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Backward Planning a Craniomaxillofacial Trauma Curriculum for the Surgical Workforce in Low-Resource Settings

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Abstract

Background

Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using competency-based curricula. We present a process for the development of a competency-based curriculum for low-resource settings in the context of craniomaxillofacial (CMF) trauma education.

Methods

CMF trauma surgeons representing 7 low-, middle-, and high-income countries conducted a standardized educational curriculum development program. Patient problems related to facial injuries were identified and ranked from highest to lowest morbidity. Higher morbidity problems were categorized into 4 modules with agreed upon competencies. Methods of delivery (lectures, case discussions, and practical exercises) were selected to optimize learning of each competency.

Results

A facial injuries educational curriculum (1.5 days event) was tailored to health professionals with diverse training backgrounds who care for CMF trauma patients in low-resource settings. A backward planned, competency-based curriculum was organized into four modules titled: acute (emergent), eye (periorbital injuries and sight preserving measures), mouth (dental injuries and fracture care), and soft tissue injury treatments. Four courses have been completed with pre- and post-course assessments completed.

Conclusions

Surgeons and educators from a diverse geographic background found the backward planning curriculum development method effective in creating a competency-based facial injuries (trauma) course for health professionals in low-resource settings, where contextual aspects of shortages of surgical capacity, equipment, and emergency transportation must be considered.

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References

  1. Injuries and violence: the facts. Geneva, World Health Organization (2010). www.who.int/violence_injury_prevention/key_facts/en/. Accessed by web 14 Sept 2017

  2. Debas HT, Gosselin RA, McCord C, Thind A (2006) Surgery. In: Jamison D, Evans D, Alleyne G, Jha P, Breman J, Measham A et al (eds) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York

    Google Scholar 

  3. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL (eds) (2006) Global burden of disease and risk factors. Oxford University Press, New York

    Google Scholar 

  4. Gosselin RA et al (2009) Injuries: the neglected burden in developing countries. Bull World Health Organ 87:246

    Article  Google Scholar 

  5. Debas H, Donkor P, Gawande A, Jamison D, Kruk M, Mock C (2015) Disease control priorities: essential surgery, vol 1, 3rd edn. World Bank Publications, Washington, DC

    Book  Google Scholar 

  6. Transforming our world: the 2030 agenda for sustainable development (2015). https://sustainabledevelopment.un.org/post2015/transformingourworld. Accessed 17 Sept 2017

  7. Ozgediz D, Riviello R (2008) The ‘other’ neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 5:6

    Article  Google Scholar 

  8. Hagopian A, Thompson MJ, Fordyce M et al (2004) The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain. Hum Resour Health 2(1):17

    Article  Google Scholar 

  9. Raykar NP, Yorlets RR, Liu C et al (2016) The how project: understanding contextual challenges to global surgical care provision in low-resource settings. BMJ Glob Health 1(4):e000075

    Article  Google Scholar 

  10. Holmer H, Lantz Kunjumen T et al (2015) Global distribution of surgeons, anesthesiologists, and obstetricians. Lancet Glob Health 3(Suppl 2):S9–S11

    Article  Google Scholar 

  11. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet 376:1923–1958

    Article  Google Scholar 

  12. Mock C, Lormand JD, Goosen J et al (2004) Guidelines for essential trauma care. World Health Organization, Geneva

    Google Scholar 

  13. Pringle K, Mackey JM, Modi P et al (2015) A short trauma course for physicians in a resource-limited setting: is low-cost simulation effective? Injury 46(9):1796–1800

    Article  CAS  Google Scholar 

  14. Wanjiku G, Janeway H, Foggle J, Partridge R et al (2017) Assessing the impact of an emergency trauma course for senior medical students in Kenya. Afr J Emerg Med 7:167–171

    Article  Google Scholar 

  15. Bergman S, Deckelbaum D, Lett R et al (2008) Assessing the impact of the trauma team training program in Tanzania. J Trauma 65(4):879–883

    Article  Google Scholar 

  16. Janeway H, Modi P, Wanjiku G et al (2015) Training the trainers in emergency medicine: an advanced trauma training course in Rwanda’s medical simulation center. Pan Afr Med J 20:242

