations in rural hospitals offered them an opportunity to improve on their clinical knowledge and surgical skills. We advocate an objective assessment of the skills and knowledge of the residents against the claimed subjective improvement.

Keywords: Clinical and surgical skills, Rural posting, Residents