Jacob S Dreyer(1), Joseph Musowoya(2), Abebe Bekele(3), David Ball(4) Departments of Surgery (1) and Anaesthesia(4), NHS Dumfries & Galloway, UK; Dept of Surgery,
Ndola Central Hospital, Zambia(2); Dept of Surgery, Addis Ababa University, Ethiopia(3).
Aim:To evaluate how a CC teaching portfolio was developed for surgery service providers in
COSECSA countries (College of Surgeons of East, Central and Southern Africa), as requested by
local surgeons, consisting of taught courses, reading material, thorough assessment and open
course evaluation opportunities.
Methods: CC training courses aimed at different levels of need (for trainees, surgeons, nurses,
health/clinical officers and anaesthetic assistants) were developed over a four year period from
established principles of teaching CC in the UK, but course contents and delivery were adapted
to local needs. An open source learning resource was developed through online review articles
written for purpose, published through an established open source resource, leading to an
electronic handbook. Feedback opportunities for local tutors and course participants were
created through informal feedback sessions, end-of-course rating and open text course
evaluation forms, pre- and post-course surveys and 6-month post-course evaluation forms.
Sustainability is supported through training of local tutors and provision of a faculty handbook.
Results: Since 2009 twelve courses for health officers, surgical trainees, senior surgeons, nurses and
anaesthetic assistants have been run in four COSECSA countries; >200 surgical service providers
have completed courses and >20 COSECSA tutors have been trained. The course curriculum has
been established with high feasibility, with constant revision. Consistently high feedback scores
show excellent inter-observer reliability. Qualitative feedback confirmed good predictive and
face validity with 95-100% of participants indicating that course had a significant impact on
surgical practice. Course management and delivery is being handed over to COSECSA tutors in
2014, with ongoing educational support from visiting faculty, as requested.
Conclusions: CC teaching to fit in with COSECSA goals can be delivered through a small group of visiting
tutors, with input from local surgeons and course participants, with high validity, reliability and
feasibility ratings. Feedback indicates that CC courses fill a specific need that have not been
available previously; it improves clinical decision making, teamwork and communication in high
pressure clinical situations, especially in managing surgical emergencies. The course can be
managed further by COSECSA faculty, with ongoing support from the course developers.