    Article  Google Scholar 

  17. Nogaro MC, Pandit H, Peter N et al (2015) How useful are primary trauma care courses in sub-Saharan Africa? Injury 46(7):1293–1298

    Article  Google Scholar 

  18. Lin Y, Scott JW, Yi S et al (2017) Improving surgical safety and nontechnical skills in variable-resource contexts: a novel educational curriculum. Ann Surg 51:229–249

    Google Scholar 

  19. Gawande A, Zinner M, Studdert D, Brennan T (2003) Analysis of errors reported by surgeons at three teaching hospitals. Surgery 133(6):614–621

    Article  Google Scholar 

  20. Greenberg C, Regenbogen S, Studdert D et al (2007) Patterns of communication breakdowns resulting in injury to surgical patients. J Am CollSurg 204(4):533–540

    Google Scholar 

  21. Moore DE Jr, Green JS, Gallis HA (2009) Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. J Contin Educ Health Prof 29(1):15

    Article  Google Scholar 

  22. Albanese MA, Mejicano G, Mullan P, Kokotailo P, Gruppen L (2008) Defining characteristics of educational competencies. J Med Educ 42:248–255

    Article  Google Scholar 

  23. Gruppen LD, Mangrulkar RS, Kolars JC (2012) The promise of competency-based education in the health professions for improving global health. Hum Resour Health 10:43

    Article  Google Scholar 

  24. Zafar SN, Canner JK, Nagarajan N, Kushner AL, SOSAS Research Group (2018) Road traffic injuries: cross-sectional cluster randomized countrywide population data from 4 low-income countries. Int J Surg 52:237–242

    Article  Google Scholar 

  25. The World Bank (2018) https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed by web 18 Jan 2018

  26. Fonollosa J, Neftci E, Rabinovich M (2015) Learning of chunking sequences in cognition and behavior. PLoS Comput Biol 11(11):e1004592

    Article  Google Scholar 

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Acknowledgements

Special thanks to the AO Alliance Foundation and AO Foundation, including Michael Cunningham, PhD, Chitra Subramanian, PhD and Diana Greiner.

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Authors and Affiliations

  1. Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA

    David A. Shaye

  2. Department of Otolaryngology, Central University Teaching Hospital, Kigali, Rwanda

    David A. Shaye

  3. Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA

    Travis Tollefson

  4. Armed Forces Institute of Dentistry/Army Medical College, National University of Medical Sciences (NUMS), Islamabad, Pakistan

    Irfan Shah

  5. Department of Maxillofacial Surgery, SDM College of Dental Sciences and Hospital, Dharwad, India

    Gopal Krishnan

  6. Plastic and Reconstructive Surgery, Department of Surgery, Western University, London, ON, Canada

    Damir Matic

  7. Section of Head and Neck Surgery, Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Marcelo Figari

  8. Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Lower Kent Ridge Road, Singapore, Singapore

    Thiam Chye Lim

  9. Department of Maxillo-Facial and Oral Surgery, University of the Western Cape, Cape Town, South Africa

    Sunil Aniruth

  10. Department of Plastic & Hand Surgery, University of Minnesota and Regions Hospital, St. Paul, MN, USA

    Warren Schubert

  11. AO Foundation, AOCMF, Davos, Switzerland

    Warren Schubert

Authors
  1. David A. Shaye
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  2. Travis Tollefson
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  3. Irfan Shah
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  4. Gopal Krishnan
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  5. Damir Matic
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  6. Marcelo Figari
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  7. Thiam Chye Lim
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  8. Sunil Aniruth
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  9. Warren Schubert
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Corresponding author

Correspondence to David A. Shaye.

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Shaye, D.A., Tollefson, T., Shah, I. et al. Backward Planning a Craniomaxillofacial Trauma Curriculum for the Surgical Workforce in Low-Resource Settings. World J Surg 42, 3514–3519 (2018). https://doi.org/10.1007/s00268-018-4690-y

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  • DOI: https://doi.org/10.1007/s00268-018-4690-y

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